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名侦探的守则

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学校2015

一 |     

A large majority of transgender adults in the United States – 78% – say living with a gender different from the one assigned to them at birth has made them more satisfied with their lives, according to a recent survey from The Washington Post and Kaiser Family Foundation.
Among respondents, more than three-quarters had changed their type of clothing, hairstyle or grooming habits to align with their preferred gender, while 31% had used hormone treatments and 16% had undergone gender-affirming surgery or a related surgical treatment to alter their appearance.
But such options are becoming available on a more limited basis, as politicians in multiple states have attempted to restrict trans Americans’ ability to seek gender-affirming medical treatments. In some states, such as Georgia and Tennessee, bans for minors were approved in the first quarter of 2023.

What Is Gender-Affirming Care? 

The Human Rights Campaign, a LGBTQ+ advocacy group, defines gender-affirming care as “age-appropriate care that is medically necessary for the well-being of many transgender and non-binary people who experience symptoms of gender dysphoria, or distress that results from having one’s gender identity not match their sex assigned at birth.” The organization notes both the American Medical Association and American Academy of Pediatrics support “age-appropriate, gender-affirming care for transgender and non-binary people.”
Conservatives often oppose the concept of gender-affirming care – which may or may not include surgical or other interventions – for various reasons, including religious beliefs and concerns about child abuse. “You don’t disfigure 10-, 12-, 13-year-old kids based on gender dysphoria,” Florida Gov. Ron DeSantis, a Republican, said at an August news conference.
Some have expressed concern about a lack of data on the possible long-term consequences of gender-affirming medical treatment for minors. A Reuters investigation, for example, found “no large-scale studies have tracked people who received gender-related medical care as children to determine how many remained satisfied with their treatment as they aged and how many eventually regretted transitioning.” Others, according to the article, have raised alarms about children who are not appropriately evaluated before receiving gender-affirming medical care.

