HHS OCR investigating Vanderbilt University Medical Center over release of transgender care records to Tenn. AG

Updated Aug. 14, 11:00 a.m.

Vanderbilt University Medical Center (VUMC) is under federal scrutiny amidst a legal challenge over its decision to release the medical records of patients receiving gender-affirming care to Tennessee law enforcement.

In a statement, a representative of VUMC confirmed that the academic system has "been contacted by and are working with" the Department of Health and Human Services (HHS)' Office of Civil Rights (OCR).

"We have no further comment since this is an ongoing investigation," the representative told Fierce Healthcare. 

VUMC has become a key focus in Nashville's political dispute over transgender care access. The system confirmed allegations filed in a class-action lawsuit last month that it had released patients' information to Tennessee Attorney General Jonathan Skrmetti’s office (see the original story detailing the case below).

The attorney general's office made those requests via three Civil Investigative Demands, which it said were part of an investigation into billing fraud. VUMC said it was legally compelled to adhere to the demands, but that the system had been in "ongoing discussions" with the office over whether additional information requested regarding the system's transgender care services was necessary.

In the class action, patient plaintiffs argued that the system should have pushed back harder on the attorney general office's demands in light of "the state’s active targeting of the transgender community," referencing recent Tennessee bills and policies regarding transgender individuals.

An attorney for the plaintiffs also told a Nashville local news team that she had been discussing VUMC's handling of her clients' records with OCR, and that the case "is a priority for them." 

July 27, 2023

Vanderbilt University Medical Center (VUMC) was hit with a class-action lawsuit this week by patients who said its decision to turn over the medical records of patients receiving gender-affirming care at its Transgender Health Clinic to the state was negligent and harmful.

The case was filed anonymously in Davidson County Chancery Court by two patients who received care at the transgender clinic, both of whom were among the 106 patients whose information was provided by VUMC in response to three Civil Investigative Demands (CID) from Tennessee Attorney General Jonathan Skrmetti’s office.

The attorney general’s office has been investigating VUMC and other related providers since September over claims that a VUMC doctor “publicly described her manipulation of medical billing codes to evade coverage limitations on gender-related treatment,” according to a June statement from the office.  

The plaintiffs wrote in their complaint that state officials including the attorney general had adopted an “anti-transgender agenda,” referencing a slew of Tennessee bills passed or proposed regarding transgender people’s use of public restrooms, participation in school sports and gender-affirming care for minors.

The health system “knew about the state’s active targeting of the transgender community” and “at a minimum, VUMC should have pushed back on the AG’s request for personally identifiable information,” the plaintiffs wrote.

“Nevertheless, it appears that instead of pushing back, VUMC simply complied with the AG’s demand and turned over all requested records. Those records included the personally identifying information of its patients and some of the most intimate details of their private lives,” plaintiffs wrote.

The plaintiffs accused VUMC of breach of contract, violation of consumer protections and negligence that led to “actual damages including increases in emotional distress, anguish, and higher costs of medical care going forward." Their class action seeks an injunction requiring VUMC to better safeguard patients’ private information and monetary damages.

Information requested in the CIDs included intake forms, patient charts, assessments and patients who had been referred to the transgender care center but only had an initial visit. The latter request and others, plaintiffs said, “exceeded even the stated nature of the investigation."

In a statement given to reporters, VUMC confirmed receiving a CID from the attorney general’s office in November plus two others in March.

The medical center said it’s “common” for providers to receive and comply with patient records requests related to billing investigations and audits from government agencies such as the attorney general. Federal and state laws including the Health Insurance Portability and Accountability Act (HIPAA) allow law enforcement to obtain these without the patient’s prior consent, VUMC said.

"All health systems are obligated to comply with these requests in law enforcement investigations, and VUMC did so,” the system said. “The state has told VUMC multiple times that the investigation is not focused on any patient and that the state will maintain records obtained in strict confidence.”

VUMC noted that the CIDs also requested additional information related to the system’s transgender services but that its legal counsel “are in ongoing discussions with the Attorney General’s office about what information is relevant to their investigation and will be provided by VUMC.”

Part of the plaintiffs’ complaint focused on the transfer of information without informing the patient.

Both the attorney general’s investigation and VUMC’s decision to turn over data were kept under wraps until last month when VUMC said it made a decision to notify the affected patients due to a separate ongoing lawsuit between the American Civil Liberties Union and Tennessee on the constitutionality of a law banning transgender care for minors. That case saw the same CIDs presented by the plaintiffs as part of the public court record.

“While VUMC is not a party to this lawsuit, and even though patient names and birthdates were removed from the information filed by the plaintiffs, the filings made clear that individual patient medical and billing records had been requested by the Attorney General,” the system said. “Because this information was now available to the public, we felt it would be best for our patients to be notified of these developments from us rather than through media reports or other means.”

At the time, the attorney general’s office said it was “surprised” by VUMC’s “abrupt notice [to patients] without any context,” and that the office “has no desire to turn a run-of-the-mill fraud investigation into a media circus.”

The office also said that its investigation was directed at the system and certain providers, “not at patients or their families,” and that the records delivered by VUMC “have been and will continue to be held in the strictest confidence, as is our standard practice and required by law.”

Regardless, the plaintiffs said they and other class members “have suffered significant anxiety and distress” due to the state having their information. Citing Tennessee’s “climate of hostility” toward transgender individuals and those perceived to be transgender, the patients now “face significant risk of harassment as a result of the [attorney general] having continued access” to their private health information, they wrote.

Transgender healthcare services have become a focal point for conservative lawmakers and officials. At the state level, it has led to policies barring access to services for transgender residents, many of which are being actively challenged in the courts. Federal-level debates have also driven a wedge between the parties when incorporated into healthcare and non-healthcare legislation alike.

Proponents of the restrictions say that the legislative and administrative bans are intended to limit harm from unproven care decisions, though gender-affirming care is generally supported by medical professional organizations such as the American Academy of Pediatrics and the American Medical Association.

Healthcare providers that have provided gender-related care to these populations have found themselves caught in the middle. In states like Tennessee with recently passed restrictions, some facilities have seen their government funding restricted should they not comply with the policies. Several others across the nation, particularly pediatric care facilities, have been targeted by harassment campaigns propagated on social media.