Case: Southampton Community Healthcare v. Bailey

This is a case about access to gender-affirming care for transgender people in Missouri. On April 13, 2023, Missouri Attorney General Andrew Bailey promulgated an emergency regulation that imposed restrictions on gender-affirming care for both minors and adults. The regulation was the first of its kind in that it applied to adults too, not just minors. It required providers to inform patients of certain claims and to ensure that patients were eligible for the care. To be eligible, patients must have experienced an “intense pattern” of documented gender dysphoria for three years and received at least 15 hourly sessions with a therapist over at least 18 months. Patients also would first have to be screened for autism and “social media addiction,” and any psychiatric symptoms from mental health issues would have to be treated and resolved.

On April 24, 2023, Lambda Legal, the ACLU of Missouri and private counsel filed this lawsuit in the Circuit Court of Saint Louis County to challenge the emergency regulation. The lawsuit was filed on behalf of Southampton Healthcare Inc., a nonprofit medical practice located and doing business in St. Louis that provides treatment for gender dysphoria to transgender individuals, including the prescription of hormone therapy; a licensed clinical social worker; and transgender individuals seeking care that would be impacted by the emergency regulation. The case named Missouri Attorney General Bailey as the defendant. In the Complaint, the plaintiffs described how the emergency regulation would harm transgender Missourians and their health care providers. The Complaint alleged that the regulation was not valid because the state failed to comply with rulemaking procedures, lacked statutory authority, issued the regulation in conflict with state law, and issued a regulation that was arbitrary and capricious. The plaintiffs sought declaratory judgment, preliminary and permanent injunctive relief, and attorneys' fees and expenses. The case was assigned to Judge Ellen H. Ribaudo.

The same day the Complaint was filed, the plaintiffs also filed a motion for a temporary restraining order (TRO) and later that day, the Court held a hearing on the motion. Two days later, on April 26, the Court stayed the implementation of the emergency regulation until May 1, 2023, so that the Court would have more time to consider the briefing in relation to the TRO motion. Without that stay, the regulation would have gone into effect on April 27.

On May 1, 2023, the Court granted the plaintiffs' motion for a TRO, temporarily enjoining implementation and enforcement of the emergency regulation. The Court found that without a TRO, the plaintiffs would be subjected to immediate and irreparable loss, damage or injury due to the high risk of the interruption of medical care and the ethical violations attached to requiring the providers to obtain "informed consent" from their patients using unsourced medical information. The Court also held that the plaintiffs had a high likelihood of success on the merits, labelling the rulemaking a "novel use" of power that "may impermissibly invade a function reserved to the legislature." The TRO was entered, and was scheduled to expire on May 15, 2023, unless otherwise extended by the Court.

On May 16, 2023 the Attorney General issued an order terminating the rule and submitted a motion to dismiss the case. The case was dismissed without prejudice on June 12, 2023.