Breaking Down the Headlines: DOJ Subpoenas for Trans Care Records Part Two- Forum Shopping and the DOJ Strategy

driepdirector
May 15
8 min read

In this blog series, we'll be breaking down some of the complex news, legal actions, and policies that are impacting LGBTQ+ folks. Each week we will breakdown one news story, legal action, or policy in clear, plain language without the clickbait, and give you tools to learn more or take action. This week, we are focusing on the recent Department of Justice (DOJ) legal actions against two hospitals providing gender affirming care to transgender minors.

First, a quick recap from Part One

DOJ filed legal actions against Rhode Island Hospital and NYU Langone Health seeking records related to gender-affirming care for minors, including identifying information
Government claims it is investigating possible “off-label” drug use, billing issues, and fraud tied to transgender healthcare
This strategy targets trans healthcare indirectly after earlier attempts to restrict care were blocked in court
Both cases were filed in North Texas even though hospitals in other states. this is called “forum shopping” — the focus of part two.

An Important Update

Today, May 14th, a Federal District Court Judge blocked the Justice Department from forcing a Rhode Island hospital to hand over records on gender-affirming care for transgender youth, saying prosecutors acted in bad faith.

District Judge Mary McElroy ruled that Rhode Island Hospital, run by Brown Health, did not have to comply with the DOJ subpoena.

The hospital and the state’s child advocate had asked the court to intervene ahead of the subpoena deadline.

This means, for the time being, Rhode Island Hospital does not have to comply with the subpoena.

Our Main Topic: What is forum shopping?

Forum shopping is a legal strategy where someone files a lawsuit in a court they believe is more likely to rule in their favor. It is generally legal, as long as the chosen court can claim some connection to the case or parties involved.

So instead of filing where something happened, they file where they think they can win.

Identifying a more “favorable” court is based on

· The judges tending to agree with your legal arguments

· Past rulings there support your position

That’s forum shopping.

It’s a common, and controversial, legal strategy.

Why does it matter?

Different courts, and different judges, can interpret laws very differently. Because of this, where a lawsuit is filed can heavily influence the outcome.

Why North Texas?

North Texas, especially the Northern District of Texas, has become a common venue for conservative and anti-trans legal actions because:

The courts are viewed as more politically conservative.
Some divisions have a very small number of judges, making it easier to predict who may hear a case.
Judges in these districts have previously ruled against LGBTQ+ protections and gender-affirming care policies.

To summarize what we've learned so far:

The DOJ filed cases involving hospitals in Rhode Island and New York in North Texas courts instead of closer federal courts.
The DOJ knows that filing in North Texas can increase the chances of receiving fast, favorable rulings for the DOJ’s goal of disrupting trans lives.
This was intentional and designed to increase the likelihood of favorable rulings against providers of transgender healthcare.

The DOJ’s Justification

Under federal law governing certain subpoenas (including those tied to healthcare investigations), enforcement can sometimes be filed where the investigation is based, not just where the hospital is located.

DOJ says its investigation into gender-affirming care providers is “being carried out in the Northern District of Texas.”

In plain terms, they’re arguing, “We’re running this investigation from Texas, so we can ask a Texas court to enforce the subpoena.”

The Paxton Connection

Texas Attorney General Ken Paxton has laid the groundwork for these federal cases.

Paxton's Previous Actions: In 2023 and 2024, Paxton personally issued state investigative subpoenas to hospitals in other states, such as Seattle Children's Hospital, demanding information on Texas residents receiving transgender-related care.
Targeting Out-of-State Care: Paxton publicly pledged to investigate any entity he suspects of providing gender-affirming care to Texas minors, even across state lines, accusing providers of "unlawful behavior" and "child abuse" under Texas law SB 14.

While the DOJ subpoenas issued to Rhode Island Hospital land NYU Langone are federal, and Paxton’s office was not directly involved in them, they follow the legal groundwork and investigations previously aggressively pursued by Paxton. How exactly? By setting legal precedent.

What is legal precedent?

