Tucson Residents Say El Rio Sold Them Out

El Rio Health in Tucson advertised itself for years as the leader in gender-affirming care not just for Tucson, but much of the state, where medical care for transgender people was either unavailable or stigmatized.

In 2018, Tucson.com reported that patients were showing up from across Arizona — from Safford to Flagstaff — because of the organization’s push to be a leader not just in LGBTQ+ health care, but specifically for youth and adults who identified as transgender.

But that reverence in the community evaporated almost overnight when, earlier this year, the group secretly removed all care for transgender and nonbinary youth receiving medical treatment. And recently, trans adults have also had issues getting access to their life-saving medicine.

El Rio Health’s decision only came to light after the nonprofit news outlet Tucson Sentinel reported it, following similar moves by other large medical providers in the state, including Phoenix Children's Hospital. The provider’s actions were in response to President Donald Trump’s executive order issued Jan. 28 that banned gender-affirming care for organizations receiving federal funds. But that action has been challenged in the courts and is currently unenforceable.

While some organizations have issued public statements or even reversed course — as Prisma Community Care in Phoenix did — El Rio Health has continued to remain silent about its decision to end care for a population it once made significant inroads with. And while some feel El Rio Health’s actions are deeply unethical, they also question whether the institution has forced doctors to violate their Hippocratic oaths.

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“What is the cliff effect of having testosterone in your formative years and then at 16 or 17 having it taken away and now the predominant hormone is estrogen — or vice versa?” said Dr. San Lyman, a natural health care provider who works with LGBTQ+ patients in a separate practice. “It feels illegal and unethical — and honestly, it feels a little bit like medical negligence.”

Lyman described El Rio Health’s roll out of removing care as akin to patient abandonment: Parents of trans youth said they were given only 48 hours’ notice that their care was going to be canceled, leaving them to scramble last minute to find medications. 

Lyman was one of at least 40 protesters who showed up outside El Rio Health’s cancer research and screening fundraiser last Saturday to push for public awareness of the medical provider's decision. The protesters, which included parents of trans youth, students, medical professionals, allies and other researchers, lined the street outside the organization’s annual "Run for the Roses" block party at Plaza Palomino.

To some extent, the protest was successful, as it managed to draw some party attendees and funders over to the picket line to explain their cause. According to those at the protest, many attendees were unaware that El Rio Health had ended care for trans youth.

“They were surprised by that,” said Hazel Heinzer, a member of Transformed, a Tucson-based parent support group who was at the protest. Others said they spoke with partygoers who said they would bring it up to El Rio Health leaders while at the fundraiser.

That lack of awareness was no accident: El Rio Health has yet to make a public statement regarding its decision to end gender-affirming care. LOOKOUT attempted to reach out to El Rio Health leadership for a statement but was unable to reach anyone.

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The federal effort to restrict gender-affirming care that prompted El Rio Health's decision has faced legal obstacles, which is the underlying argument for people who say the medical provider is abandoning its trans and gender nonbinary patients to save their bottom line.

Trump’s Jan. 28 executive order banning care for minors is currently tied up in court and unenforceable. A letter from the head of the Centers for Medicare & Medicaid Services urging providers to stop gender-affirming care for all patients — including adults — has similarly spooked medical centers into pausing care, though it, too, is also being challenged. Most recently, U.S. Attorney General Pam Bondi issued a memo filled with anti-trans rhetoric, vowing to work with prosecutors to file charges against providers who offer care to minors. Civil rights lawyers say that directive is also likely to be tied up in court and should be viewed as unenforceable for now.

Heinzer said she hopes El Rio Health and other providers get the message: Don’t pre-comply. Seeing these orders stalled in court shows that “when institutions stand up and band together against this administration, it’s successful,” she said.

The impacts of El Rio Health’s decision are not yet fully known and likely won’t be for some time, said Russ Toomey, a University of Arizona professor who specializes in transgender health and attended the protest. He said that there is research currently being done in states that revoked gender affirming care completely, but there is no current body of research to show the long term affects. In contrast, he said, "there is a large body of evidence to show this is a safe medical diversion for trans youth."

Toomey said in the past he's been invited by El Rio Health to speak to staff and provide research updates on gender-affirming care for youth, and is hoping to use his position to speak with leadership to change their position.

But at the protest, he said members of El Rio Health's board approached the protesters and explained the organization would have lost money if they didn't comply with the decision. That response, Toomey said, was callous: "There was no empathy at all."

But even if the organization was to reverse it's decision now, it still would have an image issue to deal with.

“They’ve been touting themselves for years as the provider in Southern Arizona,” said Toomey. “We’ve given them millions of dollars, only for them to turn their backs on us."