Parents sue docs for deciding gender of intersex child 10 years ago

[jjenny]

I don't believe this child was "damaged" in any way by the medical and surgical care he/ she received while in foster care.

If the child identified as female, the parents STILL say they would sue the doctors! That's just jaw dropping to me.

Basically, the adoptive parents are suing "just because" this child had ANY care at all. There is not a shred of evidence that the ABSENCE of surgical or medical care, would have been considered appropriate by any legal authorities.

In fact, if the child had NOT had any medical or surgical care at all, I think their lawsuit would have a LOT more chance of being successful.

Not doing anything is clearly NOT the best documented or researched course of action. The child was a legal and social orphan who received appropriate medical and social care for a major birth defect, IMO.

Where is the "damage" here?

The child is transgendered. He needs ongoing care and support for that, in addition to medical care for the genital condition. The care for the genital birth defect did not "cause" the transgendered situation, IMO. It's irrelevant to his transgendered situation, IMO. He was not a "normal" male who was mutilated, castrated, and rendered infertile, only to be presented as a "normal" female. This child very unfortunately has a major defect/ deformity of the reproductive system. Very likely the child is not "biologically able" to reproduce as either male or female, so preservation of one biological "assignment" is likely a moot point.

IMO, the parents have a serious issue with the child's transgendered situation-- not the genital birth defects, and subsequent the care for that. IMO, the lawsuit is a ruse for presenting their issues in a way that "blames" doctors, rather than accepting the child for whichever gender he or she decides to be.

The child isn't transgendered, he was born a true hermaphrodite. It seems better to leave such children alone at least until it can be figured out what gender the child identifies with. The damage would appear is that the child identifies as a male but was corrected into the female. It's now a lot more difficult for him to be functioning as a male than if he wasn't operated on. I do understand why doctors did it. Genetically the child is a female, and it's a lot easier surgically to convert a hermaphrodite into a female than into a male (for obvious reasons). I don't believe that this child was ever going to be able to reproduce as a male even if he wasn't operated on, due to having xx chromosomes, my understanding is that he would be sterile. So I am not sure why loss of fertility is in the lawsuit. There is also an issue in that his biological mother consented to surgery. Hindsight is always 20/20. But the doctors had consent when they carried out the surgery.

 

[T4Tide]

All legality, science, and litigation aside... this sure is a tough hand to be dealt.

Bless.

I'm sure, no matter if all the opposite decisions were made, there'd still be anguish and trauma.

 

[Margo/Mom]

One of the things I know for sure is that not “every” child that has had an “ambiguous gender” condition with medical care and surgery/ies as an infant and toddler is angry and distraught about it.

I spent time reading every single article on the now- defunct (transformed) “Intersex Society Of North America” advocacy website. I generally agree with roughly ½ of what they have on their website-- the info that is designed to be educational about what "intersex" birth conditions are. I don’t agree at all with 1/2 of what they advocate.

My overall impression is that this is a “society” of profoundly angry and frustrated individuals who are more interested in expressing their anger over social issues, and what kinds of medical intervention happened decades ago, than in advocating for the current care of these infants, kids, and young adults NOW. Maybe that's why the folded in 2008?

No one in health care, for decades upon decades (probably 30-40 years), has advocated that “intersex” birth conditions should be kept secret from patients as older kids and adults, medical records falsified, etc. That's pure baloney.

I am reminded of a video my spouse and I were made to watch during our adoption classes. The video was about VERY angry adoptees who were now adults, and furious with the circumstances of their very legal and ethical adoptions, the lack of control they had over their early lives, and the situations that lead to them being available for adoption. These people in the videos were consumed with the “unfairness” of the circumstances of their lives because they were not in biologically nuclear families (and all were adopted by loving families who were honest and tried to keep the adopted person connected to their personal histories as well as birth cultures.) If this was all a prospective adoptive parent was shown or taught, it would lead one to think *every* adopted person as an adult was dysfunctionally angry, frustrated, and obsessive about their adoptions—and we all know that this is far from the truth.

I liken this intersex advocacy somewhat to the “debate” on routine male infant circumcision. Some cultures do it, others don’t, some pay for it, others don’t, some think there is medical advantage to the procedure, others think it’s unnecessary and cosmetic. Some families would be devastated if their male infants did NOT have foreskin circumcision; others are devastated if a male child in their family IS circumcised. The ISNA (and subsequent Accord group) wants to present all of the surgical care of “intersexed” infants as if all of the care is ruthlessly cosmetic and frivolous/ elective—unless there is something serious, such as what they describe as “impaired drainage of urine”-- in which case they begrudgingly "allow" surgical intervention. That is, IMO, a very extremist position to take, and IMO, not at all representative of the majority of individuals who were born with an “intersex” condition, and are emotionally and socially healthy as older kids and adults.

