Case: Brandt v. Rutledge

4:21-cv-00450 | U.S. District Court for the Eastern District of Arkansas

Filed Date: May 25, 2021

Case Ongoing

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Case Summary

On April 6, 2021, the Arkansas legislature passed H.B. 1570 — the "Save Adolescents from Experimentation” (SAFE) Act — over the governor’s veto. The Safe Act banned healthcare professionals from providing gender transition procedures, including puberty blockers and hormones, to anyone under 18 or from referring anyone under 18 to any healthcare professional for such procedures. Additionally, the SAFE Act prohibited coverage of gender transition procedures for minors by Medicaid or private insurance. Four families with transgender children and two pediatricians brought this complaint against various Arkansas state officials in the Eastern District of Arkansas on May 25, 2021. The families and doctors, represented by the National ACLU, Arkansas ACLU, and private law firms, claimed the SAFE Act was unconstitutional for: (1) violating the Equal Protection Clause of the 14th Amendment by discriminating on the basis of sex; (2) violating the Due Process Clause of the Fourteenth Amendment; and (3) violating the First Amendment by prohibiting healthcare providers from referring their patients for medical treatments in accordance with the accepted medical standards to treat gender dysphoria. The relief sought by the families included: (1) declaratory judgment that the SAFE Act was unconstitutional; (2) preliminary and permanent injunctions on the SAFE Act; and (3) an award of reasonable attorneys’ fees. The case was assigned to Judge James Maxwell Moody, Jr.

On June 17, 2021, the United States filed a Statement of Interest echoing the Plaintiffs’ claim that the SAFE Act violated the Equal Protection Clause of the 14th Amendment. Several national and state organizations of health professionals also filed amicus briefs in support of the plaintiffs. These organizations included the American Medical Association and Arkansas Psychiatric Society.

On July 21, 2021, the court denied Arkansas’ motion to dismiss and granted the Plaintiffs’ motion for a preliminary injunction on all three proposed grounds. On August 2, 2021, Judge Moody, Jr. elaborated in a Supplemental Order, 551 F.Supp.3d 882 (E.D. Ark. 2021), focusing on the families’ equal protection claim and explaining that the SAFE ACT “rests on sex-based classifications and… transgender people constitute at least a quasi-suspect class.” Moreover, the court found that the stated intents of the bill (protecting children from experimental treatment and regulating medical ethics) were pretextual. The court looked, among other things, at overwhelming medical testimony that “gender-affirming for transgender minors may be medically appropriate and necessary to improve the physical and mental health of transgender people.”

Arkansas appealed the decision on August 20, 2021 to the United States Court of Appeals for the Eighth Circuit. Both sides filed briefs, and again, many notable individuals and institutions filed amici briefs; the United States again filed a brief supporting the Plaintiffs. On August 25, 2022, Judges James B. Loken, Jane Kelly, and Katherine M. Menendez upheld the lower court's injunction because the lower court had not abused its discretion in granting a preliminary injunction based on Plaintiffs’ equal protection claim. The three Judges affirmed arguments that transgender youth would suffer "irreparable harm" absent preliminary injunction and that enforcing the law would prohibit medical treatment that conforms with the recognized standard of care. The Judges also agreed that the SAFE Act is not substantially related to its purported purposes of protecting children from experimental medical treatment and regulating medical ethics. The Court did not address the State’s challenges to Plaintiffs’ other claims. 47 F.4th 661. Arkansas requested an en banc or panel rehearing of their appeal of the preliminary injunction, but their request was rejected on November 16, 2022. The order itself did not contain any rationale, but a concurrence by Judge Colloton, joined by two other judges, explained that Arkansas had not requested a stay for the 15 prior months.

