A bench trial to decide the constitutionality of Arkansas' transgender health care ban -- passed in 2021 but temporarily blocked before it could go into effect -- got off to a rocky start Monday morning.
First, attorneys for the ACLU and the Arkansas attorney general's office were caught by surprise upon learning the court schedule in U.S. District Judge James M. Moody Jr.'s court could only accommodate one week of testimony. Both sides came to court Monday planning for a two-week trial. Dylan Jacobs and Michael Cantrell, both attorneys with the attorney general's office, told Moody they had witnesses coming from out of state who were supposed to come in next week.
Then, less than two hours into the start of testimony, a fire alarm forced the evacuation of the courthouse for nearly a half-hour until the Little Rock Fire Department determined it was a false alarm.
Act 626 of 2021 -- the Save Adolescents From Experimentation Act -- was passed in April 2021 after the state House and Senate voted by large margins to override a veto by Gov. Asa Hutchinson.
The law was challenged in a suit filed the following month by the American Civil Liberties Union on behalf of four transgender teens and their families living in Arkansas and two physicians, Michele Hutchison and Kathryn Stambaugh. It named Arkansas Attorney General Leslie Rutledge, Arkansas State Medical Board Director Amy Embry and the 14 members of the medical board as defendants. The lawsuit contends the law violates the equal protection and due process clauses of the 14th Amendment and free speech protections under the First Amendment.
In July 2021, Moody issued a temporary injunction blocking enforcement while the matter is in court. An appeal by the attorney general's office, which is responsible for defending the state in lawsuits, was denied in August by a three-judge panel of the Eighth Circuit Court of Appeals. A request by Rutledge for a hearing by the full Eighth Circuit is currently pending.
The law -- authored by Republican Rep. Robin Lundstrum of Elm Springs and passed on primarily party-line votes -- would prohibit doctors from providing or referring transgender young people care related to gender dysphoria.
The condition is defined by the Mayo Clinic in Rochester, Minn., as the feeling of discomfort or distress that might occur in people whose gender identity differs from their sex at birth or sex-related physical characteristics.
On Monday morning, Moody announced the change to the consternation of both sides.
"I was told that Friday the parties were informed that despite the fact that you had asked for two weeks the court had scheduled one week for this case," Moody said.
Attorneys for the ACLU said they were under the impression that the court would be able to take some testimony next week, which Moody said was not the case.
"We can go as late as you need to at night to make up for that but this case is scheduled in light of all the depositions taken in this case and the fact that it's been to the Eighth Circuit and back on several issues," Moody said. "This case is going to get done this week or you can come back later, maybe in December."
Monday's testimony was presented by two expert witnesses for the plaintiffs: Dr. Dan Karasic, a psychiatrist from San Francisco who has spent more than 30 years treating patients with gender dysphoria, and Dr. Deanna Adkins, a pediatric endocrinologist from Duke Children's Hospital and Health Center in Durham, N.C.
Karasic testified most of the day, beginning at 9:30 a.m. and stepping off the witness stand just after 4 p.m. His testimony was primarily comprised of the protocols for diagnosing gender dysphoria, standards of care established by the World Professional Association for Transgender Health and the consequences of individuals with gender dysphoria receiving improper care or no care at all. Karasic said he was on the committee that established the WPATH Standards of Care 7 in 2011 and the revised WPATH Standards of Care 8, which was released last September.
Karasic said the symptoms of gender dysphoria in patients before receiving treatment include severe distress or pain and withdrawal from society.
"Many patients have withdrawn from school or, in the case of older people, jobs," he said. "They become quite impaired as far as their relationships with other people."
He said people suffering from gender dysphoria often suffer elevated rates of depression or anxiety and are prone to suicidal ideations, attempts or self-mutilation.
Asked by Cantrell if there are providers who violate the guidelines laid out in the WPATH Standards of Care, Karasic said that could not be ruled out but said it was more of an exception and that every discipline has had instances of bad actors.
"Just because there are bad or irresponsible providers out there is no more reason to ban transgender care than it is to ban any other kind of care," he said. "Transgender care is not unique in the medical field."
Adkins described the use of puberty blockers and hormonal therapy to treat gender dysphoria and the process of evaluating patients and their families, and she stressed that all therapies are individualized to the patient. She said surgical interventions such as feminizing vaginoplasty for transgender females and masculinizing phalloplasty for transgender males are not recommended for minor patients and are not performed at Duke.
Stopping hormonal treatment, she said, leads to adverse psychological effects as well as permanent physical changes that often lead to adverse outcomes for patients, she said.
"I've seen it in my practice," she said. "I lost a patient to suicide because they did not make it to their second visit when we would have been able to potentially start gender affirming hormone treatment at that time."
"Is it possible to wait until they turn 18?" Chase Strangio with the ACLU asked.
"Not for that patient," Adkins said. "For many of my patients the risks are real."
Holly Dickson, executive director of ACLU of Arkansas, said in a text message after the hearing Monday night that several plaintiffs were in the courtroom to hear the first day of testimony. She said any hurdles that might come up would be dealt with as needed, including coming back to conclude the trial in December.
"We'll do whatever we can and need to do to overcome timing, scheduling or other obstacles in our work to protect these amazing young people from their politicians," Dickson said.