A former case worker of the Washington University Transgender Center at St. Louis Children's Hospital testified Monday in the trial challenging Missouri's restrictions on gender-affirming care (Rebecca Rivas/Missouri Independent).

The former caseworker whose account of her time working at a pediatric gender clinic in St. Louis jumpstarted the legislative push to outlaw gender-affirming care for minors testified in defense of Missouri’s restriction on Monday.

Jamie Reed, who for four and a half years worked as a case manager at the Washington University Transgender Center, was the first witness called by the state in the two-week trial over the constitutionality of the law. Reed’s public statements and sworn affidavit about her experience at the clinic were the genesis for Missouri lawmakers prioritizing the ban and spurred broad investigations by the Missouri Attorney General’s Office into practitioners statewide.

Reed testified as a fact witness, meaning she couldn’t speak as an expert but could provide insight into her experiences working at the Transgender Center. Many of Monday’s questions gravitated toward the records she kept — and later shared — that contained information on the center’s patients.

Under the 2023 law, health care providers can’t prescribe new gender-affirming care medications to minors or refer them for surgery, and the state’s Medicaid program is barred from paying for gender-affirming medical care for any age. Transgender Missourians, their families and health care providers filed a lawsuit in July 2023, calling the law unconstitutional because it discriminated against transgender people.

Therapists, social workers face scrutiny in Missouri AG investigation of transgender care

Last week, plaintiffs called witnesses that testified that their medical record numbers and treatment information were listed in a document that Reed shared with Attorney General Andrew Bailey and at least one reporter.

When asked Thursday about his daughter’s information being shared, J.K. (who testified using his initials as a pseudonym) said he never consented to the information being spread.

“It’s confusing and mystifying,” he said. “I don’t know why this person would share our information. I have no idea what this person is up to.”

He didn’t interact with Reed, he said, apart from getting an email after an appointment with follow-up information from her. But somehow, his daughter’s information was in Reed’s table.

Elliott, a college student who went to the Transgender Center as a teenager and testified using only their first name, said Friday that Reed was never in appointments with them. Elliott is “terrified” that the attorney general has information related to their medical care.

“I don’t know what they’ll do with that information,” Elliott said. “I don’t think it’s any of (the state’s) business that I’m trans.”

Elliott also thought Reed’s affidavit, which was released to the public, described them in a paragraph that was so specific friends and family could identify them.

“I was extremely upset (when I read the affidavit),” Elliott said. “I didn’t think it was an accurate representation of the care I received at Wash U. There was a line I thought could represent me, and if so, I am angry that I was used without my permission.”

Reed testified on Monday that this part of her affidavit was describing multiple patients. Other paragraphs talking about “a patient” were also a compilation of more than one person, she said.

The affidavit was based on medical records, patient visits and “firsthand knowledge” she testified. 

Reed didn’t dispute that Elliott’s information was shared in a 23-page document that listed patients’ medical record numbers instead of names. She didn’t consider this private health information protected by federal law because someone would need a key with names alongside medical record numbers to identify patients.

She sent this data to Bailey after a subpoena, she testified, but she also sent it to a New York Times reporter.

Plaintiffs’ attorney Gillian Wilcox asked about the 300 pages sent to the reporter. Reed said she sent “redacted documents that contained no (private health information).”

Reed, for part of her time at the Transgender Center, tracked patients she was concerned about on a “red-flag list.” She called it that because red flags at the beach mean to “proceed with caution,” she testified.

There were 27 patients on the list, identified by name instead of medical record number. Reed says she monitored them with a nurse at the center who shared concerns with Reed that too many children were receiving cross-sex hormones and puberty blockers.

Reed sent this list to Bailey in early February 2023 at the time of her affidavit, she said.

Other records she sent to Bailey include emails compiled from her Washington University email account, a list of therapists the center often referred patients to and copies of referral letters from therapists.

Reed told The Independent previously that she redacted names in the referral letters. This was not asked in court Monday.

Wilcox asked about a letter Reed sent Bailey in April 2024, long after she ended her employment with the Transgender Center.

The letter shared information from the center’s schedule that Reed believed showed the center was accepting new patients, despite public statements that it would not.

Reed currently works as executive director of the LGBT Courage Coalition, a nonprofit that advocates against gender-affirming care for transgender youth.

She recently traveled to the American Academy of Pediatrics convention in Florida to help volunteers “educate” pediatricians on gender-affirming care. A press release on the group’s participation described it as a “peaceful protest,” but Reed did not characterize the demonstration as a protest.

She wouldn’t answer whether she supported gender-affirming care for adults or not, though she had indicated support in prior testimony. She cited “changes in (her) personal life.”

At the beginning of questioning, she testified that her spouse was “detransitioning,” or stopping testosterone treatments. Sunday evening, her spouse’s perspective was published in The Free Press, the same website that launched Reed as a whistleblower in February 2023.