These States Have Banned Gender-Affirming Care

Below are the states that have moved to restrict some form of gender-affirming care for minors so far in 2023, based largely on legislation tracking from the Equality Federation, an advocacy accelerator that works with a network of state-based LGBTQ+ organizations.
Some states, such as Arizona and Alabama, passed bans prior to this year and are not included on the list. Alabama’s law has since been blocked by a federal judge as it faces a challenge in court.
Dozens of bills are still being considered by lawmakers in other states, according to the federation. And officials elsewhere, including in Florida and Missouri, have bypassed state legislatures altogether.
Signed into law by new Republican Gov. Sarah Huckabee Sanders in March, Arkansas’ law will make health care providers liable for civil action for up to 15 years after a minor turns 18 if they performed a gender transition procedure on that minor – essentially making it easier to file malpractice lawsuits in these situations. On that note, experts say the law acts as a de facto ban on gender-affirming care for children because it makes it nearly impossible for providers to get malpractice insurance, according to the AP. In 2021, state lawmakers passed the nation’s first ban on gender-affirming care for minors. The move was temporarily blocked shortly after, but on June 20, 2023, a federal judge issued a permanent injunction against it, ruling the ban unconstitutional. It marked the first time such a state ban was overturned, but the more recent law signed by Sanders was still set to go into effect.
The state Department of Health’s Board of Medicine announced a new rule in March that prohibits several types of therapies and procedures for treating gender dysphoria in minors. The methods of care covered include sex reassignment surgeries and puberty-blocking therapies. Minors already being treated with the rule’s referenced therapies prior to the effective date of it were allowed to continue. Then, on May 17, DeSantis signed into law a similar gender-affirming care ban from the state legislature, which, in addition to prohibiting procedures from being performed on minors, also grants Florida courts “temporary emergency jurisdiction” over a child if they have been subjected to or “threatened” with sex-reassignment prescriptions or procedures. The law also requires transgender adults to get written consent before undergoing such procedures by using a form adopted by the Board of Medicine and Board of Osteopathic Medicine, according to Reuters. But on June 6, a district court judge in Florida issued a preliminary injunction that temporarily blocked enforcement of some parts of the law for specific plaintiffs.
Senate Bill 140 was signed into law by Georgia’s Republican Gov. Brian Kemp in late March. The legislation, pushed forward by the Republican majority in the state’s General Assembly, prohibits “certain surgical procedures for the treatment of gender dysphoria in minors from being performed in hospitals and other licensed healthcare facilities.” There are exceptions, including treatments that are deemed “medically necessary” and situations covering continued treatment for minors undergoing “irreversible hormone replacement therapies” prior to July 1, 2023. But a federal judge on Aug. 20 granted a preliminary injunction which blocked the portion of the law banning doctors from starting hormone therapy for transgender minors. The prohibition on surgical procedures was not covered by the injunction.
The state’s GOP Gov. Brad Little approved a bill that criminalizes providing gender-affirming care for youth. Signed on April 4 and going into effect in January 2024, the law makes it a felony to provide hormones, puberty blockers or other gender-affirming medical care to minors. Little said in a letter confirming the bill signing that policymakers “should take great caution whenever we consider allowing the government to interfere with loving parents and their decisions about what is best for their children.”
Republican Gov. Eric Holcomb signed into law on April 5 a bill banning all gender-affirming care for minors, after previously saying there was “some vagueness to it,” according to the AP. The governor said in a statement that “permanent gender-changing surgeries with lifelong impacts and medically prescribed preparation for such a transition should occur as an adult, not as a minor.” Parts of the law, however, were blocked by a federal judge on June 16 following a request for a preliminary injunction by the American Civil Liberties Union of Indiana. The order stops the law’s ban on puberty blockers and hormone treatments for minors from going into force on July 1, but does not impact the restriction on gender-affirming surgeries.
Iowa’s ban, signed into law on March 22, prohibits health care professionals from “knowingly” performing certain medical practices on minors if they are “for the purpose of attempting to alter the appearance of, or affirm the minor’s perception of, the minor's gender or sex, if that appearance or perception is inconsistent with the minor's sex.” Practices covered by the law include hormone therapies and surgical procedures. As with other states’ laws, there are some exceptions, including a “medically verifiable disorder of sex development.”
The state on March 29 joined others in banning gender-affirming medical care for minors when the Republican-led Kentucky General Assembly voted to override Democratic Gov. Andy Beshear’s veto, becoming the first state led by a Democrat to approve such a ban in 2023. The law notes that any health provider who violates the prohibition can have their license or certificate revoked. A federal judge on June 28 temporarily blocked the portion of the law that would have banned transgender youth from accessing puberty blockers and hormone therapy, but that same judge lifted the injunction on July 14 – allowing the restrictions to go into effect. A federal appeals court panel on July 31 allowed the state to continue enforcing the law.
With a successful override attempt of Democratic Gov. John Bel Edwards’ veto by the state’s Republican supermajority legislature, Louisiana approved a ban on gender-affirming care for minors on July 18. The law, which goes into effect on Jan. 1, 2024, covers procedures such as hormone therapies, puberty blockers and gender-reassignment surgeries. The ban’s ultimate approval came after a Republican lawmaker cast a tie-breaking vote to kill the legislation in May. But it was eventually resurrected and passed before Edwards’ veto.
Mississippi’s law – among the first to be enacted in 2023 – bans any person from knowingly providing or engaging in conduct that aids and abets the performance of gender transition procedures on a minor in the state. The ban also prohibits the use of public funds or tax deductions for such procedures. Republican Gov. Tate Reeves said when he signed the bill into law that “radical activists” are telling children they are “just a surgery away from happiness,” according to the AP.
