The Department of Justice on Thursday appealed a nationwide injunction a federal judge issued this week against the Obama administration's directive that public schools let transgender students use the bathrooms of their choice.
     Texas and 12 other states sued the U.S. Departments of Education, Justice and Labor, and the Equal Employment Opportunity Commission in Wichita Falls Federal Court on May 25. Two school districts, one in Texas and one in Arizona, joined as plaintiffs.
     They challenged the May 13 federal directive ordering all schools that receive federal funds to classify students based on the gender they identify with, regardless of what's listed on their birth certificates.
     On the Sunday before the first day of school in August, U.S. District Judge Reed O'Connor granted Texas a preliminary injunction. He clarified in an order Wednesday that the injunction applies to school districts throughout the nation.
     O'Connor, a George W. Bush appointee, tempered Wednesday's order by saying it does not affect any litigation involving alleged discrimination against transgender people that was underway before he entered the preliminary injunction in August.
     "The Court seeks to avoid unnecessarily interfering with litigation concerning access to intimate facilities that was substantially developed before the court's order granting the preliminary injunction," the order states.
     The case turns on the text of Title IX, signed into law in 1972 by President Richard Nixon. It states: "No person in the United States shall, on the basis of sex, be excluded from participation in, be denied the benefits of, or be subjected to discrimination under any education program or activity receiving Federal financial assistance."
     The Obama administration says the text is ambiguous and interprets the word "sex" to include discrimination based on gender identity, including transgender status.
     But in siding with Texas, O'Connor said Title IX should be interpreted by its "ordinary meaning" and that "sex" means the "biological and anatomical differences between male and female students as determined at their birth," and does not encompass gender-identity discrimination claims.
     Plaintiff states include Alabama, Arizona, Oklahoma, Louisiana, Wisconsin, West Virginia, Tennessee, Maine, Utah, Georgia, Mississippi and Kentucky.
     In an amicus brief, the Lambda Legal Defense and Education Fund accused the states of "forum shopping" to get around rulings by U.S. circuit courts that have authority over their states. The American Civil Liberties Union joined in the amicus brief with Lambda, a nonprofit that fights for the rights of gay, lesbian and transgender people.
     "Each of the relevant circuits (the Fourth, Sixth, Ninth, and Eleventh Circuits) has ruled that the prohibition of sex discrimination includes discrimination against transgender individuals," the brief states.
     The federal government appealed to the New Orleans-based Fifth Circuit, which has jurisdiction over Texas, Louisiana and Mississippi, and is widely regarded as the nation's most conservative appellate court.
     Lambda Legal attorney Paul Castillo told Courthouse News the injunction does not mean that public schools have to change transgender-friendly policies.
     "The preliminary injunction issued by Judge O'Connor does not require schools to discriminate against transgender students. ... School districts that continue to discriminate and hide behind the preliminary injunction still face a high prospect of litigation by transgender students who are harmed by the discriminatory policy," Castillo said in an email.
     To show that the injunction is not stopping Lambda Legal from defending transgender students, Castillo cited a lawsuit the nonprofit filed this month in the Western District of Pennsylvania. Three students there claim a suburban Pittsburgh school district buckled to pressure from anti-LGBT groups and changed a "longstanding, effective and inclusive bathroom policy," Lambda Legal said in a statement Thursday.
     Castillo added that Judge O'Connor's injunction is not swaying other federal courts from finding that such policies violate Title IX.
     "Notably, since the preliminary injunction was issued on August 21, three federal courts have sided with transgender students in their respective lawsuits and finding that those students are likely to succeed because Title IX requires districts to allow transgender students to use a restroom consistent with their identity," Castillo said.
     The federal government is also involved in a court battle with North Carolina over House Bill 2, which the Tar Heel State's Republican-controlled Legislature passed in March in response to a Charlotte city ordinance that expanded non-discrimination policies and said that transgender people can use the bathrooms they want.
     Under H.B. 2, people must use restrooms matching the gender on their birth certificates in schools and many public buildings. It also excludes sexual orientation and gender identity from state anti-discrimination laws.
     North Carolina officials are defending the law despite its impact on the state's economy.
     The National Basketball Association moved its 2017 All-Star game to New Orleans from Charlotte, and PayPal nixed its plans to open an office in Charlotte, in response to H.B. 2.

The death of a transgender woman in Cleveland has been ruled a homicide, making it the 23rd reported murder of a trans person in the U.S. this year.

Brandi Bledsoe, 32, died of a gunshot wound to the chest, the Cuyahoga County medical examiner ruled Thursday, The Plain Dealer of Cleveland reports. She was found dead Saturday around 10 a.m. in a driveway behind a house, with plastic bags over her head and both hands, according to the paper. She had also suffered head trauma. Her body was discovered by a young boy riding his bike.

Initial reports misgendered Bledsoe, but then members of her family came forward to say she was a trans woman, having come out to them two years ago. Bledsoe, a Home Depot employee and animation artist, was much happier once she began presenting as her authentic self, relatives said.

