Giant S.D. Hospital System Opposes 2nd Conservative State’s Bill to Protect Minors from Trans Procedures

Sioux Falls-based hospital chain Sanford Health should have taken the hint when 150 South Dakotans braved frigid January temps to protest their decision to host the 2023 — their third annual — Midwest Gender Identity Summit. Despite enjoying an unsavorily cozy relationship with Governor Kristi Noem (R), talons sunk deep into the state Senate, and an outsized influence in the business community, their radical, transgender activism had finally wafted into the open air. Needless to say, its pungent odor wrinkled many a nose in the overwhelmingly conservative state.

The slow road to exposure began two years ago when Governor Kristi Noem surprised conservatives across the nation by vetoing a women’s sports bill. A year before that, a state Senate committee quietly killed a bill to protect minors from gender transition procedures. The unexpectedly anti-conservative moves from a governor trying to establish her conservative credentials and a supposedly conservative legislature prompted investigations into what, exactly, was going on in South Dakota.

It turns out that the state’s largest employer (by a factor of seven) is Sanford Health, a massive hospital system that profits by prescribing puberty-blocking drugs to minors and performing gender transition surgeries. Sanford Health maintains an army of lobbyists to protect their interests in Pierre who swarm the capitol whenever the legislature is considering bills to obstruct their gender transition profiteering. At least two elected members of the state legislature are also registered lobbyists for Sanford Health, while another of their lobbyists runs a law firm that is a close advisor to Governor Noem, who has raked in donations from the health care system.

Sanford Health’s hot streak was broken earlier this month, when the South Dakota legislature overwhelmingly passed the “Help Not Harm” bill, H.B. 1080, which prevents a health care professional from administering puberty blockers, administering cross-sex hormones, or performing surgery “for the purpose of attempting to alter the appearance of, or to validate a minor’s perception of, the minor’s sex, if that appearance or perception is inconsistent with the minor’s sex.” The bill’s passage came after months of publicity exposing Sanford’s gender transition practices and their influence in Pierre. Faced with a veto-proof legislative majority, Noem chose to sign the bill.

So much for Sanford Health’s lobbying efforts in South Dakota. However, Sanford Health appears to be running a similar (though not identical) playbook in neighboring North Dakota.

The North Dakota House on Friday passed a bill (H.B. 1254) to protect minors from gender transition procedures — but with substantial Republican opposition.

While not identical, North and South Dakota have a variety of relevant similarities. Sanford Health, which runs 10 hospitals across South Dakota, also runs eight across North Dakota. Sanford Health is the largest employer in North Dakota, just as it is in South Dakota. The states also have similar legislative environments; both are overwhelmingly rural states, both have overwhelming (greater than 80%) Republican majorities in both chambers, and both have Republican governors who inexplicably vetoed legislation to protect women’s sports in a previous legislative session.

Another similarity is that, as in South Dakota, Sanford Health put on a full-court press when the North Dakota legislature considered legislation to protect minors from gender transition procedures. They left behind the lab coats, but multiple Sanford Health doctors testified against the bill in person at a January 24 hearing, and even more submitted written testimony against it.

At least five doctors from Sanford Health testified against the bill, which would take away their ability to profit off of confused minors. Their testimony often featured apparent contradictions, unscientific notions, and claims beyond their expertise. Yet the testimonies also featured common talking points: 1) Banning gender transition procedures contradicts expert-recommended best practices; 2) Teens will commit suicide because of this bill, and 3) Gender transition surgeries are not performed on minors in North Dakota. The first is misleading, the second is not well-supported by evidence, and the third undermines the first two.

Dr. Rachel Peterson, an OB-GYN with Sanford Health, admitted to discussing medical gender transition treatments on a young person’s first consultation, without first attempting to treat any other mental health conditions. She denied performing gender transition surgeries “on anyone under the age of 18” but insisted, “I follow guidelines set out by national organizations including WPATH (World Professional Association of Transgender Health) and ACOG (Association of Obstetrics and Gynecology).” Yet WPATH’s standards of care discuss the “benefits of … surgical treatments in adolescence,” a term which they clarify applies to minors.

“This bill will impact the care of my patients … who are born with the wrong genetic code that does not match their gender identity,” complained Dr. Luis Casas, a pediatric endocrinologist at Sanford Medical Center Fargo. “I should not be criminalized for practicing under the scope of my training and when following standards of care.” What kind of assumptions must one adopt before the phrase “born with the wrong genetic code” makes sense?

Casas added that “gender affirmation treatment is part of my practice and something that nearly every pediatric endocrinologist in the country treats” — which is rather an obvious statement. Pediatric endocrinologists treat hormone-related disorders in children, which are extremely rare. Due to the “social contagion” effect, which afflicts countless young people with gender dysphoria, the market for supplying puberty blockers and cross-sex hormones is much larger.

As Sanford Health pediatric specialist Dr. Brenda Thurlow said, “This bill would threaten their ability to practice in our state, and would make it extremely difficult to recruit pediatric endocrinology specialists in the future.” Such testimony raises the question: do these pediatric endocrinologists do anything besides prescribing gender transition medications to minors?

“If this bill passes, we know the patients and families will still seek gender affirming care which could result in a large exodus of families to other states,” warned Dr. Amanda Dahl, the other pediatric endocrinologist at Sanford Health — Casas, Thurlow, and Dahl all said there are only two in North Dakota. H.B. 1254 sponsor Brandon Prichard, told The Washington Stand there are an estimated 200 minors suffering from gender dysphoria in North Dakota. By prohibiting gender transition procedures, Dahl told the legislature, “You are telling these people they do not matter.” It’s curious that Dahl, with her highly specialized expertise in hormonal disorders, would presume to lecture a committee of legislators on a bill’s political message and demographic impact.

