A federal court in North Dakota has ruled that a group of Catholic hospitals and others should not be required by the Department of Health and Human Services to perform gender transition procedures, including those for minors.

U.S. District Court Judge Peter Welte in North Dakota issued a ruling Tuesday in the case of Sisters of Mercy, et al. v. Azar.

Welte, appointed to the federal judiciary by President Donald Trump in 2019, granted permanent injunctive relief to the plaintiffs and concluded that they are exempted from an HHS rule known as the “Transgender Mandate.” He cited the Religious Freedom Restoration Act.

“The Catholic Plaintiffs have demonstrated an entitlement to permanent injunctive relief. An RFRA violation is comparable to the deprivation of a First Amendment right,” wrote Welte.

“Having weighed the pertinent factors, the Court will permanently enjoin the Defendants from enforcing the successfully challenged interpretations of federal law against the Catholic Plaintiffs.”

The decision prevents HHS from “implementing regulations thereto against the Catholic Plaintiffs in a manner that would require them to perform or provide insurance coverage for gender-transition procedures, including by denying federal financial assistance because of their failure to perform or provide insurance coverage for such procedures or by otherwise pursuing, charging, or assessing any penalties, fines, assessments, investigations, or other enforcement actions.”

In 2016, the Obama administration implemented a new regulation through the Affordable Care Act commonly known as the “Transgender Mandate.”

The regulation required that healthcare providers perform gender transition procedures, even on minors, even if they hold religious objections to the controversial practice.

In response, a group of Catholic entities filed a lawsuit against HHS over the regulation. Those groups include an order called the Sisters of Mercy, two Sacred Heart Mercy Health Care Center clinics; SMP Health System and the North Dakota-based University of Mary.

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The Catholic plaintiffs were represented by Becket Law, a legal nonprofit that specializes in religious liberty cases and has argued litigation before the U.S. Supreme Court.

“The court’s decision recognizes our medical heroes’ right to practice medicine in line with their conscience and without politically motivated interference from government bureaucrats,” Becket Senior Counsel Luke Goodrich said in a statement. 

Under the Trump administration, HHS broadened the exemptions for the regulation in 2020. However, these changes were complicated by the Supreme Court decision Bostock v. Clayton County, which concluded that Title VII of the Civil Rights Act of 1964 applies to sexual orientation and gender identity even though neither category is specifically mentioned in federal discrimination law.

In his opinion, Welte decided that the Bostock ruling did not fully return HHS to the 2016 version of the rule, noting that in the Supreme Court “separately expressed continued commitment to safeguarding employers’ religious convictions.”

Welte is the second federal judge to rule against the HHS mandate.

In 2019, Judge Reed O’Connor of Texas, an appointee of President George W. Bush, struck down the mandate after a lawsuit was filed on the behalf of healthcare providers in five states that are members of the Franciscan Alliance as well as the Christian Medical & Dental Associations and Specialty Physicians of Illinois.


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