Parents of infants have to make decisions every day all over the world about how to deal with all kinds of birth defects and birth deformities (and yes, I know some people take a basic offense at the terms “defect” and “deformity”.) The overwhelming majority of the time, parents and surrogate parents make the absolute best decisions they can for the infants/ toddlers (and teams of doctors for kids in foster care, guardians ad litems, etc). Kids are born with all kinds of “differences” that are far more noticeable socially—craniofacial deformities, limb deformities, etc. For the most part, genital deformities are hidden from social interaction unless the person chooses to share. Choosing a gender to raise a child in “preliminarily” is done by virtually every single parent on earth—and parents of intersex kids require assistance from the medical community due to the medical issues with the child’s intersex condition.

Should a child with "lobster claw" syndrome not be treated until adulthood, so that the child can "choose" whether to surgically intervene? Should a child with cleft lip and palate be made to "wait" until adulthood to decide if their deformity should be treated-- to decide if they can talk more normally? Swallow? Should we make those kids go deaf from ear infections until they are old enough to decide if they wanted to keep their hearing? Should a child with clubfoot, or extra vestigial limbs be made to wait to adulthood to make decisions about their care, to decide if they want to try to be able to walk? Because these are valid questions, IMO, if we "decide" that kids with major intersex conditions should "wait" to have any intervention until they are "old enough" to decide.

There was nothing malicious or negligent or abusive about the care this child received in 2005. The parents need to get over their own issues about the care this child received, and get back to the business of raising this child to be whoever “she” or “he” turns out to be. If the child is a "she", great! If the child is a "he", that's ALSO great! The child has a "genital disability" that is separate from GENDER identity. The 2 are not one and the same, just as in transgendered people.

What doctors did for this child 10 years ago was not a needless or frivolous genital mutilation. Good grief.

This lawsuit, IMO, is not groundbreaking or “brave” or even a little bit appropriate. The parents, IMO, are making this situation into a MUCH more embarrassing and high profile ordeal for this 10 year old child that is necessary. IMO, they are not advocating for the child—IMO they are exploiting the child’s situation for attention and notoriety. They are not shielding and protecting THIS child from public attention.

I strongly condemn these parents for what they’re doing, and especially bringing this to such a public platform—it’s not at all a good or noble, or conscientious thing, IMO. The child has a hard enough situation to deal with as she/ he enters adolescence and adulthood—the parents are making it much, much worse, IMO.

K-Z, as an adoptive parent I have sat through some of the kinds of sessions you described. To my mind they are designed to warn off any parents who might come back and raise questions or ask for help following placement and finalization. Frankly--with my social worker hat on--I consider this to be bad practice. Certainly prospective parents need to understand the trauma of loss that adoption is rooted in. But some of those presentations strike me as being incredibly self-serving, designed to not only set the social workers as experts--but also as superior humans, having experienced and stood by kids with all kinds of issues, while some adoptive parents are overwhelmed and families disrupt. From a practice perspective, better to ease off on the scare tactics and amp up the long-term, non-judgmental, family supports post-adoption.

With all that said, I do think that much depends on what was current at the time. That the parents expressed concern at the time of adoption--not with the child, but the surgery--suggests that the surgery was not regarded as best practice. On the other hand, with some of the other examples you offered, such as cleft lip, there was a time that surgery was routinely contraindicated in children--waiting until adult growth was rreached. This changed as the result of research into the psycho-social impacts of facial anomalies. Turns out that the social smile is developmentally important.

To me, the current lawsuit is important if it results in resources to repair damages and so forth moving forward. A part of the education of Caitlin Jenner is other trans persons making her aware of the difficulty of most accessing appropriate care and treatment due to financial limitations. Insurance coverage is very spotty when it comes to gender-related issues. And few have the resources of a Caitlin Jenner.

 

[CCmakes3]

I do think the doctors probably did what was considered best practice at the time. Occasionally the AMA issues "best practice" statements for different conditions, but I wouldn't know how to look one up for a specific condition at a specific time in the past.

Times and opinions certainly do change. This was longer ago than in 2005, but about 16 years ago I took my 4-year-old son into the women's locker room to change after a swim lesson at a local community center. In the summer I would simply take him out the the car wet and throw a towel on the seat, but it was winter with sub-zero temps. If it had been the Y or a health club, I might have let him risk the men's room, but this place had programs for the homeless, substance abusers, etc., so I was more comfortable taking him into the women's room.

