Thank you, Mr. Speaker. Respectfully, I'm under oppose this amendment. This lowers the age, removes puberty blockers from the bill, and asks you to oppose the amendment with me. Thank you.

The chair recognizes Mr. Martinez Fischer to close on the amendment.

Thank you, Mr. Speaker. I have tremendous respect for Dr. Oliverson. We've worked together on policy on a number of subjects. We often sometimes start in a different place and we ultimately end up in a place where we can find some pragmatic policy. And if I understand the argument, the argument is we can't do this because it just lowers the age of what I proposed. But the most important part of the debate is the why. I mean, why can't we do that? I mean, I could understand I'm a reasonable person. I'm a rational person. I don't get to make the decisions all by myself, but I typically would hope to have a little bit more than, "Because I said so" as a response. I'd like to know why. I'd like to know, well, okay, is 16 not appropriate? Well, what about 16 and a half? What about 17? What about in a case of life or death?

I would think that as we often say, with 254 counties, 30 million people, two time zones, not everything we do fits for everybody. We can't have a one size fits all. But that seems to be the policy here. And maybe I could accept it and respectfully disagree if we're just trying to do something new, but we are not. And so that's the part where I have to wonder or question the policy proposal, the policy choice, that rather than maintain a level of consistency and look to the area of medicine where 16-year-olds do have an opinion that that will be taken to an account and to know that we are providing healthcare at that level and at that age, then we're not doing it here.

And so I hope that when you take this vote, you're not taking this vote because we're just going to back up the author because you'd rather not lower the threshold. I hope we take this vote because you think, "Well, Trey's just wrong. We don't think 16-year-olds should be making this decision. Trey's wrong. We don't think that a 16-year-old and their parent and guardian should be making this decision. Trey is wrong. We think that the best approach is just to wipe it out altogether and there is nothing that we can do that is less intrusive, that is perhaps a little bit more reasonable and less erratic." If you take that position, well then certainly don't support the amendment. But please just don't do it because sometimes we make policy for the worst reasons just because we can. And sometimes that hurts people and I think it'll hurt people in this instance. And so I'd ask you to vote yes on the amendment. I'm asking for a record vote.

Mr. Martinez Fisher sends up an amendment. The amendment is not acceptable to the author. The question occurs on the adoption of the amendment. This is a record vote. The clerk will ring the bell. Show Dr. Oliverson voting nay. Show Miss Klick voting nay. Show Mr. Martinez Fischer voting aye. Have all voted. There being 56 ayes, 81 nays, the amendment fails to adopt. The following amendment, the clerk will read the amendment.

Amendment by Moody.

The chair recognizes Mr. Moody to explain the amendment.

Thank you Mr. Speaker and members. For so many transgender youth, this healthcare is the difference between life or death. Access to this healthcare is shown to improve mental health and reduce suicide rates in those same transgender youth. Medically necessary care is an established doctrine in medicine that healthcare providers take seriously. Gender dysphoria is a recognized medical diagnosis and without this necessary and life-saving treatment, there is increased risk for mental and physical harm. This amendment would allow transgender youth access to this healthcare if their provider deemed it medically necessary for the patient. This would also allow doctors to make the best medical decisions for their patient and offer them treatment that they require. This amendment would allow children diagnosed with gender dysphoria that without treatment would suffer severe physical, mental, and psychological harm to have access to the treatment they need. And I move adoption.

Ms. Morales Shaw, for what purpose?

Mr. Speaker, will the gentleman yield for a few questions?

Will the gentleman yield for questions?

Sure.

The gentleman yields.

Rep Moody, had you heard the recent statement from the American Academy of Pediatrics, "Our organization strongly oppose any legislation or regulation that would discriminate against gender diverse individuals including children and adolescents or limit access to comprehensive evidence-based care. Any discrimination based on gender identity or expression is damaging to the socio-emotional health of children and families as evidenced by increased risk of suicide in this population. Our organizations also oppose any action that would interfere with the physician patient relationship and with parental involvement in making medical decisions for their children"?

Yes, I have heard that statement.

And following up on that, what are the benefits, or if you can name a few of them, of allowing these children to continue with the care?

Look, as I stated it, this care in many ways has been considered lifesaving. And there are medical organizations that have been on record stating that, and this amendment is going to allow what we know as an established doctrine in medicine to sit over the top of this type of care. And so when someone uses medically necessary care, that is a known doctrine and one that is taken seriously and I think provides the proper guardrails around this care.

Rep Moody, we've heard a lot already about the effects on families. Did you want to add anything to that about... I know I've heard from families personally about how this would drastically affect them and how harmful it is to what they think what their future of their family and their children looks like without this kind of medical care. Can you add to that of people that you've heard from?

