Hospitals, South Carolina sued over child's sex surgery

Tim Smith and David Dykes | The Greenville (S.C.) News

Show Caption Hide Caption Lawsuit filed over intersex surgery Two parents are suing after they say the South Carolina Department of Social Services allowed doctors to perform an unnecessary sex-assignment surgery on a toddler.

Suit alleges surgery didn%27t need to be done at 16 months old%2C before child identified with a gender

Even though the child now is physically a girl%2C he has always shown strong signs of being a male

But no ethics panel was consulted before the surgery%2C and the procedure is irreversible

COLUMBIA, S.C. — Parents of a child adopted seven years ago are suing the state, the Medical University of South Carolina in Charleston and Greenville Hospital System over the child's sex-assignment surgery, which they allege was medically unnecessary.

The surgery was "irreversible," "painful" and done without properly informing the child's legal guardians at the time — the state Department of Social Services — about all the risks and consequences of such surgery, according to the parents' lawsuit filed in Richland County Court of Common Pleas here. Lawyers for the parents said this and a second lawsuit filed in U.S. District Court are the first lawsuits of their kind filed in the USA.

The suit refers to the child as "M.C."

"Despite the fact that M.C. could have been raised as either a boy or a girl without irreversible surgery, defendants rushed to put into place a treatment plan that centered on a medically unnecessary, painful, and irreversible sex-assignment surgery on a 16-month-old child," the suit states. "Defendants permanently changed M.C.'s body, disregarding his well being and causing M.C. irreparable injury."

"We cannot comment on cases in litigation," Sandy Dees, spokeswoman for the Greenville, S.C., hospital system, said in a statement.

A decision on any surgery should have been delayed until the child was older and had identified with a gender, according to the suit. The surgery removed male genitalia, but the child more recently has identified as a male.

The child, now 8, was born with both male and female genitalia in 2004 and placed into state custody after the biological parents' rights were terminated, the suit said. State officials took the child into custody because the child's biological mother was deemed unfit and the father abandoned the child.

Dr. James Amrhein, a pediatric endocrinologist whom the lawsuit describes as an agent of Greenville Hospital System, became involved in the child's case in February 2005 and told the child's pediatrician that the child was a "true hermaphrodite," the lawsuit alleges.

He wrote that a decision needed to be made about the child's gender and "surgical correction" done, the suit said.

Reached Tuesday night, Amrhein said he doesn't recall the case.

"The medical record makes it clear that doctors felt this child could be raised as a boy or as a girl," said Anne-Tammar Mattis with Advocates for Informed Choice, a nonprofit group that advocates for the rights of intersex children. The organization, along with the Southern Poverty Law Center and pro bono counsel, filed the case on behalf of M.C.'s adopted parents, Pamela and John Mark Crawford of Richland County. "There was no compelling reason to go either way. And why they decided to do irreversible genital surgery, knowing that is unclear."

Amrhein referred the child's case to doctors in Charleston, S.C., the suit said.

Three physicians then collaborated to perform the sex-assignment surgery. Though the doctors discussed the case among themselves, they sometimes involved state Department of Social Services employees in those discussions, according to the suit.

One of the doctors, Dr. Ian Aaronson, had published an article in a medical journal in which he recognized that "carrying out a feminizing genitoplasty on an infant who might eventually identify herself as a boy would be catastrophic."

Reached Tuesday night, Aaronson said he wasn't authorized to talk about the case and referred questions to Medical University of South Carolina officials, who could not be reached for comment.

The physicians eventually urged state officials to allow the child to undergo sex-assignment surgery "in order to make his body appear female," according to the lawsuit.

"At no point did any of these doctors request an ethics consultation or alert those responsible for M.C.'s care that such measures should be taken when considering such a life-altering decision," the suit alleges.

The Crawfords also accuse the state agency of "gross negligence" in the lawsuit, alleging that even though some employees attended some meetings with the doctors, they didn't order a hearing on the issue or ask questions about the potential negative effects of the surgery.

"We hope to put other doctors, hospitals and state agencies on notice that they cannot mutilate children without being held accountable," the boy's father, who goes by Mark Crawford, said in a Tuesday press conference.

The parents became interested in adopting the child in June 2006 after they saw the child's adoption profile on the South Carolina Department of Social Services website, according to the lawsuit.

Pamela Crawford called agency officials to tell them not to perform sex-assignment surgery, having been familiar with the negative effects of such a surgery on a childhood friend, the suit said. But by then, the surgery already had been performed. The couple gained custody of the child in 2006 and legally adopted him five months later.

Although the couple initially raised the child as a female, child "has always shown strong signs of developing a male gender."

"His interests, manner and play, and refusal to be identified as a girl indicate that M.C.'s gender has developed as a male," the parents allege in their suit. "Indeed, M.C. is living as a boy with the support of his family, friends, school, religious leaders and pediatrician."

The lawsuit alleges that both hospitals committed medical malpractice by failing to properly inform state officials about the issues involved in the surgery and its possible negative outcomes.

Specifically, the suit alleges, Greenville Hospital System failed to adequately disclose the following:

• The material risks of such surgery.

• The loss of sexual function.

• The lack of medical necessity of the surgery

• Its irreversible nature.

• The ability to postpone the surgery until gender identity was certain.

• The fact that surgery "could cause significant and permanent injury to plaintiff."

The parents are seeking compensation for actual and punitive damages "through his life expectancy," according to the suit.

The Greenville hospital system isn't a defendant in a second lawsuit filed in the Charleston division of U.S. District Court.

That suit names as defendants Amrhein, Aaronson and another physician at the Medical University of South Carolina. The doctors primarily were responsible for treatment while the child was in the state's care, according to the federal complaint.

The suit also names as defendants a former state Department of Social Services director, three agency employees and three case workers, who are identified only as Defendant Doe No. 1, No. 2 and No. 3, court records show.

The federal suit challenges doctors' and government officials' decision to perform "an irreversible, painful and medically unnecessary sex-assignment surgery" on a 16-month-old child in state custody. In April 2006, one of the state employees provided the necessary consent for the child's surgery.

"We have our anxieties for how we raise him and about his future, but we try to help him focus on the positive opportunities," Mark Crawford said.

Contributing: Michelle Frizalone, WLTX-TV, Columbia, S.C.