I found a spot in the corner away from anyone else and set to helping him dry off and get dressed. I wouldn't have dreamed of having him shower in there or anything like that. Soon I became aware of a woman ranting behind me about how "some people are such perverts" and "these girls deserve some privacy, for god's sake." Burning with shame, I kept my back to her, fumbling with my son's wet suit and cursing how long it takes to shove a wet child into dry clothes. I don't think my son realized she was talking to or about us until she caught his eye and said, "Maybe your mom is deaf. Tell her she should be ashamed of herself for bringing you in here to ogle naked girls." He burst into tears and I found myself apologizing to her as I dragged my half-naked child out into the hall. It's amazing to me that 16 years later, at 6'7" and 240 lbs, all he would have to do to get back into that same locker room would be to say he identifies as a female! :laughing:

 

[jjenny]

K-Z, as an adoptive parent I have sat through some of the kinds of sessions you described. To my mind they are designed to warn off any parents who might come back and raise questions or ask for help following placement and finalization. Frankly--with my social worker hat on--I consider this to be bad practice. Certainly prospective parents need to understand the trauma of loss that adoption is rooted in. But some of those presentations strike me as being incredibly self-serving, designed to not only set the social workers as experts--but also as superior humans, having experienced and stood by kids with all kinds of issues, while some adoptive parents are overwhelmed and families disrupt. From a practice perspective, better to ease off on the scare tactics and amp up the long-term, non-judgmental, family supports post-adoption.

With all that said, I do think that much depends on what was current at the time. That the parents expressed concern at the time of adoption--not with the child, but the surgery--suggests that the surgery was not regarded as best practice. On the other hand, with some of the other examples you offered, such as cleft lip, there was a time that surgery was routinely contraindicated in children--waiting until adult growth was rreached. This changed as the result of research into the psycho-social impacts of facial anomalies. Turns out that the social smile is developmentally important.

To me, the current lawsuit is important if it results in resources to repair damages and so forth moving forward. A part of the education of Caitlin Jenner is other trans persons making her aware of the difficulty of most accessing appropriate care and treatment due to financial limitations. Insurance coverage is very spotty when it comes to gender-related issues. And few have the resources of a Caitlin Jenner.

That the parents expressed concerns about the surgery at the time doesn't indicate anything about it being regarded best practice or not. It was their personal opinion. They still adopted the child knowing the child already had surgery. Biological mother gave consent to surgery on the child. The adoptive parents are now trying to argue that mother wasn't all that present in child's life, which would make that consent invalid. But the point is, she gave consent, child had surgery, these people adopted this child knowing the child already had surgery.

 

[K_Z]

I see a distinct difference between neonatal surgery which aims to preserve or improve functionality and health, and neonatal surgery which is primarily to make the child fit a normality mold better. Say, if the child has deformed genitals that constitute a clear infection risk, surgical intervention may be completely warranted. But I see an ethical problem if unsightly bits are cut out just to make the intersex child look more like a girl or more like a boy, particularly if it goes against what the child's hormones are telling his or her brain about which gender s/he is.

JMO barring devastating complications, it's probably unlikely that a child who learned to walk after clawfoot surgery, is going to regret having the operation, miss the clawfoot and tell their parents or the doctors that it was the wrong thing to do.

First, I love your posts, Donjeta-- they always make me think critically. I don't want to give the impression I'm ranting on you-- even as I always seem to be too long winded! So here goes.

What I keep coming back to is the parents’ comments that they would be filing a lawsuit EVEN if the child had identified as female. That alone tells me that this crusade they are on has nothing at all to do with the child, and everything to do with their personal issues about gender and reproductive birth defects.

I’m very confident that this was never a case of only one “rogue doctor” making rash decisions to “lop off” tissue—this child was evaluated extensively by a whole team of professionals.

The lawsuit is about THEIR ideas about informed consent, and what THEY would have done-- 10 years after the fact. Their insistence on filing this lawsuit, AND going on the media circuit, tell me this is all about them, and not about the child at all. The child is a tool for their agenda, IMO. I think they both need extensive counseling to help them deal with all of the issues of effectively parenting this child. For the child’s sake, I hope they are getting help from mainstream, ethical providers, and not fringe activists.

I don’t agree with this lawsuit at all, and I think it’s damaging for the child, for them, for health care professionals, and for the care and acceptance of all of these kids and adults with intersex conditions.

These unfortunate kids will always have gender identity issues, because of their unique birth defects—and IMO, we are disingenuous to ever assume or think otherwise. That said, even the most strident “remove-no-tissue activists” do not advocate raising a child with an intersex condition in a neutral “third gender”. A child with both male and female genitals (inside and out), who has chromosomal mosaicism, really should be assigned a gender at birth (including doing what is needed medically and surgically). To not do so would be unethically cruel and abusive, IMO.