Representative, I've probably sat with some of the same families that you have and we sit with a lot of folks in our office and we talk about a myriad of issues. And a lot of times you'll get in a routine and you say, "Well, I know how you feel. I know how that is. I know." The truth of it is, the fact of it is when I meet with these families, I can't say that. I don't know what that is. I don't know how that situation is. I don't know how they feel and how scared they are. I can certainly listen and hear them and try to empathize, but I don't know what it's like to be in their shoes when the entire state is telling them that they need to leave.

That's a very difficult position to be in. But it is one that I need those folks to know that I know you and I have seen them and many of our colleagues have seen them and that we hear them and that we care about them. The dialogue around bills like this can be dangerous just in and of itself. And so that's something that has been impressed upon me time and time again by those families, both visiting from around the state and those I've visited with in El Paso.

Does the weaning off language that's in this bill address your concerns?

No, no, no. It's woefully inadequate.

Can you tell us a little bit about why?

Look, it..

And I mean that by sharing with the body because a lot of the people who are in here today don't have direct experience with what the families go through with their children.

Well, I think the problem with that portion of the bill, which isn't necessarily touched by this amendment, is that it keeps... It's going to necessarily have medically problematic outcomes. We do not know exactly what that's going to look like going forward. And so we had a better version of that at some point when this legislation was being considered. And I think that's something that this body should consider as well.

Well, I hope while you're up there, you'll talk about your knowledge of the serious physical, mental and emotional harm that will come by banning this kind of healthcare. Thank you.

Thank you. Now move adoption.

The chair recognizes Dr. Oliverson in opposition to the amendment.

Thank you Mr. Speaker members. With all due respect to my colleague and friend, this is very similar to the amendment that we've considered already for exemptions and I'd ask you to vote against the amendment.

Mr. Speaker.

Mr. Talarico, for what purpose?

Does the representative yield for a couple questions?

Yes. The gentleman yields.

Thank you. Representative Oliverson, Representative Moody's amendment that's before the body would allow parents to give their children this gender-affirming care if it's signed off by two doctors. Is that your understanding of the amendment?

That is my understanding, yes.

And you're opposing the amendment?

It's very similar to Representative Johnson's amendment, yes.

And you're opposed to the amendment?

Yes.

Representative Oliverson, is it fair to say that generally speaking in the medical field there are risks in providing treatment and there are also risks in not providing treatment?

Yes. That is fair to say.

Is it fair to say that sometimes these are difficult decisions?

Yes. I would argue that these are difficult decisions.

Who usually weighs these different risks and makes these difficult decisions?

Well, I think, and again obviously the short answer to your question is that in this case because we're talking about minors, that parents are the ones that ultimately have to consent for medical and surgical treatments because we don't allow children this age to make these kinds of decisions. We don't believe that their judgment is mature enough to be relied upon. And quite frankly, Representative, I can't overemphasize the importance of that point because it speaks to one of the serious problems with American practices of gender medicine involving what is known as gender-affirming care, is that it places an extreme amount of reliance on the patient's own self-perception.

And I-

For a population that we wouldn't even allow to sign the permission slip to have the procedure. So I think that's counter... I mean, in my opinion, that literally runs counter to logic.

And I agree with you that when it comes to minors, these difficult medical decisions are made by the parents.

Right.

The parents usually, especially those that lack medical expertise, rely on who?

Well, they would rely on the physician and that is where the state comes in. It is the state's obligation to make sure that those that claim to be able to practice medicine and are capable of healing are actually acting in the best interest of the patient. And so that is the whole reason why we have a medical practice act and a medical board representative.

Are there any cases where the gender-affirming care that's banned in this bill would be beneficial to treating a child's gender dysphoria?

I do not believe that the treatments that we are removing here are beneficial at all.

So you're saying there will never in the entire state of Texas be a case in which the gender-affirming care that's approved by the various-

So respectfully-

... associations be beneficial to treat gender-affirming care?

Yeah. Respectfully, Representative, scientists don't use the word never or always. But what I was submitting to you is that based on the available evidence and four independent systematic reviews of the entirety of the literature, there's no evidence to conclude that this benefits at all.

But so you acknowledge there may be a case in this big state of ours when this care would be beneficial.

I acknowledge that at this time the science tells us there is no conclusive evidence of benefit, period.

I hear that Dr. Oliverson, I'm just asking-

And I understand that you're trying to get me to say something different, but I go back to what I said earlier. Science doesn't deal in these sort of absolutes. I am telling you, I'm answering your question to the best of my ability based on the science, not based on where we want to go.