The district court held an eight-day bench trial in October 2022. On June 20, 2023, the court issued its findings of facts and conclusions of law, entered judgment for the plaintiffs on all claims, and enjoined the state from enforcing the law permanently. 677 F.Supp.3d 877. Among its findings of facts, the court found that transgender care was not experimental care, and that providing treatment for gender dysphoria wouldn't cause a person to be or remain transgender because there was no treatment that had the ability to change a person’s gender identity. In addition, the court found that parents or guardians would still be required to provide informed consent in order for their children to receive medical treatment, and the informed consent process was adequate to enable minor patients and their parents to make decisions about gender-affirming medical care for adolescents. Further, the risks of gender-affirming medical care were not categorically different from the types of risks that other types of pediatric healthcare pose, and for many adolescents the benefits of treatment greatly outweighed the risks. The court also found that adolescents with gender dysphoria were unlikely to de-transition or desist in their transition whether or not they received gender-affirming medical care.

As to conclusions of law, the court held that the SAFE Act violated the equal protection clause because it discriminated on the basis of sex, as a minor’s sex at birth determined whether the minor was able to receive certain types of medical care under the law. The court also held that the law discriminated against transgender people, as the law prohibited medical or surgical procedures related to gender transition, medical care that only transgender individuals chose to undergo. Further, the court found that Arkansas hadn’t met its burden of providing a persuasive justification for the differential treatment of transgender individuals. The state provided five reasons: i) that there was a lack of evidence of efficacy of the banned care; ii) that the banned treatment had risks and side effects; iii) that many patients would desist in their gender incongruence; iv) that some patients would later come to regret having received irreversible treatments; and v) that treatment was being provided without appropriate evaluation and informed consent. The court determined that none of these reasons were persuasive or supported by evidence at the trial. As to plaintiffs' due process claim, the court held that the Act's ban on all gender transition procedures was not sufficiently narrowly tailored to achieve the state's asserted interests, noting the plaintiff parents' fundamental right to make medical decisions for their children. Finally, the court held that the Act regulated physician speech -- effectively prohibiting physicians from informing their patients about the treatments -- and that it was a content and viewpoint-based regulation of speech subject to strict scrutiny. Applying that standard, the court held that the Act violated the First Amendment because Arkansas failed to prove that its interests in the safety of adolescents from gender transitioning procedures were "compelling, genuine, or even rational." Thus, the court entered judgment for the plaintiffs and permanently enjoined enforcement of the Act.

On July 20, 2023, Arkansas appealed the decision to the United States Court of Appeals for the Eighth Circuit (23-02681). Arkansas filed a petition for an initial hearing en banc and the court granted the petition on October 6, 2023. Following the grant of the petition for an initial hearing en banc, both sides filed briefs, and again, many notable individuals and institutions filed amici briefs; the United States again filed a brief supporting the Plaintiffs.

The appeal was argued before the Eighth Circuit, en banc, on April 11, 2024. The United States participated in oral argument.

On August 12, 2025, in an 8-2 opinion, the Eighth Circuit reversed the district court’s decision and remanded the case. The Court of Appeals found that (1) the Act does not classify on the basis of sex or transgender status (rather only of age and medical procedure) and so does not violate or even trigger heightened scrutiny under the Equal Protection Clause; (2) the Act survives rational basis review under the Equal Protection and Due Process Clauses; (3) under the Fourteenth Amendment, the nation’s history and tradition and its “historical understanding of ordered liberty” do not guarantee the right of a parent to offer his or her child a medical treatment desired by the child and approved by a physician but deemed inappropriate for minors by the state legislature; (4) the Act survives the intermediate First Amendment scrutiny required when a statute imposes a burden on protected speech that is only incidental to its regulation of other activity because Arkansas has a compelling interest in protecting the health of minors and has adequately tailored the law to serve that compelling interest.

The Eighth Circuit concluded that the district court had rested its permanent injunction on incorrect conclusions of law and reversed the judgment, remanding the case for further proceedings. As of October 15, 2025 the case is ongoing.