GOP Gov. Mike Parson on June 7 signed a bill that will restrict gender-affirming health care for minors and some adults in Missouri starting in late August. The law prevents the state’s Medicaid division from covering such treatment for people of any age, and prohibits providers from prescribing puberty-blockers or cross-sex hormones to minors until Aug. 28, 2027, unless they were being treated prior to the bill’s effective date. Missouri initially banned gender-affirming care in April through an emergency regulation from state Attorney General Andrew Bailey that limited treatments for both minors and adults, the latter of which was believed to be a first in the country. But Bailey terminated the rule – which had already been on pause due to a lawsuit – on May 16, citing the state legislature’s imminent ban. A circuit judge on Aug. 25 allowed the law to take effect.
Signed into law on April 28 by Republican Gov. Greg Gianforte, Montana’s ban on gender-affirming care for minors covers both surgical procedures and medications such as puberty blockers and testosterone. As with other state laws, the prohibition has exceptions including for someone “diagnosed with a disorder of sexual development.” Any physician who performs a banned procedure can be also sued in the 25 years following it if the after-effects result in any injury, “including physical, psychological, emotional or physiological harms.” The law takes effect on Oct. 1, according to the AP. Democratic state Rep. Zooey Zephyr, a transgender woman, was exiled from the Montana House floor after she said her fellow Republican lawmakers would have “blood on their hands” if they passed the bill.
Republican Gov. Jim Pillen signed into law on May 22 a bill that prohibits gender-affirming medical care for minors, which covers people under the age of 19 in Nebraska. The law, which also bans abortions at 12 weeks of pregnancy, includes a ban on surgical procedures and limitations on “prescribed drugs related to gender alteration.” The rules for the latter are to be determined by the state’s chief medical officer – a political appointee, according to the AP. The gender-affirming care portion of the new law goes into effect on Oct. 1, 2023.
The state’s Republican-dominated legislature on Aug. 16 voted to successfully override a veto from Democratic Gov. Roy Cooper and approve a ban on gender-affirming care for minors in North Carolina. The bill’s language covers both transition surgeries and puberty-blocking drugs or cross-sex hormones. The law goes into effect immediately, but as with other state bans that have been approved, there are some exceptions to the prohibition.
Republican Gov. Doug Burgum on April 19 signed a veto-proof bill into law that criminalizes providing gender-affirming medical care to minors. The law, which went into effect immediately as an “emergency measure,” makes performing sex reassignment surgery on a minor a felony, and makes providing gender-affirming medication such as puberty blockers to minors a misdemeanor. Burgum recommended in a statement that “thoughtful debate around these complex medical policies should demonstrate compassion and understanding for all North Dakota youth and their families,” according to the AP.
GOP Gov. Kevin Stitt on May 1 signed into law a ban on gender-affirming care for minors in Oklahoma, saying he was “thrilled” to do so and “protect our kids.” The bill allows for any physician who knowingly provides gender transition procedures to be charged with a felony, but the prosecution must occur before the minor patient turns 45. The law went into effect immediately, but on May 18 the state agreed to not enforce it while opponents sought a temporary court order blocking it.
Signed into law on Feb. 13, House Bill 1080 prohibits South Dakotan health care professionals from administering various types of gender-affirming procedures on minors. If a provider violates the law, the legislation requires a professional or occupational licensing board to revoke any license or certificate held by the provider. GOP Gov. Kristi Noem strongly supported the bill before signing it, according to the AP.
Tennessee’s legislation, which was signed by Gov. Bill Lee in March but was set to go into effect on July 1, bans health care providers from performing or offering to perform a medical procedure on a minor if its purpose is to enable that minor “to identify with, or live as, a purported identity inconsistent with the immutable characteristics of the reproductive system that define the minor as male or female.” It also prohibits such procedures if the purpose is to treat “purported discomfort or distress from a discordance between the minor's sex and asserted identity.” There are exceptions, and the law establishes penalties for providers who violate it. Just days before its July 1 effective date, a federal judge on June 28 temporarily blocked the portion of the law that would have banned transgender youth from accessing puberty blockers and hormone therapy. U.S. District Judge Eli Richardson, however, did not block the law’s ban on surgical procedures. A federal appeals court on July 8 temporarily reversed Richardson’s ruling, meaning the law can take effect at least until the court conducts a full review.
GOP Gov. Greg Abbott on June 2 signed a bill banning gender-affirming care for minors in Texas. The law contains exceptions similar to other states’ efforts at restricting transition care. The Texas Supreme Court on Aug. 31 allowed the law to go into effect on Sept. 1, overruling a state district judge who had issued a temporary injunction against the ban a week prior. The law’s passage was not Texas’ first attempt at limiting gender-affirming care: Abbott in 2022 ordered the investigation of families who were receiving such care, but the order was halted by a judge in the state.
Republican Gov. Spencer Cox signed into law on Jan. 28 the first gender-affirming care ban of the year. The Utah legislature’s Senate Bill 16 restricts health providers from performing “sex characteristic surgical procedures on a minor for the purpose of effectuating a sex change” or hormonal transgender treatment on minors who weren’t diagnosed with gender dysphoria before July 1, 2023. Cox said his approval of the law was an effort at least in part to pause “these permanent and life-altering treatments for new patients until more and better research can help determine the long-term consequences,” the AP reported.
A new law signed by GOP Gov. Jim Justice on March 29 prohibits minors from being prescribed hormone therapy and puberty blockers, or from receiving gender-affirming surgery. The law, which will take effect in January 2024, contains an exception geared toward youth for whom “treatment with pubertal modulating and hormonal therapy is medically necessary to treat the minor’s psychiatric symptoms and limit self-harm, or the possibility of self-harm.” In these cases, the minor must receive consent from their parents or guardians along with two medical providers.
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二 | 从查处的腐败案件看,一些腐败分子与行贿人之间达成一种默契,以系统特殊性、行业“潜规则”掩盖权钱交易,在请托办事时含糊其辞,在贿赂数额上笼统模糊,故意互不挑明,其实彼此之间心知肚明、心照不宣、心领神会。医药领域存在的收受医药供应商回扣问题,就是其中的典型。医药卫生事业关系亿万人民的健康权益,这是人民群众最根本的利益之一。医药领域腐败问题既严重掣肘了医疗、医保、医药事业高质量发展,也严重败坏了医疗卫生行业乃至党和政府形象。纪检监察机关配合开展全国医药领域腐败问题集中整治,精准发力、重拳出击,不断净化医药领域政治生态和行业生态,保障人民群众的健康权益。王茂生,2013年4月至2022年6月,曾任广东省茂名市高州市人民医院党委书记、院长,高州市人大常委会党组成员、副主任。对他的审查调查,源于茂名市纪委监委在办理其他案件时,一名涉案商人交代曾向王茂生行贿200多万元。

