Vanderbilt turns over transgender patient records to state in attorney general probe

Vanderbilt turns over transgender patient records to state in attorney general probe

Vanderbilt University Medical Center has turned over transgender patient medical records to the Tennessee Attorney General's office, which confirmed Tuesday it is conducting an investigation into potential medical billing fraud.

VUMC, through a spokesperson, confirmed to The Tennessean on Tuesday the facility provided patient medical records to the attorney general.

The Tennessean reviewed a VUMC notice informing patients of the move, which the facility said was the result of an investigation into "billing for transgender care services provided to individuals enrolled in State-sponsored insurance plans." The state requested medical records from Jan. 1, 2018 to the present.

The attorney general's office said VUMC began providing relevant records in December 2022, and the state's investigation is focused on the facility and certain providers, not patients.

The state has legal standing to seek the private medical records, per a health care legal expert. However, the move has sparked privacy concerns among families whose children sought treatment at VUMC amid an increasingly contentious political climate surrounding transgender issues in Tennessee, where multiple legal battles are ongoing over state policies.

"VUMC received requests from the Office of the Tennessee Attorney General as part of its investigation seeking information about transgender care at VUMC. The Tennessee Attorney General has legal authority in an investigation to require that VUMC provide complete copies of patient medical records that are relevant to its investigation. VUMC was obligated to comply and did so," John Howser, VUMC's chief communications officer, said in a statement.

In its notice to patients, VUMC said it provided the records with the AG's "assurance that the records would remain confidential as required by Tennessee law."

“We are surprised that VUMC has deliberately chosen to frighten its patients like this," AG Chief of Staff Brandon Smith said in an emailed statement.

"The Office does not publicize fraud investigations to preserve the integrity of the investigative process. The Office maintains patient records in the strictest confidence, as required by law. The investigation is focused solely on VUMC and certain related providers, not patients, as VUMC is well aware.”

Chris Sanders, executive director of the Tennessee Equality Project, an LGBTQ advocacy organization, said three different parents of transgender children called him in a panic since Monday after they were told by Vanderbilt that their child’s medical records were released to the attorney general as “part of an investigation.”

Sanders said the parents had no other details.

“They’re terrified,” he said. “They don’t know what’s next, they don’t know how this will be used or whether they will be targeted in some way. They feel like their privacy has been violated.”

Sanders said many people are upset that Vanderbilt did not fight harder to prevent turning over patient information. He said others are concerned over the implications for other politically charged issues such as abortion, and whether the attorney general could obtain reproductive health care information.

Patients affected were provided with a hotline number to call with questions and concerns, which is an answering service that asks callers to leave a name and phone number.

Tennessee Attorney General Jonathan Skrmetti said last fall his office planned to investigate VUMC's practices after conservative advocates published allegations that VUMC punished those who objected to its gender-affirming treatment program for children and that some treatments were used as money-making schemes.

Vanderbilt denied the allegations, but the story sparked a major backlash among Tennessee conservatives. Skrmetti and Gov. Bill Lee vowed to investigate the clinic's practices, though neither cited any current laws VUMC potentially ran afoul of at the time.

Paul Hales, a St. Louis-based attorney who specializes in health information privacy, said the attorney general has legal recourse under federal and state law to request patient health records if it is in fact investigating a possible issue at the medical center.

“They would have recourse under the law if they’re making a valid administrative request,” he said.

Under HIPAA law, for uses and disclosures of medical records for which authorization is not required, the records can be released for an “administrative request, including an administrative subpoena or summons, a civil or an authorized investigative demand, or similar process authorized under law.”

The information sought must be relevant to a legitimate law enforcement inquiry and is necessary when de-identification information (such as redacting a patient’s name and other identifying information) could not reasonably be used, the federal health privacy law says.

Under its patient privacy practices, Vanderbilt on its website notes that it may share medical information with law enforcement and for lawsuits or disputes.

The VUMC controversy led to heated debates within the General Assembly this spring, when the Republican supermajority dedicated its first piece of legislation to banning all gender transition treatment for minors. Democrats and local families with transgender children lobbied unsuccessfully against the bill, arguing health care should remain a private decision between doctors and families.

The law, set to go into effect on July 1, has been challenged by local families and the Department of Justice in a federal lawsuit, with a judge weighing whether to grant a preliminary injunction ahead of trial. The law bans any treatments or procedures prescribed to treat gender dysphoria, such as puberty blockers, even though doctors could still prescribe those medications to children for other reasons.

Minors currently undergoing treatment from in-state providers would have to cease treatments by next spring. Some lawmakers sought to include a child abuse portion in the legislation that would leave parents open to civil penalties if they supported a transgender child seeking gender-affirming care, but the measure was dropped before the bill's final passage.

In a separate lawsuit filed last month, two former teachers and several Tennessee teacher associations sued Tennessee over state-sponsored health plans that specifically exclude coverage for gender-affirming care their health care policies specifically exclude coverage for gender-affirming care.

A federal judge last year ruled against a Georgia county in a similar case, finding a county health care policy discriminated against a sheriff's deputy because the policy only affected transgender employees.