© 2023 St. Louis Public Radio
Play Live Radio
Next Up:
0:00 0:00
Available On Air Stations

Judge temporarily blocks Missouri attorney general’s transgender health care restrictions

Demonstrators take to the streets to protest policy and rhetoric targeting transgender people on Sunday, April 16, 2023, in downtown St. Louis.
Danny Wicentowski
St. Louis Public Radio
A demonstrator holds a transgender flag while atop a vehicle, during an April 16 protest in St. Louis against anti-trans policies and legislations in Missouri.

Updated at 9 p.m. April 26 with comments from Andrew Bailey's office, the ACLU and Planned Parenthood

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

After a hearing Wednesday afternoon, Circuit Judge Ellen Ribaudo stayed implementation of the emergency order that was slated to go into effect Thursday. Among other reasons, 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.

“This order merely stays the implementation of our rule so the court can review the briefing,” said Madeline Sieren, a spokeswoman for Bailey. “We will continue fighting for all patients to have access to adequate health care.”

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 make 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.

Yamelsie Rodríguez, president and CEO of Planned Parenthood of the St. Louis Region and Southwest Missouri, said in a statement, “Our patients can breathe a bit easier today now that the court sided with science and medicine over the Attorney General’s ideological transphobia.”

Planned Parenthood opened “pop up” gender affirming care clinics throughout the state so that transgender people could start on hormone therapy before the rule went into effect.

“This is a temporary win — not only for our patients but for everyone across Missouri because politicians have no business blocking anyone from the care they want and need,” Rodríguez said. “We are optimistic the court will permanently strike down these harmful restrictions and send a message to the attorney general that he has no business regulating people’s health care.”

Andrew Bailey, newly appointed Missouri Attorney General, speaks to the media on Tuesday, Jan. 3, 2023, after being sworn in as the state’s 44th attorney general at the Missouri Supreme Court in Jefferson City.
Brian Munoz
St. Louis Public Radio
Missouri Attorney General Andrew Bailey, shown 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 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 is experimental.

Tony Rothert of the ACLU of Missouri said in a statement after the ruling that “the health and wellbeing of thousands of transgender Missourians is at stake” with the final outcome of the case.

“The decision on whether to allow the implementation of this rule, which ignores the proven sciences and experience of health care providers, will have an immediate impact on Missourians of all ages and their access to lifesaving medical care,” Rothert said.

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 having 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 Judge Henry Autrey to move the case back to St. Louis County court, saying 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.

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 has 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 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.

Jason is the politics correspondent for St. Louis Public Radio.

Send questions and comments about this story to feedback@stlpublicradio.org.