By Eleanora Glick
Recently, it was revealed that Vanderbilt University Medical Center (VUMC) had been ordered to turn over their patients’ medical records to the Attorney General’s office of Tennessee. The Attorney General’s office stated that this was because of possible medical billing fraud. The Tennessean revealed that patients received a VUMC notice stating that the facility was being investigated as a result of “billing for transgender care services provided to individuals enrolled in State-sponsored insurance plans” and that the Attorney General had requested medical records from 2018 onward.
Before this, VUMC in October of 2022 had stopped providing gender affirming surgeries to minors in order to review their practices. At this point, VUMC had provided only about 5 surgeries a year to minors, all with parental consent and none were genital surgeries. C. Wright Pinson, MD, MBA who is the Chief Health System Officer of VUMC stated “We are pausing gender affirmation surgeries on patients under age 18 while we complete this review, which may take several months,” and also stated that the World Professional Association for Transgender Health (WPATH) had recently changed its recommendations for treatment and they needed to review their practices.
On March 2nd, 2023, Governor of Tennessee, Bill Lee, instated a total ban on gender affirming care for those under the age of 18. This bill was blocked by a judge; however, the Governor appealed to the 6th District Court of Appeals, which sided with him, allowing the bill to be effective immediately. This law prevents all gender-affirming care to trans and nonbinary minors. This ban means that they are not allowed to use 
puberty blockers or any other type of hormone therapy. This law also orders all providers in Tennessee to stop giving this care by March 1st, 2024. This bill is currently being challenged by the ACLU of Tennessee, in the case of L.W vs. Skrmetti.
Along with the bill banning minors from receiving gender affirming care, in August of 2022, a complete abortion ban was instituted in Tennessee. This ban states that at the stage of fertilization, you may not abort unless the mother absolutely needs said abortion to save their life. There is no exception for rape, incest, fetal deformation. On June 16, 2023 it was revealed that 19 attorneys general had signed a letter written to Secretary Xavier Becerra about abortion record privacy. This letter was written in opposition to a proposed ruling by the Department of Health and Human Services (DHHS) HIPAA Privacy Rule To Support Reproductive Health Care Privacy, 88 Fed. Reg. 23506. This letter opposes privacy for those who have received abortions, in their own states and outside of their home state. In this letter, they state that it is not their intention to punish those who provide and receive reproductive care, despite the fact that in Tennessee, providing an abortion is now considered a “class C felony” that could result in 3 to 15 years in prison and a fine of up to 10,000 dollars. They also state that an inability to access these records would impede investigations into “child abuse and other serious crimes.”
You might be asking yourself, why doesn’t HIPAA, or the Health Insurance Portability Accountability Act protect everyone’s records? HIPAA does have some exceptions, including a public health emergency, informing next of kin, judicial proceedings and body identification if someone dies. It is clear that states are now using the judicial proceedings exception to HIPAA to pursue all kinds of medical information to support their own beliefs.
The reasoning appears to be that because there are states that have now banned gender affirming care for minors, abortion and other reproductive care, receiving those kinds of care is now a crime. Because of the criminalizing of this care, governments now have the right to access these kinds of records as you can bypass HIPAA for criminal and administrative proceedings. They could be checking our records to see if we are receiving reproductive care or an abortion or anything else.
If the government is requesting records for abortion and gender affirming care, how do we know they will not be requesting records for other things that we do? While we do live in California, it could be possible for other states to ask for our health records. As someone who has the ability to carry a child, how do I know that my records will not be asked for if I ever need to or decide to terminate a pregnancy? When I had to help my grandmother take care of her dog, I could not even access the dog’s records without her signature because I was not the dog’s owner, yet these attorneys general want to be able to ask for the records of my healthcare? I deserve the right to have privacy in my reproductive care and my general healthcare. As does everyone. Why should the government be able to access our records without clear and fair reasoning?
I hope that one day, we will all be able to rest easy, knowing that we are not criminals for seeking health care or support from nurses and doctors for any number of challenges. I have always believed that I am able to talk to my doctors confidentially and share with them vital health information. Now, I am unsure if that information could be shared without my consent. We should not have to worry that our government will be requesting our records because they believe we are committing a crime.