These kids ALSO deserve a compassionate CHANCE to assimilate, grow up, and be considered ONE gender, just like everyone else born with one gender. They shouldn't be forced to make their birth defect the centerpiece of their life-- it's not a hobby, even if their parents are activists. I think we also have to be exquisitely careful to evaluate the true motivations of adoptive parents, so that we don't place kids with activists who are "collecting" kids with certain conditions, to bolster their own crusades.

These kids should not be “forced” to be a third gender until late childhood or adulthood, or forced to share their gender situation with everyone they meet (nor should their parents divulge that private info to just anyone.) The child should not be encouraged, persuaded, or forced to consider themselves “gender queer” either, IMO-- unless they want to identify this way when they are much older. It will soon become obvious which gender the child identifies with (as in admirable kids like Jazz), and then the child can be supported in the gender they choose.

If they identify as the opposite gender later on than the one they were assigned as a result of medical diagnosis and decision making for their birth defect, then we all just deal with it as we would for any other child that is transgendered, whose genitals don't match their self concept of their gender.

(I hope I explained my thinking!)

 

[K_Z]

Love your posts, Margo/ Mom-- my comments in blue.

K-Z, as an adoptive parent I have sat through some of the kinds of sessions you described. To my mind they are designed to warn off any parents who might come back and raise questions or ask for help following placement and finalization. Frankly--with my social worker hat on--I consider this to be bad practice. Certainly prospective parents need to understand the trauma of loss that adoption is rooted in. But some of those presentations strike me as being incredibly self-serving, designed to not only set the social workers as experts--but also as superior humans, having experienced and stood by kids with all kinds of issues, while some adoptive parents are overwhelmed and families disrupt. From a practice perspective, better to ease off on the scare tactics and amp up the long-term, non-judgmental, family supports post-adoption.

Wow-- I completely agree with this analysis! And as I posted above, I think we have to be exquisitely careful in the process of evaluating prospective adoptive parents to make sure "activist" parents aren't just adopting kids with certain conditions as little examples of what "good activists" the parents are. The kids deserve to just be kids-- they have problems enough to deal with, without having to be the centerpiece for a parental crusade because of their birth defects or disabilities. It's a fine line between being an experienced and well educated prospective adoptive parent about certain medical conditions, and being a predatory activist adopting jewels for their parental crown, KWIM?

With all that said, I do think that much depends on what was current at the time. That the parents expressed concern at the time of adoption--not with the child, but the surgery--suggests that the surgery was not regarded as best practice.

I don't really agree with this-- that the complete evaluation of the child with mosaicism and genital surgery was not "best practice" at the time. Doing "nothing" would clearly be seen as the more negligent of the two choices, medically, IMO. Forcing the child to live with 2 genders for an undetermined length of time is the least "normalizing" situation, and could easily be argued that "two genders" would cause the most mental/ psycho-social harm over time, during formative years.

On the other hand, with some of the other examples you offered, such as cleft lip, there was a time that surgery was routinely contraindicated in children--waiting until adult growth was rreached. This changed as the result of research into the psycho-social impacts of facial anomalies. Turns out that the social smile is developmentally important.

To me, the current lawsuit is important if it results in resources to repair damages and so forth moving forward. A part of the education of Caitlin Jenner is other trans persons making her aware of the difficulty of most accessing appropriate care and treatment due to financial limitations. Insurance coverage is very spotty when it comes to gender-related issues. And few have the resources of a Caitlin Jenner.

As for the lawsuit being financially necessary, I don’t really agree with that. This child was born with a very extensive reproductive defect/ disability. It is well documented in the child’s medical records, as well as social service records, and adoption records. If the parents don’t have financial means to get the child whatever care that is needed, the child will easily qualify for ongoing benefits via Medicaid, etc. Any further surgeries, functional or not, would not be “cosmetic”, but reconstructive—an important distinction. This child will not be forced to go without physical care, or mental health services. The mother is a former USAF psychologist or psychiatrist, and the father has attended law school (not sure if he’s an attorney).

 

[katydid23]

First, I love your posts, Donjeta-- they always make me think critically. I don't want to give the impression I'm ranting on you-- even as I always seem to be too long winded! So here goes.

What I keep coming back to is the parents’ comments that they would be filing a lawsuit EVEN if the child had identified as female. That alone tells me that this crusade they are on has nothing at all to do with the child, and everything to do with their personal issues about gender and reproductive birth defects.

I’m very confident that this was never a case of only one “rogue doctor” making rash decisions to “lop off” tissue—this child was evaluated extensively by a whole team of professionals.

