There will not be any winners in the ongoing dispute between Children’s Hospital of Colorado, the doctors who work there and the families who need gender-affirming care to protect their children’s well-being. There will only be hurt, pain and suffering.
That is the point for the Trump Administration that weaponizes cruelty.
On the campaign trail in 2024, Donald Trump demonized the transgender community to great effect. Kamala Harris’ campaign never found a powerful response, and it cost her votes in Midwestern states and among minority groups. That in turn pushed Trump back into the White House.
Trump knew he could appease his base by attacking a vulnerable community MAGA neither understood nor wanted to understand. After losing the culture war over marriage equality — at least for now — they turned to a minority within a minority that could be easily exploited. They traded on unfounded fears (men in restrooms with girls) and unsubstantiated conspiracy theories (schools sending children for gender reassignment surgeries without parental permission).
That messaging filtered into policy even before Trump returned to office.
The administration targeted transgender members of the community in every aspect of life. The dangers posed to targets mattered little. To the contrary, it seems many take gleeful pleasure in the distress they caused. Extolling beliefs that made an entire community almost sub-human, they see every action as both justified and righteous.
That is why they do not care about the pleas from families and children.
In contrast, I imagine that the hospitals and doctors who previously worked with those families suffer almost as severely. These are people and practices that spent careers helping a marginalized community.
For decades leading hospitals followed proven science to guide care. Study after study demonstrated that gender-affirming care not only improved lives, it saved them. It does so by reducing anxiety, depression and suicidal ideation.
That is particularly true when gender-affirming care is provided early in life. Being a teenager is already difficult; everyone has their own stories of struggle during those years. It is harder by multiple factors for people who feel trapped in the wrong body. The longer that goes untreated, the greater the risk for mental health breakdowns.
Nobody knows this better than the healthcare workers who have dealt with untreated individuals. They have been trained to recognize the issue and address it with families, methodically and over time, to treat each individual in the best manner for them.
It is a collaborative effort and a calling for those professionals. It is exactly the kind of process many in the MAGA and MAHA world claim to want, but denounce when it is for something they personally detest.
Those healthcare workers have often spent years and decades working with families to help provide long term, successful outcomes. Now they have been forced to withhold that care or lose their careers — and the care they provide to others — if they continue to provide gender-affirming care to families and their children. That is the situation we face now.
Hospitals, including Children’s, fought subpoenas issued by the Trump Administration in its early days. They sought to protect their patients’ records and rights as well as their providers’ ability to give care. They understood the stakes.
Unfortunately, so did Trump and his cronies. They also knew what strings they could pull.
Under Secretary Robert Kennedy Jr., the U.S. Department of Health and Human Services began intimidation tactics to force hospitals’ hands. They began investigations and threatened to withhold funds. They effectively put hospitals in a no-win situation; either cease gender-affirming care or face the possibility of going broke and stopping all care.
Trump, Kennedy and their ilk were willing to sacrifice all patients just to stop hospitals from caring for some specific patients.
It feels like the type of outlandish scenario I would present to my class of MBA in Health Administration students. An unwinnable Kobayashi Maru test to prove that some situations cannot be resolved to everyone’s satisfaction — that the needs of the many could be pitted against the needs of the few.
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But that is exactly the scenario hospital executives were forced into. Eventually, inevitably, they choose to protect the ongoing care of the vast majority of patients. They ceased gender-affirming care. Eventually Children’s got sued and the Colorado Supreme Court stepped in — likely to the silent applause of the hospital that “lost.”
Unfortunately, even as the hospital won the right to provide care by losing in court, the Trump Administration continued along alternate paths that would undermine the decision. In several other states individual doctors and providers who continued to defy the administration found themselves under investigation and forced to defend their medical licenses.
The not-so-subtle threat would strip healthcare workers of not just their livelihood, but the ability to treat their other patients as well. It is a disgusting and callous exercise of power akin to the proverbial abusive father: issue ultimatums with no real choice.
So now kids have to be hurt. Families have to be crushed. Doctors and hospital providers have to hold their sorrow and regret inside, hoping to salve it with the care they can still provide. And for what? So that the Trump Administration can hurt all of them.
As I said, cruelty is the point. And there is apparently plenty to go around.
Mario Nicolais is an attorney and columnist who writes on law enforcement, the legal system, health care and public policy. Follow him on BlueSky: @MarioNicolais.bsky.social.
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