The historic settlement agreement between Texas Children’s Hospital, the U.S. Department of Justice (DOJ), and the state of Texas has been fully executed, Texas Attorney General Ken Paxton said this week.
Under the terms of the settlement agreement, first announced by Paxton’s office in May, Texas Children’s, the largest children’s hospital in the United States, said it would no longer provide “gender-transition” interventions, including puberty blockers and cross-sex hormones, to minors, per Texas law.
“This historic settlement is a resounding defeat for the radical gender ideology that has preyed on Texas children under the guise of ‘care,’” Paxton said in a press release Aug. 5.
Per the executed agreement, Texas Children’s “will pay a total of $10 million to resolve these claims,” with $8,576,000 going to the state of Texas. It will also fund, for five years, a detransition clinic offering free restorative medical care to patients who previously underwent such procedures. The clinic must open by the end of October.
“Texas Children’s has agreed to pay millions back to Texas,” Paxton said. “The detransition clinic, which is the first of its kind, must open within months. Activist doctors who harmed children have been fired.”
The agreement also required the permanent termination and revocation of privileges for five physicians who performed these interventions.
The hospital is permanently barred from rehiring or credentialing the doctors and must implement new compliance measures, including bylaw changes that will automatically revoke privileges for any physician who violates Texas law prohibiting such procedures on children.
“This settlement sends an unmistakable message,” Paxton said. “If you put radical ideology over childrenʼs health, my office will go after you. We will continue to lead the way in stopping the far-left’s radical gender agenda.”
The settlement agreement resolves a yearslong investigation of the hospital by the DOJ and the state of Texas that began after whistleblower allegations surfaced claiming the hospital had continued performing sex-change procedures on minors in secret even after state lawmakers made such procedures illegal.
The Justice Department said in May that the Houston-based hospital had agreed to pay millions in civil penalties and damages for allegedly falsely billing Medicaid and other insurers for “pediatric sex-rejecting procedures.”
The federal government had alleged that the hospital violated the Federal Food, Drug, and Cosmetic Act, the False Claims Act, and federal fraud and conspiracy laws.
Following the publication of a directive by Texas Gov. Greg Abbott that transgender procedures on minors that could be considered “child abuse” under existing state law, Texas Children’s announced in 2022 that it would cease “sex-change” therapies and procedures, citing concerns that these practices were potentially illegal.
In 2023 Texas passed a law that explicitly banned puberty blockers, cross-sex hormones, and gender-transition surgeries for minors under 18.
Nevertheless, at least three doctors associated with Texas Children’s — Richard Roberts, David Paul, and Kristy Rialon — continued to perform “sex-rejecting” procedures on children throughout 2022 and 2023, according to whistleblower evidence published by Christopher Rufo, a fellow at the Manhattan Institute.
Rufo claimed that Rialon had been performing surgeries on minors ranging in age from 15 to as young as 1.
Calling the settlement “historic,” Paxton said in May that it “will ensure that the deranged child mutilators who hurt our kids are fired and held accountable.”
According to Acting Attorney General Todd Blanche, the DOJ “will use every weapon at its disposal to end the destructive and discredited practice of so-called ‘gender-affirming care’ for children.”
The Department of Justice noted that Texas Children’s cooperated with the investigation and took proactive steps that contributed to the resolution. The claims resolved in the settlement remain allegations, with no determination of liability.
“I am grateful that Texas Children’s wants to be part of the solution and no longer the problem,” said Brett Shumate, assistant attorney general for the Civil Division.