But-

From a legal perspective or from your perspective as a lawmaker. Just please understand, I'm not trying to be-

Sure.

... evasive, but I'm answering your question based on the science.

Here's my problem is you've said medical professionals don't deal in absolutes. You don't want to deal in absolutes. But this bill is an absolute ban on gender-affirming care. Is that correct?

There is no evidence that this is helpful and a growing list of harms.

I just want to make sure you're answering my question. Is this an absolute ban on gender-affirming care?

This is an absolute ban on medical and surgical procedures used for the treatment of gender dysphoria in people under the age of 18.

Are there-

I think that's a more complete answer. I think it's essentially the answer to your question.

Are there doctors in Texas who disagree with you on this?

Sure.

Does the American Academy of Pediatrics disagree with you on this?

Well, I'm glad you brought that up, Representative, because the American Academy of Pediatrics disputes with itself, however, they actually have a bad habit of suppressing their own members' willingness or desire to engage in the scientific debate about this very issue. There were resolutions brought before the House of Delegates most recently at the AAP asking them to revisit their position on this. And the board of directors refused to allow their membership to have a scientific debate. So that seems to me very much like shutting the whole conversation down, which is anathema to science.

I just want to ask again, does the American Academy of Pediatrics in their official position disagree with you on this?

I think what I'm saying to you is that the American Academy of Pediatrics at this point cannot be relied upon to reliably examine the evidence themselves. Hence, I'm not interested in what they have to say.

You're not interested in what the American Academy of Pediatrics has to say?

I think they have more or less discredited themselves by being unwilling to actually engage in a rigorous scientific debate on their own policy.

I want to talk about this amendment that Representative Moody has brought before us that would allow parents to give this important healthcare to their children if two doctors sign off on it. You said you're opposed to this amendment. I, for one, trust parents and doctors, not politicians to make these decisions. But I want to see, Representative Oliverson, if you would be willing. I do have amendments of the amendment drafted. If we replace the word two with the word three. So would you allow a child to receive this healthcare if it's approved by their parent and three doctors?

I would not. For the same reasons that I articulated when Representative Johnson laid out her amendment. And that is that there are fundamental flaws in the science underpinning gender-affirming care in America. Hence, I don't think it can be relied upon no matter how many gender-affirming care doctors agree. Their testimony is not to be relied upon.

Would you allow a child to receive this healthcare if it's approved by their parent and five doctors?

You can keep quoting numbers all night. But I think I've answered the question that there's no number of doctors that would make me comfortable.

There is no number of doctors that would make you comfortable-

Right.

... with allowing parents to give this healthcare to their child.

Yeah. I mean, we're not. Yeah.

And you're, Representative Oliverson, an anesthesiologist, correct?

I think we've established that already. Yes.

And you said that the experts in this gender-affirming care are pediatric endocrinologists?

We heard from them. Yes, yes.

And-

Those are experts.

And you've acknowledged that the Pediatric Endocrine Society disagrees with you on this legislation?

I don't know what their position is on this legislation, but I believe their position is in alignment with WPATH, whose position is to support gender-affirming care, which is not scientifically supported.

And we don't have a pediatrician who serves in this body?

No, we do not.

And we don't have a pediatric endocrinologist who serves in this body?

We do not.

So we have a group of politicians, none of whom as you acknowledge are experts in this field making a decision for the experts. Is that fair to say?

I think our job, Representative, is to represent our districts to the best of our ability.

I think it's clear that this is not about science or medicine and certainly not about keeping kids safe. I think this is about discriminating against people who are transgender. And I urge you to reconsider your position on the Moody amendment.

Okay.

Mr. Anchia for what purpose?

Mr. Speaker, I move that we record the entirety of today's debate on Senate Bill 14 and place it in the record to the extent that motion has not been made previously.

Members, you've heard the motion. Is there objection? The chair hears none. So order. The chair recognizes Mr. Moody to close on the amendment.

Thank you Mr. Speaker and members. At its base, this bill is about difference and it's about whether we treat those who are different than us with dignity. It's about whether we hear the voices of those different than us. It's about whether we allow those who are different than us to even exist among us. And this bill, as it came to the floor, gives a very clear answer to those questions and that answer is no. However, with this amendment, we can change that to give those Texans that might be different than us the dignity that they deserve. I move adoption.

Mr. Moody sends up an amendment. The amendment is not acceptable to the author. The question occurs on the adoption of the amendment. This is a record vote. The clerk will ring the bell. Show Mr. Moody voting aye. Show Dr. Oliverson voting no. Show Ms. Klick voting no.

All voted.

Have all voted? There being 56 ayes, 81 nays, the amendment fails to adopt. The following amendment, the clerk will read the amendment.

