Bills affecting transgender kids move at N.C. General Assembly

By Grace Vitaglione and Rachel Crumpler

Republican lawmakers in the North Carolina House of Representatives considered several bills affecting transgender youth this week. 

House Bill 606, which passed the House on May 6, would extend the statute of limitations for medical malpractice claims for minors who underwent a gender transition. House Bill 560 would prevent abuse or neglect allegations from being based on not accepting a children’s gender identity.

In North Carolina, an estimated 8,500 youth ages 13-17 identify as transgender, according to a 2022 report by UCLA’s Williams Institute, which researches sexual orientation and gender identity law and public policy.

Durham resident Grace Nichols, 38, who identifies as transgender and nonbinary, attended a committee hearing about House Bill 560 on April 29. Nichols told NC Health News that the bills could set a precedent for future legislation restricting people’s access to health care.

“Some of these bills actually will not go anywhere, but they serve as a messaging tactic,” Nichols said. “They plant seeds in public consciousness, which helps build support for them.”

There’s some urgency to the legislature’s work to pass these bills. The General Assembly is gearing up for the May 8 “crossover” deadline, when bills must pass in at least one chamber or else they’re dead for the remainder of the two-year legislative session, although sometimes bills that fail to successfully “cross over” sometimes appear embedded in other pieces of legislation.

Medical malpractice

House Bill 606, known as the Civil Procedure Amendment, passed the House in a 69-41 floor vote on May 6. It would extend the statute of limitations for medical malpractice claims for health care services provided to minors facilitating gender transitions. 

In general, medical malpractice claims must be filed three to four years after a given procedure, depending on the claim. This bill would give claimants 10 years from the day they turn 18 and would remove the cap on noneconomic damages. 

The bill would also prevent state funds from being used to pay for gender-affirming care for incarcerated people, including puberty blockers, hormones and surgical gender transition procedures. 

At least eight other states have passed similar laws, including Mississippi, Arkansas, Indiana and Tennessee.

Prisha Mosley testified at the House Judiciary meeting April 29 about her experience transitioning her gender starting at age 16 and de-transitioning as an adult a few years later. She said she faced “horrific surgical complications” 10 months ago, citing the top surgery she received at 18 that left her unable to breastfeed after giving birth.

“It took many years for me to realize that transition was not going to actually change my sex and that my doctors had misled me and harmed me,” Mosley said.

She sued a group of health care providers in Gaston County in 2023, but she — and others like her — could have a hard time succeeding in their suits given the high bar for malpractice cases to proceed in North Carolina. For instance, research shows that, at the current standard of care, any women who have had breast reduction or augmentation surgery can have increased odds of having challenges breastfeeding.

Deanna Jones — who identifies as transgender — also attended the meeting. She told NC Health News that she empathizes with Mosley’s experience, but said the percentage of those who regret receiving gender-affirming care is about 1 percent of people who identify as transgender and does not reflect the experiences of others in the community. Jones said she had both knees replaced, for example, and that procedure has a 10 percent average rate of regret.

Wake County resident Phoenix, 17, received gender-affirming care and said they credit the treatment with saving their life. The process to get the care wasn’t easy, said Phoenix, who requested that NC Health News only use their first name for privacy and safety concerns. Phoenix had to obtain a letter of support from their therapist and official parental consent, as well as pass multiple psychiatric evaluations and medical tests.

“The whole time, I was like, ‘Oh my god, another test,’” Phoenix said. “But I understand why they do that, and it’s necessary…it weeds out a lot of people that are maybe having body dysmorphia, or really low self esteem, or any number of things.”

Phoenix’s mother, Margaret, also said they had to have a history of and continuing independent mental health intervention in order to receive care. Margaret also requested that NC Health News not use her last name for privacy and safety concerns.

Chilling effect

Rep. Jonathan Almond (R-Concord), who introduced House Bill 606 at the meeting April 29, said plaintiffs would still have to meet the same standard for medical malpractice claims. Lawmakers in the General Assembly have established a steep bar for those claims over the past few years. 