Legal precedent is a court decision from a previous case that acts as an authority or guide for deciding future cases with similar facts or legal issues. It is a foundational principle of the legal system, and creates consistency, predictability, and ideally, fairness in the law. Court rulings, as well as methods, procedures, and legal tests established by courts can set legal precedent, not just the final ruling (who wins or loses). Precedent is primarily created by the reasoning behind a decision, which usually includes creating new procedural steps or methods for interpreting the law in future, similar cases.

Actions that May Set Precedent

Paxton’s legal actions against hospitals and doctors providing gender-affirming care set a direct precedent for the May 2026 Department of Justice (DOJ) subpoenas to NYU Langone and Rhode Island Hospital by framing such care as healthcare fraud and child abuse. Paxton’s strategy of using state investigative power to demand patient records served as a roadmap for the federal government's shift toward criminal investigation.

1. Re-characterizing Care as Fraudulent

Paxton Action: Paxton accused Texas doctors of illegally providing cross-sex hormones and using false billing codes to mask "unlawful" care, classifying it as fraud.
2026 DOJ Action: The DOJ, under the Trump administration, adopted this framework, using the Northern District of Texas to issue subpoenas investigating "healthcare fraud" and "false statements" related to transgender care for minors.

2. Targeting Out-of-State Care

Paxton Action: Paxton issued investigative subpoenas to hospitals outside Texas, such as Seattle Children's Hospital, to identify Texas children receiving gender-affirming care.
2026 DOJ Action: The DOJ applied this strategy nationally, sending over 20 civil subpoenas in 2025 and 2026 to clinics nationwide, targeting records of minors.

3. Judicial Venue Shopping (forum shopping)

Paxton Action: Paxton has consistently utilized friendly courts in Texas, particularly the Northern District of Texas, to stop gender-affirming care.
2026 DOJ Action: The May 2026 criminal subpoena against NYU Langone and the, now-blocked, subpoena for Rhode Island Hospital were issued by the U.S. Attorney’s Office for the Northern District of Texas.

4. Criminalizing Providers

Paxton Action: Paxton declared in a legal opinion that any clinician, including mental health providers, facilitating gender transition for minors is engaging in child abuse.
2026 DOJ Action: While a legal opinion is not enforceable, this opinion is one piece that supports the DOJ's 2026 move to send subpoenas to Rhode Island Hospital and NYU Langone, which demanded not only patient files but also the names of medical staff.

Paxton isn’t the only State Attorney General setting precedent. In 2023, Vanderbilt University Medical Center (VUMC) turned over records containing patient Protected Health Information (PHI) to the Tennessee Attorney General's office as part of a civil investigation into billing practices for transgender care. VUMC confirmed it provided thousands of pages of documents, including medical records.

Because VUMC provided the documents, a class-action lawsuit was filed by patients alleging "serious harm" and breaches of privacy is in progress. Plaintiffs argue VUMC should have contested the Attorney General's demand for records rather than complying. This legal action is ongoing.

Opposing Precedent?

While the actions of Paxton, and the Tennessee case against VUMC have set precedent, there has also been examples of opposing precedent set.

Widespread Rejections: Federal courts have quashed or narrowed numerous administrative subpoenas sent to over 20 providers in 2025, with at least seven different federal courts acting to block these demands.
Rhode Island Hospital (Happened Today): U.S. District Judge Mary McElroy blocked the DOJ from obtaining records of transgender patients, accusing the DOJ of "forum shopping" to a Texas judge and stating the agency was "unworthy of trust" in its handling of the case. The DOJ immediately appealed this decision.
Boston Children's Hospital (Sept 2025): A federal judge quashed a subpoena seeking records for thousands of employees and patient identifying information, ruling it was "motivated only by bad faith" and lacked a legitimate investigative purpose.
Children’s Hospital Los Angeles (Jan 2026): The DOJ agreed to narrow its request and abandon demands for patient-identifying information after families filed a lawsuit to protect their privacy.

In response to these setbacks, the DOJ has shifted the strategy and escalated.

