Opponents of Montana transgender bill say it could cripple health care, lead to more suicides

Proponent: ‘To be allowed to make this mistake as a child … is a travesty beyond words’

By: - January 27, 2023 5:54 pm
Sen. Bob Fuller, R-Kalispell, testifies in favor of his Senate Bill 99 on Friday, Jan. 27, 2023, in front of the Senate Judiciary Committee.

Sen. Bob Fuller, R-Kalispell, testifies in favor of his Senate Bill 99 on Friday, Jan. 27, 2023, in front of the Senate Judiciary Committee. The bill aims to deny gender-affirming care to transgender youth and penalize medical professional who support and perform those procedures. (Photo by Blair Miller, Daily Montanan)

A woman who testified in opposition to a Republican measure that seeks to deny gender-affirming care to transgender youth in Montana and penalize doctors and nurses who support those efforts – the third such bill over the last two sessions – said she thought about killing herself every day for 50 years before she finally transitioned at age 62.

She was one of more than 90 opponents of Senate Bill 99 who testified Friday the bill is unconstitutional, a threat to health care practitioners and would lead to more suicides among an already vulnerable group.

Dr. Lauren Wilson, a pediatric hospitalist at Community Medical Center in Missoula, said if the bill passes, it could effectively defund all Montana hospitals because the measure says public funds cannot be provided to institutions that offer or subsidize gender-affirming care.

Sen. John Fuller, R-Kalispell, prepares to open testimony at the Senate Judiciary Committee on his Senate Bill 99 on Friday, Jan. 27, 2023.
Sen. John Fuller, R-Kalispell, prepares to open testimony at the Senate Judiciary Committee on his Senate Bill 99 on Friday, Jan. 27, 2023. (Photo by Blair Miller, Daily Montanan)

SK Rossi, a lobbyist representing Bozeman, said the bill, sponsored by Sen. John Fuller, R-Kalispell, if signed into law, could put Montana’s Medicaid program at risk as well because the Affordable Care Act affirms gender as a protected class and the measure would have the state deny coverage under Medicaid and other means of funding.

Forty-four proponents of the measure testified at the hearing too, including several from out-of-state, people representing religion-linked think tanks, an OB/GYN who said her views were not popular within the medical community, and lead proponent Walt Heyer, an activist from California whose nationwide work is focused on detransitioning after he did so himself in 1991.

“I think this bill is not only very powerful, it’s very necessary. I think the way to reduce regret is to tackle the underlying issues before we introduce them to hormones and surgical procedures that they will regret,” Heyer said.

Fuller, who had two similar bills related to the trans community die in the 2021 session, said in his opening statements that his bill was about protecting children from what he called a “purely cosmetic and irreversible” procedure when they are not mentally able to make those choices. 

He called the hours of testimony that was to come from opponents about the bill being discriminatory and unconstitutional “red herrings designed to deflect attention away from a very real issue.”

But the slate of opposition – including many trans adults and children, medical doctors, pediatricians, public employee representatives, psychologists and parents of trans children – for more than three hours pleaded for lawmakers to table Fuller’s latest attempt because of the sweeping harms they say it will cause to Montana and its residents.

“Less terrible versions of this bill have died twice. I’m not sure why we’re back here now,” Rossi said. “… Honestly, it insults the values that most Montanans hold dear.”

Opponents: Bill would penalize providers of gender-affirming care

Amendments for the bill have already been introduced but will not be voted on until the bill sees executive action at a later date. But as introduced, the measure says public funds can’t be used or paid to anyone who provides medication or surgery tied to gender dysphoria, nor can any advocacy be done for any children under age 18 who are experiencing it.

It would prohibit treatments including hysterectomies, voice surgery, mastectomies, testosterone doses and other hormones, puberty blockers, genital reconstruction and more for any minors.

If the Senate does not table this, we will fight like hell for you in the House.

– Rep. Zooey Zephyr, Missoula Democrat

The measure, as introduced, would also subject any providers of those treatments to civil liability until the person they treated is 43 if that person decides they suffered any physical, psychological, emotional or physiological harm. It would also allow the state attorney general to bring actions.

