North Dakota
Ruling in North Dakota transgender health care case likely months out as trial wraps
BISMARCK — A seven-day trial over North Dakota’s ban on gender-affirming care for minors concluded Tuesday, though a final decision on the case is still months away.
The state in 2023 made it a crime for health care professionals to provide the treatments to anyone under 18.
A lawsuit brought by North Dakota pediatric endocrinologist Luis Casas alleges that the ban is an unconstitutional infringement of personal autonomy and equal protection rights.
South Central District Court Judge Jackson Lofgren took the case under advisement Tuesday. He asked the plaintiffs and defense to present their closing arguments in legal briefs to be filed at a later date.
The state of North Dakota wrapped up its side earlier that day with testimony from Stephen Levine, an adult psychiatrist.
Levine has been a psychiatrist since about 1970, and was a committee chair of a group that would later become the World Professional Association for Transgender Health — the leading professional organization for transgender health care. Like the other three expert witnesses called by the state, Levine has spoken in court in defense of several laws similar to North Dakota’s.
Levine said adolescents cannot consent to gender-affirming care, so it should be limited to adults. He also said therapy is the superior course of action for treating gender dysphoria.
Levine said he knows of many adults who have received gender-affirming care but do not appear to have benefited from it.
“I’ve had the occasional adult who I think has prospered from trans-affirmative care,” he said.
Levine also said he believes that most adolescents who believe they have gender dysphoria are really suffering from other psychiatric conditions. He said this explains the sharp increase in young people who are seeking gender-affirming care over the last 15 years.
Jan Conlin, an attorney for the plaintiffs, indicated Tuesday there are fewer than a dozen kids in North Dakota who have sought gender-affirming medical care.
“Would that surprise you?” Conlin asked Levine.
“I guess it would,” Levine replied.
Levine, like the other three witnesses who testified for the state, stressed that the medical research on gender-affirming care is nascent and unsettled.
He said that most children who believe they’re transgender later come to identify with the sex they were assigned at birth. He said he acknowledges that the North Dakota transgender health care ban may be a source of distress for adolescents who depend on the treatment, but that he’s skeptical that it would cause them to suffer significantly.
“Every crisis doesn’t necessarily harm somebody,” he said. “It’s not necessarily the end of the world for that child. It may, in fact, be the beginning of a chance to rethink this whole matter.”
Casas, the pediatric endocrinologist, last week testified that one of his patients attempted suicide after learning of the health care ban.
The plaintiffs on Tuesday brought back Gabriela Balf, a psychiatrist with experience treating adolescents with gender dysphoria, as a rebuttal witness.
Balf acknowledged that there is limited research exploring the use of transgender health care for minors. She said it is very difficult to conduct top-tier studies like randomized control trials on children because it’s unethical.
“We simply cannot do these kinds of trials with kids,” she said. “I would like to put to rest once and forever this idea that we’re not doing this because we’re lazy.”
Still, Balf said the bulk of research suggests that transgender adolescents have benefited from gender-affirming care. She also said that some of the research cited by the defense’s witnesses has been discredited.
Balf questioned why the state thought it necessary to adopt the health care law when it’s never bothered to regulate other areas of medicine.
“I find it so discriminatory to have so much scrutiny of this condition and others, they are just swept under the rug,” she said.
She said a couple years ago, a scientific review noted that more than 600 medications are prescribed off-label to children.
“And yet, they’re given to kids,” Balf said. “And nobody seems to be very bothered about it.”
Mary Steurer / North Dakota Monitor
Over the course of the trial, Casas, Balf and two other doctors with personal experience treating transgender adolescents testified that in some cases, gender-affirming medication is necessary for patients’ health and happiness.
Two teenage patients of Casas testified last week that the treatment turned their lives around. Both said they also receive therapy, but that the therapy would not be enough to effectively treat their gender dysphoria.
There are only two pediatric endocrinologists in North Dakota: Casas and Amanda Dahl, who is Casas’ clinical practice partner. Casas said he and Dahl both follow the same standards for administering gender-affirming treatment care. No adolescent can receive gender-affirming care without a diagnosis of gender dysphoria, he said. Patients and their families are also informed of what to expect and the risks of the treatment.
The gender-affirming care ban passed North Dakota’s Republican-dominated Legislature with more than two-thirds approval in each chamber.
The ban contains an exemption for children who were receiving treatment before it went into effect. However, even adolescents who fall under the exemption are no longer receiving the care in North Dakota.
Casas testified he no longer provides gender-affirming care to any minors in North Dakota, including patients he saw before the law was enacted, for fear of prosecution. Those patients must travel to Moorhead, Minnesota, to see him for treatment.
The law makes it a Class A misdemeanor to administer gender-affirming treatments like puberty blockers or hormone therapy to a minor. Anyone found guilty of doing so could face up to 360 days in jail, fines of up to $3,000 or both. Medical professionals also fear a violation of the ban could jeopardize their medical licenses, according to records filed in court.
The law also makes it a Class B felony to perform transition-related surgery on a minor. Experts have testified in the case that medical professionals do not perform such surgeries on minors in North Dakota, and did not before the ban.
This story was originally published on NorthDakotaMonitor.com
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GRAND FORKS — A North Dakota composer’s dream is turning into a statewide invitation.
Williston-based musician Emily Black-Driscoll was chosen as the North Dakota Music Teachers Association’s commissioned composer for 2026. She’s preparing an original composition that will premiere in August.
