On August 1, the state attorneys general from California, Connecticut, Delaware, D.C., Hawaii, Illinois, Maine, Maryland, Massachusetts, Michigan, New York, New Jersey, New Mexico, and Pennsylvania, Rhode Island, and Wisconsin filed a Lawsuit in the District of Massachusetts against President Trump, Attorney General Pam Bondi and the U.S. Department of Justice (“DOJ”) challenging Executive Order 14,187 (the “EO”), entitled “Protecting Children from Chemical and Surgical Mutilation”) (90 Fed. Reg. 8,771) (Jan. 28, 2025).
The Lawsuit also seeks to enjoin two actions by DOJ to implement that EO: (1) an April 22, 2025 memorandum issued by U.S. Attorney General Bondi titled “Preventing the Mutilation of American Children” (“Bondi Directive”) and a June 11, 2025 memorandum from Assistant Attorney General Brett A. Shumate to all U.S. DOJ Civil Division employees with the subject “Civil Division Enforcement Priorities” (the “Shumate Directive”).
The Bondi Directive “direct[s] all U.S. Attorneys to investigate all suspected cases of [female genital mutilation] FGM—under the banner of so called ‘gender-affirming care’ or otherwise—and to prosecute all FGM offenses to the fullest extent possible.” The Bondi Directive also states that U.S. DOJ “will investigate and hold accountable medical providers and pharmaceutical companies that mislead the public about the long-term side effects of chemical and surgical mutilation.” In addition, the Bondi Directive “direct[s] the Civil Division’s Fraud Section to pursue investigations under the False Claims Act of false claims submitted to federal healthcare programs for any non-covered services related to radical gender experimentation.” It further states that “[f]alsely billing the government for the chemical or surgical mutilation of a child is a violation of the False Claims Act and is subject to treble damages and severe penalties.” The Bondi Directive includes, by example, gender dysphoria is an “illegitimate reason” for a provider to prescribe puberty blockers.
The Shumate Directive mirrors the policy objectives and directives in the EO and Bondi Directive, and “directs Civil Division attorneys to prioritize investigations and enforcement actions advancing these priorities.” It directs the Civil Division to “use all available resources to prioritize investigations of doctors, hospitals, pharmaceutical companies, and other appropriate entities” to pursue alleged violations “of the Food, Drug, and Cosmetic Act and other laws by (1) pharmaceutical companies that manufacture drugs used in connection with so-called gender transition; and (2) dealers such as online pharmacies suspected of illegally selling such drugs.” The Shumate Directive further directs the Civil Division to “aggressively pursue claims under the False Claims Act against healthcare providers that bill the federal government for impermissible services. This includes, for example, providers that attempt to evade state bans on gender dysphoria treatments by knowingly submitting claims to Medicaid with false diagnosis codes.”
Plaintiffs assert that gender affirming care in question is not violative of any federal law and that the federal government’s actions are interfering with state interests and rights, based on the regulation of medicine as a core traditional police power belonging to the states and protected by the Tenth Amendment. The state attorneys general also claim that the EO and Directives are chilling the provision of gender-affirming care to individuals under 19 years old despite their view that such care is lawful and protected by state law. The complaint cites mainly to certain states’ anti-discrimination laws, but also includes state constitutional provisions protecting access to healthcare, and “shield laws” protecting patients and providers who seek gender affirming care in a state where it is legal from civil and criminal penalties in an out-of-state jurisdiction. The plaintiffs note that in many of their states, their state legislatures and administrative agencies have enacted statutes, laws, and regulations consistent with nondiscrimination in the provision of health care, and that the effect of the EOs and Directives is to “coerce[] hospitals, individual providers, and others to potentially violate Plaintiff States’ antidiscrimination and age-of-majority state laws.” The complaint details specific instances where medical providers in plaintiff states have altered their care practices to conform to the EO and Directives, despite the legality of the conduct under state law.
The complaint additionally challenges the Bondi Directive, and the EO’s, interpretation of the statute criminalizing female genital mutilation as applying to provision of gender affirming care, stating that the statute has two exceptions for medical care provided by a licensed physician. The complaint criticizes this interpretation and any enforcement pursuant to it as novel. Lastly, the complaint challenges the application of the False Claims Act to “medically necessary healthcare” and accurately billing for treatments, and states that the Act does not say that gender affirming care is “inherently fraudulent.”
The Lawsuit challenges the legality of the EO and Directives in their entirety and seeks to have them declared unlawful and vacated. The Lawsuit also requests that the court enjoin enforcement of the female genital mutilation statute, Food Drug and Cosmetic Act, and False Claims Act pursuant to the EO and Directives, and issue declaratory judgments stating that providing gender affirming care does not on its own violate these statutes. The states also seek that the court find the EO and Directive unlawful due the alleged violations of the Tenth Amendment, and states’ sovereignty in regulating the practice of medicine and the medical profession. As this complaint was recently filed on August 1st, there has not yet been any response filed.
