On Friday, August 14, a divided panel of the Ninth Circuit Court of Appeals reinstated a Justice Department subpoena seeking the records of transgender patients — including minors — from a telehealth practice that prescribes puberty blockers and hormone therapy. The 2–1 decision puts a question that has circled this administration’s health care enforcement for a year squarely on the table: how much does a president’s stated hostility to a form of medicine matter when his Justice Department goes looking for that medicine’s paperwork?
The provider is QueerDoc, a San Francisco–based telemedicine practice. The subpoena asks for personnel files, billing documents, communications with drug manufacturers and pharmacies, and the records of patients prescribed puberty blockers or hormones. It is one of more than twenty subpoenas the Department has sent to doctors and clinics since announcing the investigation last year. For the longer arc of how we arrived here, our transgender history archive lays out the decades that precede this moment. What is new is the appellate holding.
What the court decided
The district court had quashed the subpoena after finding it was issued for an improper purpose: to advance the administration’s policy goal of eliminating gender-affirming care rather than to investigate an actual violation of federal health care law. The Ninth Circuit majority disagreed. Writing for himself and Judge Daniel Bress, Judge Carlos Bea held that QueerDoc “did not meet its heavy burden of showing that the subpoena was issued for an improper purpose,” and that “the Executive Branch’s public opposition to ‘gender-affirming care’ is insufficient to show that an agency within the Executive Branch issued an otherwise permissible HIPAA subpoena in bad faith.” A president, the majority wrote, “may direct DOJ to exercise its statutory authority in a manner that aligns with his broader policy goals.” Or, more plainly: “Every President has law enforcement priorities, just as every President has signature policies.”
Judge Richard Paez dissented. He would have left the district court’s finding alone, writing that the conclusion DOJ acted in bad faith “was not clearly erroneous,” and that on the record before that judge, “the government failed to satisfy its prima facie burden of showing the information subpoenaed was relevant and material to its purported investigatory purpose.” You can read the full opinion in the Ninth Circuit’s decision in QueerDoc, PLLC v. Department of Justice, No. 25-7384.
Why it matters
The legal fight is about the presumption of regularity — the courtesy courts extend to the government that its ordinary tools are being used for ordinary reasons. Rebutting it is meant to be hard, and the majority said so. But the practical stakes are not abstract. These are patient files. For a population that has spent years learning which clinics are safe, the prospect of one’s chart traveling to Washington is not a procedural detail.
Two ways to read it
The Department’s position is that it has reason to believe QueerDoc may be misleading people about puberty blockers and hormones, and that investigating medical marketing claims is a routine federal function that does not become illegitimate because the president has opinions. Judges who take that view worry, not without reason, about a rule that lets any target of an investigation defeat a subpoena by pointing at a politician’s speeches.
The other reading is Judge Paez’s, and the ACLU’s. “We’re ready to continue defending one of the most fundamental principles of healthcare: every patient’s right to confidential medical care,” said ACLU attorney Adrien Leavitt. Critics note that the burden the majority describes may be effectively unmeetable — if a stated intention to end a category of care is not evidence of purpose, it is not obvious what would be. It is the same tension we traced in the federal move to restrict gender-affirming care for minors after Skrmetti, from the same court that this week paused an order on housing transgender women in Oregon prisons. The pattern is uneven, which is worth noticing: the administration keeps losing lower-court fights even while winning at the top.
The case is not over. It returns to the district court to take up QueerDoc’s remaining arguments that the subpoena is overbroad and unduly burdensome — the narrower questions that often decide what actually gets handed over.
I keep thinking about the patients. Somewhere there is a seventeen-year-old who told a doctor something true about herself, in a room she believed was private, and who did not sign up to be evidence. Whatever the doctrine turns out to require, that is the cost being weighed.