Caring for Transgender Youth & Healthcare Risk Management, Medical Ethics, and Patient Safety
A large percentage of people who read this column, visit the Sorry Works! website, and/or follow us on social media are either risk managers or folks who are professionally interested in risk, medical ethics, litigation, claims, patient safety, and/or quality issues related to healthcare organizations. This column is written for these professionals, and today is no different.
Let me also begin by saying that anytime a young person raises their hand and claims to be the opposite sex (i.e, born a boy but claims now to be a girl), all caring adults should pause and show empathy and compassion to said child. This is serious stuff that demands the attention of thoughtful, measured adults. These kids deserve love.
Needless to say, the issue of caring for transgender youth has become an incredibly hot issue with emotions running high on all sides. I hesitated to write this column...you may even say I considered self-censoring. However, two months ago something different happened here in St. Louis where I live. A whisteblower recently contacted the Missouri Attorney General and provided a sworn affidavit claiming various instances of harm to children in the transgender clinic run by Washington University in St Louis, one of America's elite universities, medical schools, and teaching hospitals.
The whistleblower, Ms. Jamie Reed, a former case manager at the Washington University transgender clinic, was not some undercover conservative or devout Christian, Jew, or Muslim, but, instead, a self-described queer woman who politically identifies as a progressive and is married to a trans man. She is the exact moral and political opposite of the Missouri's Republican Attorney General. Moreover, Ms. Reed is still an employee of Washington University (she transferred out of the transgender clinic to a different part of the university), and she and her spouse are counting on the university's generous benefits program to provide college tuition for their children. Ms. Reed put her words into a sworn and signed affidavit, which, if later proven false, could lead to loss of her job and future employment opportunities, strip away her children's free college tuition (and limit them financially in other ways), and lead to a world of legal problems. However, even if every single word in the affidavit is true, Ms. Reed still risks ostracization from her community along with possible threats of violence against her and her family. Indeed, why would Ms. Reed take such a risk, a risk that involves her children and her family, unless there was something truly wrong in the Washington University transgender clinic?
Ms. Reed's affidavit seemingly speaks to the concerns and fears of most Americans, including those on the left, who quietly mumble to themselves and their friends about social, chemical, and surgical interventions for children who claim to be transgender. Ms. Reed, in excruciating details, shares that distressed kids with a variety of mental health conditions (ADHD, anxiety, depression, violent behavior, etc) were shepherded into their transgender clinic. Sometimes, Ms. Reed asserted, clusters of kids from the same school would show up in the Washington University facility (i.e, social contagion). According to Ms. Reed, many of these children were referred out to approved counselors who wrote back with boiler plate language --- provided by the Washington University transgender clinic --- recommending the transition process commence, including puberty blockers and surgical interventions on minor children. Informed consent, according to Ms. Reed, was inadequate or rushed in most cases. Furthermore, Ms. Reed claims that several patients and parents later regretted puberty blockers and sex-change surgeries, yet the clinic’s doctors ignored these concerns and actively worked to stamp out dissent and concerns among the clinic's staff. We are doctors and we know the medicine, was the message Ms. Reed and her colleagues allegedly heard. These same doctors also allegedly declared they were building the plane as it was being flown. Again, here is the affidavit -- read and decide for yourself. The Missouri Attorney General along with Missouri state licensure boards are investigating.
This story was all over St. Louis media -- it was not restricted to FOX news or conservative/religious bloggers, but instead this has been a prominent story on the local NBC affiliate as well as the local NPR station. This was really different.
As I read the stories and listened to video interviews related to the Washington University's transgender clinic, I kept asking myself, "Where were the risk managers? Have they reviewed the informed consent in the transgender clinic and also investigated complaints and incidents of buyer's remorse? Or did the risk managers turn a blind eye because the topic of transgender is too hot to touch? What about Washington University's defense counsel, claims managers, and other like-minded folks who worry day and night about litigation?" Lawsuits will surely be filed against the Washington University clinic and the other 100 or so transgender clinics that have been developed around the United States over the last decade; there are too many stories of kids and young people regretting chemical and surgical interventions for gender dysphoria. These kids, some of them -- many of them? -- uncomfortable with their bodies hitting puberty, depressed and anxious, and easily influenced by social media personalities will also likely be easily influenced by personal injury lawyers should they have buyer's remorse. And their parents, many of whom felt pressured or rushed in the process, will jump on the litigation bandwagon. Personal injury lawyers will become strange bedfellows with Republican lawmakers who will happily extend/lengthen the statute of limitations for aggrieved transgender patients in much the same manner as has been done for sexual abuse victims of the Catholic Church. It's coming, and no amount of "sorry" or apology will stem the rage felt by people who believe they were led down the wrong path so a doctor and hospital could profit from their misery.
I have an MA in bioethics, and I cannot wrap my mind around the concept of teenagers and pre-teens being able to provide meaningful consent to a procedure that will forever change their bodies and life path going forward -- and I know many plaintiff's attorneys and medical ethicists will agree with me on this point. This notion that a 15 year old, or a 12 year old, or even a 19 year old truly knows who they are and is ready to accept the consequences of permanent, life-changing decisions is troubling (and even a bit humorous for people who really know children). Nor can I understand how parents can ethically consent to these procedures, especially given the plasticity of children/teenagers.