Further, the measure would prohibit liability insurance for health care workers against those liabilities and subject the providers to a minimum one-year license suspension if they provide anyone with gender dysphoria treatments.

“To make this mistake as an adult is a travesty,” said Jeff Laszloffy, the president of the Montana Family Foundation. “But to be allowed to make this mistake as a child, with all the adults around you telling you you’re doing the right thing, and figure out later it was the greatest mistake of your life, is a travesty beyond words.”

Several other proponents said they or their children fit in better with boys or were tomboys when they were young and believed they would have been forced to transition. Others pointed to their Christian values as reason for backing the measure. 

Some said they believed school or psychological counselors were trying to actively convince children they should transition. And many said that children were not mentally prepared to make decisions about their gender identity when they are teenagers, saying they feared those children would regret their choices.

“Here’s the dirty little secret. There is no reliable scientific evidence this improves the long-term mental health of these minors, let alone that the benefits outweigh the regrets,” said Jay Richards with the Heritage Foundation, a right-wing think tank. “… This is emotional blackmail.”

‘These decisions are not impulsive; they are life-saving’

Many of the opponents said most of those claims were wrong based on their own experiences. They also called Fuller and the Republicans on the committee who seemed to favor the bill hypocrites.

Dr. William Gallea, a Helena-based physician, said the bill would have “unprecedented effects” on Montanans’ privacy and would be a gross intrusion by the government into medicine and medical practices.

He read aloud the Republican Party of Montana platform adopted last year in which the party said it believes the government should limit its scope of activity, avoid infringing on lawful activities of citizens, protect individual privacy and free will and give parents the sole right to all reproductive decisions.

Rossi said not only did the bill and proponent testimony put Montana’s children in jeopardy, it ignored and attacked the medical community and experts in gender-affirming care at the same time “the halls of this building are filled with cries for parental rights, and protecting medical freedom, autonomy and privacy.”

“This bill runs afoul of all three of those principles,” Rossi said, adding that if it passes, the state would see a battle in court. “It is also the most blatant and most obvious attempt we’ve seen thus far this session to intimidate and erase transgender people in Montana.”

Opponents line up to speak against Senate Bill 99 in the Senate Judiciary Committee on Friday, Jan. 27, 2023.
Opponents line up to speak against Senate Bill 99 in the Senate Judiciary Committee on Friday, Jan. 27, 2023. More than 90 people testified in opposition to the bill. (Photo by Blair Miller, Daily Montanan)

Several Montanans, including multiple transgender and nonbinary teenagers, testified how they or their children had been on the verge of committing suicide until they worked with counselors, medical professionals and their parents – even when it was difficult for both sides to understand – to begin hormonal treatments after years of gender dysphoria.

Susan Howard told the committee she had felt like she was born a girl, but in the 1960s, treatments were not a widespread option. She attempted suicide as a teenager and waited 52 years, she said, until she transitioned.

“I don’t think there were too many days that went by from [age 10] until I turned 62 that I didn’t feel like killing myself,” she said.

Several parents said the bill was an attempt to undo their parental rights and the vast improvements their children have seen since beginning to transition.

“If you have not witnessed the brutal reality of the suffering, or the freedom and relief that comes on the other side of gender-affirming care, you cannot possibly know what’s best for my son or any other transgender child,” said Jaime Gabrielli of Butte, whose now-18-year-old son transitioned. “These decisions are not impulsive; they are life-saving decisions. And they do not belong in the hands of uninformed strangers who do not understand the type of help and support that my child needs to thrive and survive.”

Physicians say health care field could be crippled under measure

Dr. Eric Lowe, an emergency physician based in Bozeman, provided letters to the committee signed by more than 350 Montana health care providers opposing the bill. He and other medical professionals said lawmakers had no place legislating patient care.

He said not only would many doctors – especially pediatric endocrinologists who are often involved in gender-affirming care treatments – leave the state, Montana would struggle to recruit other doctors and medical professionals amid an existing shortage.

