Texas children's clinic loses doctors amid gender-affirming care inquiry
Earlier this month, Marenna Crawford, 17, went to prom wearing a red, corsetted dress with off-the-shoulder sleeves and a long train. The same weekend, the Round Rock, Texas, senior also learned that her health care team at Dell Children's Medical Center in Austin no longer works there.
Marenna was 6 months old the first time she was diagnosed with kidney cancer and 3 years old the second time.
Her treatment included radiation to shrink the cancer to her abdomen. A side effect was that it could cause premature menopause if she didn't have hormone replacements.
Her father Tom Crawford, said he got a call Friday, May 12, from the Dell Children's Adolescent Medicine clinic to notify him that all the doctors at the clinic were leaving. The family would have to get care for her elsewhere, he said.
A second call confirmed that there were "no doctors in the clinic," a statement the staff confirmed for the Austin American-Statesman, part of the Paste BN Network, on May 12.
Dell Children's Medical Center has been Marenna's medical care home since 2014, when the Crawfords moved from Houston to Central Texas. Though Marenna is two weeks from turning 18 and can go to a doctor for adults instead, Dell Children's has her medical history and had her trust.
"I had a very good, stable doctor already," Marenna said. "Having this taken away by one random call on a Friday was definitely startling."
Her mother, the Rev. Joanna Fontaine Crawford, posted her dismay on a TikTok video that went viral.
The Dell Children's Adolescent Medicine clinic served anyone who was transitioning from pediatric to adult care and needed a teen specialist. It also saw transgender people, patients with eating disorders, teens with puberty-related disorders and those with related anxiety and depression. It provided general medicine for youths up to age 21 and a continuum of care for people older than 21.
On Friday, Dell Children's removed the names of all the doctors practicing at that clinic from its website.
On Saturday, the hospital released this statement:
"Dell Children’s Medical Group Adolescent Medicine clinic has not closed. We are working with our staff, families, and other providers to ensure our patients’ safety and make sure we are helping families connect with the appropriate healthcare services. While the physicians who previously staffed the clinic will be departing, the clinic remains open and supported by other physicians within Dell Children’s Medical Group. We continue to be advocates for the best possible care and treatment for children in Central Texas."
It did not say how many doctors were "departing."
The Statesman tried to reach some of the affected physicians but did not receive responses.
Recently, the doctors had come under scrutiny from Texas Attorney General Ken Paxton, U.S. Senator Ted Cruz and U.S. Rep. Chip Roy for providing transgender care to minors.
"Whether they were fired or left because this is untenable, I don't blame them," said social worker and nurse practitioner Kerry Miller, who has referred patients to the clinic from her private practice. "This environment, it's dangerous."
The clinic has been calling its patients since May 5 to let them know their appointments are canceled, and it has been giving patients a list of other clinics where they can seek care.
Some of the patients first heard about the clinic lacking doctors after Joanna Crawford released her TikTok video, sparking outrage on Twitter.
Why are there no doctors at the clinic?
On May 5, Paxton announced that he was launching an investigation into Dell Children's for providing gender-affirming care to minors, which will become illegal in Texas if current bills going through the Legislature pass. The bills are expected to be signed into law by Gov. Abbott. The session ends May 29.
As part of that investigation, Dell Children's was told by Paxton to produce any documents related to prescribing puberty blockers and gender-affirming care counseling. Documents requested include policies and procedures, parental consent forms and forms that would identify patients.
Health Insurance Portability and Accountability Act rules to protect patient privacy can be trumped by a court order or subpoena, the U.S. Department of Health and Human Services says in its HIPPA guide, but the health care entity has to notify the patient and allow the person time to object to the disclosure or seek a court order to prevent it.
The spotlight on Dell Children's began before the Paxton investigation.
On April 25, Cruz and Roy sent a letter to Dr. Leah Harris, Dell Children's interim president; Andy Davis, Ascension Texas' president and CEO; and Dr. Claudia Lucchinetti, the University of Texas Dell Medical School's dean.
