The Wisconsin State Journal demonstrates how not to write about trans healthcare

Source image: Karolina Grabowski via Pexels.

A sloppy story about a malpractice lawsuit plays right into dangerous right-wing narratives.

Last week the Wisconsin State Journal ran a story about a woman suing UW Hospital and two UW surgeons headlined, “Woman says UW doctors performed gender-altering surgeries without proper consent.” The unnamed plaintiff says that amid her long, troubled history with mental illness, the surgeons removed her uterus and breasts, a procedure she now regrets. 

Sounds pretty bad, right? Here’s one of the many catches in this story: the doctor did ask for two letters of referral, and she provided them. One from her therapist and one from a doctor she claims “she had never met or spoken to in her life.”

I’m no lawyer, but this at the very least complicates things for both parties in the case. What’s with that second letter? Why would a patient use it to access such an important medical procedure, or a reputable surgeon accept it? Where does that leave accountability after the procedure? 

Here’s the worst part: I didn’t have to do any fancy journalism to get this information. I didn’t even have to read the initial complaint. It is in the WSJ story. That’s if you’re willing to wade through a nearly 1,100-word breaking-news article with a screwy structure and reckless grasp of the incendiary political context. 

Anyone reporting or editing a story of this nature in 2023 knows the stakes. Here in Wisconsin, Republican legislators are telling blatant lies about trans healthcare and about puberty blockers as they try to ban gender-affirming care for youth. In the northeastern Wisconsin town of Kiel, people called in bomb threats over the mere effort to protect a nonbinary student from bullying. (The Wisconsin Institute for Law and Liberty cynically stirred up outrage about the Kiel case in right-wing media, which doesn’t stop outlets like the State Journal from still referring to this vile and dangerous organization with the polite and laundered phrase “conservative law firm.”) State legislators and members of Congress are pushing a massive wave of anti-trans bills and other anti-LGBTQ legislation across the country. Trans and queer youth still face an elevated risk of suicide. The rampant transphobia in our politics is pouring fuel on the fire of already disproportionate rates of violence against trans people. When the potential harm of a journalistic misstep is so clear, the “well, let the chips fall where they may” excuse doesn’t wash.

But OK, back to the facts at hand, as the State Journal reported them: “[The doctor] required two letters of referral. The patient provided one from her therapist and another from a doctor ‘she had never met or spoken to in her life.’ The lawsuit doesn’t explain how or why that doctor became involved in her care.”

The problem is, you don’t read it until you get to paragraph 14. That’s after five opening paragraphs that follow the framework established by the headline, a perfunctory non-statement by UW Health, and six paragraphs on the so-called debate over trans health care. 

You may be thinking, “well, they did get to it, so, balance!” Day one in journalism 101 you learn to write in the “inverted pyramid” style, shoving all the most important information at the top because the industry lives and dies by this belief that most readers will stop reading around the 5th paragraph. 

(More people would read further along if pieces were better written and presented stories as complicated and nuanced at the start. A lot of people stop early in a piece because they think they got the gist and the rest is filler, but that’s our unscientific opinion.)

That means that the editor and/or reporter thought those first few paragraphs were what was most important for readers to know. And those first few paragraphs feed right into the right-wing narrative about trans health care—a narrative Republicans from coast to coast are using to demonize trans people and deprive them of their rights. Hell, that headline alone gives unscrupulous actors—the Charlie Kirks and Dan O’Donnells of the world—all the ammunition they need. There’s no getting around the fact that right-wingers will try to exploit this lawsuit, regardless of the facts. But the State Journal doesn’t have to tee it up so neatly for them, especially when the facts are quite messy.

