Florida's Medical Boards Disagree on Access to Gender-Affirming Care

The Florida Boards of Medicine and Osteopathic Medicine held a joint meeting Friday afternoon that devolved into chaos after the two regulatory bodies failed to agree on language regarding access to gender-affirming treatment. Florida regulators have been considering rules to ban such treatment for minors.

A provision allowing minors access to gender-affirming care in research settings was at issue.

The rule in the Standards of Practice for the Treatment of Gender Dysphoria in Minors states, "Nonsurgical treatments for the treatment of gender dysphoria in minors may continue to be performed under the auspices of Institutional Review Board (IRB) approved, investigator-initiated clinical trials conducted at any of the Florida medical schools set forth in Section 458.3145(1)(i), Florida Statutes. Such clinical trials must include long term longitudinal assessments of the patients' physiologic and psychologic outcomes."

Hector Vila Jr., an anesthesiologist from Tampa, moved to strike that exception from the rules. Patrick Hunter, a pediatrician from Pensacola, seconded the motion.

Upon receiving the question from board chairperson David Diamond, the Florida Board of Medicine voted to strike the language, but in a surprising turn of events, the Florida Board of Osteopathic Medicine voted against doing so.

The dissonance between the two governing bodies is unprecedented and poses a chaotic challenge, says board attorney Ed Tellechea.

Tellechea concludes that medical doctors, or MDs, will be regulated one way, and osteopathic doctors, or DOs, will be regulated another.

In essence, DOs will be able to provide gender-affirming care in the name of research, while MDs will not.

Regarding the ban on gender-affirming care for anyone under 18, the boards agreed, and each passed the rule.

With five members absent, the Board of Medicine voted 6-3 to adopt a new standard of care prohibiting doctors from prescribing puberty blockers and hormones to transgender patients until they are 18. There will be exceptions for children already receiving treatment.

Florida's Board of Osteopathic Medicine also voted to restrict new patient care access to this type of care.

Sarah Warbelow, legal director at the Human Rights Campaign, criticized the decision. Florida's medical board should take steps to rescind the rule and provide young Floridians with the care they need, she says.

"Today's vote to deny medically necessary, age-appropriate healthcare to transgender young people will do irreparable harm to countless Floridian kids and their families," Warbelow said in a statement. "The decision was based upon incomplete data and manipulated claims that do not reflect science, medicine, or any other evidence-based approach to life-saving, medically necessary care."

Equality Florida's director of transgender equality, Nikole Parker, joined in the criticism of the board.

"With young lives on the line, another state agency has placed the political ambitions of [Gov.] Ron DeSantis over its duty to protect Floridians," Parker said in a statement. "This rule, as written, puts transgender youth at higher risk of depression, anxiety, and suicidality. Those are the facts purposely ignored by a Board of Medicine stacked with DeSantis political appointees who have put their toxic politics over people's health and wellbeing."

Dr. Brittany Bruggeman treats children with diabetes and other metabolic disorders and those with gender dysphoria. She tells The Advocate that the board's decision to block evidence-based international and national guideline-based care for children and adolescents in Flordia will harm them.

"I've already had parents contacting me who are understandably distraught and concerned that they're going to have to move their children out of the state because of the Board of Medicine ruling, and it's causing a lot of obvious anxiety and stress for these families and who are already having to face a lot of discrimination and stress even without this on top of everything else," Bruggeman says.

"We talk about moral injury in medicine when we're not able to provide the care that we know our patients need, whether it's an insurance issue blocking appropriate care or rules and regulations that are blocking appropriate care when we're not able to provide what we think is the best care for our patients," she says.

These political decisions have a negative impact on the doctors who provide essential care to trans kids, Bruggeman says.

"It really does take a toll on your mental health and your emotional health as well. So it's been a tough thing to face, and my family will attest to that. It's something that keeps me up at night," she says.

The meeting adjourned after a contentious public comment period that featured eight pairs of contributors, each of whom had three minutes to speak.

Public comment will be allowed for 21 days before the new standard of care takes effect.