Grand Jury Subpoenas: The DOJ shifted to using grand jury subpoenas, with NYU Langone Health being one of the first to receive such a subpoena.
- This is the difference between the Rhode Island case and the New York case.
- A grand jury subpoena (NYU Langone) is a secret, powerful investigative tool issued by federal prosecutors before charges are filed to gather evidence, whereas a regular federal subpoena (Rhode Island) is a public document used during ongoing civil or criminal litigation. Grand jury subpoenas are often mandatory and lack immediate judicial review, while regular subpoenas can be challenged in open court.
- Grand jury subpoenas can make legal blocks or quashing/voiding the subpoena more challenging. This is because unlike other subpoenas, grand jury subpoenas have broad authority, often issued without prior judicial review. Motions to quash/void are frequently filed but rarely granted in full, though partial modifications are possible.

In Summary

Forum shopping is controversial, but often legal.

DOJ’s explanation for forum shopping:

“We filed in Texas because that’s where our investigation is based.”

The other, more honest explanation:

“They chose Texas because it’s a more favorable court and they’ve been losing elsewhere.”

Why it matters in this case

They’ve lost similar subpoena fights in other states, but states like Tennessee and Texas have contributed to legal precedent that supports the DOJ’s cases against Rhode Island Hospital and NYU Langone.
Texas (especially certain courts) has:
- Judges more skeptical of gender-affirming care
- A track record of rulings that align with the DOJ’s arguments
In response to setbacks with other federal subpoenas, the DOJ has escalated to grand jury subpoenas, which are more difficult to challenge. This makes the issue of forum shopping even more relevant, as the DOJ pursues grand jury subpoenas in the Northern District of Texas.

Silver Lining: The subpoena for Rhode Island is already being challenged. While the ultimate outcome of this challenge is uncertain, this is a critical legal act of enforcement against the DOJ.

What Can You Do

We’ll do our best to provide updates as these cases progress, but for quicker updates when they happen, we recommend following Lambda Legal, ACLU, and Transgender Law Center.

If you are a trans person, or the parent of a trans person

It is important to stay informed about the progression of these cases, and the sources above can help you. But remember, the DOJ has not been successful in these legal actions so far. And there are legal actions in that don’t support the DOJ’s position. For example, in April a coalition of 22 states secured a federal court order blocking an unlawful attempt by the Trump Administration to threaten healthcare providers that provide care for youth with gender dysphoria, and the other examples provided above. There are thousands of people fighting for and with you, including legal professionals, teachers, social workers, and people in all kinds of professional roles. Thousands of people you will never meet are in solidarity with you.

If you are an ally

Be an ally, visibly and proactively. Here are specific actions allies can take:

Political and Legal Advocacy

Contact Representatives: Call or write local, state, and federal officials to oppose anti-trans legislation and support protection laws.
Support Legal Defense: Donate to or volunteer with organizations like Lambda Legal, the ACLU, and Transgender Law Center.
Protest: Participate in rallies and demonstrations supporting trans rights.

Daily Interactions and Social Support

Pronouns and Names: Include your own pronouns in emails or introductions to normalize it, and always use a person’s chosen name and pronouns, even when they are not present.
Interrupt Transphobia: Speak up against anti-trans jokes, slurs, and misinformation in social settings, workplaces, and online. The rhetoric matters. It feeds the environment that threatens peoples' lives.
Respect Privacy: Do not "out" someone as transgender to others. This is incredibly dangerous to their safety.
Listen to Trans Voices: Center trans people in discussions about their lives and rights; educate yourself through books and media rather than asking them to educate you.

Economic and Material Support

Donate Directly: Support transgender individuals directly through mutual aid funds, personal fundraisers, and Patreon, particularly for expenses like gender-affirming care or legal name changes, or relocation to safer environments.
Support Trans Businesses: Buy from trans-owned businesses.
Volunteer: Offer time to local community centers or organizations that the trans community
Support Critical Resources that Already Exist- Resources like the Trans Lifeline (877-565-8860) and The Trevor Project are available to help individuals, but they need monetary support.