The Missouri Court of Appeals has ruled that the state attorney general can gain access to certain medical records from the Washington University Transgender Center at St. Louis Children’s Hospital, a decision that could have major implications for patient privacy in the state.
In a decision issued Tuesday, Judge Philip M. Hess wrote that while federal privacy laws such as HIPAA protect health records, Missouri’s consumer protection statutes give the attorney general authority to review records when they are essential to an investigation. The ruling overturns part of a lower court decision that had blocked Attorney General Andrew Bailey’s office from obtaining unredacted patient files. The case now returns to the circuit court, where a judge will determine how far the state’s requests may go and whether patient information can be sufficiently redacted to preserve confidentiality.
The dispute began in February 2023, when Bailey’s office issued a civil investigative demand seeking all electronic health records from the center, including patient names and identifying details. The appeals court said such a broad request was improper but found that the attorney general’s office still has a pathway to obtain some records if the demands are narrowed. Hess emphasized that the circuit court should modify the requests to strike a balance between the state’s investigative powers and the rights of patients.
The judges rejected several of Bailey’s broader arguments, including his claim that the attorney general should be treated as a health oversight agency under HIPAA. They also dismissed the argument that the investigative demand should be treated like an administrative order, which would have given the office wider access to private data. Instead, the ruling makes clear that any release of records must be more limited in scope.
The case has drawn national attention as part of a wave of legal and political battles over gender-affirming health care. Bailey launched the probe under Missouri’s Merchandising Practices Act, framing it as a consumer protection issue. His successor, Catherine Hanaway, took office earlier this month and has not yet indicated whether she will continue the investigation with the same intensity.
Judge Hess, who authored the opinion, was appointed to the Missouri Court of Appeals, Eastern District, in 2013 by then-Governor Jay Nixon, a Democrat. He was later retained by voters in 2016. His ruling leaves open the possibility of continued litigation as lower courts work out how much information the attorney general’s office can ultimately obtain.
Across the country, state officials have pursued different approaches to transgender health care. In Florida and Texas, attorneys general have also sought access to clinic records or data tied to gender-affirming care, sparking similar concerns about patient confidentiality. Meanwhile, courts in other states, including Arkansas, have blocked broad attempts to restrict or intrude on care. Missouri’s case highlights the unsettled legal landscape, where privacy protections and state-level investigations continue to collide.
For families and patients at the Transgender Center, the outcome will likely determine whether deeply personal medical histories remain private or become part of an ongoing state inquiry. The case underscores the growing tension between state efforts to regulate gender-affirming care and federal protections designed to safeguard patient confidentiality.
