Federal judge halts Indiana from enforcing ban on care for trans minors

The order enjoins the state from enforcing new puberty blocker or hormone bans, as well as a ban on "aiding and abetting" others in providing gender-affirming medical care for trans children.

A federal judge issued a preliminary injunction Friday afternoon halting Indiana from enforcing key aspects of the state’s new ban on gender-affirming medical care for minors — the fourth such law to face a ruling that it is likely unconstitutional.

The lawsuit against Indiana’s law, S.B. 480 in the legislature, was filed by the ACLU and ACLU of Indiana hours after the state’s Republican governor signed it into law in April. The new law is set to go into effect on July 1.

On Friday, however, U.S. District Judge James Patrick Hanlon — a Trump appointee — enjoined the state from enforcing the law’s bans on puberty blockers and hormones as treatment, as well as the law’s ban on “aiding or abetting another physician or practitioner in the provision of gender transition procedures to a minor.”

Along with the injunction itself, Hanlon also issued a 34-page opinion explaining his reasoning that followed a hearing that took place earlier this week in the case.

In the opinion, he concluded that “when the State's interests are weighed against the likelihood that Plaintiffs will be able to show that S.E.A. 480 would violate their constitutional rights and the risk of irreparable harm, Plaintiffs are entitled to a preliminary injunction.”

The constitutional provisions that Hanlon found the law likely violates are equal protection guarantees — as to the gender-affirming care ban — and the First Amendment — as to the aiding and abetting ban.

Because of that, Hanlon wrote, “while this case is pending, Defendants may not enforce S.E.A. 480's prohibitions on (1) providing gender transition procedures for minors except gender reassignment surgery and (2) speech that would aid or abet gender transition procedures for minors.”

The surgery ban was not enjoined, Hanlon explained, because the plaintiffs “lack standing to challenge that ban because gender reassignment surgeries are not provided to minors in Indiana.” As he detailed later, citing evidence provided by the parties, “in Indiana no ‘provider performs gender-transition surgery on persons under the age of 18.’”

In his equal protection ruling, Hanlon first found that Indiana’s bans on puberty blockers and hormones for treatment of gender dysphoria are sex-based classifications.

After describing how sex-based classifications are “central” to the law, he concluded, “At bottom, sex-based classifications are not just present in S.E.A. 480's prohibitions; they're determinative.”

He then applied the heightened scrutiny that sex-based classifications receive to Indiana’s law, finding that the “proffered state interests” — “protecting the wellbeing of minors and regulating the medical profession” — “are legitimate.” But, he continued, more is needed.

[H]eightened scrutiny requires a "close means–end fit," so it's not enough for the State's interests to justify some regulation of gender transition procedures for minors. Instead, the State's interests must justify S.E.A. 480's prohibition of gender transition procedures for minors.

But, the law “categorically bans the use of puberty blockers and hormone therapy for gender transition for minors,” Hanlon wrote, despite the plaintiffs’ evidence “of risks to minors’ health and wellbeing from gender dysphoria if those treatments can no longer be provided to minors.”

So, while the State has identified legitimate reasons for regulation in this area, the designated evidence does not demonstrate, at least at this stage, that the extent of its regulation was closely tailored to uphold those interests. Plaintiffs therefore have shown some likelihood of success on the merits of their equal protection claim.

Hanlon also concluded that there is evidence that the state could have taken less restrictive action, writing, “Most detrimental to Defendants' position is that no European country that has conducted a systematic review responded with a ban on the use of puberty blockers and cross-sex hormone therapy as S.E.A. 480 would.”

In sum, in light of all that, Hanlon found that plaintiffs showed “some likelihood of success” on their equal protection claim.

As to the aiding and abetting provision, Hanlon quickly found that plaintiffs justified the granting of a preliminary injunction on First Amendment grounds, writing that the provision “appears to burden speech ‘on its face and in its practical operation’ because ‘aiding and abetting’ directly prohibits referrals and collaboration among medical providers” — triggering heightened scrutiny yet again.

“Section 13(b) singles out medical providers and only one category of medical treatment—gender transition procedures,” he wrote.

Because of those findings, for purposes of the preliminary injunction, he wrote that he did not need to address parental rights, Medicaid, or Affordable Care Act claims raised by the plaintiffs.

Notably, Hanlon also made absolutely clear that his ruling applied to everyone — writing that he had the authority, while the plaintiffs’ request to make the lawsuit a class action is pending, to “prohibit[] Defendants from enforcing the enjoined portions of S.E.A. 480 against any provider, as to any minor.”

This is the fourth state ban on gender-affirming medical care for minors to have substantial portions blocked in court, following an injunction in Florida earlier this month and prior orders in cases addressing bans in Arkansas and Alabama. Additionally, Oklahoma’s attorney general has agreed not to enforce his state’s ban while preliminary injunction litigation is ongoing.

This breaking news report was updated and expanded after initial publication, with the final update at 7:30 p.m.