Florida’s Board of Medicine Further Delays Access to Transgender Healthcare
by: mike morse, 6/5/2023
For more information on the Boards of Medicine and Osteopathic Medicine Joint Committee Meeting on June 1, please check out this summary by the Rainbow Progress Fund. Subscribe to their list for more updates on what’s happening to trans folks in Florida.
A few days ago, on June 1 (ironically the first day of Pride month), I attended the Florida Boards of Medicine and Osteopathic Medicine Joint Rules and Legislative Committee Meeting, in which the two Boards were meant to meet and discuss “standards of practice for the treatment of gender dysphoria in minors,” as well as establish informed consent forms (ICFs) for both trans youth grandfathered into gender affirming care (GAC) and for trans adults. These Boards are corrupt from the start — most members were hand picked by DeSantis, and the Rainbow Progress Fund states “Nearly $300,000 in campaign donations have been collectively made by almost half of the board members to Governor DeSantis’ campaigns, raising concerns about biased decision-making.” On May 17, DeSantis signed SB 254 into law, preventing anyone under 18 from receiving GAC if they were not previously diagnosed with and being treated for gender dysphoria. SB 254 also restricts the types of providers who can prescribe hormone replacement therapy (HRT) to MDs and DOs (previously RNs prescribed 80% of HRT in the state of Florida) for both minors and adults. These required changes are currently preventing nearly all trans people from receiving HRT or other gender affirming procedures as medical practitioners have not been provided with instructions on how to move forward with gender affirming care under the new legislature. The image below explains how GAC is currently being affected in Florida:
I was honestly skeptical going into the meeting, suspicious that the Board members would have their decisions predetermined. As the meeting progressed, it became apparent that the Board members actually knew very little about their task at hand, or about GAC in general. Some members cited the same false studies that have been used to back the recent transphobic legislation. They purposefully used harmful rhetoric to discuss the possible negative side effects of HRT. For example, Board members warned that children may deal with infertility or “vaginal atrophy” as an attempt to manipulate other members who did not know as much about the realities of HRT and GAC or who may be undecided still on their stance for the forms. Multiple members were very specific about calling HRT “treatments for sex reassignment,” which is a harmful, misleading way to describe treatment for gender dysphoria, but is the direct wording from SB 254.
After some discussion, the Boards seemed to be leaning towards an informed consent form (ICF) for minors that required signatures from 1) a medical doctor or doctor of osteopathic medicine, 2) psychologist or psychiatrist, 3) ALL parents or guardians, and 4) the minor. Originally, they wanted all parties present at once, but after the public booed and a few Board members expressed disagreement, they surrendered to only requiring the medical practitioner, all parents/guardians, and the child to be present together (except in special situations such as incarceration or a parent being overseas; however, the Boards did not discuss the logistics as to how they would make provisions for these exceptions). They also wanted to restrict to a window of only six months for all minor patients to get these signatures. Creating this limitation merely implements another barrier to care, as most of these youth will be losing their doctors (before the implementation of SB 254, nurse practitioners had provided 80% of GAC, but are now banned from this practice). So finding a doctor willing to treat gender dysphoria, setting a new patient appointment, AND getting an appointment with a psych professional may not be doable in such a short period, especially since all trans Floridians will be hustling to meet this deadline. From my understanding, if the minor is unable to complete the form on time, they will entirely lose access to their care. Note: this is only the discussion regarding minors. Adult care was not mentioned at all during this time of the meeting.
The remainder of their minimal discussion was spent bouncing the responsibility of actually creating the ICFs from one Board member to another. The Boards filibustered and complicated the process further by suggesting the possible need for multiple forms, depending on the type of procedure. Some members argued that there should be separate forms for “feminization”, “masculinization”, and puberty blocking treatments. They also spoke of creating three brand new forms, rather than using informed consent templates from any other medical procedure. There is absolutely no need to create ICFs from scratch; it only further stigmatizes gender affirming care. After procrastinating by speaking in circles for many minutes and not making any definitive next steps for the creation of these proposed forms, the Boards proceeded to open the floor to public comment. They never discussed the adult ICF, therefore never completing their agenda. The Boards, which were once again disorganized, invited up dozens of trans folks, parents of trans kids, and medical professional allies.
People stepped up to ask the Boards to expedite this process, as tens of thousands of trans people across the state are stuck in limbo and are unable to refill prescriptions or receive care until these forms are created. Earlier in the meeting, a Board member had falsely argued that suicide rates are higher among patients who have received gender affirming care (GAC) because people regret their decisions and prefer to detransition. Testimonial after testimonial proved this (already) incorrect statement wrong as people expressed how GAC gave them life again. Throughout the public forum, the Board continually interrupted and cut speakers off for being “out of the scope” if their speech wasn’t exclusively about the ICF (i.e. people who shared their general trans lived experiences or frustrations with the political climate were shut down). Of course, this only further riled up the crowd of (mostly young) trans people speaking out for their right to life-saving medical care. Unfortunately, all of these fierce and exasperated statements were belittled and even mocked by the Boards’ members. The elitist Boards would only take seriously people who spoke with a professional candor, often those who also worked within the medical field.