Amendment by Moody.

The chair recognizes Mr. Moody to explain the amendment.

Thank you, Mr. Speaker and members. Suddenly stopping any medication can have severe negative and catastrophic side effects. This bill is currently written, makes no allowance for and shows no compassion to any person who has already been diagnosed with gender dysphoria and has been prescribed with a medically necessary treatment based on evidence and science. This amendment is very similar to others that we've talked about related to this legislation and those that would allow for care to be continued for adolescents who had been diagnosed with gender dysphoria and prescribed with medically necessary treatment by a licensed doctor.

This particular amendment would replace the weaning off language that is in the bill that was added to the bill in the House Committee substitute by taking a simpler, kinder, and more compassionate approach to simply allow people receiving medically necessary care to keep receiving it. The weaning off language added by the Committee substitute is woefully inadequate and entirely different from this grandfathering clause. Weaning off still strips away evidence-based medically necessary treatment for people who have been diagnosed with gender dysphoria. This amendment would at least allow people to keep receiving medically necessary care that they have been prescribed and do less immediate and irreversible harm to young people in our state.

This amendment was actually accepted on the Senate side across the building, but then was later rejected with no reason. I was initially and shockingly very proud to see my Senate colleague showing a glimpse of compassion and hope we too can add a provision to this bill allowing that care to continue. In fact, we saw in Arkansas after a bill like this passed that there was an increase in anxiety, distress, suicidal ideation and suicide attempts by young people who need this medically necessary lifesaving care. And even though the law in Arkansas has been blocked in court by a judge appointed by Donald Trump, that passage of the law still had immediate and catastrophic consequences for Arkansas youth. I want to urge you to vote for this amendment to not immediately harm Texas youth and to allow some of their care to continue when that care has already been determined to be medically necessary. I move adoption.

The chair recognizes Dr. Oliverson in opposition to the amendment.

Thank you Mr. Speaker and members. Respectfully, my colleague, we're very happy with the grandfather clause we worked on it. It addressed concerns of stakeholders and experts and so I'm going to ask you to please leave our grandfather clause alone and reject this amendment. Please vote no.

The chair recognizes Mr. Moody to close on the amendment.

Well, we talk about evidence. We talk about following it. The evidence is that passing legislation like this is going to lead to increases in suicidal ideation and suicide attempts in young folks in this situation. That's what's happened in other places. That's what's going to happen here. Let's follow that evidence too. I move adoption.

Mr. Moody sends up an amendment. The amendment is not acceptable to the author. The question occurs on the adoption of the amendment. This is a record vote. The clerk will ring the bell. Show Dr. Oliverson voting nay. Show Ms. Klick voting nay. Have all voted? Have all voted. There being 57 ayes, 80 nays, the amendment fails to adopt. The following amendment, the clerk will read the amendment.

Amendment by Flores.

The chair recognizes Ms. Flores to explain the amendment.

Mr. Speaker, members, this amendment strikes part of line 22 on page 1 of the bill. This change alters the definition of healthcare provider to clarify specifically what type of professionals this bill is referring to. It cleans up the bill and leaves no room for confusion or vagueness. This would allow for professionals who are not prescribing medications such as those who offer mental healthcare or consultations to still be able to aid children struggling with gender dysphoria. Members, if we are going to rip this life-saving healthcare away from a population already severely vulnerable to depression, self-harm, and suicidality, then we have a duty to ensure that psychologists and other non-prescribing healthcare professionals are still able to support them both in the course of their lives and in the aftermath of this bill's impact.

Ms. Howard, for what purpose?

Will the lady yield?

Will the lady yield for questions?

I'll yield for questions.

The lady yields.

Thank you. Representative Flores, I'm looking here. So you're trying to clarify about a healthcare provider because your concern is there's confusion here and it will eliminate the ability of some providers to offer their services?

Yes, correct. The way the bill is written is meant to impact those medical professionals that have pharmaceutical prescribing authority by limiting their ability to prescribe puberty blockers or hormone therapy. But the definition of healthcare provider on the first page of this bill is written vague enough to perhaps unintentionally impact or scare off other kinds of medical service providers that trans teens or teens experiencing gender dysphoria would seek out aid from such as a psychologist.

So you're concerned that mental healthcare providers would be excluded from being able to treat these young people?

Correct. Because the object of this bill is to prohibit either surgeries or procedures or prescription of drugs such as puberty blockers, et cetera. But by having such a broad definition or using the term healthcare providers, that doesn't just limit it to those who prescribe these medications or perform these procedures, that would unintentionally scare off other healthcare providers such as mental healthcare providers that can still render services to these children or these teens.