	Document
4:21-cv-00450	Docket [PACER]	Sept. 30, 2021	Sept. 30, 2021 Docket
289 4:21-cv-00450	USCA Docketing Letter U.S. Court of Appeals for the Eighth Circuit	July 21, 2023	July 21, 2023 Docket
1 4:21-cv-00450	Complaint for Declaratory and Injunctive Relief	May 25, 2021	May 25, 2021 Complaint
19 4:21-cv-00450	Statement of Interest of the United States	June 17, 2021	June 17, 2021 Statement of Interest (DOJ)
64 4:21-cv-00450	Supplemental Order	Aug. 2, 2021	Aug. 2, 2021 Order/Opinion 551 F.Supp.3d 882
193 4:21-cv-00450 21-02875	Appeal from United States District Court for the Eastern District of Arkansas - Central U.S. Court of Appeals for the Eighth Circuit	Aug. 25, 2022	Aug. 25, 2022 Order/Opinion 47 F.4th 661
226 4:21-cv-00450 21-02875	USCA Order U.S. Court of Appeals for the Eighth Circuit	Nov. 16, 2022	Nov. 16, 2022 Order/Opinion 2022 WL 16957734
283 4:21-cv-00450	Findings of Fact and Conclusions of Law	June 20, 2023	June 20, 2023 Order/Opinion 677 F.Supp.3d 877
804843313 23-02681	Brief Brandt v. Griffin U.S. Court of Appeals for the Eighth Circuit	Sept. 14, 2023	Sept. 14, 2023 Pleading / Motion / Brief 147 F.4th 867
805325846-3 23-02681	Published Opinion Brandt v. Griffin U.S. Court of Appeals for the Eighth Circuit	Aug. 12, 2025	Aug. 12, 2025 Order/Opinion

