Contempt hearing over gender-affirming care at Children’s Hospital Colorado begins

On the first day of a contempt of court hearing, attorneys for Children’s Hospital Colorado and families of transgender kids outlined their conflicting opinions of what compliance looks like with a court order that directed the hospital to resume gender-affirming care for patients under 18. 

Children’s Hospital Colorado stopped offering gender-affirming care to minors in January due to threats from the Trump administration. Four families sued Children’s Hospital after it initially stopped offering care to their children. The families are referred to by pseudonyms in the lawsuit due to safety concerns.

Attorneys for the hospital say it is in compliance with the order since it added gender-affirming care for minors back into its scope of services, despite medical providers’ refusal to prescribe such medications and patients’ inability to access them. The plaintiffs argue that’s not enough, and the hospital cannot blame providers who independently decided not to prescribe or renew gender-affirming medications. 

The Colorado Supreme Court ruled in May that the hospital violated the state’s anti-discrimination law when it stopped offering care like puberty blockers and hormone therapy to transgender patients under 18 but continued offering it to cisgender children for some hormonal conditions. The hospital has never provided gender-affirming surgeries for minors.

The state’s highest court directed a lower court to issue a preliminary injunction against the hospital. The lower court in June issued the injunction, which required Children’s Hospital to resume gender-affirming care for patients under 18.

Suspended gender-affirming care brings on dire mental health concerns for trans kids in Colorado

Despite the court order, providers who offer gender-affirming care through Children’s Hospital’s TRUE Center for Gender Diversity “each independently decided not to prescribe or renew gender-affirming medications for minors,” according to a statement from the hospital. 

A letter the providers wrote to patients says they each made the decision due to “the serious risk of federal action that could result in the inability to continue serving and caring for any patients for years into the future.” Providers said they intend to continue offering appointments to patients for education, counseling and other resources as they have since January. 

Plaintiffs filed a motion in June asking the court to hold the hospital in contempt, and a scheduled three-day hearing on the motion for contempt began Thursday. After opening statements from attorneys on both sides, Denver District Court Judge Ericka Englert closed the courtroom to the public while providers testified. She issued a court order that granted anonymity to the providers to protect their identities.  

Two plaintiff parents, referred to in the lawsuit under pseudonyms Denisha Doe and Grace Goe, testified about their daughters’ experiences receiving gender-affirming care from the TRUE Center and working with their providers. Both mothers said they sought care for their daughters from the TRUE Center because they wanted what was best for their children, and they understood the TRUE Center was the best place to receive gender-affirming care. 

Doe and Goe said they both contacted the TRUE Center through Children’s Hospital Colorado to initiate gender-affirming care for their daughters, not any providers directly. Both mothers said they did not choose who their provider would be — the TRUE Center assigned them a provider — and all communications, billing and scheduling went through the hospital, not the providers. 

In August, Englert granted the plaintiffs’ request to make the lawsuit a class action, meaning it applies to “All transgender adolescents ages 18 and younger who were receiving or will seek to receive gender affirming medical care from Children’s Hospital Colorado and were then denied or will be denied gender affirming medical care after January 2, 2026.”

Opening arguments

Elliot Peters, one of the attorneys who represents Children’s Hospital, said the preliminary injunction does not require the hospital to guarantee that providers will prescribe gender-affirming medications. He referenced language in the Supreme Court’s opinion, which says that the hospital “can’t force providers to prescribe gender-affirming care to individual patients, but it can define the scope of services it offers.”

Plaintiffs asked the hospital to allow providers to offer the care to youth if deemed necessary, not to force doctors to provide the care, the Supreme Court opinion says. 

Providers had “ample reason” to fear threats from the federal government, and declining to offer gender-affirming care is not a decision doctors who have dedicated their lives to caring for transgender and gender diverse patients made lightly, Peters said. 

A brief plaintiffs filed ahead of the contempt hearing says the Supreme Court opinion focuses on whether care is provided to patients, which, given the providers’ refusal to prescribe medications, it is not. It says the hospital needs to make more of an effort to direct the decisions and actions of providers, since it is not a “powerless bystander,” the brief says.

“CHC has already shown the ability to forbid the Providers from providing medical gender-affirming care and has, for years, imposed a code of conduct on the Providers,” the brief says. 

John McHugh, an attorney representing the plaintiffs, said the duty to comply with the court order rests with the hospital, not the providers. 

Plaintiffs asked the judge to fine the hospital $50,000 for each day it is not in compliance and to direct the hospital to comply with the June order. 

Mothers testify

Doe’s 15-year-old daughter, called Danielle in court papers, had an appointment already scheduled after the announcement that the hospital would not provide medical gender-affirming care to transgender youth. She said she was surprised the hospital didn’t cancel the appointment, but she went anyway. 

At the appointment, their provider told Doe that they could only offer prescriptions to young adults age 18 or older, but added they can still order blood work and have conversations with younger patients like Danielle. She did not get any prescription refills at that appointment. 

After providers announced their decision not to offer prescriptions to transgender minors, Doe talked to her daughter’s provider on the phone. Doe said during testimony the doctor cried on the phone, after Stan Garnett, an attorney for the hospital, asked her if the provider was disappointed to make the decision. 

Doe confirmed after a question from Garnett that she heard providers during their Thursday testimony say they made the decision not to continue medical care independently and not with the hospital. Goe also confirmed she heard providers testify about how they came to their decisions to stop offering medical care. 

Goe’s daughter, called Gabriella in court papers, is 10, so she has not yet received gender-affirming medical care. Goe said they have not returned to the TRUE Center for counseling or monitoring for signs of puberty since it stopped offering medical care, because the reason she brought her daughter there was to establish a relationship with a provider who would eventually be able to prescribe the necessary medications when her daughter reached puberty. 

McHugh asked Goe if it is likely that her daughter will start puberty while the Trump administration is still in office, and she said yes, since she estimated it can start as early as age 11 or 12. 

Goe has not spoken with her daughter’s individual provider, and she confirmed that it was her decision not to bring her daughter back to the TRUE Center. She received an automated communication from the hospital about scheduling an appointment. After she asked for clarification on whether that meant it resumed medical care, the hospital responded that it is not providing medical gender-affirming care.

Federal threats

A December declaration from U.S. Health and Human Services Secretary Robert F. Kennedy threatened to pull Medicaid and other federal funding from any facility that provided gender-affirming care to minors. Colorado joined several other Democratic-led states in suing over that policy, and an Oregon judge ruled the declaration was unlawful in March. 

In July, the Department of Justice subpoenaed Children’s Hospital for patient data as part of an investigation into off-label use of prescriptions for gender-affirming care. The hospital is fighting that subpoena.

Denver Health also stopped offering gender-affirming care to youth in January and has yet to resume that care. Some primary care offices offer gender-affirming care to transgender minors, but Children’s Hospital and Denver Health were the largest providers. Cessation of care at Children’s Hospital is estimated to have affected about 800 patients. Many offices that specialize in gender-affirming care have long waitlists for patients. 

While Colorado has shield laws that protect gender-affirming care providers and patients from criminal prosecution and subpoenas by other states, those protections don’t extend to the federal government. Colorado also passed a law that prohibits insurance plans from limiting or denying gender-affirming care that a doctor identifies as medically necessary.

Hospitals in Texas and Ohio have stopped offering gender-affirming care as a result of settlements with the U.S. Department of Justice. A grand jury in Texas is pursuing criminal charges against gender-affirming care providers.

A jury trial for the families’ lawsuit against Children’s Hospital is scheduled for early January 2027.