Health Law Daily Wrap Up, GENERAL HEALTH CARE NEWS—D. Md.: Court denies transgender youths’ emergency motion to enforce preliminary injunction, (Apr 2, 2025)

By Patricia K. Ruiz, J.D.

The court found no clear and convincing evidence that the agencies violated a specific and unequivocal command by the court.

The U.S. District Court for the District of Maryland denied without prejudice an emergency motion to enforce a preliminary injunction preventing the Trump Administration from enforcement of parts of executive orders (EOs) prohibiting the use of federal funds on youth gender-affirming care. The court found memos cited by the plaintiffs do not condition, withhold, or terminate any specific federal funding, and thus do not run afoul of the terms of the preliminary injunction order (PFLAG, Inc. v. Trump, No. 25-337-BAH (D. Md. Mar. 28, 2025)).

Executive orders. EO 14168, issued January 20, stated that the federal government recognizes two sexes, and section 3(g) prohibited the use of federal funds “to promote gender ideology.” On January 28, EO 14187 found that “it is the policy of the United States that it will not fund, sponsor, promote, assist, or support the so-called ‘transition’ of a child from one sex to another, and it will rigorously enforce all laws that prohibit or limit these destructive and life-altering procedures.” Section 4 required agencies and departments that provide research or education grants to medical institutions, including medical schools and hospitals, to “immediately take appropriate steps” to ensure that they “end the chemical and surgical mutilation of children.”

Preliminary injunction. Transgender youth challenged the EOs, arguing that hospitals paused their gender-affirming care in response to EO 14187. Their complaint alleged constitutional violations and discrimination on the basis of sex and disability. The court issued a nationwide injunction blocking enforcement of parts of the EOs prohibiting the use of federal funds on youth gender-affirming care. The court found that “the challenged provisions of the Executive Orders place significant conditions on federal funding that Congress did not prescribe,” which “the Constitution simply does not allow,” (see Court issues nationwide injunction on youth gender-affirming care Executive Orders, (Mar. 5, 2025)).

Emergency motion. Transgender youth filed a motion alleging the Trump Administration violated the preliminary injunction by issuing notices to covered entities and federal funding recipients renewing previous threats to withhold federal funds. They attached with their motion a series of notices sent by HHS on March 5 and 6, 2025, alerting federal funding recipients that the agencies may begin taking steps to appropriately update “policies to protect children from chemical and surgical mutilation,” “review [] policies, grants, and programs in light of the concerns discussed in the QSSAM [(Quality and Safety Special Alert Memo)],” and “consider re-scoping, delaying, or potentially cancelling new grants in the future depending on the nature of the work and any future policy change(s).”

The transgender youth argued the notices violate the preliminary injunction by scaring hospitals into stopping care or declining to restart care by repeating the same threats in the EOs. In response, the administration argued that the cited notices “merely inform interested parties of HHS’s concerns about the proliferation in use of puberty blockers, cross-sex hormones, and surgery to treat children with gender dysphoria and certain research and data on the potentially harmful effects of such interventions.” The administration denies that the notices condition, withhold, or terminate any federal funding or threaten to do so based on the fact that a health care entity or health professional provides gender-affirming medical care to a patient under nineteen.

The court found that the notices do not condition, withhold, or terminate any specific federal funding, and thus do not run afoul of the terms of the preliminary injunction order. The court found no clear and convincing evidence that the agencies violated a specific and unequivocal command by the court. The court added that, to the extent the plaintiffs challenged the constitutionality of the agency notices beyond their relevance to enforcing the preliminary injunction, a motion to enforce the relatively narrow scope of the preliminary injunction is not the proper vehicle for doing so.

The case is No. 25-337-BAH.

Judge: Hurson, B.

Attorneys: Zachary Benjamin Cohen (Jenner & Block LLP) for PFLAG, Inc. Christian Daniel, U.S. Department of Justice, for Donald J. Trump.

Companies: PFLAG, Inc.

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