ECF Number	Description	Date	Link Date / Link
1	COMPLAINT FOR DECLARATORY AND INJUNCTIVE RELIEF against All Defendants filed by Michele Hutchison, Aaron Jennen, Donnie Saxton, Amanda Dennis, Dylan Brandt, Kathryn Stambough, Parker Saxton, Sabrina Jennen, Lacey Jennen, Joanna Brandt, Shayne Dennis, Brooke Dennis. (Filing Fee of $402 paid. Receipt #LIT082242.) Summons issued and returned to counsel for service. (Attachment: # 1 Civil Cover Sheet) (llg) (Entered: 05/26/2021) 1 Civil Cover Sheet View on RECAP	May 25, 2021	May 25, 2021 Clearinghouse
1	COMPLAINT FOR DECLARATORY AND INJUNCTIVE RELIEF against All Defendants filed by Michele Hutchison, Aaron Jennen, Donnie Saxton, Amanda Dennis, Dylan Brandt, Kathryn Stambough, Parker Saxton, Sabrina Jennen, Lacey Jennen, Joanna Brandt, Shayne Dennis, Brooke Dennis. (Filing Fee of $402 paid. Receipt #LIT082242.) Summons issued and returned to counsel for service. (Attachment: # 1 Civil Cover Sheet) (llg) (Entered: 05/26/2021)	May 25, 2021	May 25, 2021 Clearinghouse
2	MOTION for Leave to Appear pro hac vice by Beth Echols. Fee $100 receipt number AAREDC-4019444. Filed by All Plaintiffs (Attachments: # 1 Document, # 2 Document)(Echols, Sharon) (Entered: 05/26/2021) 1 Document View on RECAP 2 Document View on RECAP	May 26, 2021	May 26, 2021 RECAP
2	MOTION for Leave to Appear pro hac vice by Beth Echols. Fee $100 receipt number AAREDC-4019444. Filed by All Plaintiffs (Attachments: # 1 Document, # 2 Document)(Echols, Sharon) (Entered: 05/26/2021)	May 26, 2021	May 26, 2021
3	MOTION for Leave to Appear pro hac vice by Beth Echols. Fee $100 receipt number AAREDC-4019456. Filed by All Plaintiffs (Attachments: # 1 Document)(Echols, Sharon) (Entered: 05/26/2021) 1 Document View on RECAP	May 26, 2021	May 26, 2021 RECAP
3	MOTION for Leave to Appear pro hac vice by Beth Echols. Fee $100 receipt number AAREDC-4019456. Filed by All Plaintiffs (Attachments: # 1 Document)(Echols, Sharon) (Entered: 05/26/2021)	May 26, 2021	May 26, 2021
4	MOTION for Leave to Appear pro hac vice by Beth Echols. Fee $100 receipt number AAREDC-4019460. Filed by All Plaintiffs (Attachments: # 1 Document)(Echols, Sharon) (Entered: 05/26/2021) 1 Document View on RECAP	May 26, 2021	May 26, 2021 RECAP
4	MOTION for Leave to Appear pro hac vice by Beth Echols. Fee $100 receipt number AAREDC-4019460. Filed by All Plaintiffs (Attachments: # 1 Document)(Echols, Sharon) (Entered: 05/26/2021)	May 26, 2021	May 26, 2021
5	MOTION for Leave to Appear pro hac vice by Beth Echols. Fee $100 receipt number AAREDC-4019464. Filed by All Plaintiffs (Attachments: # 1 Document)(Echols, Sharon) (Entered: 05/26/2021) 1 Document View on RECAP	May 26, 2021	May 26, 2021 RECAP
5	MOTION for Leave to Appear pro hac vice by Beth Echols. Fee $100 receipt number AAREDC-4019464. Filed by All Plaintiffs (Attachments: # 1 Document)(Echols, Sharon) (Entered: 05/26/2021)	May 26, 2021	May 26, 2021
6	MOTION for Leave to Appear pro hac vice by Beth Echols. Fee $100 receipt number AAREDC-4020079. Filed by All Plaintiffs (Attachments: # 1 Document)(Echols, Sharon) (Entered: 05/27/2021) 1 Document View on RECAP	May 27, 2021	May 27, 2021 RECAP
6	MOTION for Leave to Appear pro hac vice by Beth Echols. Fee $100 receipt number AAREDC-4020079. Filed by All Plaintiffs (Attachments: # 1 Document)(Echols, Sharon) (Entered: 05/27/2021)	May 27, 2021	May 27, 2021
7	MOTION for Leave to Appear pro hac vice by Beth Echols. Fee $100 receipt number AAREDC-4020089. Filed by All Plaintiffs (Attachments: # 1 Document)(Echols, Sharon) (Entered: 05/27/2021) 1 Document View on RECAP	May 27, 2021	May 27, 2021 RECAP
