California has sued a prominent children’s hospital system to prevent it from ending gender-related treatments for transgender young people.
Amid a broader push by the Trump administration to block such care, California’s action appears to be the first time a state has sued a health care provider to force it to continue, legal experts said.
In the lawsuit, Rob Bonta, California’s attorney general, argued that Rady Children’s Health, the state’s largest pediatric health system, had violated a legal agreement with the state by unilaterally deciding to stop providing hormone treatment and other gender-related health care to transgender patients under the age of 19.
The care was scheduled to end on Friday and would have affected about 1,450 patients, the lawsuit said. A San Diego County Superior Court judge on Thursday ordered Rady Children’s to keep offering the care until Feb. 10, when he planned to decide whether the hospital must continue the services while the case proceeds, according to Mr. Bonta’s office.
The state’s suit, which was filed last week, said that when the attorney general’s office approved Rady’s deal to merge with Children’s Hospital of Orange County in 2024, the hospital system was required to keep providing the same level of specialty health care, including gender-related care, through 2034.
Instead, the lawsuit said, Rady Children’s gradually began curtailing treatment for transgender young people, such as by declining to accept new patients, before telling existing transgender youth patients that the system would no longer provide them with gender-related care.
“We will not allow Rady Children’s to violate its obligations to its patients and the State,” Mr. Bonta said in a statement. “We will fight to uphold the law and ensure Californians can access gender-affirming care without facing unfair roadblocks.”
Ben Metcalf, a spokesman for Rady Children’s, which is based in San Diego, said in an email that the health system would not comment on pending litigation.
In a statement late last month, Rady’s Children said that ending gender-affirming treatments was “a very difficult decision, made to ensure we can continue serving all children and families across the communities we serve.”
The hospital said that “escalating federal actions,” including a referral to the U.S. Department of Health and Human Services Office of Inspector General for an investigation, had put its access to federal funding for low-income patients at risk.
Yvonne Gamble, a spokeswoman for the Office of Inspector General, said in an email that it was the department’s “longstanding general policy to neither confirm nor deny the existence of an investigation.”
President Trump has raised alarms about the growing number of young people identifying as transgender. In his first speech after winning the White House again in 2024, he vowed to “stop the transgender lunacy,” especially relating to medical treatment for minors.
Since he took office, his administration has sought to block such medical treatment, which he has described as “mutilation.” Other federal officials have leveraged their agencies’ power over the disbursement of federal money to pressure hospitals to stop providing the care.
The administration has said it wants to protect children from interventions that they may regret, with long-term side effects that can include infertility.
L.G.B.T.Q. groups say that under California law, gender-related health care is like any other specialized medicine and should be accessible to children whose doctors and families decide it is the best treatment. Parents of transgender children and transgender adults have said that such care is lifesaving.
Most major U.S. medical associations have endorsed medical treatments — including hormone therapies, puberty blockers and, in rare cases, surgeries — as effective in relieving the distress young people can experience when their gender identity conflicts with their sex. Earlier this week, however, the American Medical Association and the American Society of Plastic Surgeons said that gender-related surgeries should generally be deferred until patients reach adulthood.
The topic has become a subject of intense political debate around the world, with some European countries moving to limit gender-related medicine for minors, and others endorsing it.
Hospitals across the United States, including in Democratic-led states like California, have for months been limiting or eliminating gender-related care for transgender children, citing threats from the Trump administration to withhold Medicare and Medicaid money if they continue to offer such care.
Many hospitals rely on federal funding to keep their doors open and have said they are in an untenable position: Either betray a small group of their patients or be forced to stop treating all patients if the federal government were to succeed in withholding funds.
That was the argument made by Children’s Hospital Los Angeles, which shuttered its Center for Transyouth Health and Development in July. The clinic was among the nation’s oldest and most prestigious clinics focused on transgender young people, and parents of trans children across the state said the closure was a harbinger of what could come.
California and other Democratic-led states have sued the Trump administration over what they say are efforts to interfere in the regulation of health care, which they argue is a right that belongs to the states.
In December, for instance, Mr. Trump’s health secretary, Robert F. Kennedy Jr., announced that his agency would effectively bar all Medicaid and Medicare funding to hospitals that continued to provide gender treatment to minors. California joined 18 other states in a lawsuit challenging that declaration, resulting in a temporary agreement not to enforce it.
Katie Keith, director of the Health Policy and the Law Initiative at Georgetown University Law Center, said that California’s argument against Rady Children’s fits with the suit by blue states to combat the federal government’s push to undermine state control over health care.
The California suit is also unique, she said, because it hinges on a merger agreement.
“What I think we’ve not seen is states suing providers,” she said. “This feels like an escalation, but it feels quite specific to the circumstance.”
Dannie Ceseña, the director of a coalition of nonprofit L.G.B.T.Q. health care providers and community centers in California, said that he felt conflicted about the lawsuit.
“On one hand, the attorney general suing Rady Children’s for not following the hospital merger agreement is a wonderful thing and a huge step in the right direction,” he said. On the other hand, he said, the suit doesn’t address the problem of other providers, like Children’s Hospital Los Angeles, preemptively ending gender-related care.
Mr. Ceseña noted that Mr. Bonta’s office had sent the Los Angeles hospital a letter warning administrators that the state had nondiscrimination laws requiring hospitals to provide equal care to transgender patients, but the state did not sue. Thousands of families who were patients of that clinic and others that have ended transition care for minors have been scrambling to find new providers from a shrinking pool.
“This leaves all these other families out in the dust,” Mr. Ceseña said.
Amy Harmon contributed reporting.
Jill Cowan is a Times reporter based in Los Angeles, covering the forces shaping life in Southern California and throughout the state.
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