A Washington University investigation into St. Louis Children’s Hospital’s Transgender Center found that doctors at the facility followed the appropriate standard of care and did not provide prescriptions to minors without appropriate parental consent.
An investigation into the center began after a former employee complained of inappropriate behavior to online media outlet The Free Press. The allegations were also reported to the Missouri Attorney General, who launched an investigation into the claims and called them “shocking.” The University of Washington, which oversees the center, has “immediately initiated” a review, the school said.
Their review was published on Friday. The report found that the allegations, which included sex-affirming surgeries on children under 18, underwent hasty psychological assessments and claimed that parental consent was not always sought when caring for minors, “unsubstantiated”.
In the review, the university said their focus was “on blood complaints, with particular emphasis on patient harm complaints and compliance processes” and said their goal was to ensure the center met accepted standards of care by the World Professional Association for Transgender Health, the American Medical Association and the American Several national and international organizations including Psychological Associations.
“After more than eight weeks of careful consideration, the university has concluded that allegations of poor quality of care leading to adverse patient outcomes at the center are unsubstantiated,” the report reads. “Washington University physicians and center staff follow appropriate policies and procedures and treat patients according to currently accepted standards of care recommended by the American Academy of Pediatrics and other nationally recognized organizations.”
University of Washington
According to the report, 1,165 patients have received care at the center since June 2018. All of these patients have a medical record, the university noted, and patient interactions with the center range from informational phone calls to medical treatment. These 1,185 patients have made nearly 6,000 visits to the center for counseling or medical care since June 2018. Patients also visited psychologists associated with the center.
Of these 1,165 patients, 531 received “cross-sex hormones” and puberty blockers. Some patients were already on puberty blockers, a drug given to minors to delay hormonal changes during puberty, and some were started on the drug by the center. Sixty-seven patients were prescribed puberty blockers but no other hormones.
Puberty blockers are used to treat various hormonal conditions in minors. Cross-sex hormones change a person’s physical characteristics to match their gender identity. Mayo Clinic Online states that the effects of both drugs are reversible.
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 to medications prescribed” by the center’s doctors.
The report also found that appropriate mental health evaluations were being conducted against the former employee’s claims. The report states that the center requires a letter of support from a licensed mental health provider who has treated the patient before any hormone treatment can be prescribed.
“Letters of support to the center reflect individual reviews and assessments of patients,” the report said. “Records indicate that most patients had ongoing relationships with mental health providers and that center providers recommend resources for 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 common practices for prescribing drugs to minors, the report said.
The report also states 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 of prohibiting such referrals. Families who request information about doctors who perform such surgeries are provided with those details, but the center does not conduct the surgeries.
As of 2018, Washington University doctors have performed just six surgeries, all on male transitioning teenagers. These six surgeries, all of which were 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 the University of Washington for this surgery. The University of Washington no longer performs gender-affirming surgery on minors. The university said it would take extra efforts to “reaffirm its policy of banning sex-affirming surgery” in cases involving minors.
These statements dispute the former employee’s claim that the surgery was performed on minors.
The university concluded that the center should adopt a “more detailed and formalized approach” to the process of documenting parental consent and obtaining custody documents. Universities should take a more organized approach to responding to the public, the report said, and provide more education about gender affirmation to the general public. The university said it will review community engagement practices.
The university has collaborated with the hospital to form an oversight committee that will review the activities of the transgender center on a weekly basis. The committee will provide additional education on compliance procedures and safeguards for employees, patients, family members and individuals reporting 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 its website. “We remain committed to providing compassionate, family-centered care to the patients and families we serve, and we are grateful to our physicians for their dedication to their patients and their profession.”
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