Nonetheless, some medical providers and advocates worried the bill would have a chilling effect on doctors if made law. 

Bianca Allison, a pediatric primary care provider in the Triangle who serves transgender youth, said it could create “moral distress” for clinicians who want to provide gender-affirming care as part of best practice health care, but fear the potential liability. She pointed out that other types of health care are not singled out.

“It sort of suggests a stigmatizing of gender-affirming medicines and care, and not a neutral concern for patient safety,” Allison said.

Holly Savoy, executive director of Charlotte Trans Health and a psychologist serving transgender youth, said this legislation is “intimidation.”

“This is really legislation intended to intimidate providers from providing the care. They’re looking for any avenue to stop gender-affirming care for adolescents,” Savoy said.

Aron Johnson, organizing director at Equality NC, a statewide advocacy organization for the LGBTQ community, said the number of gender-affirming care providers has decreased since President Donald Trump came into office in the wake of a series of executive orders seeking to limit the rights of transgender Americans, including one targeting the provision of gender-affirming care to people younger than 19. If made law, this bill could further lower that number, he said.

The Trump administration’s Department of Health and Human Services released on May 1 what it called a comprehensive report based on its review of best practice regarding treatment of gender dysphoria — which, unusually, was unsigned by any government researchers — critical of gender-affirming care. The stance conflicts with most medical associations and the widely used World Professional Association for Transgender Health guidelines, though some countries have stepped back from providing the care as widely.

Nichols, who identifies as transgender and nonbinary, said this bill and others like it are trying to convince people that gender identities outside of a binary are “new and trendy and coerced.” 

“There’s a lot of misinformation about people coercing young people to gender transition, which is pretty preposterous,” Nichols said. “Considering the way the world is so oppressive against the queer and trans people, I don’t feel like anyone would actually choose to be put in that position.”

Foster care

Nichols recounted how they were adopted at 7 months old, and came out as lesbian in high school before eventually identifying as transgender and nonbinary. Nichols said their adoptive parent supported their identity. Otherwise, Nichols said, it would’ve taken a toll on their mental health.

“Already feeling vulnerable of losing one family and trying to adapt into a new family, if I had not had the acceptance that I had, it actually would have been fatal,” Nichols said.

Now, Nichols is concerned about House Bill 560, dubbed the Parents Protection Act, which would prevent social services workers from factoring in whether foster parents are accepting of a child’s gender identity when choosing whether to place the child in that foster home. The bill says raising a child “consistent with their biological sex” wouldn’t count as abuse or neglect. The bill would also prevent adoption agencies from disqualifying potential adoptive parents if they don’t accept a child’s gender identity.

The bill would also prevent any allegations of abuse or neglect against biological parents for raising a child consistent with their sex at birth, despite the child’s desire to do otherwise.

A state Department of Health and Human Services spokesperson said county child welfare agencies must currently provide all youth with “respectful, fair and equal treatment and access to services which includes placements.”

The spokesperson voiced concerns about the bill in a statement to NC Health News, saying the bill could undermine biological parents’ rights to make decisions about how their child is raised even while in the foster care system. 

“We have concerns that this bill undermines both the county department of social services’ ability and the court’s ability to consider all necessary information when determining an appropriate placement that prioritizes the child’s best interest,” the spokesperson said.

Rep. Donnie Loftis (R-Gastonia), who introduced the bill at the House Health meeting April 29, said with the shortage of foster parents in the state, social services workers shouldn’t disqualify potential foster parents based on their lack of acceptance of a child’s gender identity.

“I don’t want it to be used as a pre-qualifier that says, ‘Oh, you’re one of those. You are not going to be getting a child because you can’t accept that,’” he told NC Health News.

During multiple committee hearings, Loftis also cited incidents in three states of custody disputes due to lack of support for gender transitions. For example, according to reporting from WFYI, the Indiana Department of Child Services took custody of a 16-year-old who came out as transgender after receiving allegations that her parents verbally and emotionally abused her as a result of her identity. The parents sued and appealed up to the U.S. Supreme Court, which declined to hear the case. 

