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Inquiry into the Transgender Center at St. Louis Children's Hospital finds allegations of misconduct "unsubstantiated"

Health care challenges for transgender youth
Health care challenges for transgender youth 13:42

An investigation by Washington University into the Transgender Center at St. Louis Children's Hospital found that doctors at the facility were adhering to the appropriate standards of care and were not providing prescriptions to minors without appropriate parental consent. 

The investigation into the center came after a former employee made allegations of inappropriate conduct in the online media outlet The Free Press. Those allegations were also reported to the Missouri attorney general, who launched an investigation into the claims and called them "shocking." Washington University, which oversees the center, "immediately initiated" a review, the school said. 

Their review was released on Friday. The report found that the allegations, which included charges of gender-affirming surgeries to children under the age of 18, rushed psychological evaluations, and claims that parents' consent was not always sought in minors' care, were "unsubstantiated." 

In the review, the university said their focus was "on the allegations made, with a particular emphasis on allegations of patient harm and the consenting process," and said their goal was to ensure that care at the center met the standards of care adopted by multiple 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 the course of a more than an eight-week period, the University has concluded that allegations of substandard care causing adverse outcomes for patients at the Center are unsubstantiated," the report reads. "Washington University physicians and staff at the Center follow appropriate policies and procedures and treat patients according to the currently accepted standard of care, as recommended by the American Academy of Pediatrics and other nationally recognized organizations."

St. Louis Children's Hospital. Washington University

According to the report, 1,165 patients have sought care at the center since June 2018. All of those patients have a medical record, the university noted, and patient interactions with the center range from an informational phone call to medical treatment. Those 1,185 patients account for about 6,000 visits to the center for counseling or medical care since June 2018. Patients also visited psychologists affiliated with the center. 

Of those 1,165 patients, 531 received "cross-sex hormones" and puberty blockers. Some patients were already on puberty blockers, a medication that is given to minors to delay the hormonal changes brought on by puberty, and some were started on the medications by the center. 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 medications are reversible, the Mayo Clinic says online

The remaining 567 patients did not receive puberty blockers or cross-sex hormones. Interviews with providers and a review of medical records found no patients who had "adverse physical reactions caused by medications prescribed by" doctors at the center.

The report also found that appropriate mental health assessments were being conducted, contradicting the former employee's claims. The report said that the center requires a letter of support from a licensed mental health provider who has treated the patient before any hormonal treatments are prescribed. 

"Letters of support provided to the Center reflect individualized review and assessment of patients," the report said. "Records indicate most patients had ongoing relationships with mental health providers and the Center providers recommend resources to patients who may need ongoing treatment for mental health concerns. Mental health care and counseling is a priority at the Center." 

The report also found that care for minors is "provided with appropriate and well-documented parental consent," as required by university and state policies. The center's policies are consistent with general practices for prescribing medication to minors, the report said. 

The report also stated that providers at the center have not referred minor patients for gender-affirming surgery since late 2018. Since then, the center has had a policy prohibiting such referrals. Families who request information about physicians who do such surgeries have been provided with those details, but the center does not conduct the surgeries. 

Since 2018, Washington University physicians only performed six surgeries, all on adolescents who were transitioning to male. These six surgeries, which were all chest surgeries and met defined standards of care, were on referrals from other medical providers or patient-initiated self-referrals. The center did not refer any patients to Washington University for these surgeries. Washington University no longer performs gender-affirming surgeries on minors. The university said it will undertake additional efforts to "reaffirm its policy prohibiting gender-affirming surgery" in cases involving minors.

These statements dispute the former employee's claims that surgeries were being done on minors. 

The university did conclude that the center should take a "more detailed and formalized approach" to the process of documenting parental consent and obtaining custody documentation. The university should also take a more organized approach in responding to the public, the report said, and provide further education about gender affirming to the general public. The university said it will review procedures for community engagement. 

The university has also collaborated with the hospital to establish an oversight committee that will review Transgender Center activities weekly. The committee will provide additional education on consent procedures and provide protection to employees, patients, family members and individuals who report concerns. 

The university continues to cooperate with the Missouri attorney general in the ongoing external review of the center's procedures. 

"Our highest priority is the health and well-being of our patients," the university said on their 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." 

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