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North Dakota
Challengers declare victory after ND Supreme Court rules against Legislature’s attempt to alter term limits
BISMARCK — A constitutional ballot measure to amend the state’s term limits law as proposed by the Legislature will not appear on November’s ballot, the North Dakota Supreme Court ruled Thursday, siding with petitioners who argued the Legislature exceeded its authority and violated the state constitution in proposing the changes.
“The people’s voice was heard,” Grand Forks County Commissioner Terry Bjerke said in reaction to the news.
Bjerke was a member of the sponsoring committee behind the successful 2022 effort to pass a term limits initiative, which amended the state constitution by capping legislative term limits to eight years in the House and eight years in the Senate. The amendment, which became article XV of the state constitution, also included a clause barring the Legislature from making constitutional changes to term limits.
During the 2025 session, however, lawmakers narrowly approved Senate Concurrent Resolution 4008, in which the legislature proposed Constitutional Measure 1, a ballot measure to amend the term limits language to allow legislators to decide in which chamber they want to serve their 16 years, and to repeal the clause limiting the legislative assembly’s authority to propose an amendment to alter or repeal term limits.
Bjerke and former Minot legislator Oley Larsen brought the lawsuit challenging the validity of the Legislature’s action in January, and the state Supreme Court
heard oral arguments in the case
this spring.
“Those term limits may only be altered by a measure proposed by the people rather than the Legislative Assembly. And yet a few years later, the Legislative Assembly is doing what they are prohibited from doing,” attorney Zachary Wallen argued on Bjerke and Larsen’s behalf.
Tanner Ecker / The Bismarck Tribune
The Legislature’s attorneys argued the clause prohibiting legislative proposals to alter the constitutional term limits language “infringes on our republican form of government” by “limiting the people’s ability to vote on amendments proposed by their elected officials.”
Justice Jon Jensen seemed skeptical of that argument during the April 2 hearing, questioning whether a second vote was appropriate.
“The public did speak on this. The public spoke on it when it passed the original constitutional amendment and they said, ‘Legislature, you don’t even get to propose a change.’ They have already spoken on it,” Jensen said. “You want a second shot, or a second bite at the apple, not a first one, a second.”
In Thursday’s ruling, all five justices sided with Bjerke and Larsen.
“We … conclude the Legislative Assembly’s adoption of S.C.R. 4008 violated N.D. Const. art. XV … and declare S.C.R. 4008 and Constitutional Measure 1 void … We enjoin the Secretary of State from placing Constitutional Measure 1 on the November 2026 general election ballot,” the ruling said.
Bjerke thanked the legal team that worked on behalf of their lawsuit, and said he was grateful the court reached the conclusion it did.
“I’m thrilled that what the people voted on and approved has been validated,” Bjerke said.
He added that the Legislature had “multiple opportunities” to address term limits prior to 2022’s initiated measure and chose not to, and gave a nod to the country’s coming milestone and the process by which voters expressed their support for term limits.
“We’ve lasted 250 years,” Bjerke said. “I have two words for those elected leaders who think they aren’t: everyone’s replaceable.”
North Dakota
Fargo woman convicted in North Dakota fraud case now faces charges in Minnesota: A deeper dive
FARGO, N.D. (Valley News Live) – A North Dakota woman who was sentenced to 180 days in jail in Cass County for defrauding healthcare providers and Medicaid programs is now facing additional fraud charges in Minnesota.
Christine Marie Pryor, 55, pleaded guilty in November 2024 to theft by deception involving more than $50,000. She was sentenced to first serve 180 days with a 3-year sentence suspended. She received credit for 44 days already served.
Pryor was ordered to pay $82,584.78 in restitution to Southeast Human Services in Fargo, where she worked between 2018 and 2019.
How the scheme unfolded
According to court documents, Pryor worked at multiple healthcare facilities in North Dakota and Minnesota between 2018 and 2023, using the identities and credentials of three licensed professionals without their knowledge. She submitted fraudulent Capella University diplomas and transcripts to gain employment.
Investigators say Pryor admitted she searched state licensing websites for therapists who shared her first name, then used those therapists’ last names and license numbers when applying for jobs.
At Southeast Human Services, where she worked as a Licensed Addiction Counselor, Pryor earned $55,584.82 while providing therapy services to approximately 150 patients. She also opened her own counseling center, NIAM Brain Injury Center, in Fargo between 2020 and 2021, and worked at The Lotus Center in Moorhead, Minnesota, from 2021 to 2023.
Court documents say the three licensed professionals whose identities were used told investigators they had no knowledge of Pryor’s actions and did not give her permission to use their information.
Two additional charges against Pryor in North Dakota, unauthorized use of personal identifying information, were dismissed on motion of the state.
Additional charges in Minnesota
Pryor is also facing charges in Minnesota. Minnesota Attorney General Keith Ellison announced on Tuesday charges against Pryor in Clay County District Court for six theft offenses and six identity theft offenses related to defrauding Minnesota’s Medicaid program of more than $150,000.
According to the Minnesota complaint, Pryor claimed to provide psychotherapy and alcohol and drug counseling services to Medicaid recipients despite having no license or credentials to do so. Prosecutors allege she used the credentials and identities of three licensed professionals while claiming to provide Medicaid-funded services to 169 clients.
The Minnesota charges were filed as part of National Health Care Fraud Takedown Day, a joint effort involving the Department of Justice and more than 40 state Medicaid Fraud Control Units.
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