The lawsuit is about THEIR ideas about informed consent, and what THEY would have done-- 10 years after the fact. Their insistence on filing this lawsuit, AND going on the media circuit, tell me this is all about them, and not about the child at all. The child is a tool for their agenda, IMO. I think they both need extensive counseling to help them deal with all of the issues of effectively parenting this child. For the child’s sake, I hope they are getting help from mainstream, ethical providers, and not fringe activists.

I don’t agree with this lawsuit at all, and I think it’s damaging for the child, for them, for health care professionals, and for the care and acceptance of all of these kids and adults with intersex conditions.

These unfortunate kids will always have gender identity issues, because of their unique birth defects—and IMO, we are disingenuous to ever assume or think otherwise. That said, even the most strident “remove-no-tissue activists” do not advocate raising a child with an intersex condition in a neutral “third gender”. A child with both male and female genitals (inside and out), who has chromosomal mosaicism, really should be assigned a gender at birth (including doing what is needed medically and surgically). To not do so would be unethically cruel and abusive, IMO.

These kids ALSO deserve a compassionate CHANCE to assimilate, grow up, and be considered ONE gender, just like everyone else born with one gender. They shouldn't be forced to make their birth defect the centerpiece of their life-- it's not a hobby, even if their parents are activists. I think we also have to be exquisitely careful to evaluate the true motivations of adoptive parents, so that we don't place kids with activists who are "collecting" kids with certain conditions, to bolster their own crusades.

These kids should not be “forced” to be a third gender until late childhood or adulthood, or forced to share their gender situation with everyone they meet (nor should their parents divulge that private info to just anyone.) The child should not be encouraged, persuaded, or forced to consider themselves “gender queer” either, IMO-- unless they want to identify this way when they are much older. It will soon become obvious which gender the child identifies with (as in admirable kids like Jazz), and then the child can be supported in the gender they choose.

If they identify as the opposite gender later on than the one they were assigned as a result of medical diagnosis and decision making for their birth defect, then we all just deal with it as we would for any other child that is transgendered, whose genitals don't match their self concept of their gender.

(I hope I explained my thinking!)

THANK YOU!!!!!! :greatpost: I totally agree that the child should not be forced to live as a 'third' gender. They should be allowed to have a life beyond this medical issue. JMO

 

[Donjeta]

If they identify as the opposite gender later on than the one they were assigned as a result of medical diagnosis and decision making for their birth defect, then we all just deal with it as we would for any other child that is transgendered, whose genitals don't match their self concept of their gender.

(I hope I explained my thinking!)

I don't view this child as similar to any other transgendered transgendered really. It's not a case of a biological female whose self concept does not match her genitalia and it was no one's fault. It's a case of a intersex child whose self concept used to match some of his genitalia and who was first considered male when he was born . The reason his male identification is now "the opposite gender" is purely iatrogenic, because the doctors had a female bias and chose to lop off his male parts.

Gender dysphoria is a diagnosis that indicates the child somehow fails to conform with the proper biology but it's not the child who got things wrong here, it was the doctors. He probably had a "male brain" all along and does not imo become transgendered because the doctors made a wrong call and cut off the wrong bits.

 

[K_Z]

I wanted to leave this link here for reference. This is the ruling from Jan 2015, dismissing the Crawford's Federal lawsuit. The current case is proceeding in South Carolina State court, and is scheduled for trial (I think) in November 2015. They first filed the Federal case back in 2013.

Federal case dismissal (16 pages, and an interesting read for why the comparison cases cited, such as a teenager who was surgically sterilized after being told incorrectly she had sickle cell anemia, were felt to be not applicable):

https://www.splcenter.org/sites/default/files/d6_legacy_files/downloads/case/crawford_decision.pdf

A few segments from the decision to dismiss:

The “salient question” before us is “whether the state of the law in [2006] gave [the defendants] fair warning that their alleged treatment of [M.C.] was unconstitutional.” Id. at 741. Because we find that the alleged rights at issue in this case were not clearly established at the time of M.C.’s 2006 sex assignment surgery, we need not reach the question of whether M.C. alleged sufficient facts to show that the surgery violated his constitutional rights. See, e.g., Pearson, 555 U.S. at 243-45.

In our view, the alleged right at issue is that of an infant to delay medically unnecessary sex assignment surgery. By “medically unnecessary,” we mean that no imminent threat to M.C.’s health or life required state officials to consent to the surgery, or doctors to perform it. Viewed in that light, we do not think that Casey, Skinner, or Avery put reasonable officials on notice that they were violating M.C.’s constitutional rights. As we have repeatedly emphasized, “officials are not liable for bad guesses in gray areas; they are liable for transgressing bright lines.” Maciariello v. Sumner, 973 F.2d 295, 298 (4th Cir. 1992). We hold that the defendants did not transgress such a bright line in this case.

