Washington University in St. Louis said a former employee’s allegations that its pediatric and adolescent transgender clinic did not appropriately assess minors before providing them with care are unsubstantiated, according to the findings of an internal investigation released Friday.
In February, Missouri Attorney General Andrew Bailey launched an investigation into the Transgender Center at the St. Louis Children’s Hospital after Jamie Reed, who was a case worker at the center from 2018 to November 2022, alleged in a 23-page affidavit that children were being routinely prescribed puberty blockers or hormone therapy without “appropriate or accurate” mental health assessments. Bailey’s investigation is ongoing.
Reed also alleged that the center’s providers “regularly refer minors for gender transition surgery,” even though providers have testified at the state Legislature that operations are not an option for anyone under 18.
On the same day the attorney general’s office announced its investigation, Reed went public with her allegations in an op-ed published in The Free Press, a news website started by Bari Weiss, a former op-ed writer and editor at The New York Times. Reed, who has a master’s degree in clinical research management, concluded her op-ed by calling for a “moratorium on the hormonal and surgical treatment of young people with gender dysphoria.”
Washington University in St. Louis, the parent institution of the Children’s Hospital, said in a statement that it was “alarmed by the allegations” and would look into Reed’s claims.
After an eight-week internal investigation, the university said in a summary of its findings that her allegations are unsubstantiated but that it would be changing some of its practices.
“Washington University physicians and staff at the Center follow appropriate policies and procedures and treat patients according to the currently accepted standard of care, as recommended by the American Academy of Pediatrics and other nationally recognized organizations,” the university said in the summary.
In her affidavit, Reed alleged patients were routinely provided medication “without informed parental consent.” She also alleged that the center did not obtain custody agreements from divorced parents to ensure all parties consented to treatment.
Though the university does not mention these allegations in the investigation summary, it said that, going forward, the Transgender Center will require written consent from parents prior to prescribing gender-affirming medications, such as puberty blockers and hormone therapy. Previously, providers obtained verbal parental consent for treatment and documented it in the patient’s medical record, according to the summary.
The center will also require a family to provide custody agreements before an initial visit at the center if the patient is a minor, the summary said. Previously, providers would ask for custody agreements “before medical intervention in cases where decision-making authority was in question.”
Reed’s attorneys, Vernadette Broyles and Ernest G. Trakas, said in a statement on her behalf that the university did not interview Reed for its internal investigation. They also said the university “acknowledges the validity of several of Ms. Reed’s allegations,” including that the center didn’t obtain written informed consent from parents or custody agreements.
Regarding Reed’s allegations about surgery referrals, the university said the center hasn’t provided such referrals for patients under 18 since late 2018, when it adopted a policy prohibiting them.
“Upon request, some families were provided with the names of surgeons (including Washington University physicians) who provided such surgeries, and the Center’s providers have provided summaries of care for patients desiring surgical interventions,” the university said in the investigation summary.
The university said that physicians will no longer perform gender-affirming operations on minors. Washington University declined to say when it adopted this policy.
The university said a total of six operations were performed on minors by university physicians since 2018, and that all six were chest operations for adolescents transitioning to male. The referrals were all from other medical providers outside of the center or were patient-initiated self-referrals, the university said.
It noted that chest masculinization surgery for minors is within the standard of care recommended by the World Professional Association for Transgender Health, or WPATH, a nonprofit association dedicated to transgender medical care. WPATH’s standards, which were recently updated last year, recommend minors meet a list of criteria before they can be eligible for surgery.
Reed's attorneys criticized the center's use of WPATH's standards, which they said are not standards of care "in the ethical or legal sense."
"WPATH is an advocacy organization whose publications rely very little on the emerging international evidence and much more on the idea that trans health care is about the right to embodiment of cosmetic goals on demand," Reed's attorneys said. "The newest WPATH publication even contains a chapter on the rights of those of the eunuch gender. It seems clear that reasonable people would have caution in providing unquestioning affirmation to children and teens, but neither WPATH nor the Center clinic does this."
Two former employees of the center said it uses rigorous standards of care.
Jess Jones, who uses they/them pronouns and was an education liaison at the center from 2018 to 2020, shared a variety of documents regarding the center’s protocols, including documents that they said were provided to every family at their first visit, an endocrine “roadmap” that outlined steps patients had to complete to start gender-affirming treatment, and internal documents with hypothetical patient cases that the center used for teaching.
Christine Hyman, whose son has been a patient at the center since 2018, shared emails she received from Reed following her son’s appointments. The email includes one of the same documents Jones shared about masculinizing hormones. It details when a patient should freeze their eggs if they are interested in doing so and a chart on the various effects of testosterone and whether they are reversible, partially reversible or irreversible.
“They’re just a wealth of information,” Hyman said of the clinic’s doctors. “They’ve been fabulous the whole way through, especially with a parent who walked in, and I was like, ‘Help.’”
Jones said the center would sometimes “gatekeep” access to care, “which is why Jamie’s account was so appalling.”
“She made it sound like we were just handing out hormones left and right to kids,” Jones said, when in reality Jones said minors had to meet a number of criteria before they could access care.
The center declined to comment.
Cate Hensley, who uses “they” and “she” pronouns and worked at the center from August 2020 to May 2021 as part of getting their master’s in social work at Washington University, said they reported directly to Reed. They said Reed “frequently interpreted kids’ experiences as being exaggerated or not being truthful,” which was troubling to Hensley, who said that was “antithetical” to their clinical mental health training.
They said what stood out to them the most in Reed’s affidavit and op-ed was how she violated the trust of patients who did not consent to having their private health information publicly shared. They said they could identify some of the cases Reed described in her affidavit, but that Reed misunderstood or misinterpreted them.
For example, Hensley said they remember the medical team discussing a situation Reed describes in her affidavit in which a patient experienced vaginal lacerations after having sex while on testosterone, which can cause thinning of the vaginal tissue, but Hensley didn’t want to discuss it in detail because it is private patient information. They said Reed also described a child who said they identify as an “attack helicopter,” which Hensley said was a joke and is a reference to an internet meme and sci-fi story.
Hensley said the legislative landscape in Missouri, where the Republican-led House passed a bill last week that would ban gender-affirming care for minors, makes Reed’s allegations “more insidious.”
“It’s more important than ever that the center is able to continue running and provide ethical client-centered care, and what Jamie has done is not grounded in any evidence, is absolutely fueling transphobia and hate here in the state, and will directly harm kids,” Hensley said.