7	MOTION for Leave to Appear pro hac vice by Beth Echols. Fee $100 receipt number AAREDC-4020089. Filed by All Plaintiffs (Attachments: # 1 Document)(Echols, Sharon) (Entered: 05/27/2021)	May 27, 2021	May 27, 2021
8	ORDER granting 2, 3, 4, 5, 6, 7 motions to admit counsel pro hac vice on behalf of Plaintiffs. Garrard R. Beeney, Alexander S. Holland, Jonathan J. Ossip, Laura Kabler Oswell, Chase Strangio, and Duncan C. Simpson LaGoy are hereby admitted to appear before this Court as co-counsel of record in this action. Signed by Judge James M. Moody Jr. on 05/27/2021. (llg) (Entered: 05/27/2021)	May 27, 2021	May 27, 2021 RECAP
8	ORDER granting 2, 3, 4, 5, 6, 7 motions to admit counsel pro hac vice on behalf of Plaintiffs. Garrard R. Beeney, Alexander S. Holland, Jonathan J. Ossip, Laura Kabler Oswell, Chase Strangio, and Duncan C. Simpson LaGoy are hereby admitted to appear before this Court as co-counsel of record in this action. Signed by Judge James M. Moody Jr. on 05/27/2021. (llg) (Entered: 05/27/2021)	May 27, 2021	May 27, 2021
10	AFFIDAVIT by Dylan Brandt. (Echols, Sharon) (Entered: 06/08/2021)	June 8, 2021	June 8, 2021 RECAP
10	AFFIDAVIT by Dylan Brandt. (Echols, Sharon) (Entered: 06/08/2021)	June 8, 2021	June 8, 2021
9	AFFIDAVIT by Dylan Brandt. (Attachments: # 1 Affidavit)(Echols, Sharon) (Entered: 06/08/2021) 1 Affidavit View on RECAP	June 8, 2021	June 8, 2021 RECAP
9	AFFIDAVIT by Dylan Brandt. (Attachments: # 1 Affidavit)(Echols, Sharon) (Entered: 06/08/2021)	June 8, 2021	June 8, 2021
11	MOTION for Preliminary Injunction by All Plaintiffs (Attachments: # 1 Exhibit 1 - Declaration of Dylan Brandt, # 2 Exhibit 2 - Declaration of Joanna Brandt, # 3 Exhibit 3 - Declaration of Sabrina Jennen, # 4 Exhibit 4 - Declaration of Aaron and Lacey Jennen, # 5 Exhibit 5 - Declaration of Brooke Dennis, # 6 Exhibit 6 - Declaration of Shayne and Amanda Dennis, # 7 Exhibit 7 - Declaration of Parker Sexton, # 8 Exhibit 8 - Declaration of Donnie Sexton, # 9 Exhibit 9 - Declaration of Dr. Michele Hutchinson, # 10 Exhibit 10 - Declaration of Dr. Kathryn Stambough, # 11 Exhibit 11 - Declaration of Dr. Deanna Adkins, # 12 Exhibit 12 - Declaration of Dr. Armand H. Matheny Antommaria)(Walas, Breean) (Entered: 06/15/2021) 1 Exhibit 1 - Declaration of Dylan Brandt View on RECAP 2 Exhibit 2 - Declaration of Joanna Brandt View on RECAP 3 Exhibit 3 - Declaration of Sabrina Jennen View on RECAP 4 Exhibit 4 - Declaration of Aaron and Lacey Jennen View on RECAP 5 Exhibit 5 - Declaration of Brooke Dennis View on RECAP 6 Exhibit 6 - Declaration of Shayne and Amanda Dennis View on RECAP 7 Exhibit 7 - Declaration of Parker Sexton View on RECAP 8 Exhibit 8 - Declaration of Donnie Sexton View on RECAP 9 Exhibit 9 - Declaration of Dr. Michele Hutchinson View on RECAP 10 Exhibit 10 - Declaration of Dr. Kathryn Stambough View on RECAP 11 Exhibit 11 - Declaration of Dr. Deanna Adkins View on RECAP 12 Exhibit 12 - Declaration of Dr. Armand H. Matheny Antommaria View on RECAP	June 15, 2021	June 15, 2021 RECAP
11	MOTION for Preliminary Injunction by All Plaintiffs (Attachments: # 1 Exhibit 1 - Declaration of Dylan Brandt, # 2 Exhibit 2 - Declaration of Joanna Brandt, # 3 Exhibit 3 - Declaration of Sabrina Jennen, # 4 Exhibit 4 - Declaration of Aaron and Lacey Jennen, # 5 Exhibit 5 - Declaration of Brooke Dennis, # 6 Exhibit 6 - Declaration of Shayne and Amanda Dennis, # 7 Exhibit 7 - Declaration of Parker Sexton, # 8 Exhibit 8 - Declaration of Donnie Sexton, # 9 Exhibit 9 - Declaration of Dr. Michele Hutchinson, # 10 Exhibit 10 - Declaration of Dr. Kathryn Stambough, # 11 Exhibit 11 - Declaration of Dr. Deanna Adkins, # 12 Exhibit 12 - Declaration of Dr. Armand H. Matheny Antommaria)(Walas, Breean) (Entered: 06/15/2021)	June 15, 2021	June 15, 2021
