The U.S. Court of Appeals for the First Circuit has unanimously denied an emergency request by Rhode Island’s Child Advocate to block a hospital in the state from turning over medical records of minors who received gender-affirming care. 

The records were sought as part of a Justice Department investigation.

Background

The dispute traces to a DOJ administrative subpoena issued in July 2025, which demanded sensitive patient records – including personally identifying information – from the hospital regarding children treated for gender dysphoria. Federal investigators have focused on potential violations stemming from off-label prescription drug use and other practices associated with pediatric gender transition care.

When negotiations with the Rhode Island Hospital broke down, the DOJ sought judicial enforcement. 

On April 30, 2026, U.S. District Judge Reed O’Connor of the Northern District of Texas ordered the hospital to comply. 

O’Connor subsequently directed that records be submitted for in-camera review by his court, with protections in place to prevent disclosure to the DOJ while appeals remain pending.

Competing Court Orders

Rhode Island’s Child Advocate – the state official charged with protecting the legal rights of children in state care – moved separately to quash the subpoena in Rhode Island federal court. 

On May 13, U.S. District Judge Mary S. McElroy granted that motion, finding the subpoena lacked a legitimate congressional purpose, served an improper goal, and violated the 14th Amendment privacy rights of the affected minors.

The Child Advocate then turned to the First Circuit, seeking an injunction to prevent the hospital from complying with the Texas order while the appeal proceeded.

The First Circuit’s Ruling

A three-judge panel—Judges Gustavo Gelpí, Lara Montecalvo and Joshua Dunlap – on Tuesday unanimously denied the request.

The court held that the Child Advocate had not demonstrated the irreparable harm required to justify such extraordinary relief, emphasizing that the Texas order keeps the records under court seal and bars their release to the DOJ unless and until appeals are resolved in the government's favor.

Judge Dunlap concurred in the outcome but wrote separately to flag two additional concerns. 

First, he questioned whether the Child Advocate had standing to seek First Circuit relief that would, in effect, require the hospital to defy a federal order issued by a Texas court – characterizing the motion as a potential “collateral attack” on a sister district court's ruling. Second, he expressed skepticism about the merits of Judge McElroy’s decision to quash the subpoena.

Broader Stakes

The case is one of several flashpoints in an escalating conflict between the Trump administration and state officials over federal scrutiny of gender-affirming care for minors. 

Supporters of the DOJ’s investigation contend it is necessary to protect children from potentially experimental medical procedures. Opponents – including privacy advocates and the hospital – argue that compelled disclosure of sensitive youth medical records sets a dangerous precedent, regardless of how the underlying policy debate is resolved.

The matter is now likely to continue working through both the First and Fifth circuits simultaneously, with the conflicting district court rulings adding further complexity to an already fraught legal landscape.