Authored by Jonathan Turley via jonathanturley.org,

In a rare and controversial move, New York Attorney General Letitia James has ordered a Manhattan hospital to resume offering gender-transition treatment to transgender youth. NYU Langone had discontinued such treatments after funding threats from the Trump administration. It is now caught between the proverbial rock (HHS) and a hard place (NYAG).

Last year, President Donald Trump signed an executive order entitled “Protecting Children from Chemical and Surgical Mutilation,” seeking to restrict gender-transition treatment for people under 19. HHS then threatened hospitals with a cut off of federal Medicaid and Medicare funding for continuing such treatment for children.

Various European countries have also halted certain procedures after countervailing studies suggesting that the risks are too high. England’s National Health Service 2024 report on the subject, known as the Cass Report, found concerning evidence of harm for minors and inconclusive benefits.

James threatened “further action” if NYU Langone does not defy the Trump Administration, declaring that the cessation of its Transgender Youth Health Program violates New York anti-discrimination law by “jeopardizing access to medically necessary healthcare for some of the most vulnerable New Yorkers.”

NYU Langone had previously declared that it would no longer provide certain gender-transition treatments for patients under the age of 19.

James’s move could trigger a fascinating challenge. In the Feb. 25 letter signed by the attorney general’s health care bureau chief, Darsana Srinivasan, the state said that the federal regulatory change did not affect a “medical institution’s existing duties and obligations under New York law.” That raises an interesting conflict between state and federal regulations.

The letter gives the hospital until March 11 to comply and resume these treatments.

Effectively, James is ordering the hospital to defy the federal government. However, the hospital, not James or the state, would bear the financial and regulatory consequences.

While James does not state how she will penalize the hospital, the letter is likely sufficient to challenge the move. The question is whether the political costs for the NYU hospital are prohibitive. There is also the question of whether the HHS has standing or interest in challenging the move as a direct threat to federal authority.

The problem with a federal challenge is that nothing in the New York threat prevents the federal government from carrying out its intent to cut off funding. Hospitals would have to choose between penalties in New York or loss of funding in Washington. Nevertheless, New York’s move is a direct attack on the enforcement of federal policy by state hospitals.