NASHVILLE, Tenn. — Two patients have sued the Vanderbilt University Medical Center, claiming the hospital's decision to turn over detailed patient records at the behest of the Tennessee Attorney General's Office has caused them significant distress in a "climate of hostility" toward transgender people in the state.

The plaintiffs, who filed under pseudonyms, allege Vanderbilt was negligent and failed to honor its patient contract by turning over a swath of patient records without mounting a legal challenge against Attorney General Jonathan Skrmetti's office.

VUMC maintains it was legally required to produce the records to Skrmetti's office after it deployed a legal tool called a civil investigative demand against the medical center, The Tennessean, part of the USA TODAY Network, first reported last month.

The attorney general's office said it is investigating potential medical billing fraud related to VUMC's transgender care, alleging a doctor publicly described manipulating billing to evade "coverage limits." Skrmetti's office called it a "run-of-the-mill" fraud investigation that is focused on providers, not patients, and said private patient health information would remain closely guarded.

The lawsuit states the plaintiffs face "significant threats of harassment, harm, and bodily injury from being transgender or perceived as transgender."

“People should be able to feel comfortable sharing their personal medical information with their doctors without fear that it will be handed over to the government," said Tricia Herzfeld, the plaintiffs' attorney. "Vanderbilt should have done more to protect their patients."

Herzfeld is joined by Abby Rubenfeld, a longtime Tennessee civil rights attorney, as co-counsel.

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Medical center 'legally compelled' to turn over records

In a lengthy statement, VUMC said it did not take releasing patient records lightly but said it was "legally compelled" to do so by the state.

"The Tennessee Attorney General has legal authority to require that VUMC provide medical records that are relevant to a billing investigation of this nature," VUMC said in its statement. "It is common for health systems to receive requests for patient records related to billing investigations and audits by government agencies, and Federal and State law (including HIPAA) permits law enforcement agencies to obtain patient medical records in an investigation without the patient’s prior consent."

In subsequent civil investigative demands issued this spring, Skrmetti's office sought broad swaths of information, including a list of anyone ever referred to the hospital's transgender health clinic in recent years; documents related to an emotional support service offered to transgender patients; and nearly a decade's worth of emails sent to and from a general VUMC email address associated with a LGBTQ-support program.

VUMC has not yet complied with the entirety of the later demand.

"Our legal counsel are in on-going discussions with the Attorney General’s office about what information is relevant to their investigation and will be provided by VUMC," the medical center said in a Tuesday statement.

Attorney general's demands draw alarm from LGBTQ advocates

The sweeping demands from the attorney general's office alarmed Tennessee LGBTQ advocates over privacy concerns as VUMC has become a lightning rod in an increasingly contentious Tennessee political battle over transgender rights.

Skrmetti said last fall his office planned to investigate VUMC's practices after conservative advocates published allegations that the facility punished those who objected to its gender-affirming treatment program for children and that some treatments were used as money-making schemes.

Vanderbilt denied the allegations, but the story sparked a major backlash among Tennessee conservatives, particularly regarding treatments for transgender adolescents.

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Skrmetti's office and Tennessee Gov. Bill Lee vowed in September to investigate the clinic's practices over allegations of illegal conduct, though neither cited any current laws VUMC potentially ran afoul of at the time.

The attorney general's broad probe into patient records became public after VUMC informed patients earlier this summer that their records had been provided to the state as part of an ongoing investigation. The medical center said it moved to inform patients after copies of the state's investigative demands surfaced in an unrelated lawsuit challenging the new Tennessee law banning gender-transition health care for minors.

"While VUMC is not a party to this lawsuit, and even though patient names and birthdates were removed from the information filed by the plaintiffs, the filings made clear that individual patient medical and billing records had been requested by the Attorney General," the medical center said in its statement.

"Because this information was now available to the public, we felt it would be best for our patients to be notified of these developments from us rather than through media reports or other means," the statement added. "VUMC places paramount importance on securing patient privacy and confidentiality, as permitted by state and federal laws."

Reach Melissa Brown at [email protected].