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What’s next in Florida’s bid to restrict transition care for transgender kids

Surgeon General Joseph Ladapo has asked the state medical board to establish a “standard of care” for gender-affirming treatments.
Surgeon General Joseph Ladapo encouraged the Florida Board of Medicine to review controversial state Department of Health guidance against treatment beyond counseling for the distress that children and teens feel when their gender identity doesn’t match the sex they were assigned at birth.
Surgeon General Joseph Ladapo encouraged the Florida Board of Medicine to review controversial state Department of Health guidance against treatment beyond counseling for the distress that children and teens feel when their gender identity doesn’t match the sex they were assigned at birth. [ CHRIS O'MEARA | AP ]
Published Jun. 9|Updated Jun. 10

Gov. Ron DeSantis’ administration last week asked the Florida Board of Medicine to create policies that could ban or restrict transition-related care for transgender youth.

Doctors and advocates have raised questions about the potential ban since NBC News reported a June 2 letter to the board from the state’s surgeon general, Joseph Ladapo. In the letter, Ladapo encouraged the board to review controversial Florida Department of Health guidance against treatment beyond counseling for the distress that children and teens feel when their gender identity doesn’t match the sex they were assigned at birth, a condition called gender dysphoria. He also asked the board to establish a “standard of care” for gender-affirming treatments.

Here’s what we know — and what we don’t — about the medical board and how it may respond to Ladapo.

What does the board do?

The 15-member medical board is responsible for licensing Florida doctors. It sets rules for physicians and disciplines them for infractions such as health care fraud or false advertising. The board can revoke licenses and impose fines, among other penalties. The board is part of the Department of Health, which Ladapo oversees.

Related: Florida advises no social, hormonal treatment of transgender children

Who’s on the board?

DeSantis appoints board members. The state Senate confirms them to four-year terms.

Twelve members must be licensed doctors in good standing with the state. Three members must be Florida residents who are not health care practitioners.

The current board members are: Chairperson David Diamond of Winter Park; Vice Chairperson Kevin Cairns of Fort Lauderdale; Scot Ackerman of Jacksonville; Wael Barsoum of Fort Lauderdale; Ravi Chandra of Ocala; Jorge J. Lopez of Maitland; Luz Marina Pages of Miami Beach; Eleanor Pimentel of Miami; Sarvam TerKonda of Jacksonville; Hector Vila of Tampa; Michael Wasylik of Tampa; Zachariah P. Zachariah of Fort Lauderdale, a longtime and influential Republican fundraiser who’s close with the Bush family; health care attorney Maria Garcia, of Coral Gables; CareerSource South Florida board member Andre Perez, of Coral Gables; and former Department of Health general counsel Nicholas W. Romanello, of West Palm Beach.

Twelve of the 15 board members did not respond to requests for comment. TerKonda declined to comment through a spokesperson. Only Cairns and Ackerman briefly spoke with the Tampa Bay Times. When asked for his reaction to Ladapo’s letter, Ackerman said he was “still processing it.” Cairns asked for more time to review the issue.

What will happen next?

That remains unclear. The Department of Health did not respond to questions. Both Cairns and Ackerman said the board did not discuss Ladapo’s letter during a public meeting last week in Orlando.

“I’m sure it’ll be up for discussion at our next board meeting,” Ackerman said. The meeting will be held Aug. 5; details about the agenda, time and location have not been released.

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Ladapo asked the board to establish a standard of care for transition-related treatments such as gender-affirming surgery, hormone therapy and puberty blockers, which suppress the release of testosterone or estrogen. He called them “complex and irreversible procedures.” The scientific evidence supporting gender-affirming care “is extraordinarily weak,” he said.

“The current standards set by numerous professional organizations appear to follow a preferred political ideology instead of the highest level of generally accepted medical science,” Ladapo said. “Florida must do more to protect children from politics-based medicine.”

State law says the board can establish standards of care for medical practices via a rule-making process and can discipline doctors for violating its rules.

Outside of an emergency, adopting a rule can take months. To establish one, the board has to follow a detailed process that includes opportunity for the public to weigh in. The board must publish a notice on the Florida Administrative Register website to tell residents it’s crafting a rule. It may also hold public workshops and hearings to receive feedback. A proposed rule can be modified or withdrawn during this process.

The board, as of Thursday, had not posted a notice saying it’s drafting a rule on gender-affirming treatments.

Related: DeSantis: NCAA runner-up who lost to trans athlete ‘best female swimmer’

Are lawsuits expected?

If the board essentially bans doctors from offering transition-related care for minors, yes.

Michael Haller, chief of pediatric endocrinology at the University of Florida, said he thinks transgender youth and their parents or doctors would sue the state.

“To say I can’t prescribe that care,” Haller said, “that’s definitely likely to result in legal action to protect the rights of providers and families.”

Sarah Warbelow, legal director at the Human Rights Campaign, a national LGBTQ advocacy organization, agreed.

“This would be challenged on constitutional grounds, both equal protection and due process,” Warbelow said. She pointed to a court decision in Arkansas in which a federal judge temporarily blocked the enforcement of a state law that bans transition-related care for transgender youth. A similar order was issued last month in a separate federal case challenging an Alabama law.

Gender-affirming care for children and adolescents is “medically necessary,” Warbelow said. Research shows that transition-related treatments can improve the mental health of transgender and nonbinary youth, according to the Office of Population Affairs, which falls under the U.S. Department of Health and Human Services. Compared to their cisgender peers, transgender and nonbinary adolescents have an increased risk of mental health issues, substance use and suicide, the office says. Major medical organizations such as the American Academy of Pediatrics and American Medical Association support youth access to transition-related care.

“From a medical ethics point of view,” Haller said, “I’d have a real hard time not continuing to treat my patients.”

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