603 F.Supp.3d 1131
M.D. Ala.2022Background
- Alabama enacted the Vulnerable Child Compassion and Protection Act, which (inter alia) criminalizes prescribing or administering puberty blockers and supraphysiologic cross-sex hormones to minors and prohibits certain school practices regarding students’ gender identity; violations carry felony penalties.
- Plaintiffs are four transgender minors, their parents, two healthcare providers, and a pastor; the United States intervened; multiple healthcare organizations and states appeared as amici.
- Extensive evidentiary hearing: Plaintiffs and amici presented testimony and evidence that major U.S. medical associations endorse puberty blockers and hormone therapy as accepted treatments for some minors with gender dysphoria; Defendants presented testimony arguing for a ‘‘watchful waiting’’ approach and highlighting risks.
- The State defended the statute as protecting children from experimental, risky interventions and averred it does not criminalize mere speech or advice.
- The court applied the preliminary-injunction framework and found Plaintiffs substantially likely to succeed on their substantive due-process and equal-protection claims, found irreparable harm absent relief, and enjoined enforcement of §4(a)(1)–(3) (the provisions banning puberty blockers and cross-sex hormones) pending trial; other provisions remained in effect.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Substantive due process: parental right to direct medical care for children (use of transitioning medications) | Parents: have a fundamental right to direct children’s medical care, including use of puberty blockers/hormones per accepted medical standards | State: medications are experimental/risky; State may limit parental decisions to protect minors | Court: parents likely have the right; statute infringes it and fails strict scrutiny (not narrowly tailored); injunction granted as to §4(a)(1)–(3) |
| Equal protection: sex discrimination by singling out transgender minors | Minors: law discriminates based on gender nonconformity, which is sex-based under Bostock/Glenn | State: statute creates neutral categories (minors seeking specific treatment vs. others) | Court: law is sex-based classification; plaintiffs likely to succeed because State’s justifications are not exceedingly persuasive; intermediate scrutiny not satisfied |
| Void-for-vagueness: undefined terms like "cause" chill protected activity | Plaintiffs: criminal provisions are vague and chill providers/parents | State: statute has scienter requirement and State’s interpretation limits liability to prescribing/administration | Court: plaintiffs unlikely to succeed on vagueness claim at this stage (scienter and State’s interpretation mitigate vagueness) |
| First Amendment (speech): criminalization of speech that would "cause" minors to receive treatment | Plaintiffs: statute criminalizes speech and advice that lead to minors obtaining treatment | State: statute targets conduct (prescribing/administration), not pure speech | Court: plaintiffs unlikely to succeed on free-speech claim (statute targets conduct) |
| Preemption (Section 1557, ACA): federal nondiscrimination law bars Alabama restrictions on care | Plaintiffs: §1557 prohibits sex-based discrimination in health programs and thus preempts the Act | State: scope and target of §1557/enforcement mechanism make suit against state officials and preemption unclear | Court: plaintiffs not likely to succeed on preemption claim at this stage |
Key Cases Cited
- Troxel v. Granville, 530 U.S. 57 (2000) (parental right to make decisions concerning care, custody, and control of children is fundamental)
- Parham v. J.R., 442 U.S. 584 (1979) (parents retain authority to seek medical care for children subject to physician judgment)
- Bostock v. Clayton County, 140 S. Ct. 1731 (2020) (discrimination against transgender persons constitutes sex discrimination)
- Glenn v. Brumby, 663 F.3d 1312 (11th Cir. 2011) (gender-nonconformity discrimination is sex discrimination)
- Siegel v. LePore, 234 F.3d 1163 (11th Cir. 2000) (elements and standard for preliminary injunction)
- Reno v. Flores, 507 U.S. 292 (1993) (strict scrutiny applies to statutes infringing fundamental rights)
- United States v. Virginia, 518 U.S. 515 (1996) (burden for sex-based classifications requires an exceedingly persuasive justification)
- Gonzales v. Carhart, 550 U.S. 124 (2007) (scienter requirements reduce vagueness concerns)
- Holt v. Hobbs, 574 U.S. 352 (2015) (narrow tailoring/least-restrictive-means principle under strict scrutiny)