Providers Should Take Care in Evaluating Overreaching Federal Subpoenas Concerning Gender-Affirming Care Records

On September 9, 2025, Judge Myong J. Joun of the U.S. District Court for the District of Massachusetts granted Boston Children’s Hospital’s (“BCH”) motion to quash an administrative subpoena served by the Department of Justice (“DOJ”). Memorandum of Decision, In re Administrative Subpoena, No. 1:25-mc-91324-MJJ (D. Mass. Sept. 9, 2025).

Background

BCH is one of the nation’s leading pediatric hospitals and home to the first pediatric and adolescent transgender health program in the United States. The hospital provides comprehensive gender-affirming care, including medical and psychological assessments, ongoing treatment, and support services. In Massachusetts, access to gender-affirming health care is expressly protected by state law and recognized as a constitutional right. Mass. Gen. Laws ch. 12, § 11I ½(b) (“[a]ccess to … gender-affirming health care services is a right secured by the constitution and laws of the commonwealth. Interference with this right, whether or not under the color of law, is against the public policy of the commonwealth.”)

The Trump Administration has taken a firm stance against gender-affirming care (“GAC”), issuing executive orders and policy memoranda declaring gender identity a “false” idea, recognizing only “two sexes, male and female,” and directing federal agencies to withdraw support from programs recognizing gender diversity. Defending Women From Gender Ideology Extremism and Restoring Biological Truth to the Federal Government, The White House (January 20, 2025).

On January 28, 2025, Trump issued Executive Order 14187, explicitly aimed at restricting access to medical care for transgender youth. See our previous analysis of the order, but basically, it accused providers of “maiming and sterilizing” children and declared that such practices “must end” because they would “be a stain on our Nation’s history.” Protecting Children from Chemical and Surgical Mutilation, The White House (Jan. 28, 2025).

Following these directives Attorney General Pamela Bondi instructed DOJ’s Civil Division to pursue investigations of providers, pharmaceutical companies, and other entities involved in gender-affirming care. That memorandum accused providers of “mutilation under the guise of care” and ordered investigations into off-label promotion and billing practices connected with GAC. See Memorandum from Attorney General, Preventing the Mutilation of American Children, Office of the Attorney General, at 3-4 (April 22, 2025). In this context, a subpoena issued pursuant to 18 U.S.C. § 3486 sought production of documents related to BCH’s staff and its provision of GAC.

Motion to Quash Granted

The subpoena sought a wide range of information and documents relating to BCH’s provision of GAC, including personnel files, communications with pharmaceutical companies, and medical records containing patient identifiers. Judge Joun found that the subpoena was issued for an improper purpose and was “motivated only by bad faith,” noting the Administration’s publicly stated aim of ending GAC nationwide. Memorandum of Decision, In re Administrative Subpoena, No. 1:25-mc-91324-MJJ, at 14 (D. Mass. Sept. 9, 2025). Although administrative subpoenas under § 3486 have broad reach, the court concluded that this particular subpoena exceeded its statutory purpose of investigating health care fraud and instead amounted to a “fishing expedition” designed to intimidate BCH and interfere with Massachusetts’ constitutional protections for gender-affirming care. Id. at 12

Context and Improper Purpose

Judge Joun emphasized that context matters. The court pointed to recent statements by DOJ officials at the Federal Trade Commission boasting that the agency was “working on” getting GAC to “stop even in blue states,” as well as a White House article celebrating that several hospitals had stopped providing GAC following executive action. Id. at 13. These statements, the court concluded, bore no connection to the government’s asserted purpose of investigating fraudulent billing or off-label promotion. Instead, they confirmed that the true aim was to intimidate providers and curtail lawful medical services protected under Massachusetts law. Id.

Conflict with Connecticut’s Shield Law

In 2022, Connecticut enacted a health-care shield law, Conn. Gen. Stat. § 52-146x, which prohibits the disclosure of medical records related to reproductive and gender-affirming. The statute reflects the state’s public policy of safeguarding access to these services and protecting patient confidentiality. However, when a federal administrative subpoena is issued under 18 U.S.C. § 3486, providers in Connecticut will be faced with a conflict between state and federal law.

Under the Supremacy Clause of the U.S. Constitution, federal law generally preempts conflicting state law. As such, where a valid federal subpoena compels production, state confidentiality statutes may not serve as an absolute bar. This conflict will need to be resolved by the courts, and until that happens providers served in Connecticut will have to comply with § 52-146x as a basis to raise objections or seek protective orders or risk violation of Connecticut law. The statute underscores Connecticut’s strong public policy and could bolster arguments that compliance with overbroad or harassing requests would unduly burden providers or compromise state-protected rights.

Provider Guidance: Responding to Administrative Subpoenas

This ruling underscores the potential breadth of federal investigative tools and the importance of a timely legal response when health care providers receive administrative subpoenas. Even where a subpoena may ultimately be quashed, recipients must still respond—ignoring such a demand can result in enforcement proceedings. If your organization receives an administrative subpoena relating to gender-affirming care or other medical services:

• Do not ignore the subpoena. Federal law requires a timely response. Failure to act can result in enforcement proceedings.
• Consult counsel immediately. Experienced health care counsel can evaluate the scope of the requests, advise on patient-privacy obligations, and determine whether a motion to quash or modify is appropriate.
• Preserve relevant records. Ensure that potentially responsive documents are preserved and secured to avoid claims of spoliation.
• Assess confidentiality risks. Subpoenas may request sensitive patient or staff information. Providers should work with counsel to evaluate whether production would violate state constitutional protections, HIPAA, or other privacy laws.

Bottom line: Receipt of such a subpoena is a serious legal matter requiring immediate attention and a strategic response.

As new developments arise, we will continue to update our Dobbs Decision Resource Center. In the meantime, please contact one of the lawyers in Shipman’s Health Law practice group if you have questions about this ever-changing legal landscape.