Rhode Island Hospital asks Fifth Circuit to axe DOJ subpoena for trans patient records

The hospital argues the subpoena was issued for the improper purpose of pressuring it to end gender-affirming care.(CN) — Rhode Island Hospital asked the Fifth Circuit Wednesday to reverse a federal judge’s order requiring it to comply with a Justice Department subpoena seeking extensive information on the hospital’s treatment of transgender youth, including patient records.The hospital’s attorney, Matthew Fitzgerald, told a three-judge panel that the order — which was entered the same day the government filed its petition — was issued without due process, as the hospital wasn’t given a chance to respond. He also argued the Justice Department lacked a legitimate purpose for investigating the hospital’s provision of gender-affirming care, saying its real goal was to use a burdensome subpoena to pressure the hospital into stopping such treatment since the feds reached settlements with at least six other hospitals requiring them to do just that.“Imagine a future Department of Justice that is against the AR-15 rifle,” Fitzgerald said. “So they say, ‘We’re going to investigate the manufacturers of this rifle on suspicion of something — aiding and abetting, perhaps, the drug cartels in Mexico. We’re going to send them subpoenas. We’re going to ask for the personnel files of everyone at the company, everyone involved in the manufacture of these guns, the entire files. We’re going to ask for any contact information they have for the buyer of every AR-15 rifle for the last six years.’ And when the gun companies squeal and say it’s unduly burdensome, it’s for an improper purpose, the government says, ‘Well, if you stop manufacturing this rifle, we’ll claim victory and go away.’”Justice Department attorney John Bailey said the government is lawfully investigating potential violations of the Food, Drug, and Cosmetic Act. While it is legal for doctors in Rhode Island to prescribe puberty-blocking drugs and cross-sex hormones for the treatment of gender dysphoria — a use for which they have not been approved by the FDA — it is not legal for drug manufacturers and distributors to promote such off-label use. Bailey insisted the Justice Department is seeking evidence from Rhode Island Hospital showing such improper promotion by manufacturers and distributors.But U.S. Circuit Judge Irma Ramirez questioned why the government is seeking patient records if it’s targeting drugmakers.“If you are investigating whether the manufacturers are misbranding the drugs, then why not start with the manufacturers or limit the scope of the subpoena to communications to the hospital or to the doctors about these allegedly misbranded drugs?” the Joe Biden appointee asked. “Why ask for patient files and personnel files?”Although the hospital is in Rhode Island, the government filed its petition for enforcement in the Fort Worth division of the Northern District of Texas, where the two active federal judges are both deeply conservative.Shortly after Chief U.S. District Judge Reed O’Connor, a George W. Bush appointee, entered the enforcement order, U.S. District Judge Mary McElroy granted motions by the hospital and the Rhode Island Child Advocate — which represents the interests of children in state care — to quash the subpoena. McElroy, a Donald Trump appointee in Rhode Island, found the subpoena violated the constitutional privacy rights of minor patients and lacked a legal basis, noting the hospital’s off-label prescribing of puberty-blocking drugs and cross-sex hormones is not illegal.Bailey told the Fifth Circuit panel that the hospital is producing responsive records, with patient information anonymized, for the Texas federal court to hold privately while the two appeals are resolved.U.S. Circuit Judges Kyle Duncan and Kurt Engelhardt, both Trump appointees, criticized the hospital for filing a motion to quash in another court after O’Connor ruled. Duncan said the hospital had created a “procedural conundrum” through parallel proceedings, and Engelhardt called its actions a “sharp practice” that potentially raises ethical concerns.But Fitzgerald said the case in Rhode Island was started by the Child Advocate, and he argued the hospital was justified in joining that challenge to the subpoena because O’Connor’s order was void for lack of due process.In July 2025, the Trump administration announced it had issued “more than 20 subpoenas” to doctors and clinics that provide gender-affirming care to minors. This followed an executive order from Trump calling for an end to such treatments, which the president described as “the maiming and sterilizing of a growing number of impressionable young children.”Numerous federal judges have blocked or limited these subpoenas, but in August a divided three-judge panel of the Ninth Circuit — the only federal appeals court to have ruled on the issue thus far — overturned a federal judge’s order quashing such a subpoena. A George W. Bush appointee and a Donald Trump appointee ruled, over the dissent of a Bill Clinton appointee, that the lower court was wrong in finding the subpoena was issued for an improper purpose. The clinic targeted by that subpoena has sought rehearing by the full appeals court.Subscribe to our free newslettersOur weekly newsletter Closing Arguments offers the latest about ongoing trials, major litigation and rulings in courthouses around the U.S. and the world, while the monthly Under the Lights dishes the legal dirt from Hollywood, sports, Big Tech and the arts.Additional Reads