The New Frontier in the Battle Between Ideology and Reality?
Dr Eithan Haim asks if hospitals have really stopped transitioning kids after Trumps EO?
Since Trump's inauguration, there has been a whirlwind of activity with one of the most prominent being the aptly-named Executive Order "Protecting Children from Chemical and Surgical Mutilation."
The order was effective in targeting the ideology's institutional infrastructure, the most important of which was Medicaid funding. Because, consider that the country's largest transgender programs are run at hospitals that receive 50% (often more) of their reimbursements for patient care from Medicaid.
The risk is pretty clear then - no Medicaid funding, no hospital. Losing 50% of all insurance reimbursements is a recipe for financial insolvency. In the days following the executive order, I believe this was the driving factor behind so many children's hospitals announcing the closure of their transgender programs.
This is worth celebrating as a major victory. However, it is still important to ask a simple question - will these children's hospitals really shut down these programs or will they just take the sign off the door?
I suspect the latter.
Duplicitous Institutions?
A similar thing happened in March 2022 when Texas Children's Hospital (TCH) in Houston, TX - the world's largest children's hospital and one of the most prestigious - released a public statement announcing they would shut down their pediatric transgender program to avoid "potential criminal legal ramifications." The timing of the statement made sense since it came a few weeks after an opinion from the Texas Attorney General that indicated that these transgender interventions could be investigated as child abuse.
Did TCH actually shut down their program?
Of course not.
In fact, it was only three days until they got back to it - they implanted a puberty blocking device in an 11-year-old who believed she was transgender. And they not only continued the transgender program but expanded it behind closed doors into a large multi-disciplinary clinic.
I am intimately familiar with all of this since I was the anonymous whistleblower who exposed it with Christopher Rufo in May 2023. The reason I bring it up is because if a hospital in Texas was willing to do this, wouldn't hospitals in blue states follow the same template?
Legal threat arises from state or federal authorities.
The hospital releases a public statement to demonstrate outward compliance.
The misconduct is continued behind closed doors.
But how far are these activists really willing to go now that Trump is in office? Would they really violate federal law to continue these interventions?
It is my belief that, yes, they would. What happened at TCH offers insight into this as well.
After our initial story came out in May 2023 detailing the hospital's deception, a few days later, another whistleblower reached out to Rufo. This time it was a nurse who worked in the transgender clinic. A year later, in June 2024, Rufo and the same whistleblower released another even more explosive story, and this time she elected to go public with her identity.
Vanessa Sivadge alleged that not only did TCH continue their transgender program - now limiting it to patients 18 years and above - the doctors in the transgender clinic were manipulating patient data and billing Texas Medicaid for "gender affirming care-related" hormone interventions.
The last point, billing Texas Medicaid, is especially important because it is illegal - State law explicitly excludes Texas Medicaid funds from being used for interventions related to "gender affirming care."
When the story came out, I remember people asking that if this was true, how was it that no red flags were raised by Texas Medicaid? As a doctor myself, I knew how easy it would be. All you have to do is change the patient's gender on their medical record and then use a false diagnosis that covers the same intervention.
Since this is a way for activist doctors and hospitals to bypass Trump's executive order and red state legislation, it is worth digging into this further.
How They Hide it.
Whenever a doctor treats a patient they 1) diagnose a problem, and 2) provide a treatment. Both are associated with a specific code (diagnosis codes are defined by the ICD system) and are submitted together to insurance. As long as the treatment code makes sense for the diagnosis (i.e. appendectomy for appendicitis) you won't have a problem. If they don't add up (i.e. appendectomy for depression), a red flag is raised to the insurance company whether private or public.
In order to avoid raising any red flags, all a doctor has to do is manufacture a clinical situation centered around their intended intervention. For example, if a doctor wanted to prescribe a 16-year-old girl testosterone while concealing the fact it was for "gender affirming care," it could be done in three simple steps:
1) Change the sex of the patient from female to male.
2) Instead of entering the true diagnosis of "gender dysphoria," submit a false diagnosis like "endocrine abnormality unspecified."
3) Enter the treatment code for supplemental testosterone injections.
By changing the patient's sex in the medical record (female to male) and combining this with a broad, but reasonable sounding diagnosis (i.e. endocrine abnormality, unspecified), the doctor can manufacture a claim that appears perfectly normal to insurers. As a result, the patient gets poisoned, the doctor gets paid, and the insurance company and/or taxpayers have no idea they're getting scammed.