Our core inquiry is whether a reasonable official in 2006 would have fair warning from then-existing precedent that performing sex assignment surgery on sixteen-month-old M.C. violated a clearly established constitutional right. In concluding that these officials did not have fair warning, we do not mean to diminish the severe harm that M.C. claims to have suffered. While M.C. may well have a remedy under state law,3 we hold that qualified immunity bars his federal constitutional claims because the defendants did not violate M.C.’s clearly established rights.

We therefore reverse the district court’s denial of the defendants’ motions to dismiss and remand with instructions to dismiss the complaint.

REVERSED AND REMANDED WITH INSTRUCTIONS
3 We have been advised that M.C. filed separate suits in state court asserting state law claims against the defendants.
Appeal: 13-2178 Doc: 92 Filed: 01/26/2015 Pg: 16 of 16

I think this link is also upthread, but including it again here because it has a lot of information about the case.

http://www.buzzfeed.com/azeenghorayshi/born-in-between

 

[cocomod]

I still contend that the doctors in this case had parental consent to perform this surgery. They did not perform a surgery that they could reasonable expect would cause injury to the child. They did not perform a surgery that was not a standard at the time. They went by their best "guess" because of the chromosomes in the baby; they didn't just "perform the easiest" surgery. Although performed at a later age, it was still a standard in their industry to perform this particular surgery on children with this condition.

What bothers me about this couple is that they say they had hoped that no surgery had been performed when they adopted the child; it sounds like they already had a bias. It also sounds like they would have sued if the doctors had chosen either way.

Again, I will say, I believe that their efforts and money would be better spent on education and prevention. Prevent further "injuries" to a child by either passing laws or educating the doctors and the public on their point of view. At this point, I think it is a personal point of view as to whether the surgery performed on babies causes emotional scarring. I think it would be hard for a child to be raised with this issue either way. They have two conflicting things going on with their bodies. Noone can be expected to understand something like that!

 

[al66pine]

....
What bothers me about this couple is that they say they had hoped that no surgery had been performed when they adopted the child; it sounds like they already had a bias. It also sounds like they would have sued if the doctors had chosen either way.
....

abbm sbm.
Agreeing w you. Pam stated "... that she and Mark would have sued regardless of whether M.C. had turned out to be a boy or a girl.”

* http://www.buzzfeed.com/azeenghorays...0be#.ju0vBrlKw Aug.5

 

[Margo/Mom]

I don't know that gender reassignment is covered under Medicaid, is it?

There are still a lot of whackaloons who vote who regard such things as perverse and balk at the notion of taxpayer dollars accommodating them.

 

[K_Z]

I still contend that the doctors in this case had parental consent to perform this surgery. They did not perform a surgery that they could reasonable expect would cause injury to the child. They did not perform a surgery that was not a standard at the time. They went by their best "guess" because of the chromosomes in the baby; they didn't just "perform the easiest" surgery. Although performed at a later age, it was still a standard in their industry to perform this particular surgery on children with this condition.

(Respectfully snipped for focus.)

I think there is a "social services" reason why the original surgery was not performed until the child was 16 months old. It sounds like the mother's parental rights were not terminated at the point in which the child entered foster care for neglect (approx. 3 months of age, until 17 or 18 months of age), and the bio mom and the social workers were both involved with making medical decisions for the infant. For 13 consecutive months, of his 16 months of life before the surgery, he was in foster care, but bio mom still had parental rights. (Surgery was in approx. April 2006.)

M.C. was born on Nov. 20, 2004, in a hospital in Greenville, South Carolina. Shortly afterward, South Carolina’s Department of Social Services started looking into possible neglect by his biological parents.

By February 2005, when M.C. was 3 months old, his biological father abandoned the family. Shortly after, the state of South Carolina determined that his mother was an unfit parent, and he was taken into state custody. Decisions about M.C.’s medical care from there on out were supposed to be made by social workers as well as his biological mother, whose parental rights had not yet been formally terminated.

M.C.’s biological mother signed the consent form, but according to the Crawfords’ lawyers, she attended only one of M.C.’s three medical appointments, hadn’t spoken to his physicians in two months, and missed his surgery. Social services signed off as well.

A psychiatrist by profession, Pam is forward and effusive; Mark a timid and self-deprecating stay-at-home dad to their five kids. They met in California in the ’90s, while Mark was studying law at Stanford University and Pam was in the Air Force, then moved to the South to start a big family.

After their first two children, the couple decided to adopt and to focus on kids with special needs. “I guess we felt pretty privileged,” Pam told me. “We were like, we have the means, we have the desire for a bigger family, and so we said maybe we should do this.”

They brought M.C. home at 20 months old.

That may have been a trial placement when they brought him home at 20 months-- foster to adopt; I'm not sure the Crawfords could have completed the adoption quite that fast.