12	BRIEF IN SUPPORT re 11 Motion for Preliminary Injunction,, filed by All Plaintiffs. (Walas, Breean) (Entered: 06/15/2021)	June 15, 2021	June 15, 2021 RECAP
12	BRIEF IN SUPPORT re 11 Motion for Preliminary Injunction,, filed by All Plaintiffs. (Walas, Breean) (Entered: 06/15/2021)	June 15, 2021	June 15, 2021
13	NOTICE of Appearance by Nicholas J. Bronni on behalf of All Defendants (Bronni, Nicholas) (Entered: 06/16/2021)	June 16, 2021	June 16, 2021 RECAP
13	NOTICE of Appearance by Nicholas J. Bronni on behalf of All Defendants (Bronni, Nicholas) (Entered: 06/16/2021)	June 16, 2021	June 16, 2021
14	NOTICE of Appearance by Michael Cantrell on behalf of All Defendants (Cantrell, Michael) (Entered: 06/16/2021)	June 16, 2021	June 16, 2021 RECAP
14	NOTICE of Appearance by Michael Cantrell on behalf of All Defendants (Cantrell, Michael) (Entered: 06/16/2021)	June 16, 2021	June 16, 2021
15	NOTICE of Appearance by Emily Yu on behalf of All Defendants (Yu, Emily) (Entered: 06/16/2021)	June 16, 2021	June 16, 2021 RECAP
15	NOTICE of Appearance by Emily Yu on behalf of All Defendants (Yu, Emily) (Entered: 06/16/2021)	June 16, 2021	June 16, 2021
16	NOTICE of Appearance by Vincent Moore Wagner on behalf of All Defendants (Wagner, Vincent) (Entered: 06/16/2021)	June 16, 2021	June 16, 2021 RECAP
16	NOTICE of Appearance by Vincent Moore Wagner on behalf of All Defendants (Wagner, Vincent) (Entered: 06/16/2021)	June 16, 2021	June 16, 2021
17	MOTION to Dismiss for Lack of Jurisdiction, MOTION TO DISMISS FOR FAILURE TO STATE A CLAIM () by All Defendants (Wagner, Vincent) (Entered: 06/16/2021)	June 16, 2021	June 16, 2021 RECAP
17	MOTION to Dismiss for Lack of Jurisdiction, MOTION TO DISMISS FOR FAILURE TO STATE A CLAIM () by All Defendants (Wagner, Vincent) (Entered: 06/16/2021)	June 16, 2021	June 16, 2021
18	BRIEF IN SUPPORT re 17 Motion to Dismiss/Lack of Jurisdiction, Motion to Dismiss for Failure to State a Claim filed by All Defendants. (Wagner, Vincent) (Entered: 06/16/2021)	June 16, 2021	June 16, 2021 RECAP
18	BRIEF IN SUPPORT re 17 Motion to Dismiss/Lack of Jurisdiction, Motion to Dismiss for Failure to State a Claim filed by All Defendants. (Wagner, Vincent) (Entered: 06/16/2021)	June 16, 2021	June 16, 2021
19	STATEMENT of Interest of the United States re 1 filed by USA. (jap) (Docket text modified on 6/17/2021 to include filing party.)(cmn) (Entered: 06/17/2021)	June 17, 2021	June 17, 2021 Clearinghouse
19	STATEMENT of Interest of the United States re 1 filed by USA. (jap) (Docket text modified on 6/17/2021 to include filing party.)(cmn) (Entered: 06/17/2021)	June 17, 2021	June 17, 2021 Clearinghouse
20	NOTICE of Appearance by Ka Tina Rena Guest on behalf of Elizabeth Anderson, Rhys L Branman, Robert Breving, Jr, Amy E Embry, Edward Gardner, Rodney Griffin, Betty Guhman, Veryl D Hodges, Brian T Hyatt, Timothy C Paden, Don R Philips, Leslie Rutledge, William L Rutledge, John H Scribner, Sylvia D Simon, David L Staggs (Guest, Ka Tina) (Entered: 06/17/2021)	June 17, 2021	June 17, 2021 RECAP
20	NOTICE of Appearance by Ka Tina Rena Guest on behalf of Elizabeth Anderson, Rhys L Branman, Robert Breving, Jr, Amy E Embry, Edward Gardner, Rodney Griffin, Betty Guhman, Veryl D Hodges, Brian T Hyatt, Timothy C Paden, Don R Philips, Leslie Rutledge, William L Rutledge, John H Scribner, Sylvia D Simon, David L Staggs (Guest, Ka Tina) (Entered: 06/17/2021)	June 17, 2021	June 17, 2021

Case: Brandt v. Rutledge

4:21-cv-00450 | U.S. District Court for the Eastern District of Arkansas

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