A Minnesota mom filed a lawsuit Wednesday against her 17-year-old transgender daughter, along with county health boards, a school district and local health care nonprofits.
"It was brought to my knowledge that my son (sic) began receiving hormone replacement treatments from Park Nicollet Health Services to transition from male to female, with medical assistance paying for this," Anmarie Calgaro told reporters in a St. Paul, Minnesota court. "I was not consulted or informed about this in any way."
In a video of the press conference posted to Facebook, Calgaro and attorney Erick Kaardal repeatedly refer to the teen in question as male—despite a doctor's letter included in the complaint that states the teen "has had appropriate, permanent clinical treatment for transition to the new female gender."
Calgaro's lawsuit challenges a Minnesota law that allows minors to access medical care and procedures without the consent of their parents.
"Medical service providers determine whether a teenage child is emancipated," Kaardal said at Wednesday's press conference, adding that this allows minors to receive "elective, non-emergency medical procedure(s)."
Minnesota does not have a legal process for the emancipation of minors. But the law makes it clear that minors who aren't living at home are essentially considered adults when it comes to medical care: "Any minor who is living separate and apart from parents ... and who is managing personal financial affairs, regardless of the source or extent of the minor's income, may give effective consent to personal medical, dental, mental and other health services, and the consent of no other person is required."
NBC OUT was not able to track down the minor for comment. But notably, the emancipation statement included in the complaint—which the teen created along with Mid-Minnesota Legal Aid in June 2015—states that "mother has made it known to him that she no longer wishes to have any contact with him," "knows where he is and has made no attempts to bring him home," and "has taken no actions to report him as a runaway or taken legal action to keep him in her home."
The emancipation notice was filed in Stearns County District Court in October 2015. But Calgaro disputed the claims about her relationship with her child, and expressed frustration that she was left out of the teen's subsequent health care decisions.
Also included in the complaint was a doctor's letter dated January 2016 that stated the teen had undergone gender transition treatment and should be issued new identity documents with female gender markers.
"The news that county agencies and health service providers, the school and other county and state offices were completely bypassing me came as a total shock," Calgaro said while beginning to cry. "Why wasn't I even notified?"
Potential Impact on Abortion Law
Kaardal is not the only attorney on the case. Calgaro is also being represented by an anti-abortion law firm called the Thomas More Society. The firm is also currently defending David Daleiden, the anti-abortion activist who was indicted by a Texas grand jury in January for buying and selling human organs in an attempt to frame Planned Parenthood. While Thomas More Society's other cases include fights against insurance coverage of birth control and trying to block an Illinois transgender high school student from accessing the girls bathroom at school, the majority of the firm's cases are geared toward fighting abortion.
Minnesota's statute that allows minors to make their own medical decisions is echoed in the state's parental notification law regarding abortion. According to Minnesota statute 144.343, no non-emancipated minor may access an abortion procedure until 48 hours after parents have been notified that the procedure will take place.
It is unclear whether the Thomas More Society is using Calgaro's case as a backdoor fight against the abortion law—after all, a minor could ostensibly declare herself emancipated in order to get around the parental notification—nonetheless, the legislative connection is impossible to ignore.
Transgender Teen Healthcare
While the Thomas More Society's press release refers to a "life-changing operation" undergone by the teen, the vast majority of transgender people don't have surgery until after age 18—if they have surgery at all.
"Surgery is highly unlikely before 18," said Jamison Green, a former president of the World Professional Association for Transgender Health (WPATH), the standard bearer for transgender health care policy.
Green noted that the teen in question has likely only been on hormone therapy for a year or less. And, he said, "In most cases, it's best to be on hormones for at least a year before surgery."
"Doctors are going to monitor the effects of the hormones and the psychological development the patient goes through," Green said. "And at a certain point, the doctors will determine when surgery is an option. In the case of male-to-female transition, you want to see how much breast growth occurs before you do anything to modify the chest."
For most trans youth, the process of gender-affirming treatment begins with psychological care. Green told NBC OUT that with most transgender teens being at higher risk for self-harm and suicide, receiving support for the identified gender is the first step.
