UVA v. VCU: AN UPDATE ON TRUMP'S ANTI-TRANS POLICY
Last week two federal courts suspended President' Trump’s Executive Order banning gender affirming surgery and medications for individuals under the age of 19 even if parental consent was given.
The key part of the Executive Order impacting Virginia’s university-based medical centers was the following: the head of each agency that “provides research or education grants to medical institutions, including medical schools and hospitals, shall, consistent with federal law and in coordination with the Director of the Office of Management and Budget, immediately take appropriate steps to ensure that institutions that receive federal research or education grants end the chemical and surgical mutilation of children.”
Attorney General Miyares immediately followed up on the Executive Order with a letter ordering UVA and VCU Health to cease providing gender affirming medication and surgeries for individuals under 19. Within days, both UVA and VCU Health stopped providing these treatments, including individuals who had been currently patients at their institutions.
In recent days, however, UVA and VCU Health have chosen divergent paths in response to the temporary restraining orders issued by the federal judges.
Crystal Graham of the Augusta Free Press reported that UVA has resumed gender affirming care for patients under 19, stating that “UVA Health will continue to monitor legal developments in this case and provide our patients with the best possible care under Virginia and federal law.”
Graham reports that VCU Health took the opposite position, noting that the Governor Youngkin told the health system that “Miyares prior directive that prohibits gender-affirming services” detailed in the President’s Executive Order still stands.
Medically speaking, I’m not in the position to know what the correct response response to the restraining order is. I can understand UVA Health’s interest in continuing to treat patients, especially current ones under their care. At the same time, if the restraining order is lifted in two weeks and the Executive Order is implemented, the patients and their families may believe that they are in an untenable yo-yo situation.
VCU’s response avoids this, but at the expense of providing care for the patients and families where treatment has been initiated but not completed. The five Richmond-based General Assembly members who sent the VCU leadership a letter criticizing VCU Health’s original decision to suspend care before the Executive Order was tested in court won’t be pleased with its latest decision.
But VCU’s statement referred to the direct involvement of Governor Youngkin after the restraining order was issued. It’s inconceivable that the Governor did not direct UVA Health to act similarly. And it’s equally improbable that Presidents Ryan and Rao did not ultimately make these decisions and did not consult with at least some members of their hospital and university boards inasmuch as a gubernatorial directive always contains an implicit threat.
Confronted with a Democratic General Assembly, Governor Youngkin may not have a significant number of legislative accomplishments. But he has used his executive power and board appointments to bend college university policies in his direction more than most Virginia governors. UVA’s decision to reject his directive on responding to the restraining order is notable. I expect we haven’t heard the end of it.