What’s next in Florida’s bid to restrict transitional care for transgender children

Last week, Governor Ron DeSantis’ administration asked the Florida Board of Medicine to create policies that could prohibit or restrict transitional care for transgender youth.

Doctors and lawyers have raised questions about the potential ban since BNC News reported a June 2 letter to the board of state surgeon general Joseph Ladapo. In the letter, Ladapo encouraged the council to review controversial guidelines from the Florida Department of Health against treatment beyond counseling for the distress children and adolescents experience when their gender identity does not match the sex they were assigned at birth, a condition called gender dysphoria. He also asked the council to establish a “standard of care” for gender-affirming treatments.

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

What does the council do?

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

Related: Florida advises against social and hormonal treatment of transgender children

Who is on the board?

DeSantis appoints board members. The State Senate confirms them for four-year terms.

Twelve members must be licensed physicians in good standing with the state. Three members must be Florida residents who are not medical professionals.

Current board members are: Chairman David Diamond of Winter Park; Vice President Kevin Cairns of Fort Lauderdale; Scot Ackerman of Jacksonville; Wael Barsoum of Fort Lauderdale; Ravi Chandra of Ocala; Jorge J. Lopez of Maitland; Miami Beach’s Luz Marina Pages; Miami’s Eleanor Pimentel; Sarvam Ter Konda of Jacksonville; Hector Vila of Tampa; Tampa’s Michael Wasylik; Zachariah P. Zachariah of Fort Lauderdale, a longtime and influential Republican fundraiser who is close to the Bush family; health care lawyer Maria Garcia of Coral Gables; Andre Perez, board member of CareerSource South Florida, 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 spoke briefly with the Tampa Bay Weather. When asked for his reaction to Ladapo’s letter, Ackerman said he was “still processing it.” Cairns requested more time to consider the matter.

What will happen next?

It remains unclear. The Health Ministry did not respond to questions. Cairns and Ackerman said the board did not discuss Ladapo’s letter at a public meeting last week in Orlando.

“I’m sure that will be discussed at our next board meeting,” Ackerman said. The meeting will take place on August 5; details on the agenda, time and location have not been released.

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Ladapo asked the council 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 described them as “complex and irreversible procedures”. The scientific evidence supporting gender-affirming care “is extraordinarily weak”, he said.

“Current standards set by many 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 council can set standards of care for medical practices through a rule-making process and can sanction doctors for breaking its rules.

Outside of an emergency, adopting a rule can take months. To establish one, the council must follow a detailed process that includes the opportunity for the public to intervene. The council must post a review on Florida Administrative Registry website to tell residents it’s about making a rule. It may also hold public workshops and hearings to receive feedback. A proposed rule may be modified or withdrawn during this process.

The board on Thursday had not issued a notice that it was drafting a rule on gender-affirming treatments.

Related: DeSantis: NCAA finalist who lost to ‘top swimmer’ trans athlete

Are there any lawsuits to be expected?

If the council essentially prohibits doctors from offering transition-related care for minors, yes.

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

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

Sarah Warbelow, legal director of the Human Rights Campaign, a national LGBTQ advocacy organization, agrees.

“It would be challenged on constitutional grounds, both equal protection and due process,” Warbelow said. She pointed to an Arkansas court ruling in which a federal judge Temporarily blocked enforcement of a state law that prohibits transitional care for transgender youth. A similar command 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 non-binary youth, according to the Bureau of Population Affairs, part of the US Department of Health and Human Services. Compared to their cisgender peers, transgender and non-binary adolescents are at increased risk for mental health issues, substance abuse and suicide, according to the office. Major medical organizations such as the American Academy of Pediatrics and the American Medical Association support young people’s access to transition-related care.

“From a medical ethical standpoint,” Haller said, “it would be very hard for me not to continue to treat my patients.”

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