When a Washington-based telehealth practice received a federal subpoena last June, seeking details about patients, founder Dr. Crystal Beal was prepared.
Beal had been running the gender-affirming medical clinic for seven years, providing telemedicine in 10 states. In that time, they watched as debate around the care became increasingly contentious and access started to shrink. State bans emerged preventing minors from getting care and Donald Trump vowed during his presidential campaign to target trans rights.
“So when the subpoena arrived, it was not unexpected," Beal said.
"I didn’t know what was going to happen, but I assumed something was going to happen," said Beal. "And I was really lucky to already be engaged with legal support, so I had people to go to."
The subpoena sent to Beal’s practice, QueerDoc, was one of more than 20 the U.S. Department of Justice issued to hospitals and clinics throughout the country that provide gender-affirming care, including for minors. Other recipients, made public in federal court challenges, include Boston Children’s Hospital, Children’s Hospital of Philadelphia, University of Pittsburgh Medical Center Children's Hospital, Children’s Hospital Colorado and Children’s National Hospital.
Seattle Children’s also received a subpoena, according to court documents. The hospital did not respond to requests for comment.
The orders are part of the Trump administration's broader efforts to restrict access to gender-affirming care — many of which have been blocked or paused over the last year. Last week, U.S. District Court Judge Mustafa Kasubhai in Oregon halted a declaration Health and Human Services Secretary Robert F. Kennedy Jr. published in December, warning doctors and hospitals they could lose all federal insurance reimbursement from Medicare and Medicaid if they continued to provide this care.
Kasubhai said in Thursday's ruling that Kennedy overreached and did not follow proper administrative procedures before issuing the declaration.
Federal judges, including in Seattle, have also quashed at least six of the government’s subpoenas, which doctors and legal experts have said set a dangerous precedent in protecting patient privacy. The subpoenas demand a slew of personal patient details, such as names, addresses, Social Security numbers, diagnoses, insurance details and prescriptions, in addition to staff information.
"This is a tool they’re improperly using to end the provision of gender-affirming care," said Adrien Leavitt, an ACLU of Washington attorney working with QueerDoc in the case. "It impacts a patient’s ability to go to the doctor in really basic ways that I think we can all understand, because we all go to the doctor and expect a profound level of privacy in that relationship."
Beal started QueerDoc in 2018, after moving from Florida to Washington for medical residency training. They were looking for a program that would offer a "different experience and culture than what I had in the South," Beal said. "I got that, and I stayed."
Beal founded the practice with the hope of increasing access to gender-affirming care for trans and gender-diverse people who lived outside big cities, though QueerDoc now serves patients in both rural and urban areas. As telehealth providers, QueerDoc physicians write prescriptions for hormone therapy and puberty blockers. They do not provide mental health or surgical care.
The clinic has seen growing demand especially since 2020, Beal said, when the COVID-19 pandemic further popularized telemedicine. And while Beal began as the sole physician, the practice now has two other part-time doctors, mainly working with adult patients.
U.S. District Judge Jamal Whitehead, in rejecting the federal subpoena of QueerDoc in October, wrote that the government had "abandoned good-faith investigation in favor of policy enforcement through prosecutorial coercion." When a federal agency issues a subpoena to "intimidate and coerce providers into abandoning lawful medical care,” he added, it “abuses the judicial process."
Beal said in a recent interview that Whitehead’s order was a "hope-giving document to read."
"It’s often quite easy to focus on all the ways in which things are going wrong," the QueerDoc founder said, pointing to the dozens of adolescent gender clinics throughout the country that have closed due to federal threats, including recently Mary Bridge Children’s Hospital clinic in Tacoma.
“The judge’s decision really gives me hope,” Beal said.
The DOJ has appealed five of the subpoena rulings, which Beal said they also expected.
QueerDoc’s case was the first to be heard in an appeals court. Leavitt said he wasn’t sure why the federal government pushed to expedite QueerDoc’s case, but the timing is noteworthy because whatever happens could affect the Justice Department's legal strategy and judges' decisions in other appeals, STAT News reported.
During the hearing this month in the U.S. Court of Appeals for the Ninth Circuit, a three-judge panel in Seattle listened to oral arguments from attorneys representing QueerDoc and the federal government, and asked about concerns of patient privacy, the district court’s ruling, the purpose of the DOJ’s investigation and the scope of the subpoena, among other questions.
The DOJ initially argued it was investigating health care fraud and whether off-label promotion of puberty blockers and hormone treatment for minors violated federal law. The federal government specifically cited the Food, Drug and Cosmetic Act, which aims to protect the public from misbranded products and ensure the safety of food, drugs, medical devices and cosmetics.
QueerDoc’s attorneys, meanwhile, said the subpoena was issued in bad faith. While the government said it was interested in potential violations of the federal act, its ultimate goal was to end gender-affirming care, QueerDoc attorneys argued. In his October decision, Whitehead agreed.
At the March appeals hearing, Sarah Welch, representing the DOJ, acknowledged the federal government’s clear opposition to gender-affirming care, but said that didn’t mean it couldn’t investigate related issues.
“It’s just not the case that expressing a policy view about an industry or a practice amounts to an improper purpose that could taint an investigation,” Welch said.
In response, Paula Ramer, representing QueerDoc, reiterated points in Whitehead’s decision about issuing subpoenas "under the guise" of looking into possible violations of the federal act, and noted the DOJ has been "shifting explanations" of what it’s investigating and why.
"We don't disagree with the government that the president can certainly have a policy agenda and that they can take steps to carry out that policy agenda," Ramer said. "What they can’t do is issue a subpoena and use an unrelated investigatory tool in an effort to end that care, something for which Congress has not legislated against."
Judges also asked about the DOJ’s claims that it’s investigating "manufacturers or distributors engaged in misbranding" and providers submitting false insurance claims. QueerDoc, a provider that prescribes medication and does not take insurance, is neither, Whitehead wrote in his order. Welch said that’s part of what the request for documents is trying to seek clarity on.
Circuit judges have not announced a decision. The process could take weeks to months, Leavitt said.
The appeals case involving Seattle Children’s has not yet been heard. Children’s gender clinic is the only remaining hospital-based clinic in the state that provides gender-affirming care to trans and gender-diverse youth, though the range of its services is no longer clear.
Beal said they’ve heard from many families who are "on pins and needles" after Mary Bridge closed its gender clinic, which offered gender-affirming medical and behavioral health care, and other medical providers in the Pacific Northwest similarly scaled back services. Beal added that it’s “really phenomenal” Children’s has continued to push back against federal pressure.
The hospital won its challenge against the subpoena last September, and filed an amicus brief in QueerDoc’s case to support Whitehead’s decision.
Beal is also grateful for the support their patients and other physicians have provided over the last year. While receiving the subpoena was "terrifying and the legal back-and-forth has required a lot of time and attention, they’ve found comfort in their community.
“This almost never feels like a weight to me,” Beal said. “I spend my work helping people be who they are. I can't imagine a more joyful and rewarding career.”
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