A pride flag is seen hanging from Providence City Hall on Tuesday, June 11, 2024, hours before the Rhode Island House of Representatives passed two bills that would protect doctors against potential out-of-state litigation for providing gender-affirming care. The pink and blue chevrons represent trans pride and were added to the pride flag around 2018. (Alexander Castro/Rhode Island Current)
Picture this: A person comes to Rhode Island to get an abortion, or receive hormone therapy so they can transition. This hypothetical person lives in a state that has banned those services. The patient gets the care they want — and the Rhode Island doctor who provided that care gets a lawsuit from the patient’s home state.
Should Rhode Island preempt the possibility of such interstate litigation? The Senate thought so when it approved a bill, the Healthcare Provider Shield Act, by Newport Democrat Sen. Dawn Euer on May 2.
Tuesday evening, the Rhode Island House agreed with its Senate colleagues and passed Euer’s bill as well as its House sibling by Rep. John Edwards, a Tiverton Democrat. Euer’s bill passed 50-14 and Edwards’ passed 50-15.
“If we don’t stand up and shield our doctors and nurses from foreign legal attacks, then they will go to the other 13 states who have already passed this bill and provided that protection,” said Rep. Robert Craven, a North Kingstown Democrat, as he introduced the bill on the House floor.
Nearby states like Massachusetts, Maine, Connecticut, Vermont, New York and New Jersey have all enacted shield laws relating to either or both transgender care and abortion.
The bill is a little different since it triumphed on the Senate floor: Euer’s version was amended for the second time to match Edwards’ amended bill, which was OK’d by a House Committee meeting Monday. Some of the revisions include giving courts discretion in how or whether to enforce subpoenaed documents, and giving the governor discretion to enforce interstate extradition, in the event an interstate lawsuit were to occur.
The “no” votes on each bill were identical (excepting Rep. Brian Newberry, a North Smithfield Republican, whose vote was not recorded on Euer’s bill). Eight of the House’s nine Republicans, six Democrats and the House’s sole independent, Jon D. Brien of Woonsocket, comprised the nays. Ten representatives did not vote, including one Republican, Cranston’s Barbara Ann Fenton-Fung.
One Republican was eager to speak up — so eager, in fact, that House Speaker K. Joseph Shekarchi felt he had to offer an ultimatum.
“Rep. Morgan, I have been Speaker for four years. I’ve never had to cut anyone’s mic off, and I don’t want to do it today, but I will,” Shekarchi told Rep. Patricia Morgan, a West Warwick Republican.
“This bill does not protect children,” Morgan said. “Litigation and threat of litigation, does, and this removes from any doctor, any provider, the threat of litigation.”
Morgan cited England’s recent discontinuation of puberty blockers for youth as one reason she did not support the shield bills. Puberty blockers are drugs that delay secondary sex characteristics by suppressing hormones like estrogen or testosterone, meaning trans youth can explore different gender identities. The drugs comprise a major part of gender-affirming care, but they are reversible and can be used in conjunction with other therapies or forms of affirmation.
As far as Edwards was concerned, Morgan wasn’t discussing the content of his bill anyway. The House floor manager boomed a point of order from his seat at the back of the chamber: “The Rep. is not being germane,” Edwards said. “She’s talking about malpractice.”
Shekarchi agreed, and Morgan’s mic went quiet on the session broadcast. Shortly afterward, at 7:01 p.m., Shekarchi noted the time and the session paused for dinner.
The Senate still needs to stamp Edwards’ bill — a process known as concurrence — before the legislation heads to Gov. Dan McKee’s desk.
The two-pronged bills — part abortion rights, part transgender health care — seemed bound to invite discussion as they had in both chambers’ Judiciary Committees. But after three hours of spirited discussions on casinos, human remains and retirement accounts earlier in the night, the discourse seemed tame. The shield bill was the last to be discussed before the House took a break for dinner, which the reps approved 37-30.
Survey shows trans youths afraid to attend school
Even when transgender kids do receive care, external pressures remain. June 1 kicked off LGBTQ Pride Month, but the Rhode Island Department of Health seemed to start two days early by drawing attention to issues facing young trans people. On May 30, the health department shared a report that had been published sans fanfare nearly two months earlier.
An estimated 3.5% of the statewide youth population, or about 1,500 individuals, identify as transgender, according to “Health and Safety of Transgender High School Students in Rhode Island,” which relies on 2021 and 2023 state surveys.
The data brief noted upfront that someone’s gender identity doesn’t cause mental or physical health issues. Rather, trans youth experience bullying, violence, and rejection from family or peers at higher rates than cisgender kids (those who identify as their birth-assigned gender).
The numbers supported that argument, with obvious disparities between transgender and cisgender students. Some of the deeper rifts involved being forced into having sex — reported among 27% of trans youth, but only 6% of cis students — and feeling too afraid to attend school. In a state with a chronic absenteeism problem, 29% of trans students skipped school because they felt unsafe, compared to only 9% of cisgender kids. Alcohol, nicotine and pot use were all more prevalent among transgender kids.
Also significant was data on suicidal ideation. Among trans kids, 56% had “seriously considered” suicide, 45% had made a suicide plan and 36% had attempted to die by suicide. Among cisgender students, those rates were 14%, 12% and 8% respectively.
The health department participated in the Rhode Island Trans Health Conference on June 1 at Rhode Island College. Two sets of programming — one tailored for the trans community, and one for health care providers — focused on the wellbeing of transgender people at levels both personal and systematic. One presentation in the provider track covered the importance of shield laws.
Doctors and providers often want a more interdisciplinary understanding of their trans patients and trans issues in general, said Syd Loiselle, a clinical social worker who coordinated the conference. But those resources aren’t always easy to find or access in a comprehensive way.
“We had a lot of public health speakers, which was helpful, that we’re able to talk specific clinical issues but through a bigger lens, which I think is sometimes missing from direct clinical education that people get,” Loiselle said of this year’s conference.
A research abstract co-authored by Loiselle in March pointed to the value of gender-affirming care for youths’ self-confidence. After receiving some form of gender-affirming care, the study’s participants were observed to be more comfortable talking to their caregivers about their gender.
A supportive family or community might help fill in gaps policy can’t directly provide. According to the health department data, 71% of trans students felt “so sad or hopeless” that they stopped doing things they normally loved.
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