The Statesman obtained a copy of the letter from Cruz's office. It named a licensed social worker at Dell Children's who provided evidence that "your organization 'transitions' children as young as eight and nine years old" and that "young children could begin taking life-changing hormones as soon as after the first appointment."
The letter continues: "We, along with millions of Texans, find it deeply concerning that DCMC is providing experimental, unproven and dangerous medical procedures to young children."
The letter also asked the hospital to answer how many minors Dell Children's has treated for gender dysphoria, a medical term for the sense that a person's body doesn't match their gender identity. Cruz and Roy also wanted to know how many federal dollars Dell Children's used to treat gender dysphoria and the financial benefit to Dell Children's for providing such care.
What will happen to patient care now?
Dell Children's said it is keeping the clinic open but sending patients to seek care elsewhere.
It is not clear which doctors will cover the clinic and when they will start. It's also not clear what will happen to the residents who work in the clinic and need to be supervised by a physician who is board certified to treat adolescents in order to get that training.
Dell Children's did not respond to a request for answers to these and other questions.
Affecting the transgender community
Jacqueline Murphy, 22, had been seeing the adolescent medicine team since she was 16. When the clinic called her May 5, she thought it would no longer provide the gender-affirming care and hormone replacement therapy she was receiving. A second call May 9 confirmed that she no longer had a primary care team there.
"I've had a lot of ups and downs during my time with them," she said. "They've always had an extremely empathetic and professional model."
When she sought care as a 16-year-old, it was with her parents' support and consent.
The clinic, she said, "had a very in-depth process in determining what was right for me and what was the best way to go about it," she said. "It resulted in care that saved my life."
In addition to gender dysphoria, she was struggling with depression. If she had been forced to experience her voice lowering and getting facial hair, she said, "it would have crushed me in a way that is almost hard to describe."
Because she is an adult, she can find care elsewhere, but she will have to spend time vetting those clinics to make sure they are skilled in treating and supporting transgender people.
Iona Bates, 21, began seeing the team about 18 months ago for gender-affirming care. When she got the call from the clinic last week, "I was a bit shocked."
The staff, she said, "used the term 'parting ways.' That sounds like corporate speak for 'got fired.’ ”
Before the doctors left, they were able to prescribe her a year's worth of estrogen.
The hormones, she said, made her "a lot happier. I felt better about myself."
As an adult, she said she doesn't feel safe to seek care in Texas.
Some families who were cared for by the clinic have moved, including Healther Crawford and her son Cass, who left last summer for Minnesota, which has safe harbor laws to support transgender children. "I knew this legislative session was going to be a disaster," she said. "We had to get somewhere safe where Cass can live their life."
Cass was 12 when he told her he was transgender. He had gender dysphoria, particularly around his period. The adolescent care team helped him suppress his period with birth control.
"That saved their life," she said of Cass, now 16.
Not just gender care
Elizabeth Doyle, 25, a patient at the clinic since 2021, was supposed to have an appointment Tuesday with the Adolescent Medical Team, which cares for her, but when she checked her medical portal to find her appointment, it was gone. She has called the clinic and left a message.
"The whole thing is really devastating for the eating disorder community," she said of learning that she no longer has a medical team. "These people were able to care for my whole body, my whole self. It's going to be extraordinarily difficult to replace that."
For health care professionals who work with people with eating disorders, the loss of these doctors is having a huge effect on their patients.
"Eating disorders affect every system of the body," Miller said. "You need someone who knows what it means when their electrolytes are off or when their phosphorus is off. That is a sign we need to hospitalize someone because their heart is going to go out."
She said of herself and colleagues who used the clinic as a place to refer patients or to consult on patients, "We're scrambling. I don't know where to send them. I don't feel comfortable recommending them to someone we don't know who could do them harm."
That sentiment is echoed by Tina Laboy, a dietitian who owns TLB Nutrition Therapy, which has 10 providers.
The clients in her practice were calling nonstop last week, worried about where they will go.
Without having another trusted clinic, she is going to have to teach all of her patients about self-advocacy and send them with information to give a doctor about eating disorders.
"We might not be getting a crucial piece of their care, which is labs or weights or vitals," she said. "It's the client who suffers.
"This is life-altering," Laboy said.