Mount Sinai “Transgender” Care Settlement With U.S. Department of Justice

Private Malpractice Suits Expected

Our firm is currently reviewing malpractice cases concerning “gender-affirming” or “transgender” medicine, including potential cases arising out of care rendered at Mount Sinai Hospital in Manhattan, New York.

A recent settlement between Mount Sinai Health System and the U.S. Department of Justice (DOJ) concerning pediatric gender-related services highlights what appear to us to have been significant irregularities in the provision of that care. The settlement calls for Mount Sinai to stop providing puberty blockers, cross-sex hormones, and surgical procedures for gender transition to minors, pay an undisclosed monetary penalty, and dedicate $2 million to free medical care for people suffering harmful consequences from gender-related care received as children.

DOJ stated that the resolved claims were allegations only, that there had been no determination of liability, and that Mount Sinai denied all allegations.

Mount Sinai’s settlement with DOJ is one of many recent developments that increase our concerns over this area of medicine at Mount Sinai, as well as other institutions.

Of particular concern is body-altering treatment offered to minors based on a diagnosis of “gender dysphoria”—distress related to an incongruence between a person’s experienced gender and sex characteristics. Such treatments have included giving cross-sex hormones or “puberty blockers” and sometimes surgery, such as removing healthy breasts from teenage girls or even removal of genitalia. While a few years ago such treatment was often simply accepted as the new “standard of care,” many reputable medical authorities increasingly question the medical, legal, and ethical basis for such treatments. Sources addressing the medical evidence include the American Society of Plastic Surgeons and the Cass Review and NHS England’s response.

Even for adults, patient informed consent may be violated in “transgender medicine.” This may occur if so-called “gender-affirming” treatments, such as removing body organs or cross-hormone treatment, are given without a physician providing accurate information as to the expected results or information about the actual rates of “regret” among those who have undergone body-altering treatments.

Recent Mount Sinai Settlement With the U.S. Department of Justice

Serious problems in “gender-affirming” medicine are highlighted, in our view, by the recent settlement between Mount Sinai Health System and the U.S. Department of Justice.

On September 4, 2026, DOJ announced that Mount Sinai Health System agreed to resolve a federal investigation into potential violations of federal law arising from specified gender-related interventions furnished to children by discontinuing puberty blockers, cross-sex hormones, and surgical procedures for gender transition to minors and paying an undisclosed monetary penalty (U.S. Department of Justice, Office of Public Affairs, September 4, 2026).

DOJ also announced that Mount Sinai will dedicate $2 million to providing free medical care to people who suffer harmful consequences from gender-related interventions they received as children. This commitment is separate from the undisclosed monetary penalty; DOJ did not describe it as a malpractice fund.

A Mount Sinai spokesperson was quoted as saying that Mount Sinai sought the settlement so it would not be compelled to produce sensitive patient records to a grand jury (Gothamist, September 4, 2026). We are skeptical of this claim. We believe Mount Sinai’s pediatric transgender program has come under increasing financial pressure from threats of loss of federal funding and private malpractice suits. At the same time, New York State authorities, including the New York State Attorney General, have been threatening hospitals and other providers with legal action if they do not continue to provide such services.

Therefore—and while this is opinion—it is our belief that Mount Sinai may have been motivated to enter into an agreement with DOJ to discontinue specified pediatric transgender services that were becoming a financial liability, in a way that it could claim it was “forced” to do so by federal authorities.

We believe that recent events at Mount Sinai are a fascinating window through which to see how medicine—and the business and politics of medicine—affect how hospitals provide care.

Context: Recent Federal Actions to Discourage Pediatric Cross-Gender Medicine Through Funding Restrictions

The recent DOJ settlement with Mount Sinai appears to be part of a broader “push back” against “gender-affirming medicine” that has gathered momentum both medically and politically.

Notably, the Centers for Medicare & Medicaid Services (CMS) recently finalized a rule ending federal Medicaid and Children’s Health Insurance Program (CHIP) funding for specified “sex-rejecting procedures” for minors, effective October 13, 2026 (CMS, August 11, 2026). New York and other states filed a challenge to that rule on September 2, 2026 (New York Attorney General, September 2, 2026).

A threatened cutoff of federal funding was a “big deal” for transgender programs such as Mount Sinai’s. The final rule concerns federal Medicaid and CHIP funding for the specified services. A separate proposed rule would condition hospital participation in Medicare and Medicaid on not providing specified interventions to minors; that proposal had not been finalized when this page was prepared.

Recent Suits for Malpractice in “Transgender Medicine”

In addition to increasing pressure from the federal government to discontinue “transgender” programs for minors, we believe recent success in private malpractice suits against providers has also created pressure on hospitals to curtail or end those practices.

Outside New York, a number of prominent cases have gone forward alleging malpractice in transgender medicine. Recently, a Westchester County jury returned a malpractice verdict against a psychologist and a surgeon in a detransition case involving chest surgery on a minor, finding inadequate evaluation and consent.

While the recent New York verdict was based on the particular facts of that case and did not “outlaw” the entire field, it did provide a “bellwether” example showing that even a jury in a New York jurisdiction such as Westchester may, in an appropriate case, find that the provision of so-called “gender-affirming” care failed to meet accepted standards of medical practice—particularly if provided to a minor.

Before the recent DOJ settlement, Mount Sinai had reportedly stopped providing services such as puberty blockers and hormone therapy to minors earlier in 2026, although it made no formal announcement. We believe this was motivated, at least in part, by the potential loss of federal funding and an apparently increased potential for malpractice liability.

