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William Malone
2/4/2020 7:17:53 PM
"Julianne Young" <juliannehyoung@gmail.com>
"David Pickup" <davidpickuplmft@gmail.com>, "Eunie Smith" <alaeagle@charter.net>, "Fred Deutsch"
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<Greg.Scott@heritage.org>, "Shupe Jamie" <jamie.shupe@yahoo.com>, "Steve Smith" <steve@stevesmithlaw.com>, "Timothy
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Subject: Re: Idaho Vital Statistics Integrity Act - short window for

Yes, with one small adjustment in *’s below.
On Tue, Feb 4, 2020 at 7:54 PM Julianne Young <juliannehyoung@gmail.com> wrote:
Would the following summary of you statement (as opposed to a quote) meet your approval:
The society of evidence-based gender medicine has declared that the conflation of sex and gender in health care is
alarming, subjects hundreds of thousands of individuals *to the risk
of* unintended medical harm, and will greatly impede medical research.

On Tue, Feb 4, 2020 at 11:33 AM William Malone <malone.will@gmail.com> wrote:
I agree with the points you’re all making. The quote in question is from a comment to HHS that our group (SEGM)
submitted last year— we struggled about the wording of this sentence. Perhaps Julianne you could paraphrase our
warning about conflating sex and gender, and use language that is preferable to you and your target audience? In
this instance, we straddled the fence, using terms we don’t agree with or at a minimum are poorly defined, but
added the modifier "-identified”, not leaving it as “transgender” and “cisgender”, hoping to convey that these are
not universally accepted stand-alone terms in the medical world.
Here is a link to the public comment, and the
full text:
https://www.regulations.gov/document?D=HHS-OCR-2019-0007-148044
The Society for Evidence-Based Gender Medicine (SEGM) strongly supports the rights of all individuals to be treated with respect and dignity, and to have access to evidence-based medicine the
hallmark of quality health care. In order to achieve this goal, it is critical that healthcare providers, organizations, and payers maintain a clear distinction between sex and gender. Gender identifiers in
medical records provide healthcare workers with key information about an individuals sense of self. The markers of natal or biological sex contain lifesaving information that is essential for healthcare
decision-making.
Clinicians making medical decisions must assume that natal or biological sex is accurately documented in a medical record. Depending on the patients biological sex, the same blood test result can be
interpreted as either normal or abnormal and requiring prompt medical attention. Knowing a patients biological sex can be a matter of life or death in a range of healthcare events, from pregnancies to
organ failure and subsequent transplants.

More than 10,000 articles in the medical literature detail sex differences in epidemiology, pathophysiology, and clinical manifestations as well as pharmacokinetics and pharmacodynamics. New data
underscoring the importance of biological sex to multiple physiological processes emerge daily, including recent research suggesting that even blood transfusions are more successful when matched to
the individuals biological sex.(1) Given the explosion in the field of genetics, in the coming years we will learn about many more instances where biological sex sets into motion key disease processes,
and we will identify more treatments that rely on knowledge of the patients biological sex.
The current trend toward the conflation of sex and gender in medical records has the potential to jeopardize patient safety and result in medical malpractice. The results of a study published in the
Journal of the American Medical Association (JAMA) determined that more than 5% of all records of transgender persons presenting for inpatient hospital care have inconsistent sex markers.(2) This
number is likely to drastically underestimate the true prevalence of the conflation of sex and gender in medical records, since the researchers could only determine the inconsistency in the minority of
cases where a patient was undergoing a surgical procedure that clearly contradicted the recorded sex (e.g., a hysterectomy for a male).
The conflation of sex and gender in healthcare is alarming and is poised to subject hundreds of thousands of transgender and cisgender-identifying individuals to unintended medical harm from
receiving incorrect diagnoses and being subjected to incorrect treatments. It will also greatly impede scientific research, not only in the area of transgender treatments, which sorely lacks quality longterm outcome evidence, but also in other areas of medical research.
For these reasons, SEGM supports the HHS proposal to clarify the definition of sex for healthcare purposes. In addition, SEGM calls on healthcare organizations in the US to develop guidelines for the
appropriate use of the sex and gender fields in the Electronic Medical Records (EMRs) to ensure that individuals suffering from gender dysphoria are treated with respect and dignity and receive
accurate and appropriate medical care.
References
1. Alshalani, A., Li, W., Juffermans, N., Seghatchian, J. and Acker, J. (2019). Biological mechanisms implicated in adverse outcomes of sex mismatched transfusions. Transfusion and Apheresis Science,
58(3), pp.351-356.
2. Canner, J., Harfouch, O., Kodadek, L., Pelaez, D., Coon, D., Offodile, A., Haider, A. and Lau, B. (2018). Temporal Trends in Gender-Affirming Surgery Among Transgender Patients in the United
States. JAMA Surgery, 153(7), p.609.

