Editor’s Note: The following article was originally published by Rhode Island Current on May 19, 2026. Reprinted with permission.
A Rhode Island Hospital spokesperson said Tuesday night that the hospital would turn over some medical records of transgender youth, with identifying information redacted, to a federal judge in Texas ahead of a midnight deadline.
That’s even though Rhode Island’s Office of the Child Advocate was awaiting a response to its request for emergency relief from a Boston appeals court to stop the delivery of the records, which were demanded Monday by Chief Judge Reed O’Connor of the U.S. District Court for the Northern District of Texas.
O’Connor’s order instructed the hospital to relinquish the documents for in camera review only, which means they would be held in custody of the court for the time being, and not available to the public — or the government, O’Connor noted, and specified that not all the documents had to be sent at once.
“Yesterday, the federal judge in Texas ordered Rhode Island Hospital to produce records to him — not the government — while the appellate process plays out to determine the validity of the DOJ subpoena,” a spokesperson for Brown University Health, the healthcare organization to which Rhode Island Hospital belongs, said in an unsigned email to Rhode Island Current Tuesday at 6:27 p.m. “The judge will maintain the records under seal in the interim, and they will be inaccessible to the government. Therefore, we will make an initial production today.”
The spokesperson added that the “production to the Texas court will not include patient identifying information,” a stipulation with which DOJ “unequivocally” agreed last week in Rhode Island Federal Court “that it would accept records from the hospital that do not contain sensitive personal health information.”
The hospital’s decision runs counter to the work of attorneys for Child Advocate Katelyn Medeiros, who petitioned the U.S. Court of Appeals for the First Circuit to issue a ruling by 10 p.m Tuesday, to outrun the 11:59 p.m. Central Time deadline set Monday by O’Connor, who ordered an initial batch of records to be sent on USB drives or similar media by the deadline.
Kevin Love Hubbard, an attorney with the Lawyers’ Committee of RI representing the child advocate in the case, said via text message Tuesday night that it was “tough to comment with all the uncertainty” before any decision emerged.
But, Hubbard added, “The order from the Texas court is unprecedented. As a result, we had to seek emergency relief from the First Circuit, which does not usually act on such a compressed timeline.”
O’Connor had ruled that the hospital should comply with his April 30 decision enforcing a U.S. Department of Justice (DOJ) subpoena, part of a nationwide investigation that started last July of potentially fraudulent billing and coding practices for drugs used in hormone therapy and the treatment of gender dysphoria, such as puberty blockers.
Rhode Island U.S. District Judge Mary McElroy slashed down the underlying subpoena last week, arguing in her ruling that the feds’ arguments were cloaked in bad faith, and that the documents’ sharing would violate affected youths’ privacy rights.
The advocate’s motion, filed Tuesday morning, argues that handing over the records “would inflict the same chilling harms, and harm to the children’s privacy, that the [Rhode Island] district court identified.”
“This motion does not ask this Court to review, vacate, or direct any action by the Texas court,” Tuesday’s filing by the Child Advocate’s legal team reads. “It asks this Court to preserve the effectiveness of the District of Rhode Island’s order, and to prevent irreparable injury to Rhode Island children, pending appeal.”
The Office of Child Advocate represents children in state care and some youth who receive behavioral health services through the state. An unspecified number of these youths in state care have their information in the Rhode Island Hospital records, which contain data on young patients’ identities, diagnoses, clinical assessments, and family, health and treatment histories.
The government argued in court that the hospital had been largely unresponsive, sending over only one six-page document in response to requests for 15 separate categories of information — claims largely disputed by lawyers for both the child advocate and the hospital in a May 12 court hearing before McElroy.
The Child Advocate’s filing in the First Circuit Tuesday was quickly followed by a response from the DOJ, which had sought to undo McElroy’s ruling with its own plea to the Boston appellate court. The DOJ filed its notice of appeal last Thursday, May 14, the same day the department’s procurement mission was seemingly halted by McElroy’s order.