So what would end up happening? What's the outcome for these young people if that's the case?

Well, you can just imagine that if first of all they're taken off these drugs that have been helping them or they're going to be, all of a sudden if these mental health providers are scared off, as we've seen in other instances such as when we have in reproductive cases where we have scared off medical providers from performing certain services, it would be detrimental to these kids to not be able to reach out to mental health providers to help them going through these transitions.

Thank you.

Members, please. This bill is very simple. It removes any ambiguity as to who this legislation is truly aimed to regulate or prohibit from either prescribing medications or performing procedures that are enumerated in the bill. So please, let's make sure that we don't unintentionally scare off mental health professionals by including them in this broad term of healthcare providers. I appreciate your support of this amendment. Thank you.

The chair recognizes Dr. Oliverson in opposition to the amendment.

Thank you, Mr. Speaker and members. Respectfully, I'm going to oppose this amendment. Our construct is very, very narrow to the medical treatments and surgical treatments, and so mental health is not in this bill. In fact, we like mental health. And so respectfully, I'm going to oppose the amendment.

The chair recognizes Ms. Flores to close on the amendment.

Members, number two, on page one under [inaudible 00:27:56] X says, "Healthcare provider means a person other than a physician who is licensed, certified, or otherwise authorized by this state's laws to provide or render healthcare or to dispense, prescribe a prescription drug in the ordinary course of business or practice of the profession." I am simply deleting the terms, "provide or render healthcare" so that there isn't any confusion and there is no ambiguity that mental health providers can still continue to provide services to the youth. So please, members, I appreciate your consideration and please vote yes on this amendment.

Ms. Flores sends up an amendment. The amendment is not acceptable to the author. The question occurs on the adoption of the amendment. This is a record vote. The clerk will ring the bell. Show Ms. Flores voting aye. Show Dr. Oliverson voting nay. Show Mr. Frazier voting nay. Show Mr. Jetton voting nay. Show Ms. Klick voting nay. Have all voted. There being 56 ayes, 82 nays, the amendment fails to adopt. The following amendment. The clerk will read the amendment.

Amendment by Turner.

The chair recognizes Mr. Turner to explain the amendment.

Thank you, Mr. Speaker. Members, we've talked a lot about how this bill is going to impact physicians today and interfere with their ability to care for their patients. This bill also has the potential to impact pharmacists. So this amendment that I have before you now allows for patients who have already received a prescription for medications to be able to continue to fill those prescriptions after the passage of this bill. If it does in fact pass. This prevents people from having to abruptly stop taking a certain medication, many of which have adverse side effects from spontaneous cessation and severe withdrawal symptoms. Currently, the bill bans provision of best practice healthcare only in cases when care is intended to transition a child's biological sex as determined by the child's sex organs, chromosomes, and indigenous profiles. The same care is given to youth for a variety of reasons, some of which are written into the bill itself. For example, youth experiencing precocious puberty take puberty blockers as expressly still allowed in this bill. But they also take these medications for other conditions such as acne or endometriosis.

The bill as it stands, would not allow people traveling through the state of Texas to get a prescription filled without putting the pharmacist in danger because they are not familiar with our laws. Pharmacists don't always know for what purpose or exact diagnosis a medication is for when they fill the prescription. And as written, the bill would put the onus on pharmacists to determine for themselves if the prescription they have is for transition related purposes since these treatments are only banned for transgender youth and even then only when used under certain best practice circumstances. This is a recipe for discriminatory enforcement and could lead to pharmacists denying legitimate prescriptions to patients. I move adoption.

The chair recognizes Dr. Oliverson in opposition to the amendment.

Respectfully to my colleague, I'm going to request that you oppose this amendment. This is similar to other amendments that we have talked about already today. I do have tremendous respect for Representative Turner, Chairman Turner. But respectfully, I'm going to ask you to vote no.

The chair recognizes Mr. Turner to close on the amendment.

Well, I would agree with Dr. Oliverson that this amendment is similar to other amendments in the extent that these amendments are all designed to mitigate the tremendous damage and harm that is being done by this bill. However, this amendment is different. This amendment speaks very narrowly to pharmacists to ensure that already prescribed medications can continue to be administered so that people don't have adverse side effects from abrupt cessation of taking medications. So I would ask that you vote for this amendment.

Representative Turner sends up an amendment. It is not acceptable to the author. Question occurs on the adoption of the amendment. It's a record vote. The clerk will ring the bell. Show Dr. Oliverson voting nay. Show Representative Shine voting nay. Have all voted. Being 57 ayes and 78 nays, the amendment fails to be adopted. Following amendment-