"She wasn't very outgoing before she told us," her cousin John Craggett told The Plain Dealer."She just wasn't happy with who she was. When she told us, she was honestly a lot better as Brandi. She was happy."

"She was really beautiful," Craggett added. "She was really sweet and nice. That's what bugs the crap out of me about this. Whoever did this can rot in hell."

Bledsoe had grown up in Nebraska and moved to Cleveland several years ago, family members said. She had lived with her grandfather in Cleveland for a time, but she recently got a place of her own.

"We got along great when she lived with me," Johnnie Ledbetter, her grandfather, told The Plain Dealer. "I wish she was around more after she moved out."

She is at least the fourth transgender woman killed in Cleveland since 2012, the paper reports. Police said they are taking her identity into consideration in investigating the crime, but they have yet to determine a motive or make an arrest.

The nationwide count of reported murders of trans people has already made 2016 the deadliest year on record, and Bledsoe's death puts it two above 2015's total of 21. The actual number is likely much higher, as many trans people are misgendered in death, or their murders are not reported by media.

The New York State Health Department has signaled it intends to allow transgender youth to receive Medicaid coverage for hormones that forestall puberty, wiping away prohibitions that have been criticized by lesbian, gay, bisexual and transgender groups.

The move, announced on Wednesday in a proposed rule in the State Register, would allow minors who are being treated for gender dysphoria to receive Medicaid payment for pubertal suppressants and cross-sex hormone therapy, which mimic the biological chemistry of the opposite gender. Previously, the state had covered such hormone treatments for adults, a change that took effect last year.

In the proposed rule, the department stated that its concerns about the safety and efficacy were supplanted after it “had the opportunity to talk to a number of practitioners who treat minors” with gender dysphoria, who uniformly agreed that hormone therapies were medically justifiable for young people who feel that their birth sex is not their true gender.

“The proposed changes therefore would make Medicaid coverage of transgender care and services available, regardless of an individual’s age, when such care and services are medically necessary to treat the individual’s gender dysphoria,” the rule reads.

The change will not take effect immediately; the rule has a 45-day comment period, and the state can formally adopt it after that time.

New York is not the only state to allow Medicaid — a joint federal and state program — to cover such hormone treatments, said Sasha Buchert, a staff lawyer with Transgender Law Center in California, which has long had such coverage.

But Ms. Buchert said New York’s move was a “significant step forward” in providing care for transgender people of all ages.

“These decisions,” she said, “should be made by physicians.”

The decision in New York came during a legal battle — and after victories — for advocates for transgender rights, both in New York and in other parts of the nation.

“Puberty is traumatic, or can be, for all people, but it’s incredibly traumatic for transgender people,” said Belkys Garcia, a staff lawyer with the Legal Aid Society, one of several groups that filed a federal suit against New York’s restrictions on payments for transgender treatments. She added that puberty suppressants, in particular, allow some young people grappling with gender dysphoria “time to figure themselves out,” even if they do not eventually transition to the opposite sex.

New York was among a handful of states that had enacted prohibitions on Medicaid payments for such treatments, a policy that dated back to the administration of Gov. George E. Pataki, a three-term Republican who left office in 2006. Since then, there were several failed legal attempts to overturn those rules.

But advocates have been emboldened in recent years by both a broader cultural acceptance of transgender people as well as actions by Gov. Andrew M. Cuomo, a Democrat, including in late 2014 when he instructed the Department of Financial Services to guarantee insurance coverage for gender dysphoria. Last fall, the governor also announced Anti-discrimination measures for transgender people in housing and other areas, using his executive power to overcome a legislative logjam in the Republican-led State Senate.

In March 2015, the Health Department, already facing legal action, adopted rules that allowed for some coverage, including gender reassignment surgery for adults displaying “a persistent and well-documented case of gender dysphoria,” but stopped short of covering minors as well as certain treatments the state considered cosmetic, rather than medically necessary.

In July, however, a federal judge in Manhattan, Jed S. Rakoff, of United States District Court, ruled that such restrictions on the so-called cosmetic procedures were not legally defensible, but wanted a trial for the issue of whether treatment for youth was medically necessary. More legal arguments are planned for this month, but though the proposed rule on youth coverage could satisfy the court.

The state’s action on Wednesday also would appear aimed at addressing the judge’s concerns, by clarifying the state’s intent to allow Medicaid coverage for a wide variety of treatments including mastectomy,hysterectomy and breast augmentations, as well as electrolysis — which is often expensive — in certain cases.

The legal team pushing for the changes — including Legal Aid, the Sylvia Rivera Law Project, and Willkie Farr & Gallagher — says it will continue to push the state for fast action on the proposed rule. “Without a judgment from the court, there’s nothing to say the state can’t make another change,” Ms. Garcia said.

Health Department officials characterized the change as another sign of Mr. Cuomo’s “commitment to equality in all areas.”

“These proposed regulations build upon existing science to ensure that youths who have been diagnosed with gender dysphoria receive medically necessary care,” said James Plastiras, a spokesman for the department. “And render moot any claim that current standards don’t provide that care.”

