ACLU sues to enjoin bill banning gender-affirming care for minors

Editor’s note: This article has been updated.

The American Civil Liberties Union has filed a federal lawsuit challenging legislation banning gender-affirming medical care for minors, roughly one hour after Indiana Gov. Eric Holcomb signed the bill into law.

Senate Enrolled Act 480 prohibits any physician or practitioner from providing gender transition procedures to an individual under the age of 18. It also prohibits aiding or abetting another physician or practitioner to do so and establishes civil enforcement actions.

The ACLU of Indiana and ACLU National are challenging that law in the Indiana Southern District Court on behalf of the plaintiffs, which include four minors and their parents, a doctor and a medical center that serves the LGBTQ community.

The lawsuit claims SEA 480 violates the First and 14^th Amendments, as well as the Medicaid Act and the Affordable Care Act. It is seeking class certification and an injunction against the bill.

Ken Falk, legal director of the ACLU of Indiana, said in a news release that gender-affirming health care is “life-saving” for their clients.

“This law would be devastating to trans youth and their families, causing them serious injuries and forcing those who can, to uproot their lives and leave the state to access the gender-affirming care they need,” Falk said in the release.

But Tyler Johnson, the bill’s author who is also an emergency room physician, said “other countries are scaling back their use” of gender-related procedures.

“We have the utmost compassion for children suffering with gender dysphoria and they deserve sensible counseling,” Johnson, a Republican from Leo, said in a statement. “… Since these procedures have irreversible and life-altering effects, it is appropriate and necessary for our state to make sure these procedures are performed only on adults who can make the decision on their own behalf.”

The plaintiffs

In a press conference that was held soon after the lawsuit was filed, Falk and several plaintiffs discussed what the legislation means for them and their children.

“We’re very optimistic that before July 1, this will not be a worry that they need to have,” Falk said, referencing the date the bill will take effect.

Even before it was signed into law, SEA 480 heavy pushback, with protests and long debates in both the Indiana House and Senate.  

That pushback continued Wednesday after Holcomb signed the bill. 

Chase Strangio, deputy director for transgender justice with the ACLU’s LGBTQ & HIV Project, said laws like SEA 480 “do not stand up when tested in court.”

“We are honored to fight alongside these plaintiff families and medical providers to challenge this unconstitutional and illegal intrusion into the rights of adolescents, their parents and the medical providers who care for them,” Strangio said in a news release. “…This care is well-studied and widely accepted. And we know as trans people who have benefited from this treatment that stripping it away from us only causes harm and does nothing to protect children.”

Two of the parent-plaintiffs, Beth and Nathaniel Clawson, issued a statement about their transgender daughter, who is 10 years old and who they say is “fearful about what will happen to her if she cannot get gender-affirming medical care when puberty begins.”

“Starting around the age of two years old, our daughter began telling us who she is. When she was three and a half years old, after researching gender dysphoria and consulting with both her therapist and pediatrician, she socially transitioned. That means we started using she/her pronouns and letting her dress as a girl. That was seven years ago, and she hasn’t wavered at all in knowing who she is,” Beth said in the new release.

Nathaniel added, “As her parents, the most important thing to us is that she knows that we love her, trust her, and will do whatever it takes to ensure that she has every opportunity to grow and develop as her true self regardless of her gender identity. Laws that ban her ability to access gender affirming care take that opportunity away from her.”

Speaking during the Wednesday press conference, the Clawsons said they met with Sen. Johnson but felt like he wasn’t listening to their concerns or allowing them to ask what his rationale was.

“The feeling that we got from him was he was checking a box to say that he listened to us, but while I’m talking to him, I can see from his body language that he’s not listening,” Beth said. “And he would not engage with us in ways that we could answer any questions or ask him why he thinks the way he thinks or where he’s getting his information — he refused to share with us while we were pouring our hearts out to him.”

They added that they are worried about their daughter going through heavy testosterone puberty.

“Our child has been living as her true self for the past seven years and the idea of her going through the wrong puberty is terrifying for her and terrifying for us,” Beth said. “She’s watched her older siblings go through puberty. She understands what happens. I have zero concern about the temporary pause of puberty for my child, whereas I have so many concerns about her actually having to go through the incorrect puberty.”

Another plaintiff-parent, Ryan Welch, spoke about his transgender son, M.W., and what the legislation means for him.

According to the complaint, M.W. is a 16-year-old transgender boy who socially transitioned at 14 and who receives hormone therapy — specifically, testosterone — from the Gender Health Program and Riley Children’s Health.