Let’s talk about the trans health debate-ness of this piece and this woman’s lawyers. In paragraph nine we learn the lawsuit “was filed by attorneys at Eckland & Blando, a law firm in Minneapolis. Daniel Cragg, the lead attorney on the case, said it’s the first case filed of several the firm is evaluating involving gender-altering procedures.” Some quick Googling shows that Cragg has started a Substack called “Detransition Network,” which the State Journal story doesn’t mention. The first paragraph of his one and only post is chock full of the same transgender moral panic bunk that has been debunked countless times but refuses to go away. Note also that the post was “originally published” on the Substack of the Foundation Against Intolerance & Racism (FAIR). This organization sprouted from the endless “anti-woke” grift that is Bari Weiss’ career. Its Board of Advisors has included people like Andrew Sullivan (a commentator with a long history of saying bizarre things about race), and Christopher Rufo (architect of the anti-“Critical Race Theory” panic and point man in Florida Governor Ron DeSantis’ fascist crusade to capture higher education). In other words, Cragg has at least a “leave room for the Holy Ghost” proximity to the most odious, bigoted, and disingenuous corners of the far right.

So we have a man and a law firm on a mission: to litigate trans healthcare so surgeons hesitate or even refuse to administer gender-affirming care. But only to trans individuals. (I don’t remember seeing calls for requiring two letters of reference from therapists before cisgender people undergo cosmetic surgery.) 

Even with that agenda, Cragg told the State Journal: “We’re not doing this as a [public relations] maneuver like a lot of the destransitioner cases are. This is a straight personal injury [medical-malpractice] case.” The man is on a mission and even he couldn’t turn this into a trans healthcare case. Because it’s not. But it will still be used as ammunition to deny trans youth and trans adults access to the care they need. 

A reporter might also pause and question the credibility of a lawyer who wants to have it both ways: firmly planting at least one foot in a transphobic crusade, while claiming that this particular lawsuit is about a specific instance of malpractice and not trans healthcare as such. Which is it, guy? 

By the way, day one in journalism 101 you also learn to give readers the “who, what, when, where, why, and how” of a story. This crucial, contextual aspect of “why” comes in paragraph 10—pyramid’s gettin’ mighty narrow down here, boys!—and that “why” is quite muddled.

This isn’t to say that UW Health is blameless in this case. In fact, the WSJ offers a pretty extensive rundown of the history of Dr. Jay Lick, one of the surgeons named in the lawsuit:. 

Five years ago, UW-Madison’s obstetrics and gynecology department said it changed its surgical consent process to ask patients to sign consent forms on the day of surgery, not before, after a case involving Lick in which a patient’s ovaries were not removed as desired during a hysterectomy in 2015. After the patient discovered her ovaries had not been removed, Lick took them out during a second surgery the same day with no complications, according to the Wisconsin Medical Examining Board. The board did not take action against Lick’s license, accepting continuing education he completed as what the board would have ordered. Lick was involved in another case in which a Dane County jury in 2019 awarded an Oregon woman and her husband $435,000—reduced to $300,000 because of a state cap—after finding Lick failed to disclose information about a procedure after the birth of the couple’s son, causing injuries that led to a hysterectomy and loss of fertility.

Note that none of these previous cases involved gender-affirming care, not of trans or cis people. So we have a surgeon with a history of issues with informed patient consent and a woman who presented a document from a doctor she now claims to have never met, to meet the requirement in order to have her breasts and uterus removed. 

And people shouldn’t be completely callous to what has happened to the plaintiff in this case; she was obviously under a lot of distress and her story raises real questions about mental health care in this country. But we should remember her story is an extreme outlier and does not reflect the realities of the vast majority of transgender people, a population that more often than not, is denied or cannot access the care they need. Even with the supposedly growing acceptance of transgender people today, the number of people who are publicly out as trans is incredibly small. The number of people who have de-transitioned is vanishingly rare, and their stories are complicated. 

The framing of this woman’s story is going to be used to justify denying incredibly rare procedures to a small and extremely vulnerable population. The State Journal is complicit in amplifying that narrative, even when the journalist did the work of uncovering all the ways this story is not about gender-affirming care. It’s not even clear from the article where that framing came from. The woman? The lawyers? The editors? This crosses the line between sloppiness and being a faux-unwitting accomplice.

It would have been so easy to do the right thing: to explain that this story—which has already been picked up by the anti-trans industrial complex as a story about trans rights gone amok and will be weaponized against that community—is not actually about trans health care. Instead, the State Journal sharpened that weapon.