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Judge temporarily blocks Missouri Attorney General’s transgender health care restrictions

Demonstrators protest policy and rhetoric targeting transgender people on April 16 in downtown St. Louis.
Danny Wicentowski
St. Louis Public Radio
Marchers carry signs at Kansas City's first trans pride march in June 2019.

The decision came after Bailey's office unsuccessfully attempted to move the case to federal court.

A St. Louis County judge has temporarily blocked Missouri Attorney General Andrew Bailey’s restrictions for transgender minors and adults to access gender affirming care.

After a hearing Wednesday afternoon, St. Louis County Judge Ellen Ribaudo stayed implementation of the emergency order which was slated to go into effect Thursday. Among other things, Ribaudo said she wanted time to review a brief from Bailey’s office on a temporary restraining order requested by those suing to stop the restrictions.

Ribaudo’s move came after hours of sometimes emotional testimony on whether to temporarily block the rules, which LGBTQ advocates say constitute some of the most extensive restrictions in the country for transgender adults to receive gender affirming care.

Earlier this month, Bailey issued rules that would, among other things, require someone seeking hormone therapy or gender transition surgery to have three years of documented gender dysphoria, a screening for autism, and making sure mental health conditions are “treated” and “resolved.”

The ACLU of Missouri, Lambda Legal and Bryan Cave Leighton Paisner filed suit in St. Louis County on behalf of several Missourians contending Bailey does not have the authority to issue the rules, adding that they went beyond his powers over consumer protection issues. And Jim Lawrence of Bryan Cave noted that some mental health conditions, such as ADHD, cannot be “resolved” as the rules specify.

He added that several of his clients can’t always “live out in the open” — except with their medical providers who would be affected by this rule.

The attorney general now wants to stick his nose in it and deny that one last safe place for thousands of Missourians,” Lawrence said.

Andrew Bailey shown from below in the midst of a crowd of reporters holding up microphones and recording devices.
Brian Munoz
St. Louis Public Radio
Missouri Attorney General Andrew Bailey shown here in January shortly after being sworn in.

Bailey argued that the rules amount to informed consent for both minors and adults, and contended that some of the treatments are “experimental” in nature. Solicitor General Josh Divine pointed to Scandinavian countries coming to the conclusion that the treatments were not “evidence-based.”

“Our regulation says if you do these things, you have to ensure basic safety procedural guardrails to get informed consent,” Divine said.

“It doesn’t make any sense that informed consent would be allowed for 16 and 17 year-olds, but not 18 and 19 year-olds,” he added.

He also said that the rules amounted to wanting to get people mental health therapy sessions before embarking on puberty blockers or, in the case of adults, hormone therapy or gender transition surgery.

But plaintiffs seeking to block the rule countered that the treatments have been around for decades and have helped transgender people live happier lives. They also cited medical associations that strongly disputed that gender affirming care was experimental.

One of the people who watched the proceedings was Geddy Cary-Avery, a transgender woman who lives in west St. Louis County.

She said it would basically be impossible for transgender people to get screened for autism or go through the 15 hourly sessions of therapy in the rules since there are not enough providers for potentially thousands of people. And she also criticized a requirement for transgender people to be screened for “social contagion” before getting access to gender affirming care.

“The idea that human identity is a contagion is really dangerous,” Cary-Avery said. “If you treat me as an infection vector for being trans, then you can justify any amount of violence against my body. Because you’re preventing someone from getting hurt in that justification. You want to keep my voice out of society, because you think if kids hear me they’re likely to be more trans? That doesn’t make any sense.”

Bid to move case to federal court falters

Ribaudo’s decision came after Bailey’s office tried unsuccessfully to get the case moved to federal court.

The plaintiffs immediately responded with a request to U.S. District Court Judge Henry Autrey to move the case back to St. Louis County court, adding that there were no federal questions at play in the lawsuit.

Autrey agreed. He said that the attorney general was “struggling” and “grappling” for a reason the case should be in federal court.

“There is no federal question that can be culled from the pleading in this case,” Autrey said.

Among other things, Divine noted that he was more than two hours away from St. Louis County and wouldn’t be able to get to the hearing in person. Autrey then questioned why that was the case when the attorney general’s office had an office in downtown St. Louis.

Also during this hearing, Divine said there “there is no irreparable harm if this gets delayed a day or two.” He also criticized the plaintiffs’ characterization that Bailey was a “despot” who was pushing the rules through unilaterally.

In response to the “despot” remark, the ACLU of Missouri’s Anthony Rothert responded: “That’s absolutely true. That’s exactly what we’re saying.”

Ribaudo is expected to rule on the temporary injunction request on Monday.

Since entering the world of professional journalism in 2006, Jason Rosenbaum dove head first into the world of politics, policy and even rock and roll music. A graduate of the University of Missouri School of Journalism, Rosenbaum spent more than four years in the Missouri State Capitol writing for the Columbia Daily Tribune, Missouri Lawyers Media and the St. Louis Beacon. Since moving to St. Louis in 2010, Rosenbaum's work appeared in Missouri Lawyers Media, the St. Louis Business Journal and the Riverfront Times' music section. He also served on staff at the St. Louis Beacon as a politics reporter. Rosenbaum lives in Richmond Heights with with his wife Lauren and their two sons.
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