679 F.Supp.3d 668
M.D. Tenn.2023Background
- Tennessee enacted SB1, banning specified "medical procedures" for minors when the purpose is to enable a minor to live with a gender identity inconsistent with sex at birth or to treat distress from that discordance; effective July 1, 2023, with a limited continuing-care exception through March 31, 2024.
- "Medical procedures" in SB1 includes puberty blockers and cross-sex hormones; surgeries were also banned but plaintiffs lacked standing to challenge the surgical ban at the preliminary-injunction stage.
- Plaintiffs are transgender minors, their parents, and a treating physician; they challenge SB1 as violating the Fourteenth Amendment (Due Process and Equal Protection) and seek a statewide preliminary injunction (except they do not seek to enjoin the private right of action provision).
- The district court applied the Winter preliminaries standard and addressed standing, likelihood of success on the merits, irreparable harm, balance of equities, public interest, and scope of relief.
- The court held plaintiffs substantially likely to succeed on both the Due Process claim (parental right to direct medical care implicating strict scrutiny) and the Equal Protection claim (law facially discriminates on transgender status and sex; intermediate scrutiny applies), and found irreparable harm, favoring a preliminary statewide injunction as to non-surgical treatment bans.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Standing to challenge non-surgical bans | Plaintiffs (minors, parents, physician) have Article III standing to seek injunctive relief against SB1's non-surgical prohibitions | Defendants contend some plaintiffs (e.g., Dr. Lacy) lack standing; no plaintiff can show injury from surgical ban | Court: plaintiffs (other than for surgery claim) have standing; no standing to challenge surgical prohibition at PI stage |
| Substantive Due Process — parental right | SB1 infringes parents' fundamental right to direct medical care of children, so strict scrutiny applies | Defendants urge plaintiffs define the right too broadly and that historical tradition disallows a new affirmative right | Court: parents have fundamental right to direct medical care (Kanuszewski); SB1 infringes that right and fails strict scrutiny at PI stage |
| Equal Protection — class and scrutiny | SB1 facially discriminates against transgender minors and creates sex-based classifications; intermediate scrutiny applies | Defendants argue only rational-basis review is applicable; claim law is neutral or permissible regulation of medical practice | Court: SB1 discriminates on transgender status and sex; transgender persons are a quasi-suspect class; intermediate scrutiny applies and SB1 likely fails it |
| Substantial relation / state interest | Plaintiffs: record shows benefits of gender-affirming care and disputed/mitigable risks; SB1 is underinclusive (permits same treatments for other conditions) | Defendants: state has important interest protecting minors from medical risks; point to FDA and foreign practices | Court: record does not show an important interest or a reasonable fit; SB1 is underinclusive and not substantially related to asserted interests |
Key Cases Cited
- Overstreet v. Lexington-Fayette Urb. Cnty. Gov’t, 305 F.3d 566 (6th Cir. 2003) (preliminary injunction is extraordinary relief; irreparable-harm requirement)
- Winter v. Natural Resources Defense Council, 555 U.S. 7 (2008) (four-factor preliminarily injunction standard)
- Kanuszewski v. Michigan Dep’t of Health & Human Servs., 927 F.3d 396 (6th Cir. 2019) (parents possess a fundamental right to direct medical care of their children)
- Bostock v. Clayton County, 140 S. Ct. 1731 (2020) (discrimination based on transgender status entails discrimination based on sex)
- U.S. v. Salerno, 481 U.S. 739 (1987) (facial-challenge framework and discussion of "no set of circumstances")
- City of Los Angeles v. Patel, 576 U.S. 409 (2015) (focus of facial challenge is the group for whom the law is a restriction)
- Brandt v. Rutledge, 551 F. Supp. 3d 882 (E.D. Ark. 2021) (similar law enjoined; discussion of parental rights and equal protection)
- Ladapo v. Willis, (opinion cited in text) (N.D. Fla. 2023) (district court analysis enjoining a Florida ban on gender-affirming care; relied on by this court)