At first, Jack ignored the email they got from Vanderbilt University Medical Center, until they learned that Tennessee’s Attorney General had requested the medical records of transgender patients like them.
“Oh, that’s what this is. This isn’t like, you know, a reminder to get a shot or telling me that I got an appointment coming up. This is like, ‘Hey, by the way, we shared your information. Have fun with that,’” Jack says. WPLN News is not using Jack’s full name out of concern for their safety.
Tennessee Attorney General Jonathan Skrmetti began requesting documents related to VUMC’s transgender clinic last fall. In March, Skrmetti updated the ask to include the names of patients referred to the clinic and the providers who referred them, as well as all emails to and from the medical center’s general LGBTQ health program going back to 2015, according to court documents.
“I’m definitely feeling scared,” Jack says. “This is not even close to the first time that I feel like my life as a trans person is being targeted in this state by a long shot.”
Tennessee has passed a record-breaking number of anti-LGBTQ laws in the past three years. Its first-of-its-kind law restricting drag was struck down earlier this month, but AG Skrmetti has said he intends to appeal that decision.
Now, his office is investigating VUMC for potentially getting around the state insurance plan’s limitations on gender-affirming care. Tennessee’s healthcare plan does not cover any gender-affirming care, although it does cover hormone therapy for cisgender employees.
The AG’s office says it began investigating VUMC after allegations that a doctor there had found a way to bill insurance for gender-affirming care anyway.
“Put yourselves in our shoes,” Jack says. “You’re a marginalized group. You’ve seen piece of legislation after piece of legislation that is targeting you and people like you. And then all of a sudden, the attorney general has the most intimate details of your medical history … Even if that’s the end of it, that is still terrifying.”
The AG’s chief of staff, Brandon Smith, says that his office keeps patient’s records in the “strictest confidence, as required by law,” and that its investigation is “focused solely … on providers, not patients.”
“Then, why did you need identifying personal information of these patients?” asks Ray Holloman, chair of the TN Transgender Task Force.
His organization has been counseling VUMC patients, some of whom no longer feel comfortable at the clinic.
“Did Vanderbilt do everything they possibly could do to protect patients, patient records and patient safety?” he asks.
The answer to that question is complicated, says Brice Timmons, a civil rights lawyer who litigates health care claims.
“It is a tough spot for a hospital to be in, to face a facially legitimate investigation on one side and to have to worry about patient confidentiality on the other,” he says.
A spokesperson for VUMC was not able to say if the medical center pushed back against the AG, but Timmons says it would’ve been an uphill battle, even with the request’s wide scope.
“If a court were reviewing that, I would think that they would want some pretty good evidence that all of that information was reasonably necessary to pursue the administrative investigation.”
But state attorneys general don’t have to go through a court first. Health privacy laws like HIPAA make a lot of exceptions for law enforcement, so patients and their providers don’t have much recourse.
“I don’t think there’s anything that we’ve seen from this administration and the Tennessee Attorney General’s Office to indicate that they wouldn’t be willing to use the information that they obtained through this administrative investigation in other processes.”
Health privacy laws, Timmons says, rely on the government acting in good faith, but trans patients don’t have the luxury of trust right now.
“That they should be able to just rely on the good faith of the Tennessee AG’s Office is patently ridiculous in light of what feels to people in this state like a war on trans people and gender non-conforming people generally.”
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