The DOJ’s own response Tuesday to the child advocate’s parry: “At the outset, the Advocate’s motion is badly procedurally confused,” the federal attorneys wrote, reiterating later that it is “procedurally bizarre.”
The feds have already moved to invalidate McElroy’s order, they wrote, and therefore, “the Advocate seeks an injunction in an appeal she did not file.”
“The federal judicial system simply cannot work this way,” the DOJ argued.
The Child Advocate filed a response in the evening Tuesday argued that “the government creates a multi-part strawman” in an attempt to defuse the child advocate’s argument.
“The Child Advocate’s request is hardly the procedural irregularity the Government claims,” the response reads. “Instead, it is a straightforward request to preserve this Court’s jurisdiction in the face of exigency created by the Texas court.”
Tuesday’s DOJ filing maintains the department’s argument that, “The administrative subpoena at issue was validly issued as part of a valid criminal investigation into ubiquitous federal crimes, such as misbranding by pharmaceutical companies and fraudulent billing by healthcare providers.”
McElroy’s order “misunderstood the nature of these offenses and wrongly shielded an entire industry from federal criminal scrutiny,” the feds wrote.
Rhode Island attorney Eric Olshan argued in court last week that the hospital, as neither a drug manufacturer nor a distributor, is not necessarily subject to such an investigation.
The unsigned statement from a spokesperson for Brown University Health said the institution has “sought to act in a manner consistent with applicable laws.”
Whose jurisdiction is it anyway?
O’Connor’s latest order intensified a heated debate over the procedural mechanics and legal permissibility of not only the hospital and the government, but the courts themselves.
Central in this fight across court districts and state lines is the doctrine of collateral attack. A “collateral attack” involves trying to have one court revisit another court’s judgments, in a case where another venue has already made a decision.
The DOJ pinned its hopes partly on the collateral attack doctrine, arguing that the Child Advocate’s original motion in Rhode Island’s federal court was a means of subverting the Texas judgment.
But a collateral attack may be permissible when the original court unfairly excluded certain parties or information from its decision-making. McElroy’s May 14 ruling reasoned in part that the child advocate’s motion was not barred from a collateral attack, as the feds claimed, because she was not a party to the Texas case and was not given an opportunity to be heard in that venue. Furthermore, she represents children’s constitutional privacy rights, rather than the hospital’s interests.
Still, McElroy acknowledged also that she could not directly cut down O’Connor’s enforcement order demanding the hospital turn over records.
The gap between what McElroy directly nullified — the DOJ’s subpoena — and what she admittedly could not — the Texas court’s order — empowered O’Connor’s retort on Monday.
“The only fair reading then is that Judge McElroy prohibited the DOJ from taking the specified actions related to obtaining documents from RIH but left the Enforcement Order otherwise in effect,” O’Connor wrote. “This narrow remedy leaves no question that this Court can vindicate the Enforcement Order, so long as the Government does not commit any of the prohibited acts.”
O’Connor’s compromise for the hospital to turn over the records in camera seemed a reasonable compromise to the feds, who wrote in their reply Tuesday to the Child Advocate that such a submission “will not inflict irreparable harm on the patients the Advocate represents.”
“The whole point of in camera review is to preserve everyone’s rights and privileges while litigation unfolds; it is backwards to treat in camera production as irreparable harm in itself,” the DOJ wrote.
The Child Advocate sees it differently: Once the records leave Rhode Island, her filing states, “the privacy injury will have already occurred.”
“Requiring RIH to compile and surrender the identities and medical records of every child who received medical care for gender dysphoria signals to children and their parents and guardians that no court order can protect their privacy,” the advocate’s motion states.
The court battle could potentially reach an even higher echelon, something O’Connor hinted at in his order Monday.
Rhode Island Hospital, O’Connor wrote, could “seek reconsideration or file any other motion in this Court and to seek relief before the United States Court of Appeals for the Fifth Circuit or the United States Supreme Court but not in front of any other court.”
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