Tennessee Amendment Would Ban Out Of State Care For Trans Youth, Define As Child Abuse

An anti-trans healthcare bill, TN SB0001, is scheduled for a hearing on Wednesday, February 1st. A new amendment I obtained would ban out of state care and criminalize parents for child abuse.

Tennessee has been the site of some of the worst proposed and passed anti-trans laws in the last 5 years. On my legislative risk map which tracks the risk of anti-trans legislation for all states, I have Tennessee as one of six states falling in the “worst anti-trans laws” category. As such, any movement of anti-trans bills in Tennessee warrants special attention. A new amendment to a bill, SB0001, that will be heard Wednesday has been recently provided to me by Jace Wilder of the Tennessee Equality Project. This amendment, which has yet to appear on the bill’s website, would take an already terrible health care ban for transgender youth and make it worse by banning telehealth, banning distribution of medications, and charging parents parents of trans youth who “consent to administer” gender affirming care regardless of where that care may occur. Collectively, these amendments would likely ban out of state gender affirming care and would result in the removal of trans children from their families.

The bill, including the proposed amendment, is expected to be heard on Wednesday, February 1st at 1:00 by the Senate Health and Welfare Committee. Though the amendment does not year appear on the site, activists expect it to be held to the last moment and then introduced. The provisions in the original bill would ban gender affirming care for those under 18, which is cruel enough. This bill would withdraw people from that care, forcing them to medically detransition. Such a bill is unconscionable and has been advocated against by medical organizations representing hundreds of thousands of physicians. On Friday, a similar bill was heard in the Montana Senate Judiciary and those opposing the measure heavily outnumbered those supporting. Similarly, Missouri held a hearing which included healthcare bans like this one and it lasted 9 hours as testimony was heavily slanted against the bill - transgender kids and their families pleaded with legislators not to pass it and harm them. Utah became the first state to enact a health care ban into law this weekend - it is already being challenged in court.

The Tennessee bill contains similar language to all of the above bills, but this new amendment would make it worse by making illegal all alternatives means to obtaining gender affirming care. It would target out of state telehealth providers, ban “distribution,” and charge providers and parents with child abuse for following medical best practices. See these three amended sections of the bill that I have obtained through from the Tennessee Equality Project:

Image 1. Provision that defines telehealth as against the law. Note - “medical procedures” includes the provision of hormones and blockers.

Image 2: A ban on “distribution” of hormones and puberty blockers.

Image 3. Defining this care as child abuse.

Collectively, these provisions would ban out of state care for trans youth. The telehealth provision applies to “residents” and does not contain provisions that specify that the care has to occur within the state. Even going across state lines to engage in telehealth could possibly violate that section. Even if one managed to get gender affirming care out of state, returning to Tennessee with that medication could put a parent in violation of the clause in image 2 - distributing hormones or puberty blockers. The only way doing so is “authorized pursuant to this chapter” is if the youth is intersex or one of the protected groups this bill does not cover. Lastly, the mere act of deciding to leave the state to obtain gender affirming care could be interpreted as “immediate danger” of “consent to administer or perform a medical procedure” that is in violation of this law. Conceivably, this could even be weaponized against parents of trans youth that would wish to flee the state after the law was passed in order to obtain gender affirming care elsewhere.

Legislation targeting out of state providers and bringing transgender youth out of state was first considered in Idaho’s 2022 bill. This bill would have banned traveling across state lines with trans youth to obtain gender affirming care. It would have specified a felony under genital mutilation laws for “helping a minor travel out of state” for gender affirming care. The bill passed the Idaho House on a party line vote 55-13 before being killed in the Idaho Senate. SB0001 similarly could be used to target people trying to obtain gender affirming care out of state.

The use of child abuse mechanisms is particularly egregious. If found guilty of providing or consenting to gender affirming care under this amendment, trans youth could be taken from their parents and their parents could be charged with crimes. Parents could also see their parental rights terminated if they are seen at risk of “committing further child abuse,” or in this case, providing gender affirming care or leaving to provide gender affirming care for their trans youth. The use of child abuse provisions has been considered in several states so far, likely drawing inspiration from Governor Greg Abbott in Texas’ weaponization of child abuse provisions against the parents of trans kids by erroneously interpreting child abuse statutes to apply to gender affirming care.

I spoke to Alejandra Caraballo, a clinical instructor at the Harvard Law School Cyberlaw Clinic, about this amendment, "This amendment would go far beyond restricting gender affirming care within Tennessee. It would criminalize parents who leave the state to obtain gender affirming care for their child since it would be considered 'child abuse.' Additionally, out of state providers could also be liable if they treat the patient via telehealth, regardless if the patient is in the state or not."

It is important to note that these same provisions could potentially be used at a later date to target abortion care for trans youth. The weaponization of state law against telehealth providers and against distribution has lead to several states considering or passing laws that protect providers in those states. The most recent examples of protective legislation that have passed are the Patient and Provider Protection Act in Illinois ad H.5090 in Massachusetts. Senator Friedman of Massachusetts specifically cites overreaching policies like the proposed Tennessee amendment as a reason for its existence:

Specifically, An Act expanding protections for reproductive and gender-affirming care:

Protects health care providers and those seeking reproductive and gender-affirming care in Massachusetts from other states’ overreaching, extraterritorial anti-abortion and anti-gender-affirming care laws;

This bill and others will be heard in Tennessee on January 31st and February 1st. Here is the schedule:

• SB0001 will be heard on Wednesday, February 1st at 1:00 P.M in the Senate health and Welfare Committee.

• It’s companion healthcare bill in the house, HB0001, will be heard in the House Health Subcommittee on Tuesday, January 31st at 1:30 P.M..

• There will likewise be a ban on drag that targets transgender people as well, SB0003, that will be heard in the Senate Judiciary Committee that will be heard on Tuesday, January 31st at 3:00 P.M..

I have been informed that you can simply show up to testify at any of these hearings.

When speaking to Jace from the Tennessee Equality Project, he questioned Tennessee’s focus on transgender people over other legislative priorities and stated, “the Tennessee Equality Project will continue to make sure that the voices of trans folks are not just heard but empowered and protected in the face of state endured erasure.”

Even if the amendment does not get introduced, the bill itself represents a major attack on the transgender community of Tennessee. The forced medical detransitioning of trans youth would absolutely harm youth in the state. Tennessee already has a suicide rate that is 30% higher than the national average, and trans youth are at especially high risk of suicide.

This bill has been heavily promoted by conservative commentators and is anticipated to the part of a major showdown for anti-trans legislation. Matt Walsh was the first person to report this bill shortly after he held an anti-trans rally against Vanderbilt Hospital in October. The rally featured right wing extremists and militants such as the Proud Boys, who have been accused of violence and intimidation by the Southern Poverty Law Center. Matt Walsh, a resident of Nashville himself, has been behind major conservative pushes against transgender rights in the United States. Chloe Cole, political detransitioner who advocates for anti-trans laws along with Matt Walsh and appeared at the rally, also appears to be in the state and may testify.

If you want to follow along, I plan on live-tweeting many of these hearings including SB0001 at my twitter account @erininthemorn. If the hearing is anything like other trans hearings we have seen this year, there will be passionate testimony from those organizing against the bills. Should Tennessee pass these bills and sign them into law, the state would be the most restrictive state on transgender people in the United States. Opponents to the bill will do everything possible to ensure that does not happen.