Hospital turns over transgender patient records to Tennessee attorney general in investigation

Vanderbilt University Medical Center has turned over medical records for transgender patients to the Tennessee attorney general's team in what his office confirmed is an investigation into potential medical billing fraud.

A Vanderbilt University Medical Center spokesperson confirmed to The Tennessean on Tuesday that the hospital provided the records to Attorney General Jonathan Skrmetti's office.

In a state that has moved to ban gender-affirming care for transgender youth, the revelation that their records were handed over to the state spurred fear for some families — despite assurances from the attorney general’s office that the records would remain confidential and that patients aren’t the target of the investigation.

The state ban doesn't take effect until July 1, and it is being challenged in federal court by the U.S. Department of Justice and others.

Vanderbilt University Medical Center spokesperson John Howser said the attorney general's office requested information about transgender care at VUMC.

"The Tennessee Attorney General has legal authority in an investigation to require that VUMC provide complete copies of patient medical records that are relevant to its investigation. VUMC was obligated to comply and did so,” Howser said in a statement.

Brandon Smith, the attorney general's chief of staff, told The Tennessean that the office “maintains patient records in the strictest confidence, as required by law” and that the investigation is focused “solely on VUMC and certain related providers, not patients.” He said the office has been investigating potential medical billing fraud by the hospital and related providers since September 2022. The hospital began providing patient records to the office in December 2022, Smith said.

The attorney general can request patient health records under federal and state law if the office is investigating a possible issue at the hospital, Paul Hales, a St. Louis-based attorney who specializes in health information privacy, told the newspaper.

Chris Sanders, executive director of the LGBTQ+ advocacy group named the Tennessee Equality Project, told The Tennessean three different parents of transgender children contacted him Monday after Vanderbilt informed them about the release of the records to the attorney general.

“They’re terrified,” he told the newspaper. “They don’t know what’s next, they don’t know how this will be used or whether they will be targeted in some way. They feel like their privacy has been violated.”

On Tuesday, Smith, the attorney general’s chief of staff, said Vanderbilt had “deliberately chosen to frighten its patients” about providing the records.

Smith said the office “does not publicize fraud investigations to preserve the integrity of the investigative process.”

Tennessee in particular has been caught in the center of the conflict over transgender youth medical care — ever since video surfaced on social media last year of a Nashville doctor touting that gender-affirming procedures are “huge money makers” for hospitals. Vanderbilt paused all gender-affirming surgeries for minors afterward.

The video prompted calls by Tennessee’s Republican leaders for an investigation into Vanderbilt. At the time, none of the politicians could point to a specific law that the hospital had violated.

The private nonprofit hospital said it had provided only a handful of gender-affirming surgeries to minors over the years, but has put a temporary pause on the procedures to review its policies.

On average, Vanderbilt has said it provided five gender-affirming surgeries to minors every year since its transgender clinic opened in 2018. All were over the age of 16 and had parental consent, and none received genital procedures.

Meanwhile, Tennessee's new ban on gender-affirming care for transgender youth will take effect in less than two weeks, barring action by a judge.

The law prohibits doctors from providing gender-affirming care to anyone under the age of 18, including prescribing puberty blockers and hormones.

It allows doctors to perform these medical services if the patient’s care had begun prior to July 1. However, that care must end by March 31, 2024.

At least 19 other states have enacted laws restricting or banning gender-affirming care for minors, and federal judges have temporarily blocked similar bans in Alabama and Indiana, while permanently blocking a ban in Arkansas. Three states have banned or restricted the care through regulations or administrative orders.