I also have an MS in biology, and the trained biologist in me cannot fathom how puberty blockers are without risk and can be turned on and off without consequences -- despite the claims of trans advocates that puberty blockers are "reversible." Indeed, puberty is not just about the blossoming of sexual organs (and sexual desires), but it is also a critical developmental window when the entire body, including the brain and all major organs along with the skeletal system, is bathed in hormones /chemicals to complete the physical transition to adulthood. Saying puberty can be altered, interrupted or switched on and off without harm is experimental, at best, or reckless and immoral at worst.
As a parent of teens, I also do not believe social interventions with children such as changes to names, pronouns, hair, and clothing can be undone easily, if at all. Indeed, it seems there are no free passes with "trying" transgender interventions. So, why would anyone rush to make permanent changes to something as plastic as a teenager, or pre-teen? If a 25-year old or 35-year old wants to have a sex change and declare a new name and pronouns with clothing and hair to match, hey, it's a free country...but a teenager? A child?
More troubling is the reasoning typically proffered to support social, chemical, and surgical interventions for children who identify as trans: Because medical groups have decided it is good. Seemingly every news story on this topic typically includes a paragraph (or mention) that several major medical groups are supportive, and this fact is often as positioned in said story as a rebuttal to a quote or viewpoint expressing concern about transgender care. This morally lazy defense of transgender care is infuriating. As we know, history is littered with the moral failings of organized medicine, from physicians and medical researchers experimenting on Black people from slavery through the 1980's; the support and involvement of medical doctors in the Holocaust; and more recently (including now) the belief among many physicians that medical errors can be concealed from patients and families. Indeed, Sorry Works! has been in business for nearly 20 years because doctors screw up...a lot! Are doctors screwing up royally with the transgender movement? How many injured kids will it take for us to find out? And, again, where are the risk managers, medical ethicists, med-mal defense lawyers, and the like?
I love physicians. I am lucky to have many physician friends, and my life and the life of my family has been improved and extended due to excellent care by many compassionate physicians. However, I know personally medicine gets many things wrong, often with tragic consequences. I also know that the medical profession as a political force is too often morally weak and self-serving --- just look at the tort reform movement. Just because a group of doctors gets together and says it is so, doesn't necessarily mean a damn thing -- especially when kids are in the mix.
Where is the patient safety movement, of which Sorry Works! is a member, on this issue? We rightly raise our voices following instances of egregious medical errors. We complain loudly when healthcare organizations and physicians put profits before patient safety. And, we in patient safety would never go along with something simply because doctors decided it was a good idea. Yet, patient safety seems silent on transgender care for youth? Perhaps the Reed affidavit will shake them from their slumber.
For that matter, where are the medical ethicists? Medical ethics/bioethics was partially birthed due to the Holocaust and the unconsented medical experiments forced on innocent Jews and other victims of Nazi doctors. Informed consent and autonomy are typically the first concepts/issues any bioethics/medical ethics student learns in any formal training program. The Reed affidavit -- and the larger debate over caring for transgender youth -- is all about informed consent along with autonomy, non maleficence, etc. Hopefully the ethicists will awaken from their slumber, too.
There are many voices who are not silent, including young people who now regret and grieve what has been done to their bodies. Some of them openly ask on social media, "Why didn't the adults stop me? Why didn't someone hit the brakes?" Ms. Reed, the Washington University whistleblower, heard some of these voices first hand. However, in the spirit of full disclosure and balance, many people, from activists to parents of transgender kids, have challenged Ms. Reed's narrative in the media -- you can read a sampling here, here, and here, or search Google yourself. Surely there is some truth, maybe a lot of truth, in these stories, but there are also probably a lot of defensive, self-serving comments too. Yet, remember who Ms. Reed is...the queer woman who seemingly is risking it all, including the future of her own children. Ask yourself why Ms. Reed is making this stand. Moreover, in response to the Reed affidavit, last week the Missouri Attorney General moved to ban all transgender care, making the Missouri the first state to take such action. The Reed affidavit is a must read for all who care about this issue.
A central theme in the book, "Irreversible Damage," authored by Wall Street Journal writer Abigail Shrier, is adults need to hit the brakes on this issue. Hitting the breaks does not mean we are going to be hateful to these children. Not at all. Never! Again, these kids need love. The Swedes and English have hit the breaks. American adults need to provide thoughtful, measured and compassionate responses to the recent surge in children identifying as transgender. This is love. As a parent or guardian, love can mean saying "Wait a second, let's think this through and take our time," and sometimes love sounds like, "No, you're not doing this....you don't know what you are doing or asking for. I am here to protect you, even if you hate me now for saying 'no'....you will thank me down the road." Love is not always easy, or pretty, when it comes to teenagers and children.
Healthcare risk managers -- along with their colleagues in legal and claims -- need to start asking more questions about transgender care, and even hit the breaks on social, chemical, and surgical interventions for transgender youth. This can be love. Love for their healthcare organizations as well as the clinicians, patients, and families they serve. It is time for the patient safety movement to raise its collective voice on this issue -- this is also a form of love. And medical ethicists, with their deep and thoughtful training, must weigh in on this critical issue -- this too is a form of love.
Surely, there will be some who find this column to be "hateful" or "bigoted" in some manner, and others will accuse me of harboring a "phobia." I reject any such smears, and, again, this column was not written for individuals who would make emotionally charged -- and factually baseless -- allegations. Instead, this essay was penned to encourage thoughtful, measured souls across the political spectrum to engage on this topic. Sorry Works! has a history of getting people to dialogue about difficult yet necessary issues, and hopefully this instance is no different. May we all move forward in love and do right be these kids.
Sincerely,
- Doug
Doug Wojcieszak, MA, MS
Sorry Works!
618-559-8168 (direct dial)
doug@sorryworks.net