The article says the Crawfords first saw the child on an adoption website when the child was 18 months old, so parental rights for bio mom were terminated somewhere between 16 and 18 months. Things were obviously not going well for the bio mom wanting to, or being able to parent this child-- she may have voluntarily surrendered her parental rights after the surgery, or maybe the court removed them. Either way, the bio mom definitely still had parental rights when she consented, along with social workers, to the surgery at 16 months.

The decisions about this child's surgery were clearly not rushed (or superficially considered), relative to MOST infants with these conditions back in 2006-- and I think that will ultimately be important during the State trial. There was a lot of time, and medical discussions, and social services involvement, over the 16 months of the child's life, before the decision for the surgery was made.

As I understand it, the Crawfords are currently suing for improper informed consent, among other things. I'm reluctant to think the courts will see things their way, but we'll see.

It's quite interesting to me that the adoptive mom is an MD psychiatrist-- she definitely *should* understand the issues surrounding care decisions and informed consent, as well as the issues of the social services involvement. So I find it rather odd that she is suing for those specific issues, when she knew this child's situation before they ever brought him home. Makes me wonder about her motivations/ personality-- JMO. I'm also bothered by the way the mother, in particular, has made this a high profile case. In their home area, it won't be a secret "who" the child is-- it just bothers me a whole lot that the mom (who is supposed to be a doctor and a mental health professional) has breached this child's privacy so egregiously.

 

[Margo/Mom]

I still contend that the doctors in this case had parental consent to perform this surgery. They did not perform a surgery that they could reasonable expect would cause injury to the child. They did not perform a surgery that was not a standard at the time. They went by their best "guess" because of the chromosomes in the baby; they didn't just "perform the easiest" surgery. Although performed at a later age, it was still a standard in their industry to perform this particular surgery on children with this condition.

What bothers me about this couple is that they say they had hoped that no surgery had been performed when they adopted the child; it sounds like they already had a bias. It also sounds like they would have sued if the doctors had chosen either way.

Again, I will say, I believe that their efforts and money would be better spent on education and prevention. Prevent further "injuries" to a child by either passing laws or educating the doctors and the public on their point of view. At this point, I think it is a personal point of view as to whether the surgery performed on babies causes emotional scarring. I think it would be hard for a child to be raised with this issue either way. They have two conflicting things going on with their bodies. Noone can be expected to understand something like that!

Bio mom's signature on a piece of paper is consent. That doesn't necessarily make it informed consent. And the fact that she did not have custody at the time raises a lot of questions in my mind--such as, was she competent?

I would love to sit on a jury for this case--there are lots of details that I would love to consider. As it is, I don't have a really strong inclination to make a judgment one way or the other.

 

[K_Z]

I don't know that gender reassignment is covered under Medicaid, is it?

There are still a lot of whackaloons who vote who regard such things as perverse and balk at the notion of taxpayer dollars accommodating them.

If this child and family opts for more medical treatment or surgery, I think it would be covered by either the mother's family medical policy, or Medicaid. The reason being that this child is not a typical gender reassignment-- this child had a major birth defect, that resulted in one gender being selected-- and a bunch of social issues that lead to TPR and subsequent adoption. I think a compelling justification can be made for whatever care the child needs now and in the future. (In fact, I think the argument to provide care for this child could be more compelling and more easily financially justified than for typical gender reassignment care-- JMO.)

The mother, BTW, should have really excellent health coverage. According to articles, she's a state employee psychiatrist at one of the SC state long term inpatient psych hospitals (mostly criminal commitments). The articles say the dad stays home with the 5 kids-- and 3 of the 5 are special needs. I'm guessing they have really comprehensive health coverage in their situation. They haven't said they are suing for money to cover medical needs for this child. I could be wrong, but I think this child probably has pretty good coverage for care now and in the future.

 

[SophieRose]

Bio mom's signature on a piece of paper is consent. That doesn't necessarily make it informed consent. And the fact that she did not have custody at the time raises a lot of questions in my mind--such as, was she competent?

I would love to sit on a jury for this case--there are lots of details that I would love to consider. As it is, I don't have a really strong inclination to make a judgment one way or the other.

You might be interested in reading the actual state complaint.

https://www.splcenter.org/sites/def...loads/case/Crawford_State_Complaint_Filed.pdf

 

[K_Z]

Thank you, Sophie Rose, for posting the State complaint, filed May 14, 2013.

After reading all 58 pages, I am more convinced than ever that this lawsuit is part of a mom parent "activist" with an ax to grind-- and wanting to use the justice system to further the cause-- when apparently she is unable to have influence on the medical community in her role as a psychiatrist physician. The mother, in particular, is using this child's sad and unfortunate situation (IMO!) to make a point. I would go so far as to say maybe this family was not a good match for this child's situation, since the child had already been treated surgically several months before the adoptive parents even expressed interest.

