by Vanguard Staff
OAKLAND, Calif. — California Attorney General Rob Bonta on Thursday sued Rady Children’s Health, accusing the state’s largest pediatric health system of illegally shutting down gender-affirming medical care for patients under 19 in direct violation of binding conditions imposed on a major hospital merger approved just over a year ago.
The lawsuit, filed in San Diego County Superior Court, seeks a permanent injunction forcing Rady to restore gender-affirming care services to the same levels that existed when its merger with Children’s Hospital of Orange County and affiliated entities closed in January 2025.
It also seeks civil penalties and other equitable relief, arguing that the hospital system acted unilaterally, without notice or approval, and in open defiance of California law .
“Rady Children’s Health has chosen to violate its merger agreement and California law in response to the Trump Administration’s illegal campaign against providers of gender-affirming care,” Bonta said in a statement announcing the lawsuit.
Bonta added, “Rady flagrantly disregarded its legal obligations by unilaterally deciding to preemptively comply with the Administration’s demands and cease medically necessary care for roughly 1,450 patients. We will not allow Rady to violate its obligations to its patients and the State. We will fight to uphold the law and ensure Californians can access gender-affirming care without facing unfair roadblocks.”
In its complaint, the attorney general’s office lays out a detailed account of how Rady, which provides care to more than 200,000 children annually and operates three major children’s hospitals in Southern California, began quietly curtailing gender-affirming care months before announcing a full termination.
According to the lawsuit, Rady has provided gender-affirming medical care for approximately 14 years and is the largest pediatric provider of such care in Southern California, serving about 1,900 patients as of late 2025, including roughly 1,450 patients under the age of 19.
The merger that created the current Rady Children’s Health system was conditionally approved by the attorney general in November 2024, following an extensive review process that included an independent health care impact analysis and public meetings.
As part of that approval, the state imposed strict conditions requiring Rady to maintain “the same types and levels of gender-affirming care services that were offered at the time the merger closed” for at least 10 years.
The conditions also explicitly prohibited discrimination on the basis of gender or gender identity and required Rady to obtain the attorney general’s approval before reducing, relocating, or eliminating those services.
The lawsuit alleges Rady ignored those obligations entirely. Beginning around July 9, 2025, the complaint says, Rady stopped accepting new gender-affirming care patients who lived outside San Diego and Imperial counties, while continuing to accept patients from those areas for other types of medical care.
In October 2025, Rady allegedly stopped scheduling gender-affirming chest surgeries for patients under 19. On Dec. 22, 2025, it stopped accepting new gender-affirming care patients of any age.
The final step came on Jan. 20, 2026, when patients received a brief message through Rady’s online portal informing them that gender-affirming care would end entirely for patients under 19 effective Feb. 6. The same day, Rady publicly confirmed the decision.
According to the complaint, Rady never sought or obtained approval from the attorney general for any of these actions, nor did it provide a justification or attempt to amend the merger conditions, as required by state regulations.
The court filing notes that an independent monitor appointed to oversee compliance with the merger conditions repeatedly informed Rady in writing that the attorney general had not approved any change and did not consent to ending care.
The state argues that Rady’s actions not only breach the merger conditions but also constitute unlawful business practices under California’s Unfair Competition Act and violate state health and safety laws requiring 90 days’ notice before eliminating supplemental health services.
The complaint states that Rady gave patients just 17 days’ notice and failed to notify Medi-Cal managed care plans, the California Department of Public Health, or local county officials.
The consequences, the attorney general contends, are severe and immediate. “Because RCH is California’s largest pediatric health care system, covering large swaths of Southern California, the complete termination of medically necessary, gender-affirming care will have devastating impacts on the roughly 1,450 patients who will lose access to vital care with just 17 days’ notice,” the lawsuit states.
It adds that the discontinuation of care is “likely to cause the gender dysphoria of RCH’s patients to worsen, which may increase their mental distress and anguish,” and will dramatically reduce access to such care across the region.
The complaint further alleges that Rady’s decision has left hundreds of patients “in medical limbo,” unable to quickly secure care elsewhere in a state where alternative pediatric providers are increasingly scarce.
Families and advocates, according to the filing, have reported heightened anxiety, depression and suicidal ideation among affected patients, as well as significant distress among their parents.
Beyond the immediate impact on patients, the lawsuit frames the case as a test of the state’s authority to regulate nonprofit hospital mergers in the public interest.
California law gives the attorney general broad power to approve, deny or condition such transactions precisely to prevent the loss of essential services, particularly for vulnerable populations.
Allowing Rady’s actions to stand, the complaint argues, would “eviscerate” the statutory scheme and undermine the attorney general’s role in protecting access to health care statewide.
The lawsuit asks the court to compel Rady to resume gender-affirming care for patients under 19 at the same capacity and scope that existed when the merger closed, to toll the merger conditions for the period of noncompliance, and to impose civil penalties of up to $2,500 per violation. It also seeks recovery of attorneys’ fees and costs.
The case is the latest in a series of legal battles led by Bonta aimed at countering federal efforts to restrict or chill access to gender-affirming care. In August 2025, Bonta co-led a lawsuit challenging threats by the U.S. Department of Justice to prosecute providers offering such care to minors, even in states where it is protected by law.
In December 2025, he sued the U.S. Department of Health and Human Services over a declaration by Secretary Robert F. Kennedy, Jr., claiming gender-affirming care fails to meet professionally recognized standards and could jeopardize providers’ access to Medicare and Medicaid.
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