Claims that fueled Missouri GOP crackdown on trans care ‘unsubstantiated,’ university says

A St. Louis transgender center’s internal review of allegations that it harmed children found them to be unfounded, after the explosive claims from a former employee fueled an aggressive effort by Missouri Republicans to severely restrict access to gender-affirming care.

Washington University in St. Louis on Friday released the results of its internal investigation into its transgender clinic at St. Louis Children’s Hospital, which said “allegations of substandard care causing adverse outcomes for patients at the Center are unsubstantiated.”

The report’s conclusions are unlikely to quiet efforts to restrict gender-affirming care. Missouri Attorney General Andrew Bailey, a Republican, put forward regulations in the wake of the allegations that providers say will effectively end care for both adolescents and adults. The new rules, set to go into effect Thursday, require 15 separate hourly therapy sessions over 18 months before a person can receive care.

Bailey continues to conduct an investigation into the Washington University clinic alongside the Missouri Department of Social Services and Division of Professional Registration. The General Assembly is also considering bills that would prohibit doctors from providing transgender health care to people under 18.

Washington University said Friday that its “highest priority is the health and well-being of our patients.”

“We remain committed to providing compassionate, family-centered care to all of the patients and families we serve, and we are grateful to our medical practitioners for their dedication to their patients and their profession,” the university said in an unsigned statement.

Jamie Reed, a former employee at the center, signed an affidavit alleging the center excessively provided hormone therapy to mentally ill children without first treating their underlying mental health issues. Reed also said the center misled the public and parents about the therapy services provided.

The Free Press, a site founded by former New York Times opinion editor and columnist Bari Weiss, first published in February the claims by Reed, who described herself as a progressive queer woman who is married to a transgender man.

Washington University said Friday it immediately launched a “comprehensive and in-depth assessment” of practices and care provided at the clinic after The Free Press article was published on Feb. 9. The university didn’t say how the investigation was conducted.

“The review affirmed that physicians and staff at the Center follow appropriate policies and procedures and treat patients according to the accepted standards of care, as recommended by the American Academy of Pediatrics and other nationally recognized organizations. We also continue to cooperate with a formal investigation by the Missouri Attorney General,” the university said.

Bailey spokeswoman Madeline Sieren said in an email the state attorney general’s investigation is continuing.

“The transgender center’s assertions don’t line up with what we’ve uncovered so far in our investigation,” Sieren said without elaborating.

An attorney for Reed didn’t immediately respond to a request for comment.

Katy Erker-Lynch, director of the Missouri LGBTQ advocacy organization PROMO, in a statement noted that last year the organization honored the co-directors of the center for their work as champions for the transgender community in health care.

“We are unsurprised to hear all the standards of care are being followed at the Center because we hear from parents every single day about the high quality of care given to them and their children,” Erker-Lynch said.

Center will update consent rules

The university released a four-page summary of its conclusions. Interviews with providers at the center and a review of medical records identified no patients who had “adverse physical reactions” from medications prescribed at the center, the document says.

Joey, a 22-year-old transgender man who started receiving care when he was 16 at the center, said on Friday that “of course” the allegations were unsubstantiated. Still, he expressed doubt that the investigation’s findings would curtail attacks on the center and other providers of gender-affirming care.

“I think that the opposition to this care do not look to science or reality or lived experiences for their beliefs,” said Joey, who has asked The Star to identify him only by his first name out of fear of retribution.

The investigation found that center providers hadn’t referred any patients under 18 for gender-affirming surgery since late 2018, when the center adopted a policy prohibiting those referrals.

The review identified six surgeries that had been performed by Washington University physicians since 2018 – all chest surgeries for adolescents transitioning to male. All of the surgeries were the result of referrals from other medical providers or patient-initiated self-referrals, not a result of direct center provider referrals, the review found.

“Washington University physicians no longer perform gender-affirming surgeries on patients under the age of 18,” the summary says.

In all, the summary says 1,165 patients have sought care at the center since June 2018, with these patients accounting for 6,000 visits to the center for counseling and medical care. Nearly 600 patients have received cross-sex hormones, puberty blockers or both.

The review found that the university needs a more formal approach to documenting parental consent and responding to public engagement. It recommends requiring specific written consent prior to prescribing gender-affirming medications and says the university has already updated its protocols.

The center now also requires families to provide custody agreements before an initial visit by patients under 18. Previously, custody agreements were obtained before medical intervention in cases where there was a question about who had decision-making authority.

The summary also notes that the university has taken “additional efforts” to reaffirm its policy prohibiting gender-affirming surgery to the hospital’s department of pediatrics and surgery. It doesn’t provide details.

The university, along with St. Louis Children’s Hospital, has created an oversight committee that will review the center’s activities on a weekly basis. The committee will provide additional education on procedures surrounding consent and reporting adverse events, as well as “protection for employees, patients, family members, and other individuals who report concerns.”

Reed’s allegations came amid a broad push by Republicans nationally to regulate the lives of transgender people, including prohibiting or severely limiting access to gender-affirming health care. Members of Congress and state legislators have also sought bans on transgender athletes competing in girls’ and women’s sports; Kansas lawmakers forced a ban into law over Democratic Gov. Laura Kelly’s veto earlier this year.

But the efforts have been especially pronounced in Missouri, where Republicans control the governor’s office and have supermajorities in the legislature. At one point this year, Missouri had the most anti-LGBTQ bills of any state, according to a database from the American Civil Liberties Union that tracks legislation nationwide.

While Missouri legislators have targeted procedures that assist minors in transitioning genders, Bailey’s proposed rules would severely limit care for adults as well. Groups supportive of transgender rights have promised to sue over the regulations.

Washington University said Friday that it was analyzing the impact of the regulations.