Mary Bridge leaders cite 2 federal threats behind gender clinic closure

The decision to shutter a Tacoma pediatric gender clinic has drawn skepticism from some legal experts who say the hospital, though pressured by the Trump administration, acted prematurely.

But leaders at Mary Bridge Children’s Hospital and its MultiCare Health System said the increasingly aggressive federal threats to all of their Medicare and Medicaid funding if gender-affirming care continued essentially forced them to close the clinic that sees hundreds of trans and nonbinary youth. If Mary Bridge did not halt care for those patients, and federal funding was pulled, the entire hospital would be at risk, they said.

In an interview, MultiCare CEO Bill Robertson said he doesn’t think the hospital jumped the gun,” though the closure is not something he and his team wanted.

“This has been distressing for us,” Robertson said. “It’s a sad time for us as an organization that is thought to be an important resource to these kids.”

That being said, “we’re responding to the real reality of a new enforcement regime,” Robertson added. “There will be enforcement actions against us if we continue to provide this care.”

Emily Brice, co-executive director of advocacy at Northwest Health Law Advocates, isn’t so sure.

“I’m looking for the legal signal that tells me this is a decision that Mary Bridge needed to make at this time,” Brice said. “I haven’t yet been able to identify one.”

She acknowledged it’s possible the hospital is “aware of something I’m not.” Still, her sense is the clinic’s closure came too soon, given that gender care for minors remains legal in Washington state and proposed rules from the U.S. Department of Health and Human Services have not yet gone into effect.

Mary Bridge is not the only health organization to scale back gender-affirming medical services in the past year, as efforts to end this care from the Trump administration have intensified. Children’s hospitals in Los Angeles and Washington, D.C. – where gender-affirming care for minors also remains legal – made similar announcements last year.

While the Mary Bridge gender clinic is the first in the state to close completely, other Washington health care providers have introduced new limitations. Kaiser Permanente, for example, still provides hormone treatment, puberty blockers and gender-affirming mental health care to minors, but no longer offers surgeries to patients under 19.

Mary Bridge confirmed in September its plans to cut its gender clinic waitlist of about 150 families, but said at the time it would continue to serve those who were already receiving gender-affirming medication.

With last week’s news, about 320 patients who were still receiving care at the clinic will have to find a new provider. Of the remaining patients, about 180 are under 18, a hospital spokesperson said. About 130 patients are 18 and over, and will have the option of transferring their care to an adult provider within MultiCare’s system, Robertson said.

“This is rather unprecedented in my experience in health care,” he said.

Despite the closure, Dr. Barbara Thompson, Mary Bridge’s medical director, said the hospital’s gender-affirming care services have remained in line with guidance from all major medical groups in the U.S., including the Pediatric Endocrine Society, the World Professional Association for Transgender Health and the American Academy of Pediatrics.

“We still clinically stand behind our American societies for the care that we’ve provided,” Thompson said.

A pair of federal threats

When asked about the reasoning behind the decision to close Mary Bridge’s gender clinic, Robertson pointed to two federal approaches.

One is related to the regulatory actions Health and Human Services Secretary Robert F. Kennedy Jr. introduced in December that target gender care through the Centers for Medicare and Medicaid Services. The proposals are not final or legally binding.

The proposed rules would revise the requirements that Medicare- and Medicaid-certified hospitals must meet to receive CMS funding, prohibiting hospitals from providing gender-affirming care to patients under 18, Robertson said.

A period of public comment is open until Feb. 17. It’s not clear whether the proposals will go into effect immediately after that – but MultiCare leaders believe they will.

“We would not be viable if we lost Medicare and Medicaid,” Robertson said. “Mary Bridge would have to close or couldn’t operate, and MultiCare would have to cease operations.”

Mike Faulk, a spokesperson for state Attorney General Nick Brown’s office, said in an email Monday the proposed HHS rules are still subject to notice and comment by the public and have “no legal effect at this point.”

Any final agency rules that might eventually be issued would not apply retroactively, Faulk said.

A separate federal approach MultiCare is worried about is related to a declaration Kennedy signed Dec. 18 that proclaims pediatric gender-affirming care does “not meet professionally recognized standards of health care.”

Under the declaration, providers who offer gender-affirming care to patients under 18 would be considered out of compliance with those standards.

MultiCare is interpreting the declaration to mean that if a hospital bills the federal government for care considered to be “inappropriate” or “ineffective,” it could become a target of other enforcement actions, Robertson said.

He believes the declaration is enforceable now, referencing the pediatric hospitals that have been referred to the HHS Office of the Inspector General for investigation, including Seattle Children’s hospital.

Mary Bridge is not yet one of those hospitals, and has not received any direct communication from HHS on this topic, Robertson said.

However, he believes they’re on the federal government’s radar.

Brown’s office is less certain about how or when Kennedy’s declaration might be applied.

“We don’t really know because what they are doing is unprecedented,” Faulk wrote. His office believes the declaration took effect immediately under its own terms.

The state is currently a plaintiff in a multistate lawsuit, filed in Oregon, against Kennedy and HHS over the declaration, which the complaint argues is unlawful. Brown’s office will likely know more about the declaration’s application next week, when the federal government is expected to file its brief, Faulk said.

HHS press secretary Emily Hilliard declined to answer questions from The Seattle Times about how the agency interprets either of these federal actions. Instead, she wrote in a statement that HHS has a responsibility to “protect children and prevent taxpayers from footing the bill for chemical and surgical sex-rejecting procedures.”

Questions from legal experts

The threats from the federal government are “very scary,” said Omar Gonzalez-Pagan, senior counsel and health care strategist at Lambda Legal, a nonprofit legal aid group that advocates for LGBTQ+ rights.

Hospitals are “understandably risk-averse institutional players in the health care field” and facing a significant amount of pressure, said Gonzalez-Pagan, who’s based in New York.

“It is a horrible choice that is being placed upon hospitals,” he said. “But hospitals don’t have to make that choice when that pressure point is unlawful. … They just need to stiffen up their spine.”

Gonzalez-Pagan reiterated that Kennedy’s proposals have not gone into effect and said the health secretary’s declaration is “on incredibly thin legal ice.” In addition, several courts have found evidence that the federal government’s attempts to restrict gender care for minors are illegal, he said.

Brice, of Northwest Health Law Advocates in Seattle, also said she can understand the concerns of health providers like Mary Bridge.

“But I also think that should be balanced against a concern for the patients who are losing their access,” she said. “I’m not certain why you would make a hasty decision on this when there are patients that you know for sure will not receive the services that they need.”

At MultiCare, which has locations in Washington, Oregon and Idaho, Robertson noted the importance of keeping medical decisions between patients and providers.

“There’s a lot of things about health care that we think should be left to the clinicians who take care of patients to sort through,” he said. “We believe in vaccines. We believe in making sure kids have the support for the journey of growing up.”

Robertson continued, “I think it’s important in a community to have a breadth and depth of opportunities available to us. The federal government is restricting some of that.”

He couldn’t say whether the gender clinic might reopen in the future.

“My crystal ball isn’t great these days,” he said. “As society changes and our legal environment changes, we’re always looking to find ways to take care of people. … But I would say that, you know, nothing’s permanent.