A state investigation of the Washington University Transgender Center in St. Louis expanded to include therapists and social workers across the state who work with minors seeking gender-affirming care.
Documents made public as part of various lawsuits show that Attorney General Andrew Bailey has obtained a collection of unredacted and loosely redacted records of transgender children, including a list of patients that received care at the Washington University Transgender Center at St. Louis Children’s Hospital.
He is also seeking untethered access to the university’s digital medical records system.
The attorney general’s use of private medical records, and the targeting of therapists and counselors, has interrupted the health care of LGBTQ Missourians and has families worrying about their children’s privacy.
Katy Erker-Lynch, executive director for Missouri LGBTQ advocacy organization PROMO, told The Independent she fears that the pressure will drive health care providers out of the state, especially impacting rural Missourians.
“The attorney general has created a hostile environment for medical providers where they are afraid to stay and practice medicine,” she said.
The saga began last year when Bailey launched an investigation based on an affidavit from Washington University whistleblower Jamie Reed. Bailey is using the affidavit to question other gender-affirming-care providers like Planned Parenthood, which he has said he hopes to “eradicate.”
The probe involves the Missouri Division of Professional Registration, which oversees medical licensing in the state. According to records obtained by The Independent, the agency interviewed 57 health professionals as part of the inquiry and had 16 cases open as of early May.
While Bailey announced the division would assist in the investigation when he first announced it, therapists did not expect to be included — or have their license to practice put at risk.
The division’s chief legal counsel, Sarah Ledgerwood, told The Independent that the division and its boards can’t join other officials’ investigations. When asked about Bailey’s investigation, she said the boards “can only complete investigations based on receipt of a complaint.”
Division Director Sheila Solon said last year that she anticipated complaints as part of the attorney general’s investigation.
Kelly Storck, a licensed clinical social worker with a focus on LGBTQ-positive therapy, was interviewed last year and expressed grave concerns about unredacted medical records of minors being in the hands of a state official who has repeatedly opposed gender-affirming care.
When the division contacted Storck for an interview, she hired a lawyer before meeting with the investigator.
During the meeting, she says the investigator had a small stack of unredacted letters Storck had sent the Transgender Center to recommend clients for gender-affirming care.
Storck recalled senior investigator Nick McBroom telling her he wasn’t fully sure what he was doing, saying she was taking the interview more seriously than it was. He questioned why she had a lawyer.
McBroom asked about the process of writing letters of support, Storck said, opening a file with just a portion of the letters she had sent to the Transgender Center. She said she noticed the documents had green underlines added and asked McBroom if they were his edits. He didn’t seem to know the source of the underlines.
After a 30-45 minute interview, McBroom asked her to write up her process. Through her attorney, she declined, and her case was closed soon after.
McBroom declined to speak to The Independent about the case.
“I still have a lot of distrust about who initiated it,” Storck said, “and who was in my documents.”
Parents of transgender children told The Independent they have heard whispers of other therapists facing investigation.
Multiple providers declined to be interviewed about the investigation out of fear of retaliation. Storck, though, had already faced the attorney general as one of the plaintiffs attempting to block an emergency rule targeting transgender care filed by Bailey last year.
A fight for patient privacy
A legal battle between Washington University and the attorney general’s office shows the records used in the interviews may have directly come from the university itself.
In the attorney general’s office’s response to the litigation, a timeline is laid out of the university turning over three sets of documents. In its second document production, Washington University gave the attorney general a list of patients in a spreadsheet.
“The supplemental production included a spreadsheet titled ‘Transgender Patient data,’” the attorney general’s office wrote. “Which included various workbooks chronicling patient names, encounters and medications, among other information.”
The attorney general’s office has declined to comment about the scope of the investigation and the source of investigative documents. Washington University also declined comment.
People who have received care at the Transgender Center have asked to be notified if their health records are accessed, but many assume some of their information is already in the attorney general’s hands.
The Independent asked Reed if she provided any of the documents to the attorney general.
“I cannot definitively say what the therapists are being handed (or) where it came from,” she said. “We just don’t really know where those things directly came from. The one thing I will add is that any documents that were provided to the attorney general’s office from me were redacted.”
Reed said she did not give any documents that would be stored in the electronic health records software Epic. When asked where else the records could come from, she said, “email or shared drive.”