What I wish the Board would understand is that these testimonials are direct responses to the inevitable deaths of trans people across the state. People spoke out of fear for their lives under the new legislation as they expressed the terror they felt in not knowing whether or not they would be able to continue their medical treatment. I know the Board members would like to use these aggravated statements as an excuse to paint us as crazy, unstable, and having “low IQ” (as they said in their discussion). People act out of self-preservation when their lives and stability are at risk, and the Board members need to understand what is at stake by delaying this whole process. The Board’s responsibility should be ensuring that all people are able, with minimal barriers, to receive health care that improves both physical and mental health. The Board should not see gender affirming care as different from any other health care.
The ICF can be formatted based on any other medical prescription or procedure — there is no reason to be creating a brand new form. This is merely becoming a way to stall and ultimately prevent trans patients from competent health care. The Boards took nearly two hours of public comment, and then voted to schedule the following meeting for three weeks from now. The adult care ICF was not mentioned once by the Board members — and now trans people will be waiting even longer to get their prescriptions filled, have appointments confirmed, etc. At the time SB 254 was signed into law, the Boards of Medicine and Osteopathic Medicine were given two months to create the ICFs and establish standards of care for minors under an emergency order. This first meeting was already two weeks into this time period — two weeks during which trans folks have been without healthcare already. Now, the Boards won’t be meeting for three more weeks, and from what I can tell, there was no plan set to work on these forms at all during the interim period. These fascist tactics are just an attempt to disenfranchise trans folk of their right to bodily autonomy.
Following the meeting, I sent a letter to the Board of Medicine, since I did not have an opportunity to speak at the meeting. My letter is below:
Text:
To the Florida Board of Medicine, 06/02/2023
My name is Mike, I am a 26-year-old non-binary transgender person from Brevard County, FL, and I was in attendance of the Joint Rules and Legislative Committee Meeting of Florida’s Boards of Medicine and Osteopathic Medicine on June 1 to discuss the informed consent forms for gender affirming care for both minors and adults. Overall, to say I was disappointed with how the meeting was handled would be an understatement. From the start, the Board members did not give me any confidence that they had any knowledge of the task at hand. Additionally, the Board did not publicly discuss all the agenda points; instead, the floor was opened for public comment after the Board briefly spoke about care for minors and did not once discuss care for adults in front of the public. The standard I am aware of for public comment is that it should occur after all agenda points are finished, and before the meeting is adjourned.
I did not have a chance to speak yesterday, but I do have a recommendation for BOTH the minor and adult informed consent forms. Gender affirming care is simply a medical process and should not be treated differently than any other procedure or treatment. There is no need to create a brand-new informed consent form, as that will just take more time and further stigmatizes the trans community. This process should be simple; a pre-existing informed consent form should be adapted to include language relevant to gender affirming care and hormone replacement therapy, NOT “sex reassignment treatment.”
I also ask that the Board please do not include the amendment that during this interim period, doctors are not able to change dosage for their clients. This could be considered borderline malpractice as it should be up to the doctor’s expertise to decide what dosage of medication their client needs. Trans people need to adjust their meds all the time for a multitude of reasons, often to lower them, not just raising them. If trans folks are not able to lower or adjust and balance their medication, this is more likely to cause harm to the person in the long run. Hormone levels can be unbalanced in trans people just like in cisgender people, which is why doctors regularly monitor these levels and adjust as needed.
Finally, I ask that the Board expedite this process as quickly as possible. Delaying this process is preventing thousands of individuals from being able to receive their medication or proper healthcare. This in itself should be considered malpractice, as this limbo is keeping people from receiving life-saving treatment. Although, as the Board stated, there have been few studies to show physical harm for stopping or reversing hormone replacement therapy, I can tell you from firsthand experience (as can many of my peers) that the mental effects of reversing this treatment can be life threatening. The deprivation of medical treatment will directly lead to increased depression, anxiety, and suicidality amongst the trans population. I urge the Board to understand the importance and repercussions of delaying access to our healthcare.
After listening to the dozens of outraged trans folks and their allies, I also ask that the Board please do not completely disregard or hold in contempt the emotional responses they heard throughout the day. While speakers were consistently met with remarks that their comments were “out of the scope” of the discussion, I ask that you, the Board, please take into context that for the most part, these (mostly young) people are speaking out in reaction to threats to their health and wellbeing. What you, the Board, experienced firsthand yesterday is merely a population living in fear as they watch their rights to bodily autonomy and access to life-saving health care be stripped away right in front of them through the creation of these laws and emergency orders. While the Board has no ability to change the laws that have been signed, it is and should be the Board’s top priority to ensure that ALL people have access to health care with as few barriers as possible.
Mike Morse — Brevard County, FL
For more information on the Boards of Medicine and Osteopathic Medicine Joint Committee Meeting on June 1, please check out this summary by the Rainbow Progress Fund. Subscribe to their list for more updates on what’s happening to trans folks in Florida.
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