The New York State Attorney General Enters the Chat

Telling New York Hospitals They Must Continue to Provide “Gender-Affirming Care” or Potentially Face State Legal Action

In apparent “push back” against increasing federal pressure against transgender medicine, New York State legal authorities appear to have been pursuing a campaign to pressure health-care providers to continue providing transgender medical interventions—under threat of potential New York State legal action.

Notably, New York Attorney General Letitia James has announced that hospitals withholding gender-related interventions from transgender patients “while offering such services to cisgender individuals” could violate New York human-rights law. The obvious implication is that closing the doors of such programs could lead to legal action by New York State (Letter from Letitia James to health-care providers, February 3, 2025).

The New York Attorney General’s Health Care Bureau has also informed NYU Langone that if it did not resume medically necessary puberty blockers and hormone therapies for patients under 19 diagnosed with “gender dysphoria,” it could face “further action” (Associated Press, March 3, 2026; GO Magazine, March 4, 2026; Executive Law § 296(2); Civil Rights Law § 40-c).

But the Actual Legal Authority of New York State to Require Hospitals to Provide “Gender-Affirming” Treatments to Minors Appears Doubtful

Although New York legal authorities have threatened legal action against hospitals for discontinuing transgender interventions for minors, as of September 8, 2026, we are aware of no related proceedings initiated by New York State against a hospital.

In the specific case of the New York Attorney General’s Health Care Bureau, its purported deadline for NYU Langone to resume its “gender dysphoria” treatments appears to have passed without reported enforcement or legal action by that agency (Washington Square News, April 2, 2026).

The legal basis to claim that anti-discrimination law requires the provision of transgender medicine to minors also appears questionable in light of a recent U.S. Supreme Court holding. In United States v. Skrmetti, 605 U.S. 495 (2025), the Supreme Court upheld Tennessee’s law restricting specified treatments for minors against the Equal Protection Clause challenge before it. The Court did not decide the requirements of New York law.

Did Mount Sinai Settle With DOJ to Protect Itself Against Legal Action From New York State?

As noted, it appears that Mount Sinai may have been motivated to stop specified pediatric transgender services for financial reasons, including loss of federal funding and the threat of malpractice lawsuits.

However, facing “pushback” by advocates of “gender-affirming care” and New York State legal authorities—hinting at civil-rights litigation if providers do not provide such services—one interpretation of Mount Sinai’s settlement with DOJ is that Mount Sinai found a way to discontinue specified pediatric transgender services under federal authority and claim that the decision was “out of its control,” meaning forced by federal enforcement action.

What action, if any, New York’s Attorney General or other state officials will take in response to the recent Mount Sinai–DOJ settlement is uncertain. Reportedly, the New York State Attorney General is “reviewing” the settlement (Gothamist, September 4, 2026).

How Does This Affect Potential Patients Harmed by Transgender Medicine?

We believe that Mount Sinai’s agreement to pay an undisclosed monetary penalty and to dedicate $2 million to free medical care for people who suffer harmful consequences from gender-related interventions received as children is a telling indication of how many medical experts are now shifting against a “no-questions-asked” approach to transgender treatments, particularly for minors.

It is important to know that the public DOJ announcement identifies nothing that appears to foreclose private malpractice suits concerning the type of conduct addressed by the Mount Sinai settlement. Whether a particular patient has a claim depends on the patient’s care, the available proof, causation, injury, any applicable release, and filing deadlines.

That is, if a patient was harmed by improper medicine—whether called “transgender medicine” or “gender-affirming care”—we remain able to evaluate and bring appropriate cases. Recent experience in other states, as well as New York, suggests that these cases, when appropriately brought, can be viable based on sound medical and legal principles and can lead to successful results in a courtroom.

How Do We Evaluate Whether “Transgender Medicine” Provided Was Malpractice?

While transgender medicine is a unique field and subject to its own proponents and critics, all medicine is subject to general principles of negligence and malpractice.

That is, regardless of whether a patient identifies as “trans,” “nonbinary,” or carries a diagnosis of “gender dysphoria,” all medical practitioners—including mental-health professionals, surgeons, and endocrinologists providing hormone treatments—are responsible for and subject to overall medical standards which, when violated, may constitute medical malpractice.

Medical malpractice in New York is a common-law claim. A patient generally must prove that a medical provider departed from accepted standards of care and that the departure was a proximate cause—that is, a substantial factor—in causing injury (Johnson v. Montefiore Medical Center, 2026 NY Slip Op 04911 [1st Dep’t 2026]). Those questions are typically developed through expert testimony. Experts, in turn, are informed by the profession’s own standards, including widely shared principles of medical ethics.

Separately, Public Health Law § 2805-d creates a claim for lack of informed consent. Such a claim may arise if a patient is not informed of reasonable alternatives and the reasonably foreseeable risks and benefits that a reasonable practitioner under similar circumstances would have disclosed. The patient must also establish the statute’s remaining elements, including that a reasonably prudent person would not have undergone the treatment if fully informed and that the lack of informed consent caused injury.

In some instances, it appears that physicians have told parents of minors considering cross-sex hormones or other transgender interventions that the treatment is proven effective to decrease the risk of suicide.

This assertion has been subject to criticism in recent literature. Poor or inaccurate information about the actual benefits, risks, or alternatives to medical interventions for “gender dysphoria” may, depending on the facts, violate informed-consent rights and provide an appropriate basis for legal action.

We have developed our own knowledge in this evolving area of medicine, including an understanding of relevant guidelines from WPATH and surgical and endocrinology societies. We have also developed relationships with notable experts from relevant fields, including mental health, pediatrics, endocrinology, and surgery.

Our experience in medical malpractice generally, and in this area of medicine, positions us to evaluate whether care in transgender medicine or “gender-affirming care” fell below applicable standards of practice or violated a patient’s informed consent.

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