Vanderbilt University Medical Center (VUMC) confirmed Tuesday that it turned over transgender patients’ medical records to the Tennessee attorney general as part of an investigation into medical billing—a move that stirred controversy and privacy concerns.
VUMC offers transgender-related health care for adults and minors in Tennessee and nearby states, where these services are increasingly limited amid polarizing debates and legal clashes over transgender issues across the U.S. Families whose underage children received gender-affirming care at the center felt particularly violated over the record sharing.
The scope of how many patients were affected and details about the investigation remain unclear, but the VUMC said it involved patients enrolled in TennCare insurance plans and that it was asked to submit medical records dating back to 2018, according to screenshots circulating from patients who received notice that they’d been affected.
“The Tennessee Attorney General has legal authority in an investigation to require that VUMC provide complete copies of patient medical records that are relevant to its investigation,” John Howser, VUMC’s chief communications officer, told TIME in a statement. “VUMC was obligated to comply and did so.”
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Much of the backlash on social media against VUMC this week expressed outrage over patient privacy and HIPAA rights, but under federal and state statutes, the medical center is legally required to comply with the attorney general’s investigation and hand over patient records.
“Do we believe that Vanderbilt Medical Center could have fought this and taken a bigger stand? Absolutely. But at the same time, we believe that it would have just prolonged the inevitable because the attorney general unfortunately, has the law on his side,” Lance Preston, executive director of the Rainbow Youth Project, a nonprofit that advocates for LQBTQIA+ young people, says.
Preston worries that months from now, the investigation might halt, but the attorney general’s office would still have a comprehensive list of transgender patients—an idea that’s sparking fear, particularly among transgender youth.
Following the news this week, Tennessee Attorney General Jonathan Skrmetti’s chief of staff, Brandon Smith said, “We are surprised that VUMC has deliberately chosen to frighten its patients like this.” Smith said the attorney general had been investigating potential billing fraud since September and that VUMC began providing patient records in December. Smith emphasized that the investigation was directed toward VUMC and related providers, not patients.
Preston says between June 20 and June 21, Rainbow Youth Project’s crisis received hundreds of calls from both young people and parents that were frightened over the turning over of VUMC’s transgender patient records.
Callers were in varying degrees of mental health crisis over the news, including intense fear and suicidal ideation, Preston said. “Even though the numbers are high, and it’s hard for us to handle that call volume, we would much rather see them reaching out than not,” Preston says.
Rainbow Youth Project had a similar spike in calls last spring after Texas Governor Greg Abbott instructed child welfare agents to investigate child abuse among parents who provided their children gender-affirming care, a move that was later blocked. “People don’t understand that whether a new bill passes or it gets vetoed, just to talk about it creates fear and crisis,” Preston says.
Gender-affirming care uses medical procedures like hormone therapy and surgery to help a person transition from their assigned gender at birth to the one they identify as. Access to gender-affirming health care, especially for minors, is somewhat limited throughout the South following a myriad of restrictions over the past year.
Nashville, where VUMC is located, is a hub in the region for transgender-related health care. Neighboring states, Arkansas and Kentucky, each currently have under a dozen transgender-affirming providers, according to the Campaign for Southern Equality, a nonprofit.
VUMC said it started its Transgender Health Clinic in 2018 to address the heightened risk of mental and physical illness that transgender people face. Prominent medical associations, such as the American Medical Association, have researched and supported gender-affirming care for minors.
Last fall, right-wing political commentator Matt Walsh made a series of social media posts condemning VUMC’s gender-affirming surgeries for minors and hosted a “Rally to End Child Mutilation” in Nashville. VUMC stated that it followed standards of care set by the World Professional Association of Transgender Health, but after pressure from Republican lawmakers in September, urging the medical center to cease gender-affirming surgeries on minors, VUMC decided to halt all such surgeries temporarily.
VUMC noted that gender-affirming surgeries for minors have been rare at the center, at an average of five per year, and only with patients aged 16 and up.
In February, the Tennessee legislature overwhelmingly passed Senate Bill 1, banning gender transition health care for minors, beginning July 1. The Justice Department filed a complaint in late April challenging the bill, but it has yet to move forward.
Over the past year, just like the medical center, Vanderbilt University has been embroiled in controversy surrounding transgender issues.
The Vanderbilt College Republicans, a student organization, hosted a debate on campus in early April over whether it should be legal for minors to receive gender-affirming care. The debate was preceded by a protest and several other student groups criticized the event, arguing that it was offensive and told transgender students that their existence was up for debate.
Induja Kumar, a junior at Vanderbilt studying political science and climate studies, advocates for the university administration to do more to protect queer and transgender students. “You can find so many anonymous op-eds by trans students on campus,” she says, but publicly, “people are really afraid to speak out.” She says she’s witnessed peers who are vocal about being transgender or queer get doxed and harassed on the internet. Kumar worries that speaking with TIME could have similar consequences for her, but persists to vocalize her concerns.
“What happens when medical records are turned over to the attorney general in the next investigation?” Kumar says, anxious about future privacy breaches against transgender students as well as patients receiving reproductive health services. Abortion is extremely limited in Tennessee. “How many students are at risk of having their medical privacy violated, and then being criminalized because of that?” Kumar adds.
Preston notes that 77 teens who called Rainbow Youth Project over anxiety about the VUMC medical record dissemination reported that they didn’t want to receive or continue counseling in Tennessee. “They’re afraid if they go to mental health counseling, and they reveal their gender identity or sexual orientation, that’s going to lead to their records being turned over or their families being investigated,” Paxton says.
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