To really bring this point home, consider that this exact scheme was detailed in a lawsuit filed by the Texas Attorney General, Ken Paxton, against Dr. Brett Cooper, a Dallas-based endocrinologist specializing in "gender affirming care."
In Paxton's lawsuit, he alleges that Dr. Cooper changed a 16-year-old patient's sex from female to male and used the diagnosis of "endocrine abnormality, unspecified" as justification for testosterone injections. Paxton alleges this was done to circumvent the passage of SB-14 - the state law that bans gender interventions on children. At the time of this article's writing, two other Texas physicians have been sued by Paxton for similar schemes meant to continue gender interventions for children in violation of SB-14.
And it's not like the concept of using fraudulent diagnosis codes is foreign to these radical healthcare providers. Quite the opposite actually. If you google "gender affirming care diagnosis codes," one of the top five results is from the Campaign for Southern Equality. It is a resource to educate healthcare providers about what false diagnoses are most likely to get covered without raising any red flags from insurance companies.
This is essentially an online guidebook for how to commit medical fraud and not get caught. This is pretty remarkable when you consider that unlike online manuals for cooking meth or manufacturing explosive devices, which are generally confined to the dark web, this resource is one of the top five results generated from a basic google search.
This highlights a recurring theme within transgender medicine - the most blatantly criminal is not hidden from public view but rather placed front and center. The most depraved, the most fraudulent, the most harmful, is presented with the greatest confidence as the most beneficial, the most lifesaving, the most essential.
Reconsider the question from before - how far are these activists willing to go now that Trump is in office? Would they really violate federal law to continue these interventions?
Of course, they would.
Code Enforcement
This will represent one of the new frontiers going forward. We have largely won the intellectual debate, we are continuing to win on the legislative front, and we scored a huge political victory with the election of President Trump.
Now we have to win on enforcement. If major children's hospitals are lying about shutting down their gender program and fraudulently billing insurance companies to conceal the existence of their programs, they have to be exposed, their public funding withheld, and the doctors prosecuted.
The good thing is that this is much easier than convincing hearts and minds. All state and federal governments have to do is follow the law. And usually, it's very obvious who these activist doctors are since they will often advertise their criminal intentions publicly.
Once a doctor is identified as a target, their billing codes can be evaluated for any suspicious changes. For example, if a doctor was frequently using the ICD code for "gender dysphoria" prior to January 20, 2025 and then they start using "endocrine abnormality, unspecified," you can be confident that you just uncovered a scheme to conceal a gender program and scam insurance companies.
And the databases for these insurance codes already exist. They provide a remarkably granular view into the billing practices of nearly every physician in the country. Do No Harm utilized this type of information to generate their Stop The Harm database. State and federal authorities can work with the private groups who utilize this data to narrowly tailor their investigations and surgically target the most likely offenders.
Major hospital systems and activist doctors have come to believe they are immune from legal consequences because they have gotten away with blatantly criminal conduct for the last decade. Since these doctors are not hardened criminals, all that is required is maximum aggression in a few high-profile cases to send a clear message.
The day their actions are brought back into line with the reality of existing criminal law is the day that children will no longer be mutilated and sterilized in our country's largest hospitals.
Non-compliance with "transgender bans" is as simple as filling out forms. Since President Trump was elected and signed the executive order I have been to two doctor's offices. Both have forms asking about preferred pronouns, one had questions on the form about gender identity, and the last, a gynecologist, has "gender neutral" bathrooms! Also my new iPhone has a space on contact list to specify pronouns. I fear nothing has changed.
I like the pragmatic idea of checking insurance records for prior diagnoses of "gender dysphoria" and comparing to later diagnoses of unspecified endocrine disorders. Cracking down on insurance fraud is a great idea - a little like how Al Capone was taken down through tax evasion.
However, we cannot give up on changing hearts and minds. That remains the single most important thing we can do to end the harm to young people from the dangerous chemical and surgical interventions meant to change appearance to that of the opposite sex, and from the harm of encouraging body hatred, body rejection and reality-denial.
18-year-olds (or 19-year-olds based on the latest EO) are still way too young to be doing this to their bodies, and people will keep find ways of getting the chemicals and even the surgeries until society realizes this is insane and cruel. The harm (but for a tiny fringe group of nuts who may keep it up) ends when society comes to its collective senses.