The Senate version of the bill, Senate Bill 442, passed the rules committee on May 6, but it’s not clear when it will have a vote in that chamber.

Pushback from foster parents and advocates

Some foster care advocates and parents have concerns about the foster care bill. Gaile Osborne, executive director of the Foster Family Alliance of North Carolina and a foster parent to six children, said foster parents should not be involved in deciding whether a child’s gender identity is correct or not. She called it “overstepping.”

If foster parents feel very strongly about disagreeing with a child’s identity, it’s just not the right placement for the child, she said.

“They need safe and loving homes, whatever their pronouns are, and I just don’t think that this is the answer to the question: ‘How do we get more foster homes?’” she said.

Sen. Lisa Grafstein (D-Raleigh) expressed concerns at the Senate Judiciary meeting May 6 about the Senate version of the bill. She said it doesn’t protect parents who do support their children’s identity, and she referenced the Texas governor’s order that parents who provide gender-affirming care for their kids be investigated for child abuse.

If a family not providing gender-affirming care shouldn’t be a factor, the bill should also protect the decision of those who will provide that care, Grafstein said.

Courts have placed injunctions on the Texas orders, and there’s a strong risk North Carolina laws would quickly end up in court as well.

Rep. Deb Butler (D-Wilmington), who has served as a foster parent, said during a May 6 House Judiciary committee meeting that she was evaluated on points like whether her home had a ramp or bedroom on the first floor before taking in a disabled child. She had cats, so a child allergic to them could not stay with her. 

“If we care enough to ask about cats and ramps and food allergies, my god, we must be sensitive to trans youth when placing them,” Butler said. “By the time you get to foster care, you’ve already suffered immeasurably, and to place a child who has expressed gender identity issues or concerns into a home with the knowledge that that family is not supportive or thoughtful about that issue is doing further damage to that child.” 

Margaret, Phoenix’s mother, said she used to work as a court-appointed advocate for children in foster care. She said the child’s best interest should always be first priority, but this bill would ignore that.

“This an attempt to redefine child abuse without any medical or legal authority to do it,” she argued.

Potential mental health impacts

Erica, a mother to a transgender daughter who asked to only use her first name for privacy and safety concerns, said she worries some foster parents would target queer foster children in order to try changing them. 

Her own daughter became depressed, starved herself and engaged in self-harm while residing with relatives, where her identity was not supported, Erica said. She worries the same would happen to other queer children in unsupportive households.

Johnson from Equality NC pointed to a study where over half of LGBTQ+ youth said they felt safer living on the street than in a foster home where their identity wasn’t accepted. Making this bill law might provoke queer foster children to run away because of hostility from foster parents, he argued.

Transgender youth face disproportionately high rates of anxiety, depression and suicidal ideation, which a lack of familial support can exacerbate, said Allison, the pediatric primary care provider who serves transgender youth. That can play out in poor behaviors at school, self-harm and other outcomes.

“This bill legitimizes rejection and erasure of a child’s identity under the guise of protection,” Allison said. “It’s at odds with what we know supports resiliency and well-being in LGBTQ youth.”

Changes for transgender youth

Last legislative session, Republican state lawmakers passed a trio of laws affecting transgender youth in August 2023 over the veto of then-Gov. Roy Cooper. Since then, transgender youth in North Carolina have faced more restrictions accessing gender-affirming health care, participating in sports and expressing and learning gender identities at school.

Now, with two more bills affecting transgender youth advancing, more changes could be on the way.

House Bill 560 passed the House Rules committee on May 6, and it’s not clear when it will have a vote in the full chamber.

House Bill 519, known as the Parents’ Medical Bill of Rights, was passed by the House on May 6 in a 68-41 floor vote. The bill is more expansive legislation affecting all minors — not just transgender youth — that would expand parents’ access to their children’s health care and health records.

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