"The clinic may just be doing harm reduction: getting them started in a way that supports their identity," Green added. "If the teen is presenting as female, name-change documents are very important. They reduce anxiety and exposure to certain kinds of violence that are preventable when you show people your ID."
Green doesn't live in Minnesota, so he couldn't speak with authority on local law and policy. But Phil Duran, the Legal Director at OutFront Minnesota, told NBC OUT the lawsuit's allegations were perplexing at best.
"At 17 years old, a trans girl is at best going to get access to counseling and hormones," Duran said. "There's reference in the press release to a surgery or operation. It would be incredibly unlikely—vanishingly unlikely—that a minor would get access to surgery."
The lawsuit's references to emancipation also struck OutFront's Duran as confusing—especially because the state law does not employ the term at all. Instead, it simply allows for minors who are living on their own to make their own medical decisions.
"There's no evidence that this kid is legally emancipated," Duran said. "It's a head scratcher as to what [Calgaro] expects the court to do to reverse a decision that was never made."
The lawsuit asserts that Calgaro's parental rights are stripped by the law, and also that her constitutional right to due process is violated.
"If there had been a court order of emancipation, then Anmarie would have received notice and an opportunity to be heard," attorney Kaardal said at the Wednesday press conference.
But if Calgaro's lawsuit—which again, names her own teenage daughter as a defendant—is successful, approximately 6,580 transgender and gender non-conforming (GNC) high school students in the state of Minnesota could encounter more obstacles to the care that experts say they desperately need.
Minnesota's Trans and Gender Non-Conforming Youth
The estimate of 6,580 trans and GNC teens attending high school comes from the Minnesota Department of Education's 2016 Minnesota Student Survey—which this year included questions about gender identity for the first time. Responding to a question about whether they identify as "transgender, genderqueer, genderfluid, or unsure about your gender identity," 2.5 percent of high school students answered 'yes.' With the state's Department of Education data offering a total of 263,238 9-12 graders, that means nearly 7,000 fall somewhere on the gender non-conforming spectrum.
David Edwards has encountered quite a few of those teens in his leadership role with Transforming Families, a community-led group that "supports parents of gender-diverse kids." Edwards also knows firsthand what it's like to grapple with the challenges of raising a transgender child: He and his wife filed a complaint with the St. Paul Human Rights Department after other parents protested their trans child's attendance at a local kindergarten.
At Transforming Families, Edwards said, "Our families come from a wide variety of backgrounds and come into our group from vastly different places in terms of acceptance and support for their kids."
Parents are often resistant at first, but Edwards said that when they learn about the mental health risks faced by transgender youth, "they usually end up making the choice to do what's best for their kid."
At the press conference on Wednesday, Calgaro—along with attorneys—repeatedly referred to her child as "my son," using male pronouns exclusively to describe the teen despite the lawsuit including a doctor's statement asserting the teen's legal status as female. That raised Edwards' hackles.
"Purposefully mis-gendering a transgender person is an act of violence. To continually do that to your child is not only insensitive but also really harmful," said Edwards, who added that 38 percent of the trans and GNC teen survey respondents said they had attempted suicide.
Parenting Through the Courts
At the press conference, Calgaro told reporters that "The transitioning thing isn't even the issue, the issue is that he's able to make these [medical] decisions." What Calgaro said she wants is for parents to be notified and included in their minor children's medical decisions.
But OutFront's Duran said that independently accessed transition-related care hasn't been an issue for most Minnesota parents, and "making medical decisions on your own is not the same as emancipation."
"I think mom is grasping at straws," Duran told NBC OUT, "and trying to construe the kid's decision as a state-imposed violation of her constitutional rights."
According to documents included in the lawsuit, Calgaro's daughter turns 18 next July, meaning that the case will not be relevant to the family for long. But it could inspire more parents to try to oppose their transgender children in court—a terrifying prospect for LGBTQ youth, many of whom already struggle with acceptance at home.
"It's unfortunate that this mom is choosing to parent through the legal system," Edwards said. "That doesn't seem productive at all."
But Calgaro, talking to reporters on Wednesday, suggested that her case is bigger than her family alone: "I'm also taking this action for the benefit of all parents and families, who may be facing the same violation of their rights—so that they and others in the future may be spared from the same tragic events."