Fifth Circuit Hears Rhode Island Hospital Bid to Quash DOJ Subpoena

Rhode Island Hospital on Wednesday urged a three-judge panel of the U.S. Court of Appeals for the Fifth Circuit to reverse a Texas federal judge’s order that requires the hospital to comply with a Justice Department subpoena seeking extensive records on its treatment of transgender youth, including patient files, according to Courthouse News Service and Bloomberg Law.

Arguments before the panel

Hospital attorney Matthew Fitzgerald told Judges Kyle Duncan, Kurt Engelhardt and Irma Ramirez that Chief U.S. District Judge Reed O’Connor of the Northern District of Texas entered the enforcement order the same day the government filed its petition, without giving the hospital a chance to respond. Fitzgerald argued the Justice Department lacked a legitimate investigative purpose and was using a burdensome subpoena to pressure the hospital to stop gender-affirming care after reaching settlements with at least six other hospitals that required them to do so, Courthouse News reported.

Justice Department attorney John Bailey said the government is investigating potential Food, Drug, and Cosmetic Act violations by manufacturers and distributors that promote off-label use of puberty-blocking drugs and cross-sex hormones. Prescribing those drugs for gender dysphoria is legal for doctors in Rhode Island, Bailey said, but manufacturer promotion of unapproved uses is not. Ramirez, a Biden appointee, asked why the government seeks patient and personnel files if the target is drugmakers rather than limiting the demand to communications about the drugs, Courthouse News reported.

Parallel orders in Texas and Rhode Island

Although the hospital is in Rhode Island, the government sought enforcement in Fort Worth. Shortly after O’Connor’s order, U.S. District Judge Mary McElroy in Rhode Island granted motions by the hospital and the Rhode Island Child Advocate to quash the subpoena, finding it violated minor patients’ constitutional privacy rights and lacked a legal basis because the hospital’s off-label prescribing is not illegal, Courthouse News reported.

Duncan and Engelhardt, both Trump appointees, questioned the hospital’s decision to litigate the quash motion in Rhode Island after O’Connor had already ruled. Duncan said the parallel proceedings created a “procedural conundrum,” and Engelhardt called the hospital’s approach a “sharp practice,” according to Courthouse News. Bloomberg Law reported that Duncan and Engelhardt expressed doubt that the hospital was denied due process. Bailey told the panel the hospital is producing responsive records with patient information anonymized for the Texas court to hold privately while the Fifth Circuit and First Circuit appeals proceed.

Broader subpoena campaign

In July 2025, the Trump administration said it had issued more than 20 subpoenas to doctors and clinics that provide gender-affirming care to minors, following an executive order seeking to end such treatments. Numerous federal judges have blocked or limited similar subpoenas. In August, a divided Ninth Circuit panel became the first appeals court to reverse a lower-court order quashing one of them; that clinic has sought rehearing en banc, Courthouse News reported.

Developing: The Fifth Circuit has not issued a decision on Rhode Island Hospital’s appeal, and the First Circuit appeal of Judge McElroy’s quash order remains pending.

Sources: Bloomberg Law, Courthouse News Service.