On Feb 4, 2020, at 9:52 AM, Kelsey Coalition <kelseycoalition@gmail.com> wrote:
For KC talking points, I use the phrase: "individuals who identify as transgender or non-binary" rather than "transgender" or "non-binary" without the modifiers.
On Tue, Feb 4, 2020 at 11:10 AM James Shupe (Formerly Jamie Shupe) <jamie.shupe@yahoo.com> wrote:
Another note on cisgender. If I'm not mistaken the word was coined by transgender activist Julia Serano between 10 and 20 years ago. Trans activists don't get to decide
what the rest of us are.
They've gotten away with the same thing for gender identity, claiming we all have one, which also isn't true.
So the pattern has been that transgender activists say things and create language and everyone just adopts it without question.
James Shupe

Sent from Yahoo Mail on Android
On Tue, Feb 4, 2020 at 10:44 AM, Kelsey Coalition
<kelseycoalition@gmail.com> wrote:
Looks great! My only concern is with the quote from SEGM. Will, would you consider this? First, the reference"cisgender-identifying individuals." I believe there is way to
make this point, without using a word like "cis" which indirectly endorses the ideology upon which transgender identities are based.
My other suggestion with the quote is to add non-binary. Even though transgender has become an umbrella term covering both, some nonbinary individuals do not say
they are transgender. Many forms offer both categories for people to check when they identify themselves.
Will, could SEGM consider rewording this -- something like "not only transgender individuals, but ALL persons" as well as add a reference to nonbinary? ~KC

On Tue, Feb 4, 2020 at 10:35 AM Natasha Chart <natasha.chart@gmail.com> wrote:
This is great, I love it. Thank you for doing this.
On Tue, Feb 4, 2020, 9:43 AM Julianne Young <juliannehyoung@gmail.com> wrote:
After visiting with Stephen Smith last night I have determined that the best way to counter the arguments raised in the law-suit is the insert some additional language into our legislative intent,
rather than addressing another section of code. My additions are highlighted below. Your feedback is sincerely appreciated.

The legislature finds a compelling interest in maintaining accurate, quantitative, biology-based statistics on Idaho certificates of birth which provide vital statistics fundamental to the
performance of government functions that secure the public health and safety, including, but not limited to, identifying public health trends, assessing risks, conducting criminal investigations, and
helping individuals determine their biological lineage, citizenship, or susceptibility to genetic disorders; and,
The equality clause prohibits purposeful discrimination and not facially neutral laws of general applicability such as a biology-based definition of sex which has been consistently applied since
our nation's founding.
Decades of court opinion have upheld the argument that the biological distinctions between male and female justify separate but equal treatment under the law and a defined category of sex
which relies on biological fact is the only category which can be demonstrated to have obvious, immutable, and distinguishable characteristics.
The definitional erasure of biological sex significantly impacts the rights of others and would constitute manifest injustice in undermining the implementation of many policies which have been
advanced to secure the privacy and interests of individuals specific to their biological sex.
The erasure of biological sex negatively impacts the health and safety of all individuals. For example, the Society for Evidence-Based Gender Medicine has declared that “the conflation of
sex and gender in healthcare is alarming and is poised to subject hundreds of thousands of transgender and cisgender-identifying individuals to unintended medical harm from
receiving incorrect diagnoses and being subjected to incorrect treatments. It will also greatly impede scientific research, not only in the area of transgender treatments, which sorely
lacks quality long-term outcome evidence, but also in other areas of medical research.”
“Vital statistics” is defined in Idaho Code Section 39-241(21) as “data,” (being the plural of “datum”) which is a known fact; and,
Idaho certificates of birth are of an evidentiary character and prima facie evidence of the facts recited therein (Code Section 39-274); and,
Age and Sex, unlike the names of natural parents whose rights have been terminated, are legally applicable facts fundamental to the performance of public and private policies and contracts.
The failure to maintain accurate, quantitative vital statistics and legal definitions upon which government and others may with confidence rely constitutes a breach of the public trust; and
Government has a compelling interest in maintaining the public trust and confidence and a duty to fulfill, to the best of its ability, those functions which rely on accurate vital statistics; and,
Therefore, the legislature directs that an Idaho certificate of birth documents specific quantitative, material facts at the time of birth: time of birth, date of birth, place of birth and biological sex.

On Tue, Jan 21, 2020 at 10:34 AM Richard Mast <RMast@lc.org> wrote:
All,

Please meet Steve Smith, an Idaho allied attorney, and Idaho Representative Julianne Young. They have been working on a birth certificate protection bill, to reverse a recent court
decision striking down sex-based birth certificates in Idaho. This will restore the status quo, making Idaho one of four states that require birth certificates to reflect sex, along with
Kansas, Ohio, and Tennessee.

Julianne has a short window to receive comments (especially desired from the medical experts).

Matt Sharp provided ADF factual findings for the recitals and some edits. I have accepted his changes; made a few suggested edits of my own, and thus open it up to you all for any

input for Julianne and Steve.

There may be an opportunity for expert testimony, but I leave the details on that to Rep. Young.

Thanks,

Richard L. Mast, Esq.*
Senior Litigation Counsel
Liberty Counsel
PO Box 540774
Orlando, FL 32854
(407) 875-1776 phone
(407) 875-0770 fax
LC.org

Offices in DC, FL, and VA
*Licensed in Virginia
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