Boston, MA – October 2025
The U.S. Department of Justice has asked a federal judge in Massachusetts to reinstate a subpoena issued to Boston Children’s Hospital (BCH) as part of an investigation into the hospital’s gender clinic for minors. In a 32-page memorandum filed on October 7, the government argued that the court’s earlier decision to block the subpoena was based on legal error and deprived investigators of their right to obtain key records.
The subpoena seeks internal documents from BCH’s “Gender Multispecialty Service” (GMS), a program that has been at the centre of public debate over medical interventions for children who say they identify as the opposite sex. The Justice Department has been examining whether the hospital’s clinicians may have committed federal health-care offences—such as improper billing, false claims, or misbranding of pharmaceuticals—by prescribing puberty blockers or cross-sex hormones to minors without sufficient medical justification.
Government Says Court “Misapplied the Law”
Earlier this year, the U.S. District Court in Boston quashed the subpoena, siding with BCH after the hospital argued that the request was overly broad and motivated by politics. In its new filing, the Department of Justice contends that the judge “committed manifest error” in at least four ways.
First, the government says the court wrongly shifted the burden of proof from the hospital to federal investigators. Under settled law, the recipient of an administrative subpoena bears the burden of proving that it is invalid or unduly burdensome. The memorandum argues that BCH provided no such evidence, and that the court instead required the government to justify its investigation before it could even review the documents.
Second, prosecutors claim the judge imposed an unprecedented standard, demanding that the government show a detailed factual basis or “articulable suspicion” of wrongdoing before enforcement. “That is not the law,” the memorandum states. “A procedurally valid subpoena must be enforced absent clear evidence of bad faith or impropriety.”
Third, the government says it was denied the opportunity to supplement the record with additional factual support once the court adopted that new, higher standard. To cure that, the Justice Department now offers a detailed preview of the evidence it says justified the subpoena.
Alleged Irregularities at the Gender Clinic
The Justice Department’s filing sets out several areas of concern. Using anonymised insurance claims data, investigators reportedly identified hundreds of children listed as having “central precocious puberty” (CPP) even when they were aged 10 or older—an age at which puberty would not normally be considered premature. According to the government, that pattern suggests the diagnosis may have been used to justify prescriptions for puberty-blocking drugs.
The memorandum also cites public statements by several BCH clinicians. One, Dr. Amy Tishelman, allegedly acknowledged in a 2022 interview that the hospital had reduced the time spent on psychological assessments before initiating puberty blockers—from roughly 20 hours to about two and a half. Another, endocrinologist Dr. Jeremi Carswell, was quoted as saying puberty blockers were prescribed “like candy” and acknowledged the risk of long-term effects on fertility and bone density.
The government contrasts these internal and professional acknowledgments with BCH’s public communications, which it says described puberty blockers as “temporary” and “fully reversible” and claimed they cause “no permanent changes.” That discrepancy, prosecutors suggest, could amount to deceptive or misleading statements made in connection with federally reimbursed care.
A third clinician, psychologist Laura Edwards-Leeper, has publicly expressed concern that some children were being “rushed” into medical transition with inadequate evaluation. The filing argues that these statements collectively justify federal scrutiny.
Contesting a Finding of “Bad Faith”
The fourth major argument in the Justice Department’s brief takes aim at the earlier court’s suggestion that the subpoena was issued in “bad faith” or as political harassment. The government rejects that conclusion outright. “Policy motives do not equate to bad faith,” the memorandum says. It notes that investigating the clinical and billing practices of hospitals is a lawful exercise of federal oversight, particularly when public funds or controlled substances are involved.
The department also emphasises that the Attorney General’s policy concerns about experimental medical procedures on minors are legitimate matters of public interest and law enforcement, not partisan ideology.
Broader Legal and Policy Implications
The case has become one of the first major federal tests of how far the government can go in scrutinising paediatric gender medicine. At issue is not only the medical ethics of such treatments, but also the legal power of federal agencies to demand documents from hospitals without first showing probable cause.
Legal analysts note that if the Justice Department’s motion succeeds, it will strengthen the government’s authority to investigate health-care providers under existing administrative subpoena powers. If the court upholds its earlier decision, it could significantly narrow those powers and insulate large medical institutions from early investigative review.
The controversy comes amid a nationwide shift in how governments and medical bodies approach gender-related interventions for minors. Several European countries, including Sweden, Finland, and the United Kingdom, have curtailed or halted the routine use of puberty blockers for gender distress in adolescents, citing uncertain evidence of benefit and emerging risks. In the United States, a growing number of states have restricted such practices or placed them under paediatric ethics review.
Next Steps
The Massachusetts court has not yet set a date for hearing the Justice Department’s motion. If the judge declines to alter the earlier ruling, the government is expected to appeal to the U.S. Court of Appeals for the First Circuit.
Whatever the outcome, the case is likely to set an influential precedent. A reinstated subpoena could force Boston Children’s Hospital to disclose internal communications, treatment protocols, and billing data—information that could reshape both medical practice and public policy. Conversely, a reaffirmed quash order could limit future federal oversight of gender-related medicine, leaving state medical boards and insurers as the primary regulators.
As the legal battle unfolds, it highlights a growing question in American medicine: who decides what constitutes appropriate care for children experiencing distress about their sex, and to what extent the state can—or must—intervene.