A few things that stood out to me:

BBM

Based on her familiarity with the negative effects of these surgeries, through the experience of a childhood friend, Mrs. Crawford called the agency and clearly expressed the family's desire not to subject M.C. to unnecessary sex assignment surgery. Unfortunately, the surgery had already been completed. Mr. and Mrs. Crawford gained custody of M.C. in August 2006, and legally adopted him on December 11, 2006.

https://www.splcenter.org/sites/def...loads/case/Crawford_State_Complaint_Filed.pdf

Three times in the complaint, the plaintiffs mentioned and criticized the absence of presenting M.C.'s case to a hospital ethics committee, as though that were somehow a standard procedure that was omitted. There was no ethical conflict, as the care discussed and planned was well within medically standard procedures, and there was no apparent disagreement on the part of SC social workers and the bio parent who still had rights of decision making. The fact that the adoptive parent/s have an ethical conflict with what was decided before they took custody and adopted M.C. is moot. Their disagreement does not equal medical malpractice, nor gross negligence (the 2 counts in the civil case).

The complaint also alleges that there should have been court hearings on the medical decisions for this child, related to the proposed sex assignment surgery. Why?? Many medical decisions (even permanent ones) for kids in foster care are made by the bio parent and social workers, in a team fashion with medical providers. The absence of a court hearing on the validity of the decision for sex assignment surgery is not evidence of anything-- there was no need or requirement for such. Imagine how clogged the court system would be if every significant medical decision for kids in foster care had to be brought to a hearing. That's just not at all how the decision making process works. And IMO, the mother clearly knows this.

The complaint also makes it VERY clear that this child's medical situation regarding gender assignment was VERY complicated, and not at all clear. The federal court weighed in on that, and I think that the state court will echo the same opinion. No one made a rushed or frivolous decision for this child's surgery-- the outcome of the child "choosing" the opposing gender was known, but a decision needed to be made. The Crawfords insist that the surgical decision could have been FURTHER delayed until some nebulous point in the future. There is not a shred of medical support for doing nothing in 2006-- and volumes of literature advocating the definitive choice of a gender for BOTH rearing, and surgical re-assignment. If the literature and researched practice is WRONG, as Mrs. Crawford believes, she needs to demonstrate that scientifically. Otherwise, it's just her opinion, against the body of literature, and many successful outcomes, that says otherwise.

I am beginning to think that the Crawfords should not have been approved to parent or adopt this child-- knowing the mother's MD Psychiatrist, background, as well as her strong opposition to the medically standard care the infant M.C. had ALREADY received.

This child's situation had become a "cause" for the mother, before she ever even heard of M.C. As I posted upthread, it is an exquisitely difficult and critical situation for everyone involved in the adoption system to make sure prospective adoptive parents with a substantial knowledge and interest in *certain* medical conditions, are not adopting kids with those conditions to further their own activism or causes. Sadly, I think this is exactly what happened here. The mother admitted a bias that was formed far before she ever met M.C., and then embraced that bias as "advocacy" in her adoption of this child, and the lawsuits. (filed with the help of the southern Poverty Law Center.)

That the mom was a USAF veteran, and an MD, and a psychiatrist, and already had special needs kids, and had a law school educated stay at home husband, helped push the adoption along quickly, IMO.

I'm feeling really sad for this child, who appears more and more to be a tool for the mother's interests and efforts at a specific agenda she could not influence thru her status and career as a physician and mental health professional.

I'm increasingly doubtful that this state case will be decided in favor of the plaintiff.

 

[Nova]

So in that case, ALL intersex children would go through their social teen years having two genders represented by dual sexual organs? That sounds very difficult for anyone to endure, imo. I would rather have only one gender and then if I thought it was the wrong one, I would reassign, if necessary. JMO

You have a point, which is why it is common nowadays to allow prepubescent children (after much counseling) to take hormones at ages that surprise most of us. An intersex child could still make his/her own decision, even if s/he did so at 10 or 12; it isn't an either/or choice of birth or adulthood.

(Sorry, Katy. You said EXACTLY the same thing in a later post. I should have known.)

 

[Nova]

Adolescence is hard for everyone, especially those who are different or don't fit into one of our neat and tidy cultural boxes. But I think our culture should change to accept intersex children instead of the other way around.

http://www.pbs.org/wgbh/nova/body/intersexual-life.html

I might agree if social pressure were the only issue. But I believe there are physiological reasons to assign sex earlier rather than later, even if social acceptance isn't an issue.