A University of Washington investigation of the St. Louis Children’s Hospital Transgender Center found that doctors at the facility upheld appropriate standards of care and did not provide prescriptions to minors without parental consent appropriate.
The investigation into the center came after a former employee made allegations of inappropriate conduct to online media outlet The Free Press. These allegations were also reported to the Missouri Attorney General, who launched an investigation into the allegations and called them “shocking”. The University of Washington, which oversees the center, “immediately launched” a review, the school said.
Their notice was published on Friday. The report found that the allegations, which included accusations of gender-affirming surgeries on children under 18, rushed psychological assessments and claims that parental consent was not always sought in care to minors, were “unfounded”.
In the review, the university said it focused on “the claims made, with particular emphasis on claims of patient harm and the consent process,” and said its goal was to ensuring that care at the center met the standards of care adopted by several national and international organizations, including the World Professional Association for Transgender Health, the American Medical Association and the American Psychological Association.
“After careful consideration over a period of more than eight weeks, the University has concluded that the allegations of substandard care resulting in adverse outcomes for patients at the Center are unfounded,” the report states. “Physicians and staff at the University of Washington at the Center follow appropriate policies and procedures and treat patients according to currently accepted standards of care as recommended by the American Academy of Pediatrics and other nationally recognized organizations. .”
According to the report, 1,165 patients have sought care at the center since June 2018. All of these patients have medical records, the university noted, and patient interactions with the center range from an informative phone call to medical treatment. . These 1,185 patients represent approximately 6,000 visits to the center for advice or medical care since June 2018. Patients have also consulted psychologists affiliated with the center.
Of these 1,165 patients, 531 received “cross-sex hormones” and puberty blockers. Some patients were already taking puberty blockers, a drug given to minors to delay the hormonal changes caused by puberty, and some have started taking the centre’s drugs. Sixty-seven patients were prescribed puberty blockers but no other hormones.
Puberty blockers are used to treat a variety of hormonal conditions in minors. Cross-sex hormones change a person’s physical characteristics to match their gender identity. The effects of both drugs are reversible, states Mayo Clinic Online.
The remaining 567 patients did not receive puberty blockers or cross-sex hormones. Interviews with providers and a review of medical records revealed no patients who had “adverse physical reactions caused by medications prescribed by” the center’s physicians.
The report also revealed that proper mental health assessments were underway, contradicting the former employee’s claims. The report says the center requires a letter of support from a licensed mental health provider who treated the patient before any hormone treatment is prescribed.
“Letters of support provided to the Center reflect individualized review and assessment of patients,” the report states. “Records indicate that most patients had ongoing relationships with mental health providers, and Center providers recommend resources to patients who may need ongoing treatment for mental health issues. Mental Health Care and advice is a priority at the Centre.”
The report also found that care for minors is “provided with appropriate and well-documented parental consent,” as required by university and national policies. The center’s policies are consistent with general practices for prescribing drugs to minors, according to the report.
The report also says providers at the center have not referred underage patients for gender-affirming surgery since late 2018. Since then, the center has had a policy prohibiting such referrals. Families requesting information about doctors who perform such surgeries have been provided with these details, but the center does not perform the surgeries.
Since 2018, doctors at the University of Washington have only performed six surgeries, all of them on transitioning teens. These six surgeries, all of which were chest surgeries and met defined standards of care, were on the recommendation of other medical providers or on the recommendation of the patient. The center did not refer any patients to the University of Washington for these surgeries. The University of Washington no longer performs gender-affirming surgeries on minors. The university said it would undertake further efforts to “reaffirm its policy prohibiting gender-affirming surgery” in cases involving minors.
These statements challenge the former employee’s claims that surgeries were performed on minors.
The university concluded that the center should take a “more detailed and formalized approach” to the process of documenting parental consent and obtaining custody documents. The university should also take a more organized approach to responding to the public, the report says, and provide additional gender affirmation training to the general public. The university said it would review community engagement procedures.
The university has also worked with the hospital to establish an oversight committee that will review the activities of the transgender center on a weekly basis. The committee will provide additional training on consent procedures and ensure the protection of employees, patients, family members and people who report concerns.
The university continues to cooperate with the Missouri Attorney General in the ongoing external review of the center’s proceedings.
“Our top priority is the health and well-being of our patients,” the university said on its website. “We remain committed to providing compassionate, family-centered care to all of the patients and families we serve, and we are grateful to our medical practitioners for their dedication to their patients and their profession.”