Michelle Gamage, Local Journalism Initiative Reporter, The Tyee

The U.S. government is collecting data on health-care workers providing gender-affirming care in Canada.

In mid-April the U.S. Department of Health and Human Services launched a “snitch line” website where anyone could report health-care workers in Canada or the United States performing “chemical and surgical mutilations of children,” which is how the current administration describes gender-affirming care. (We’ll get to why that description is inaccurate in a minute.)

Originally the website allowed people to select a Canadian province or territory when reporting a health-care professional. Later, the website was updated to remove provinces. But as of Tuesday the website still asks for the “zip/postal code” of the worker and lets people enter “None” for what state they work in.

When The Tyee asked Health and Human Services, or HHS, why it had included and then removed Canadian provinces and still included an option to report a postal code, a spokesperson said the update reflects “our intended focus on conduct in the U.S.” They did not say if they made the changes based on pushback.

Focusing on the United States is not the same as limiting data collection to the United States.

When The Tyee asked Health Canada if it knew the snitch line still let people report postal codes, Health Canada told The Tyee it would “follow up” with HHS to “flag the remaining typographical error.”

Health Canada said it had previously flagged the “design issue,” which led to the removal of the option to select provinces and territories. HHS did not mention Health Canada in its response to The Tyee.

B.C. Health Minister Josie Osborne called the HHS initiative targeting clinicians supporting gender-affirming services “reprehensible.”

“Our government believes no one should ever be the target of violence or oppression because of who they are,” Osborne said in an email to The Tyee. “We stand proudly to support trans people and the clinicians ensuring they receive the health-care services they need.”

Trans Care BC has removed clinician names from its website and notified staff about the U.S. initiative as a precaution, a spokesperson for B.C.’s Health Ministry said. The service is provided by the Provincial Health Services Authority.

The Tyee asked if similar precautions should be taken for all health-care workers offering trans health care or gender-affirming care, and the ministry said Trans Care BC has made sure “health professionals are aware of the issue.”

Cross-border reach is new, but the tactics aren’t

“I can’t say it’s anything other than appalling,” said Adrienne Smith, a lawyer and litigation director at the Catherine White Holman Wellness Centre, which operates a legal clinic in B.C. for Two-Spirit, transgender and gender non-conforming people.

“I’m also sad to say I’m not remotely surprised. This regime’s attack on trans people has been relentless and it has always been a tactic of the anti-trans lobby to target care providers and make it difficult for them to provide services,” Smith said.

The snitch line is also a diplomatic issue that impacts Canadian sovereignty, they said. It boils down to a foreign country trying to control what care a doctor decides to offer their patient.

The United States seems to be focused on using fear as a tactic, Smith said.

“Even if the executive order is later found to be illegal, the damage has really been done by frightening people,” they said.

The U.S. government is trying to say providing “peer-reviewed, legitimate and life-saving health care is somehow wrong and dangerous,” and to increase the reach of “absolutely illegal harassment” to an international level, Smith said.

Smith said targeting health-care providers is a “typical move out of the playbook” for groups also opposed to reproductive health care and HIV-AIDS treatment.

However, they added, “being targeted by a nation, particularly one with a nuclear arsenal, is new and terrifying. Targeting health-care providers on a global scale is absolutely terrifying.”

Smith said it’s unfortunately common for transgender people to get doxed, meaning their names, addresses, workplaces and even photos of their children’s schools might be maliciously shared online, so it’s not surprising the strategy has been extended to their health-care providers.

Law enforcement has been “inadequate” in protecting transgender people from online harassment, doxing and threats, Smith said. “Even when it reaches the level of criminal harassment, trans people very rarely are able to enforce their rights because the police don’t believe them online. They don’t believe it’s a crime. The online poster has an alias. It’s very difficult.”

“Every single time a politician says something anti-trans it’s technically a crime: it’s discrimination, harassment and disrespect to the point of vilification,” they said. “That’s significant in law and we have yet to see a remedy for that kind of crime.”

Letting those actions go unchecked gets read as support, Smith said.

Smith said it’s critical for politicians to stand up and say transgender people are welcome members of Canadian society and to offer legal and practical advice for trans people and health-care practitioners to keep themselves and their families safe. This should include resources to relocate or protect their identity if needed, and should also include a clear way to deal with the harassment that will come from being doxed.

Once someone’s information has been shared maliciously online it’s not enough to take the information down because it’s already out there, they added.

“It’s extremely dangerous and everyone should be very concerned,” they said, noting that doxing often leads to death threats. “Everyday life will be much more dangerous for people who are providing this kind of health care.”

Doxing can also come from lawsuits, such as a 2019 case in which an unsupportive father sued his 14-year-old transgender son’s health-care providers to try to prevent his son from accessing gender-affirming care.

The courts ruled that the teenager, identified in court as A.B., had the right to gender-affirming medical care. But A.B. was still named publicly by his father in media interviews and was sent “hundreds of death threats and suggestions that this young person was monstrous and should kill themselves,” Smith said. The doctors also faced online and in-person threats.

The United States has many strategies to collect data on transgender people, Smith said. Several U.S. states have directed child protection branches to collect data about transgender youth, for example. Canadians who have crossed the border, applied for a visa or applied for a Nexus card with ID that said they were transgender are also likely in a database, they said.

Gender-affirming care can be social, legal and medical

Gender-affirming care covers a broad set of health care and supports, including a combination of social, legal and medical supports, according to Health Canada.

The HHS snitch line is built out of President Donald Trump’s Executive Order 14187, also known as “Protecting Children from Chemical and Surgical Mutilation,” which includes anti-retaliation protection for “whistleblowers” who report medical professionals performing “irreversible medical interventions” on children.

This misrepresents what gender-affirming care actually is.

Health Canada says medical supports for youth can include hormone blockers, which delay the onset of puberty, and gender-affirming hormone therapy, which helps someone develop the physical features that align with their gender identity.

Hormone blockers are evidence based, well researched and safe. They’re also reversible: if a patient stops taking them, they will restart puberty, Health Canada says.

When it comes to gender reassignment surgery, Canada follows the World Professional Association for Transgender Health’s standards of care, which allow for surgery for people 18 or older.

Smith said the U.S. government is testing the waters to see how the American people and international community react to its treatment of transgender people and migrants. The United States has also been illegally detaining and deporting migrants.

“That’s why saying no at every possible juncture is important,” Smith said.

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