Many surgical procedures would not necessarily be appropriate for minors — “It’s rare that people are getting surgery under 18,” Ms. Garcia pointed out — though they could be covered in some cases under the department’s proposed rule.

But the major benefit for transgender youth would primarily be the hormone treatments, according to medical professionals.

Dr. Carolyn Wolf-Gould, a family practitioner at the Gender Wellness Center in Oneonta, N.Y., part of Bassett Healthcare Network, said that blocking the physical characteristics of puberty could offset the need for difficult surgeries, particularly for “youth that are assigned male at birth.”

“Once male puberty has occurred it’s very hard to reverse those changes,” Dr. Wolf-Gould said, noting the genital and facial changes and hair growth that occur usually during that period, along with physical bulking.

She added that for birth-females intending to transition to male, mastectomies can cause “painful and unsightly scars.”

There is also, however, a major emotional benefit to allowing “a youth to go through puberty in their affirmed gender,” she said.

“It provides tremendous psychological relief,” she said, adding that delaying puberty can provide “a sense that they suddenly have some control going on with their body.”

The Human Rights Campaign Foundation — in partnership with the AAP and the American College of Osteopathic Pediatricians — today released a comprehensive support guide for the parents, allies and health care providers of transgender children.

Developed in association with AAP/ACOP physicians and mental healthprofessionals who have worked extensively with transgender children, the support guide, Supporting and Caring for Transgender Children, is intended to detail what it means for children to be transgender and why medical experts now embrace a “gender-affirming” approach.

“We know more than ever before about what transgender children need to grow up safe and healthy, and a large part of that is being accepted, nurtured and supported in their gender identity by their family, physicians and community,” Karen Remley, MD, MBA, MPH, FAAP,executive director and CEO of the AAP, said in the press release. “We hope this new guide will become a useful tool for anyone who has a transgender child in their life.”

While the guide provides easy to understand explanations of gender identity, fluidity, exploration and how identity differs from sexual orientation, it also is intended to help dispel misinformation that has provided a platform for North Carolina’s discriminatory HB2 law that denied transgender people access to public restrooms and facilities based on their gender identity.

Portions of HB2, also known as the Public Facilities Privacy and Security Act, directly addressed children in public schools, and stated that, “in no event shall that accommodation result in the local boards of education allowing a student to use a multiple occupancy bathroom or changing facility … for a sex other than the student’s biological sex.”

“The ACOP is excited to be a part of this guide providing pediatricians, otherprimary care physicians, allied health staffs, patients, families and caretakers with this vital information for transgender youth,” ACOP President, Carl R. Backes, DO, FACOP, said in the release. “We suggest all efforts ensuring transgender young people be respected and valued.”

In addition to its backing of the support guide, the AAP is developing a policy statement on caring for transgender youth that it plans to publish in 2017.

In the landmark case, Katharine Prescott argues the Rady Children's Hospital-San Diego (RCHSD) in California discriminated against her transgender son based on his sex.

The civil complaint filed in a federal court in the state of California comes amid a raging debate in the United States about the rights of the lesbian, gay, bisexual and transgender (LGBT) community.

The 14-year-old transgender boy, Kyler Prescott, committed suicide about five weeks after staying at the hospital in 2015 where he was treated for having suicidal thoughts and self-inflicted wounds.

The suit claims the hospital violated anti-discrimination provisions in federal and state laws, including the Affordable Care Act, President Barack Obama's signature healthcare law.

The plaintiff's attorney, Alison Pennington, with the Oakland-based Transgender Law Center, said she believed it was the first case to claim an underage transgender person had suffered sex-based discrimination under the Affordable Care Act.

Less than half a dozen similar suits have claimed discrimination against adult transgender people since the law was enacted in 2010, she said.

In a telephone interview, the mother said filing the lawsuit was painful, but she hoped it would ensure no other parents or child go through the same ordeal.

"I believed that they would be able to help him feel better," she told the Thomson Reuters Foundation.

"They really just made things worse."

According to the suit, RCHSD said on its website that it was competent in caring for transgender children and teens.

But the complaint claims that the hospital's nursing and other staff "repeatedly addressed and referred to Kyler as a girl, using feminine pronouns."

The transgender boy, who had legally changed his name and gender, subsequently called his experience at the hospital "horrible," the complaint said.

A spokesman for RCHSD said that while he could not comment on pending legal matters, "any allegations of wrongdoing, including discrimination, are investigated thoroughly and followed up on."

Court documents did not list a defense attorney.

The Affordable Care Act is the first federal healthcare law to explicitly ban discrimination against transgender people, said Dru Levasseur, a spokesman at Lambda Legal, a New York City-based LGBT rights group.

A ruling by a Minnesota federal court last year became the first to recognize discrimination against a transgender person under the healthcare law, Levasseur said.

The mother is seeking damages and restitution, as well as an injunction that would force the hospital to institute policies preventing the discrimination of transgender youth based on sex.

In 2011, the National Transgender Discrimination Survey found that 41 percent of transgender and gender non-conforming U.S. respondents said they had attempted suicide.

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