Pediatricians, families of trans youth seek a shield law for providers of gender-affirming care
For Eida Fuji, the mother of a transgender child, access to gender-affirming medical care wasn't a matter of 'policy disagreement' but a matter of life and death for her family.
'I was faced with a choice of burying a son or gaining a daughter,' Fuji said in a tearful testimony to state lawmakers last month. 'My daughter is alive today because she had access to the gender-affirming care she needed. This care did not harm her or confuse her. It saved her life. Without it, I have no doubt I would be mourning my daughter instead.'
Despite widespread support from medical groups, the nation has seen an increase in legislative, political, and cultural attacks against gender-affirming care, including social transitioning and puberty blockers.
Nevada law doesn't restrict medically necessary gender-affirming care.
Yet, families of trans children along with pediatricians throughout the state still worry bans in other states could prevent trans youth from seeking care and doctors from providing it.
Senate Bill 171, sponsored by Democratic state Sen. James Ohrenschall, seeks to enact a shield law for medical providers who offer gender-affirming care and prevents a medical license board from punishing or disqualifying providers.
The bill passed out of the Senate Commerce and Labor Committee Thursday in a party-line vote.
The legislation also prevents a Nevada governor 'from surrendering or issuing a warrant for the arrest of an individual who is charged in another state with the crime of providing, assisting or receiving medically necessary, gender-affirming health care services unless those acts are prohibited under Nevada law.'
He sponsored a similar bill in 2023. It passed both houses in a party-line vote and then was vetoed by Republican Gov. Joe Lombardo.
In his veto message, the governor wrote the bill 'decreases the Executive Branch's authority to ensure the highest public health and child safety standards for Nevadans.'
Ohrenschall, along with the numerous medical providers and pediatricians who testified in support of the bill, said the legislation is needed more than ever.
'Many states have criminalized or otherwise restricted gender-affirming care, even when it's medically necessary or provided with the informed consent of the patients and their families,' he said.
The states that have passed bans 'not only harm transgender individuals but create a climate of fear and uncertainty for health care providers who offer gender-affirming health care services.'
Democratic state Sen. Melanie Scheible, a cosponsor of SB 171, said the bill was necessary to address the fact 'we are currently living in a constitutional crisis' and some states 'are attempting to expand their jurisdiction beyond their legal borders in ways we have not seen in generations before us.'
'If people, who apparently do not understand how state's rights work or how the United States Constitution is structured, are going to attempt to come to Nevada, threaten our providers for following our laws and not following their laws, we are saying to our providers 'we are going to protect you,' ' Scheible said.
Though Lombardo vetoed the shield law in 2023, he did sign other legislation expanding protections for the trans community.
Leann McAllister, the executive director of the Nevada chapter of the American Academy of Pediatrics, noted that Lombardo also signed legislation that shielded in-state providers serving out-of-state patients who sought abortion care.
'In my mind, evidence based care is evidence based care,' McAllister said. 'Why should abortion care be covered and not gender affirming care?'
The American Academy of Pediatrics policy regarding trans kids 'encompasses all sorts of gender affirming care, even including the social transition,' which helps children and their families access their identity, said Terence McAllister, a Las Vegas based primary care pediatrician.
'The more important thing, the thing we really concentrate on, is the social transitioning and the mental health support from the very beginning,' he said. 'We know that children who are trans are at higher risk for depression, anxiety and suicide. It's not because they're trans, It's because they're not accepted.'
Other medical interventions that are considered gender-affirming care include hormone treatment and puberty blockers.
'The most extreme type of intervention are surgical interventions, which are exceedingly rare in pediatrics,' he said. 'I've had no patients of mine who have gone to that step. It is just very unusual, very rare in pediatrics.'
Nevada state law hasn't restricted specific types of gender affirming care, as long as it's deemed medically necessary and a parent or guardian has granted consent.
Though the state hasn't actively sought to limit gender-affirming care like other states, Julpohng Vilai, a pediatrician based in Southern Nevada, said offering health care for LGBTQ adolescents has become increasingly challenging over the years.
Vilai's patients tell him it is already a struggle for those in the LGBTQ community, in particular trans youth, to find adequate health care. Nevada already struggles with a physician shortage, making it all the more challenging for trans youth to find a doctor.
As a result, many trans youth don't seek needed care 'because they're not sure if they can find it,' he said.
'When they actually do find a provider who is not only willing to provide that care, but has a lot of experience in providing that care and wants to provide, the support and care that people need is really important,' he said.
Another reason finding care has become difficult is partly due to increased anti-LGBTQ rhetoric around the country and a growing number of bills in state legislatures seeking to restrict trans people from access to health care and public accommodations.
President Donald Trump's return to office has intensified the attacks against the trans community.
There are already pediatricians who were 'already on the fence' on providing gender-affirming care, who have decided not to take on trans patients 'at risk of retaliation or legal consequences,' Vilai said.
Many doctors backing SB 171 worry efforts by other states to restrict medical care for trans youth could exacerbate provider uncertainty and reluctance in Nevada. That's why they are imploring lawmakers to pass a shield law to protect medical providers, they said.
Ohrenscall said 26 states have passed bans on gender-affirming health care 'that have caused significant harm to the community.'
Last year, Texas Attorney General Ken Paxton sought to investigate an out-of-state provider offering gender-affirming care to a minor. Paxton accused a Seattle hospital of providing puberty blockers, which are banned in Texas, to youth in the state.
His investigation was dropped. However, supporters of Nevada's bill worry there could be future efforts to investigate or even extradite doctors in other states who provide gender affirming care.
Scheible used the example of marijuana laws and how various states mandate where consumption is legal and how many ounces a person may possess. Nevada's laws, she said, could be different from Colorado's law.
She added it would be ludicrous for Nevada officials considered arresting or investigating someone in Colorado.
'That's exactly what other states are trying to do,' she said. 'They are trying to say in Texas we are going to ban the prescription of puberty blockers.'
SB 171 is opposed by conservative groups, including the Nevada Republican Party, which argue the bill decreases the governor's authority to 'ensure the highest public health and child safety standards for Nevadans' — an echo of Lombardo's veto message two years ago.
Ohrenschall reiterated that the legislation doesn't change 'what is legal, medical care in Nevada.'
'What it does do, and what it will do if it is passed, is protect health care providers, patients and their families when seeking legal medical care in Nevada,' he said. 'Much of the opposition testimony is misinformed. We did not hear from any health care provider opposed to this bill.'
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