And specialists like those who perform gender-affirming care also do important work like treating pediatric diabetes, he said, which could force children who have other medical needs to transfer to emergency rooms outside of Montana.

Others refuted claims from proponents about gender-affirming care. Multiple medical organizations, including the American Medical Association, have deemed hormone therapy and surgeries medically necessary in certain cases. Some opponents wondered why Montana should then decide they are not only illegal but punishable by law.

“These are the result of research and careful consideration. Lawmakers should not use their authority to override the consensus of the medical community,” said Dr. Heather Zaluski of Shodair Children’s Hospital in Helena. “More broadly, this bill is problematic because it would drive away the doctors. Doctors do not want to practice in a state that criminalizes evidence-based treatments.”

Rep. SJ Howell, D-Missoula, testifies in opposition to Senate Bill 99 on Friday, Jan. 27, 2023.
Rep. SJ Howell, D-Missoula, testifies in opposition to Senate Bill 99 on Friday, Jan. 27, 2023. (Photo by Blair Miller, Daily Montanan)

Dr. Kathryn Brogan, a psychiatry specialist at Shodair, said the measure would force doctors to choose between their sworn oath of “do no harm” or adhering to law outsourced from the medical community “to non-medical lawmakers.”

Two Montana state representatives testified in opposition as well – Missoula Democrats SJ Howell and Zooey Zephyr. Howell is nonbinary and Zephyr is the first elected transgender lawmaker in Montana.

Howell said they believed the task of lawmakers was to make Montanans’ lives better through their shared values of privacy, freedom, fairness and protection from government overreach.

“This bill does not do that,” Howell said.

Zephyr said she specifically ran for office because of the measures Fuller introduced last session.

“I’m here because I believe when we are going to talk about trans people, when we are going to draft legislation that is going to directly impact trans people, we need to hear and listen from trans people in our community,” she said.

Zephyr said she took issue with the description of gender-affirming surgery that proponents gave as “mutilation” because she has undergone the surgery. She said she’s heard from constituents who say their children or grandchildren who are trans feel scared to come back to Montana or want to leave because of measures like SB99 and that she would stand up on behalf of the trans community.

Rep. Zooey Zephyr, D-Missoula, testifies in opposition to Senate Bill 99 on Friday, Jan. 27, 2023.
Rep. Zooey Zephyr, D-Missoula, testifies in opposition to Senate Bill 99 on Friday, Jan. 27, 2023. (Photo by Blair Miller, Daily Montanan)

“If the Senate does not table this, we will fight like hell for you in the House,” she said.

During questions from lawmakers, some Republicans seemed to trivialize the discussion at hand. Sen. Daniel Emrich, R-Great Falls, tried to get a psychiatrist to say gender dysphoria was a dissociative disorder. She declined. Sen. Chris Friedel, R-Billings, repeatedly conflated gender-affirming care with a hypothetical “suicide affirming care,” asking the psychiatrist why if his son was set on killing himself he could not find a facility to provide such care.

“No, sir, you should seek help for your son,” the psychiatrist said.

By the end of the five-hour hearing, doctors and representatives from the American Civil Liberties Union of Montana had agreed that the bill was unconstitutional and would put funding of hospitals, care providers and clinics at risk of losing funding altogether and subject practitioners to “financial ruin,” as Dr. Timothy Mitchell testified.

Dr. Mary Anne Guggenheim, a pediatric neurologist and former House representative, told lawmakers all the evidence showed they should table the bill and “keep it there.”

“This is absurd. It will not only hurt children and families, it will harm the state of Montana. Some physicians and health care providers and customers will likely leave. Many others will never consider coming to a state where they are prevented from giving appropriate medical care,” she said. 

“The stain on Montana’s reputation will be long-lasting.”

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Blair Miller
Blair Miller

Blair Miller is a reporter based in Helena who primarily covers government, climate and courts. He's been a journalist for more than 12 years, previously based in Denver, Albuquerque and mid-Missouri.