Missouri AG issues emergency order restricting gender-affirming health care

Missouri Attorney General Andrew Bailey (R) on Thursday put into effect an emergency regulation claiming gender-affirming health care for transgender minors is already illegal under a state law prohibiting certain medical interventions in the absence of “substantial guardrails.”

Bailey, who is facing reelection this year, said Thursday that because gender-affirming medical interventions are considered “experimental,” they are covered by an existing Missouri law governing “unfair, deceptive, and unconscionable business practices,” which includes the administration of health care services.

Bailey first issued the emergency regulation in March. The rule includes some restrictions for transgender adults, in addition to youth.

The emergency rule enacted Thursday states that it is “an unfair, deceptive, fraudulent, or otherwise unlawful practice” for any person or health organization in Missouri to recommend or administer gender-affirming health care to patients without certain protections in place, including informed consent disclosures and lengthy psychological or psychiatric assessments.

“This emergency rule is necessary to protect the public health, safety, and welfare, and also to protect a compelling governmental interest as the attorney general is charged with protecting consumers, including minors, from harm and investigating fraud and abuse in the state’s health care payment system,” the emergency regulation states.

Under Bailey’s emergency regulation, which is effective April 27 and will expire next year, transgender people of all ages in Missouri will be unable to access gender-affirming health care without having exhibited three years of a “medically documented, long-lasting, persistent and intense pattern of gender dysphoria.”

Health care providers must also ensure annually that a patient’s gender identity is not being influenced by social media or their peers. Those seeking access to gender-affirming health care must also be screened for autism, and any existing comorbidities like anxiety and depression must be “treated and resolved” before treatment is administered.

Bailey’s promulgation of the emergency rule follows an announcement from his office in February that a multiagency investigation had been launched into a St. Louis pediatric transgender clinic following accusations of malpractice by a former employee.

In a first-person account published by the Free Press in February, Jamie Reed, a former employee of the Washington University Pediatric Transgender Center at St. Louis Children’s Hospital, claimed hospital staff frequently failed to properly inform transgender youths and their families of the potential side effects of gender-affirming health care and in some cases provided treatment without parental consent.

Reed made similar claims in a sworn affidavit to Bailey’s office, triggering the investigation. Sen. Josh Hawley (R-Mo.), responding to Reed’s claims, announced in February that his office had launched a separate investigation into the hospital’s transgender center.

Reed’s account has been challenged by reporting from the St. Louis Dispatch. Nearly two dozen parents of children seen at the clinic told the outlet that Reed’s allegations are “just not true.”

Bailey in a statement on Thursday said his office has so far uncovered “a clandestine network” of clinics across Missouri “who are harming children by ignoring the science.”

“My office is stepping up to protect children throughout the state while we investigate the allegations and how they are harming children,” he said.

Gender-affirming health care for both transgender youths and adults is supported by most major medical organizations, including the American Medical Association and the American Academy of Pediatrics.