In a 10-page report released on April 16 by staff for the Democratic majority of the U.S. Senate Finance Committee, the Republican attorneys general of Tennessee, Missouri, Indiana, and Texas are accused of using “abusive legal demands” to collect the medical records of transgender patients in furtherance of the attorneys general’s “ideological and political goals.”
According to the document, which is titled “How State Attorneys General Target Transgender Youth and Adults by Weaponizing the Medicaid Program and their Health Oversight Authority,” the attorneys general used specious or misleading legal pretexts to justify their issuance of civil investigative demands to healthcare providers.
For example, the office of Tennessee Attorney General Jonathan Skrmetti framed the request as part of a probe into the potential misuse of Medicaid funds, while the offices of Indiana Attorney General Todd Rokita and Missouri Attorney General Andrew Bailey cited suspected violations of consumer protection laws. The office of Texas Attorney General Ken Paxton, which demanded records from “at least two hospitals located in Texas as well as at least two medical providers” in Washington and Georgia, did not disclose why the requests were issued.
The report found that information requested by the attorneys general’s offices included “invasive items such as unredacted physical and mental health records, photographs of children’s bodies, correspondence to hospitals’ general email addresses for LGBTQIA+ patients, and lists of people referred for transgender health care.”
In response, and in what the committee called “a grave violation of patient privacy and trust,” some providers turned over “near-complete, patient-identifiable” information while others used legal processes available to them such as privacy protections in the Health Insurance Portability and Accountability Act to share fewer details with the attorneys general’s offices.
The report noted that Vanderbilt University Medical Center in Nashville had “failed to object in any material manner to the Tennessee attorney general’s sweeping request and then caused undue terror to young patients and their families by supplying the Tennessee attorney general with some of the records requested and then, again, by erroneously notifying some patients of medical record disclosures that had not occurred.”
News concerning Vanderbilt’s receipt of and compliance with the demands from Skrmetti’s office was made public in June, sparking widespread concern and panic among many of the center’s trans patients and their families. Some, according to the report, experienced suicidal ideation and emotional distress including depression and anxiety.
A plaintiffs’ lawsuit was filed in July over VUMC’s failure to redact personally identifying information from the medical records. The following month, the center disclosed plans to comply with an investigation by the U.S. Department of Health and Human Services Office of Civil Rights.
In a statement to NBC News, Michael Regier, the medical center’s general counsel and secretary, said the hospital disputes the findings published in the committee’s report and had submitted “a detailed letter outlining our concerns about its proposed findings before it was released.”
“We made every effort to both protect our patients and follow the law,” Regier said, adding that, “At no point did we violate privacy laws, and we strongly disagree with any suggestion that we did.”
However, the committee’s report notes that by contrast, providers in other states like the Washington University School of Medicine in St. Louis refused to turn over patient records, citing privacy concerns and HIPAA regulations. And after staff for U.S. Sen. Ron Wyden (D-Ore.), the committee chair, had requested and reviewed copies of correspondence between VUMC and the Tennessee attorney general’s office, they concluded that the documentation “sheds light, for the first time, on the full extent of VUMC’s acute and repeated failures to protect its patients.”
For example, the report explains that after Skrmetti’s office issued the initial request to VUMC, it followed up with two additional civil investigative demands for “confidential information across 18 categories without any bounds on the number of patients or people implicated” ranging from “employment contracts for physicians to volunteer agreements for the
VUMC Trans Buddy Program to communications to and from a general email address.”
In response, the hospital shared “65,000 pages of documents, including the medical records of 82 transgender patients.” The information that was provided pursuant to receipt of Skrmetti’s office’s third civil investigative demand is unknown.
Washington Blade courtesy of the National LGBTQ Media Association.