## Facts

- Arkansas enacted Act 626, prohibiting healthcare providers from providing or referring minors for “gender transition procedures,” including puberty blockers, cross-sex hormones, and certain surgeries.
- The Act also restricted public funding and insurance coverage for such care and allowed insurers to deny coverage.
- Plaintiffs included transgender minors seeking or receiving gender-affirming care, their parents, and treating physicians.
- Plaintiffs challenged the Act under the Equal Protection Clause, substantive due process (including parental decision-making), and the First Amendment (limits on referrals and counseling).
- State officials defended the Act as protecting minors from allegedly experimental or harmful treatments and as a regulation of medical practice.
- Plaintiffs moved for a preliminary injunction before the Act took effect; after a hearing, the district court issued a written order granting relief.

## Issues

1. Whether plaintiffs showed a likelihood of success that Act 626 violates the Equal Protection Clause by singling out transgender minors and gender-affirming care for categorical prohibition.
2. Whether plaintiffs showed a likelihood of success that the Act violates substantive due process by interfering with parents’ ability to obtain medically indicated care for their children and minors’ interests in bodily integrity and medical treatment.
3. Whether the Act’s ban on referrals and related communications raises serious First Amendment concerns for physicians’ professional speech.
4. Whether plaintiffs established irreparable harm, and whether the balance of equities and public interest favored enjoining enforcement pending final judgment.

## Decision

- The court granted a preliminary injunction enjoining enforcement of Act 626’s challenged provisions before they took effect.
- The court found plaintiffs likely to succeed on equal protection and due process claims and found serious First Amendment questions.
- The court found imminent, irreparable harm to transgender minors from denial or forced discontinuation of medically indicated care.
- The court held the balance of harms and public interest favored preserving access to care and preventing enforcement of a law likely unconstitutional.

## Legal Principles

- A preliminary injunction requires showing likelihood of success on the merits, irreparable harm, that equities favor the movant, and that an injunction serves the public interest.
- A law that prohibits treatments for one group while allowing the same treatments for others based on the reason for treatment can constitute differential treatment supporting equal protection scrutiny.
- Parents have a protected liberty interest in directing the medical care of their children, subject to constitutional limits on state interference.
- Statutory bans on physician referrals and medically appropriate recommendations can implicate the First Amendment by restricting content-based professional communications.
- Threatened loss of medically necessary care and resulting psychological and developmental harms may constitute irreparable injury not compensable by damages.

## Conclusion

The district court preliminarily enjoined Arkansas’s categorical ban on gender-affirming medical care for minors, concluding that plaintiffs were likely to prevail on constitutional claims and that allowing the law to take effect would cause irreparable harm outweighing the state’s asserted interests.


Brandt v. Rutledge, 2021 WL 3292057 (E.D. Ark. 2021)