The Indiana Attorney General’s Office has contracted with a conservative Washington D.C.-based law firm to help the state investigate claims of healthcare providers misrepresenting the risks of gender transition care and procedures to their patients of any age. 

The agency, led by Attorney General Todd Rokita, signed an agreement in November with Cooper & Kirk, PLLC, which allows the firm to investigate claims of such cases for the office’s consumer protection division and to help defend the state’s existing laws on gender affirming care. 

Under the contract, which runs through March 2025, Cooper & Kirk is able to investigate claims of misrepresentation tied to gender affirming care for both adults and minors, despite no state law barring any procedures or care for adults.

The contract appears to only require payment from the state if the firm helps win a case with monetary judgment. As of late January the Attorney General’s Office said it had not made any payments to the firm.

The agreement between Rokita’s office and Cooper & Kirk, which helped Indiana in its case against social media app TikTok, continues the attorney general’s recent scrutiny of healthcare organizations that provide gender affirming care to young Hoosiers in the wake of the Indiana General Assembly’s 2023 debate and ban of such care for minors. 

Letters sent last March

In March 2023, as lawmakers debated the bill that would ban gender affirming care for minors, Rokita sent letters to medical facilities around the state that alleged clinics misrepresented the risks of gender transition procedures to minor patients, likening the care to child abuse.

Eskenazi Health, Indiana University Health and a clinic in Goshen — medical facilities that responded to Rokita’s request last year —were essentially subpoenaed for more information about transgender care for minors at their facilities, according to reporting by the Indiana Capital Chronicle. Indiana University Health in a statement last year told IndyStar it did not perform gender affirming surgeries on minors, but it did provide other kinds of evidence-based care to youth.

A judge in November denied an ask from those healthcare institutions to stop Rokita’s requests, known as civil investigative demands. In January, the Attorney General’s Office filed to dismiss the case after it resolved a dispute on the requested information.

From 2023: Holcomb signs bill banning transgender surgeries, puberty blockers for minors

Gender affirming care covers a range of treatments, including medical and psychological ones, that support a person’s gender identity, according to the World Health Organization.

Republican lawmakers in states around the country in recent years have taken steps to ban these types of procedures for minors, including the 2023 bill in Indiana. That law is blocked while the federal case, which is now a class action lawsuit, challenging the legislation continues.

Do providers share risks?

Rokita is not the only Republican Attorney General pursuing information about transgender medical cases. Texas Attorney General Ken Paxton late last year sent letters to medical providers in Georgia and Washington seeking records of Texas minor patients who received gender affirming care, according to the Texas Tribune. Seattle Children’s Hospital sued the Texas Attorney General’s Office in December to block release of that information.

A spokesperson for Rokita’s office told IndyStar in December that the agency is concerned about gender transition procedures and whether patients, both minors and adults, could be “deceived, abused or treated unfairly by medical providers.” 

The spokesperson, who did not provide examples, said “it has been publicly reported” that medical providers prescribe “puberty blockers, sex hormones and surgeries” to patients without disclosing risks.

When asked whether Indiana has received allegations of medical providers failing to disclose risks of gender affirming care, the spokesperson directed IndyStar to file a public records request.

A national group of scientists and medical providers focused on treatment and research tied to hormones told IndyStar there are clear guidelines for practitioners that emphasize the importance of fully informing patients about the side effects of gender affirming care. 

The Endocrine Society in a statement said it has a clinical practice guideline for health professionals with recommendations stating that transgender and gender-diverse adolescents should be “informed fully” about risks before care, citing the potential for adverse effects on fertility preservation options as examples of what patients can experience.

“The Society’s Clinical Practice Guideline recommends proceeding with treatment as conservatively as possible to give transgender and gender-diverse youth and their parents time to consider their options,” The Endocrine Society said. 

Cooper & Kirk cases

The Cooper & Kirk law firm is not new to work with the Indiana Attorney General’s Office nor legal efforts critical of transgender people. 

Cooper & Kirk attorneys in 2023 filed a lawsuit on behalf of parents at a Virginia Beach school to force the district to comply with the state’s Republican governor’s policies on limiting accommodations for transgender students, according to the Associated Press.

The firm dropped the lawsuit in October after the school district voted for rules that align with the governor’s requirements, the AP reported. 

The law firm has three active contracts with the Indiana Attorney General’s Office, including the contract on investigating gender affirming care cases. The other contracts are tied to Rokita’s lawsuit against TikTok and a general agreement with the firm to help the state in general litigation matters.

The Attorney General’s Office has not had to make any payments to Cooper & Kirk for any of the current contracts. Under the TikTok and gender affirming care contracts, the law firm would receive a certain percentage of any monetary judgments it helps the state win in legal cases, starting at 25% of any dollar amount recovered between $2 million and $10 million.

Rokita sued TikTok in 2022 over allegations the app does not protect children from mature content and that it deceives users about the Chinese government’s ability to access data. The case was dismissed by a state superior court judge in November. 

In 2023: Indiana judge tosses out Todd Rokita’s lawsuit of ‘hyperbolic allegations’ against TikTok

The attorney general’s office’s contract with Cooper & Kirk plans for the law firm to help defend the state’s ban on gender-affirming care for minors. The state continues to defend the law against a legal challenge brought by the ACLU of Indiana. 

The ACLU filed the lawsuit in April just hours after Gov. Eric Holcomb signed the bill into law. A federal judge temporarily blocked portions of the law in June through an injunction that states Indiana is unable to prohibit treatments for minors while the lawsuit is ongoing. The judge in January approved making the case a class action lawsuit.

As of late January, a trial on the lawsuit is scheduled for April 2025. 

IndyStar archives contributed to this story. Contact IndyStar’s state government and politics reporter Brittany Carloni at brittany.carloni@indystar.com or 317-779-4468. Follow her on Twitter/X @CarloniBrittany.