三 | 茂名市纪委监委对涉医疗腐败问题线索高度重视,调取和高州市人民医院有业务往来的数百家供应商资料,排查发现,王茂生利用职权为多家供应商在药品、耗材、医疗器械的采购以及工程建设等方面提供帮助,从中收受回扣。让他们没有想到的是,王茂生多年收受的回扣竟高达2亿余元。

四 | 王茂生从医近40年,早年是茂名市人民医院著名的心胸外科专家,由于技术精湛被誉为“王一刀”。2013年,媒体曝光了高州市人民医院医药采购回扣门事件,正副院长都被免职追责,王茂生临危受命调任该院担任党委书记、院长。

五 | 这个任命本来是期望他能以“王一刀”的权威和果断,向不良风气开刀。但遗憾的是,从手术台到管理岗位的他,位置变了,思想也在变,最终自己也深陷回扣门。首先找上门来的,是王茂生之前就认识的一个医药供应商许灿。听说王茂生当了院长,许灿立即联系了他,直白地请托他关照。涉案商人 许灿:恭喜他当院长、当领导了,能不能安排一点生意做做,他也没拒绝,他就说先等他摸清楚情况。除了老相识,也不断有人想方设法想要成为他的新朋友。后来向王茂生行贿金额最大的医药供应商李少刊就是其中之一。李少刊当过医生,以聊医学为名频繁找王茂生聊天,其实双方都清楚他到底想聊什么。

六 | 能不能把自己代理的产品送进医院,关系到的利益相当大,因此有些不良供应商不惜拿出业务额的一部分来行贿,这就是所谓的带金销售。当时,王茂生身兼院党委书记、院长,在医院内部人事任命、资金使用、医药采购等方面都拥有绝对的话语权和决策权。

七 | 虽说医药采购程序有相关制度规定,但在实际操作中都被架空。失控的欲望加上失控的权力,导致严重的腐败也就在所难免。高州市人民医院是一家三级甲等综合性公立医院,医疗服务覆盖高州及周边广大城乡地区,每年的采购体量不小。虽然有2013年回扣门事件的前车之鉴,但在重金引诱下,王茂生还是铤而走险。只不过为了防范被查处,他费尽心思用各种方式来遮掩受贿行为。王茂生大部分受贿所得都是找人代持,行贿人在广州、湛江、茂名等地为他购买多套房产、商铺,全部登记在别人名下。他还让医药供应商把部分钱存到以他人名义开的证券账户,但却是他在实际控制。收的现金怎么藏,王茂生也动了一番脑筋。他让李少刊出资在当地给他买了套房,装修时在阳台上专门设计了一个隐蔽的夹层用来藏收受的钱款,外边再用柜子遮挡。然而,王茂生所有精心隐藏的贪腐行为,最终都像这个夹层一样,被专案组揭开了外表的伪装,暴露在光天化日之下,他的全部赃款赃物也被追缴归案。广东省高州市人民医院原党委书记、院长 王茂生:你有贪欲,而且还见钱眼开,欲壑难填,内心的这种良知给这种贪欲所遮蔽了,所以我进来了也是罪有应得。

八 | 王茂生案揭示出部分医药用品采购中仍然存在滋生腐败的空间,不良医药供应商行贿的花费被转嫁到经营成本当中,直接侵害了群众的利益。涉案商人 李少刊:回扣你不可能无缘无故送给他,那都是打在经营成本里面的。损害的一个是老百姓,一个就是国家,国家医保要支付很多钱。茂名市纪委监委针对这些案件暴露出的问题进行系统梳理,提出对策建议,同时在卫健系统深入开展警示教育,推动市卫健部门开展以案促改促治工作,包括健全药事委员会决策机制,落实医疗卫生系统物资采购、招投标等相关制度和流程,切实推进国家医药集中采购落地见效等根本性举措,有效挤压了采购价格里的水分,也大大压缩了滋生腐败的空间。截至目前,茂名市医疗机构次均住院费用同比下降7.49%,医药费用同比下降6.69%,群众负担明显减轻。相关阅读电视专题片《反腐为了人民》第三集《揭开腐败隐身衣》妻子实控投资34家公司!唐一军大搞权钱交易出镜忏悔“无地自容”©2025中央广播电视总台版权所有。未经许可,请勿转载使用。责任编辑:迟晓涵。

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