Sanford Health clinical psychologist Danial Sturgill (who holds a doctorate but not a medical degree) also spoke beyond his expertise, opining that breast construction and removal surgeries “in transgender care … are life-saving for some individuals.” Sturgill then proceeded to add, “as for other surgeries with youth, these procedures are exceedingly rare and not being done in our state.” This suggests that “top” surgeries are performed on minors in North Dakota, despite protestations to the contrary.

Another testimony indirectly supporting that conclusion was that of Dr. Nicholas Adams, who works at the Center for Plastic Surgery in Fargo. Why does a plastic surgeon care about lawmakers prohibiting a form of surgery on minors which no one practices?

“We are the experts,” Adams berated lawmakers, arguing that the bill “flies in the face of established medical science and the overwhelming consensus of the medical community.” He cited statements from the American Academy of Pediatrics (AAP), the American Medical Association (AMA), and the World Professional Association for Transgender Health (WPATH), two long-captured professional organizations and a transgender activist group.

Sanford Health staff were not the only health care professionals who opposed North Dakota’s bill to protect children from gender transition procedures — which is the same thing as saying Sanford Health is not the only North Dakota medical institution that has abandoned their Hippocratic duty in pursuit of lucrative profits.

Another opponent was Dr. Gabriela Balf-Soran, a psychiatrist representing North Dakota Psychiatric Society, a branch of American Psychiatric Association (APA), and who is also a WPATH member. She stated unironically that, if the bill was passed, “Physicians who are part of their professional associations … will be in the situation of not being able to practice ethically in North Dakota,” and that the bill would force them to “break their professional ethics code, Hippocrates’s oath,” and commit “malpractice.”

Cue the facetious horror! Of course, the real malpractice, unethical activity, and violation of the pledge to do no harm is committed by health care professionals who subject minors — who cannot reasonably consent — to harmful, experimental, irreversible procedures, which leave them permanently disfigured and/or with a lifelong dependency on medication. This is why the North Dakota legislature, and those of other states, have resolved to address the issue in the first place.

More health care professionals simply made the same points over again. “I do not perform gender affirming surgery in anyone under the age of 18,” insisted Dr. Heather Sandness Nelson, an endocrinologist and infertility specialist at Essentia Health, another health care chain with a hospital in Fargo. New Story Counseling Services director Naomi Tabassum warned, “I would advise the writers of this bill to consult with medical and mental health professionals when attempting to legislate health care law in this state.” Heidi Selzer-Echola, medical director for Canopy Medical Clinic, which treats minors with gender dysphoria, accused legislators of “targeting a specific population of people for no other reason than misunderstanding, fear and prejudice” and called the bill “completely unethical.” It’s like they all held a meeting and drafted their talking points jointly.

One reason why Sanford Health and other health care providers can so shamelessly advocate for abusing children in this manner is that professional organizations with longstanding reputations have given them cover. For those taking notes, opponents of the bill could quote the AAP, AMA, and APA on the record in favor of gender transition procedures for minors. Representatives for local branches of the AMA and APA even submitted testimony themselves. These organizations have recently revised their stances not because the evidence changed, but because their ideology did.

Sanford and their allied transgender ideologues likely hope to derail North Dakota’s bill to protect minors from gender transition procedures through a combination of public and private pressure, just as they did successfully in South Dakota three years ago.

However, several factors make the North Dakota government less arable soil for Sanford cash crops than its neighbor to the south. First, no registered Sanford lobbyists hold elected office in the state legislature.

Second, Sanford Health lacks the monetary influence with North Dakota Governor Doug Burgum that it has with South Dakota Governor Kristi Noem. Whereas Noem’s top career donor is Sanford Health, Burgum’s top donor is himself. He spent $1.3 million of his own money on his reelection campaign in 2020, another $3.2 million in other races in 2020, and nearly $1 million targeting opponents in 2022.

Third, Sanford-backed legislators can’t quietly kill the bill in a Senate committee, as happened in South Dakota in 2020. “North Dakota’s the only state where there’s no such thing as dying in committee,” said Prichard. Every bill gets a vote in the full chamber.

That said, the Senate committee’s recommendation to pass or not pass a bill can have a major influence on the full Senate. It’s too early to say whether H.B. 1254 will pass the North Dakota Senate.

However, Prichard said the more important objective is whether the bill can achieve a veto-proof majority. “It’s important to have the votes from the beginning to override the veto,” he said. Burgum’s office has not indicated his stance on H.B. 1254, but Prichard might be thinking back to Burgum’s veto of a women’s sports bill in 2021; the Senate failed to override the veto by four votes. H.B. 1254 already passed the House 66-25, achieving the two-thirds majority needed for a veto override with three votes to spare.

When Sanford Health worked to kill South Dakota’s 2020 bill to protect minors from gender transition procedures, they succeeded because of a lack of public attention or organized support for the measure. This year, a similar bill passed over Sanford’s opposition because of increased public pressure.

Sanford Health might have a more difficult time stopping a bill to protect minors from gender transition procedures in North Dakota, but they’re certainly trying to do so. Public pressure in North Dakota might help push H.B. 1254 over the line in that state too.