The records investigators had of Storck’s patients included names, something Reed said she redacted before providing to the attorney general.
Becky Hormuth and her 17-year-old son Levi, who was a patient at the Transgender Center, have been hearing about the scope of Bailey’s investigation for months.
They learned that the attorney general’s office had been looking into Levi’s psychologist’s records and heard about other providers that had interviews related to their support for gender-affirming care.
Levi said the attorney general’s work seemed like “complete government overreach.”
Bailey’s actions, like a tip line about gender-affirming care and an emergency rule that sought to limit access to certain procedures and prescriptions, prompted Hormuth to prepare to move out of state.
“It is very invasive, what he’s doing,” she told The Independent. “The state has already basically disrupted our lives. They’ve disrupted our families, our children’s lives with the legislation that has passed. Then for him to continue going on is even more invasive and damaging.”
When lawmakers passed a ban on gender-affirming care for minors that included a provision that allowed broad medical malpractice claims, the Transgender Center stopped providing Levi’s medication.
Hormuth learned from other parents to make her son’s medication stretch, just in case it would be a long time before a refill.
She had requested an appointment with a provider in Illinois prior to the law’s passage, and Levi was on a waiting list. The center told her at the time that they weren’t taking new out-of-state patients because there was already a large influx from multiple states.
But eventually, Hormuth got a call that they were ready to take out-of-state patients. So, she and Levi make periodic trips to Chicago to go to the doctor.
Levi is old enough to receive hormone-replacement therapy at the Planned Parenthood of the St. Louis Region’s clinics, which accept transgender patients 16 and up for gender-affirming care.
But Hormuth wanted to take her son someplace outside of Bailey’s reach.
“I was absolutely dead set against going to Planned Parenthood locally because I knew that as soon as we would establish ourselves at Planned Parenthood… that (Bailey) was going to come there and start digging through those papers and those personal records,” she said. “I absolutely was not going to give him the chance at any other aspect of our family’s life.”
Both branches of Planned Parenthood in Missouri are also subjects of Bailey’s investigation, according to court filings, despite the attorney general’s office only publicly announcing an investigation into the Transgender Center.
The attorney general is not allowed to investigate medical malpractice claims, but it can look into false advertising under the state’s consumer protection law, known as the Missouri Merchandising Practices Act.
Bailey used that law to file an emergency rule, which he later rescinded before a court case could decide its bounds, and he is utilizing it again to dig into gender-affirming-care providers.
In a case in the Circuit Court of Jackson County, Bailey’s office admits the investigation into the Washington University Transgender Center at St. Louis Children’s Hospital has multiple subjects.
Planned Parenthood Great Plains filed a lawsuit to avoid the attorney general’s civil investigative demands which it argued sought sweeping information about its practice and patients.
In court documents, Solicitor General Josh Divine wrote that the civil investigative demand was looking into the organization and others in addition to the Transgender Center.
“The attorney general is investigating (the Transgender Center) and ‘others in the state’ who ‘may have used deception, fraud, false promises, misrepresentation, unfair practices, and/or the concealment, suppression, or omission of material facts within the scope of the Missouri Merchandising Practices Act,’” Divine wrote. “The attorney general has already made unequivocally clear that (Planned Parenthood) is under investigation.”
Similar arguments are on display in a case between the Planned Parenthood affiliate in St. Louis and the attorney general’s office.
“(Bailey’s) request encompasses hundreds, if not thousands, of patient records concerning treatment decisions, discussions with physicians, mental health assessments and prescription information, among other areas,” Planned Parenthood’s attorney wrote in its lawsuit.
Judges ruled in favor of the attorney general’s office in both cases, which have been recently appealed.
A case filed by Children’s Mercy Hospital in Kansas City against Bailey’s investigative demands also went in favor of the attorney general.
Washington University’s case against the attorney general’s office is yet to be decided.
This fall, the attorney general’s office will defend the state in a case that seeks to reverse a ban on gender-affirming care for minors passed last legislative session.
Storck said the inquiry has compounded anxieties about access to gender-affirming care that patients have following the passage of the ban.
“I really was so afraid that some of my clients were going to be in absolute emergent situations and really struggle to get access to health care,” she said. “My patients have connected with what they need, but it is now an all-day or multiple-day event to get medical care. Previously, they could have gotten it (within two hours).”
