Australia's leading provider of medical indemnity insurance has announced that it will cease to cover doctors in private practice who perform certain sex change procedures on minors, citing a significant risk of litigation.
Gender Clinic News (GCN) reports that MDA National informed its member of the landmark decision in an email, explaining that in “response to the high risk of claims arising from irreversible treatments provided to those who medically and surgically transition as children and adolescents, MDA National is restricting cover for practitioners in private practice.”
The decision comes as several European nations have dramatically altered course in their approach to treating the epidemic of youth suffering from gender dysphoria and seeking medical transition. Sweden, Finland, Norway, and England have all placed severe restrictions on medical sex changes for minors after systematic reviews of the evidence for such interventions revealed it to be of extremely poor quality.
“[From July 1, we] will not cover you or make a payment when the claim against you arises in any way out of your assessment that a patient under the age of 18 years is suitable for gender transition,” reads the MDA National email to members.
In addition, the insurer will no longer cover doctors who face a claim after “initiating prescribing of gender affirming hormones for any patient under the age of 18 years.”
“We consider it appropriate that the assessment and initial prescribing for patients transitioning under the age of 18 years occurs with the support and management of a multi-disciplinary team in a hospital setting,” the email explains.
In a statement to GCN, a spokesperson for MDA National explained that members would still be able to provide a broad range of care to gender dysphoric minors.
“We have been very targeted in the risks we have sought to exclude, which means that members will still be able to provide a broad range of healthcare to children and adolescents with gender dysphoria,” said the spokesperson.
For now, this includes administering puberty blockers, although the spokesperson acknowledged that “there is some uncertainty around the effects of longer-term use of puberty blockers [and] not all effects of puberty blockers are reversible.”
When it comes to surgery, the insurer will no longer cover claims arising from a surgeon assessing minors as being eligible for procedures such as bilateral mastectomies.
“We will still cover claims arising from the ongoing prescription of cross-sex hormones in line with the regime prescribed by the appropriate specialist,” she told GCN.
“However, we will not indemnify any member for claims that arise out of an assessment that a child or adolescent was suitable for transition, or for claims that arise out of the initial prescribing, even if these activities were performed within a multi-disciplinary team within a hospital.”
“Members of such a multi-disciplinary team should ensure they have cover from the hospital, their employer or from another indemnity provider,” she added.
The decision could mark a significant shift in the field of gender medicine, as under Australian law, physicians are not permitted to practice in areas of medicine where they lack insurance coverage. Therefore, the new rule would mean the legal risk of performing this experiment on gender-confused minors would be concentrated in gender clinics in state-funded children’s hospitals.
Dr Philip Morris, president of Australia’s National Association of Practising Psychiatrists (NAPP), supports MDA National’s decision.
“We are encouraged by the idea that the medical indemnity people have identified that gender transition is a significant event and may be irreversible, and therefore the actual treatment should only be conducted after a multidisciplinary assessment in a hospital environment,” Dr Morris told GCN.
The NAPP guidance for managing children and adolescents suffering from gender dysphoria is being sent to politicians across Australia. The NAPP acknowledges that “childhood and adolescence is a time of rapid physical and psycho-social growth and profound personal development, during which young people may question their identity, sexual orientation and gender.”
“As the child matures and progresses through puberty this questioning usually transforms and resolves, and the young person, in the majority of cases, accepts his/her biological sex and adult body,” explains the NAPP guide.
“Currently, while some individuals report a successful transition, we are not aware of published long-term outcome studies that have followed up adults who have undergone childhood or adolescent transition that show substantial benefit,” the guide continues.
“As a consequence, there is no consensus that medical treatments such as the use of puberty-blocking drugs, cross-sex hormones or sexual reassignment surgery lead to better future psycho-social adjustment.”
Meanwhile, in the United States, Oregon Democrats are seeking to mandate health insurance companies to cover these experimental sex change procedures, although the bill specifically excludes detransition-related treatments.
Under HB 2002, insurers would be prohibited from denying gender-related interventions if such interventions have been deemed “medically necessary” by a “physical or behavioral health care provider.”