“The fact that he had a chance to live his authentic self, to be who he really is, and to have that taken away, especially since what he’s doing is very safe, very, very safe — it has zero side effects other than the effects we want to have — and to purposely take that away from him and to force him back into very, very dark times is cruel and it’s unbelievable that we’re even having to fight this,” Welch said.

Welch said before his son started receiving treatment, he dealt with depression, anxiety and isolation.

Another plaintiff, Dr. Catherine Bast with Mosaic Health & Healing Arts, said she joined the lawsuit because the legislation prohibits her work.

“At Mosaic, we know that gender affirming care saves lives. Studies show that when gender dysphoria is treated with gender affirming care, the risk of self-harming behaviors, including suicide, diminishes,” Mixhi Marquis, executive director of Mosaic Health and Healing Arts, said in a news release. “When politicians require us to deny essential lifesaving care, they ignore science and instead mandate harm and endanger lives.”

Support and opposition

One of the defendants in the complaint, Republican Indiana Attorney General Todd Rokita, spoke in favor of the legislation after it was signed.

“Signing the bill that protects our children from irreversible and damaging decisions was the right move by the governor,” the AG said in a news release. “Banning these experimental procedures is critical for the health and wellbeing of future generations. My office is thankful for the General Assembly’s hard work to ensure this got across the finish line. We are ready to defend it in court.”

Also supporting the measure is the Alliance Defending Freedom, a nonprofit legal organization that describes itself as “committed to protecting religious freedom, free speech, parental rights, and the sanctity of life.”

“Denying the truth that we are either male or female hurts people, especially vulnerable children. Indiana is right to stop the injection of political agendas into the health care system by ensuring that children are protected from life-altering, so-called ‘gender transition’ procedures,” Alliance Defending Freedom Senior Counsel Matt Sharp, director of the ADF Center for Legislative Advocacy, said in a news release. “We are grateful to Gov. Holcomb and the Indiana Legislature for joining the growing coalition of states taking a stand for children and for truth by enacting these vital protections.”

Sen. Shelli Yoder, D-Bloomington, responded to the signing of the legislation differently.

“I am incredibly disappointed, but unsurprised, to see Governor Holcomb attach his name to this reactionary, cut-and-paste hate bill,” Yoder said in a statement. “Contrary to the Governor’s statement, facts and public record show the vast majority of American medical associations recognize gender-affirming care as safe and necessary. One in three trans youth will attempt suicide, and more grapple with depression and anxiety — appropriate intervention, including medical transition, greatly reduces those odds.”

Likewise, House Minority Leader Phil GiaQuinta, D-Fort Wayne, released a statement saying, “Conservatives are leaning into the culture wars and putting politics over parents. Let’s face it: no parent has it all figured out but the last thing they need is help from politicians.  Hoosiers value freedom, family and the opportunity to live life with minimal interference from the government.

“Indiana Republicans — supposedly the party of small government — have now given themselves the unilateral authority to dictate what health care choices parents are able to make for their children,” GiaQuinta continued. “This legislation or issue may not affect your family directly, but should be a warning to every Hoosier that, with the swipe of a pen, your liberties can be taken by the Indiana GOP.”

Kasey Suffredini, vice president of advocacy and government affairs at The Trevor Project, noted in a press release that Indiana is the 11^th state to ban gender-affirming health care this year.

“This ban flies in the face of long-established standards of care and guidance from every major medical and mental health association in the country, and denies young people of critical care that has saved lives for so many,” Suffredini said in a statement. “Personal medical decisions should be made between patients, their doctors, and their families, not by politicians.”

The case is K.C., a minor child by her parents and next friends Nathaniel and Beth Clawson; M.W., a minor child by his parents and next friends Ryan and Lisa Welch; RYAN and LISA WELCH; A.M., a minor child by her mother and next friend Emily Morris; EMILY MORRIS; M.R., a minor child by his parents and next friend, Maria Rivera; MARIA RIVERA; CATHERINE BAST, M.D.; MOASAIC HEALTH AND HEALING ARTS, INC.; all plaintiffs on their own behalf and on behalf of classes and sub-classes similarly situated v. THE INDIVIDUAL MEMBERS OF THE MEDICAL LICENSING BOARD OF INDIANA, in their official capacities; EXECUTIVE DIRECTOR, INDIANA PROFESSIONAL LICENSING AGENCY, in her official capacity; ATTORNEY GENERAL OF INDIANA , in his official capacity; SECRETARY, INDIANA FAMILY AND SOCIAL SERVICES ADMINISTRATION, in her official capacity; INDIANA FAMILY AND SOCIAL SERVICES ADMINISTRATION, 1:23-CV-595.