Four Years, One Fighter: How Ken Paxton Finally Brought Texas Children’s Hospital To Justice

There is a particular kind of public servant who treats a press release as the end of the work, and another kind who treats it as the beginning. The difference between these two dispositions is the difference between a politician and a fighter. Texas Attorney General Ken Paxton is the latter, and the settlement he has just secured with Texas Children’s Hospital is the proof.

Under the agreement, the hospital will pay a $10,000,000 fine, terminate every physician involved in the chemical and surgical transition of minors, and open the state’s first detransition clinic to provide care to the children it harmed. The hospital that once denied, then minimized, then secretly continued the mutilation of children will now fund their recovery. Pause on that sentence, because it is rare in public life that wrongdoing is so directly converted into restitution. The institution that caused the injury is now compelled to treat it.

To understand why this matters, and why it took four years, it helps to walk back to the beginning of the story, because the beginning explains the end.

In February 2022, Paxton issued a formal attorney general opinion concluding that puberty blockers, cross-sex hormones, and surgical transition performed on minors could constitute child abuse under existing Texas law. The opinion was not legislation, and Paxton did not pretend otherwise. It was a legal interpretation, the kind of careful analytical document that attorneys general issue all the time and that ordinarily attracts little notice. This one detonated. Governor Greg Abbott directed the Department of Family and Protective Services to investigate parents who had subjected their children to such procedures. Hospitals and clinics across the state stopped offering the treatments, citing legal risk. Texas Children’s Hospital publicly announced it had ended its pediatric gender transition program. The state’s medical establishment, which had spent years insisting these interventions were settled science, suddenly discovered it could live without them.

A reader might reasonably ask at this point, if the hospitals stopped and the state moved on, what was left to fight? The answer is that the hospitals had not, in fact, stopped, and Paxton was among the first to suspect it.

In 2023, the Texas legislature, prompted in significant part by Paxton’s opinion and the public reckoning it triggered, passed Senate Bill 14. Governor Abbott signed it in June of that year, and it took effect on September 1, 2023, prohibiting licensed medical providers from administering gender transition procedures and treatments to anyone under 18. The statute did what Paxton’s opinion had foreshadowed, converting a legal interpretation into a clear legislative command. The Heritage Foundation, which has documented the spread of these prohibitions across the country, has noted that Texas became one of the most consequential states to act, in part because of the size of its pediatric medical infrastructure and in part because of the seriousness with which its top legal officer treated the issue.

Then came Dr. Eithan Haim.

Haim was a surgical resident at Texas Children’s, and what he saw inside the hospital did not match what the hospital had told the public. The institution that had announced, with considerable fanfare, that it was discontinuing pediatric transgender interventions was, in fact, continuing them. Haim brought the evidence to the journalist Christopher Rufo, who published it in May 2023. The records Haim provided were redacted and anonymized. No patient was identified. No patient was harmed by the disclosure. What was harmed was the hospital’s public posture, and through it, the broader narrative that gender-affirming care for minors was both rare in Texas and safely contained.

This is where the story turns from medical to political, and where a reader unfamiliar with the case might expect the federal government to applaud a whistleblower who exposed evidence of unlawful pediatric procedures at a major hospital. That is not what happened. On May 29, 2024, the Biden Department of Justice charged Haim with four felony counts of HIPAA violations, charges that carried a potential sentence of 10 years in prison. The published reporting had named no patients. The disclosures had served a plain public interest. The hospital, by contrast, had misled the public about whether it was still performing these procedures. The DOJ chose to prosecute the doctor.

It is worth being precise about what this prosecution signaled. HIPAA is a privacy statute, and privacy enforcement is ordinarily a civil matter or, when criminal, reserved for cases involving identifiable patient harm or commercial misuse of records. Haim’s case had none of those features. The aggressive felony posture, the decade-long sentencing exposure, and the timing in the middle of a presidential election year together suggested something other than neutral enforcement. To Haim’s supporters, and to a growing share of the public, the prosecution looked like a warning shot, an effort to deter other clinicians from coming forward with politically inconvenient evidence about transgender medicine for minors. The case did not need to end in conviction to do its work. The mere fact of the charges was sufficient to chill every resident, nurse, and physician in the country who might otherwise have spoken up.

Paxton went to bat for Haim. He did so publicly, repeatedly, and at a moment when defending a whistleblower against a federal prosecution was not a politically costless act. Four days after President Trump was sworn in for his second term, Paxton’s efforts bore fruit. The DOJ dropped all charges against Haim, with prejudice. The case that had threatened to put a young surgeon in federal prison for the offense of telling the truth was dismissed. A lesser official might have taken the win and moved to the next file. Paxton did not.

He kept investigating Texas Children’s. He kept building the case. He spent the better part of two additional years constructing the evidentiary and legal predicate for the settlement announced today. The $10,000,000 fine is the smallest part of it. The termination of every physician involved in the program is more significant, because it removes from the pediatric medical workforce the specific clinicians who continued these procedures after the public was told they had stopped. The detransition clinic is the most significant element of all, because it acknowledges, in the form of an institutional commitment funded by the hospital itself, that there are children who were harmed and who require care. This is not a symbolic concession. It is a working clinic, paid for by the institution that created the demand for it.

A skeptical reader might ask whether all of this could have happened without Paxton. The honest answer is no. The 2022 opinion came from his office. The 2023 legislation followed from the legal and political space that opinion created. The investigation that produced the settlement was opened in response to Haim’s disclosures and prosecuted by Paxton’s team. The defense of Haim against the federal prosecution was led, on the state side, by Paxton. Every link in the chain runs through the same office, and the same officeholder, across four years and two presidential administrations. This is not a coincidence. It is what persistence looks like when it is attached to a clear conviction about what the state owes its children.

Which brings us, unavoidably, to the Republican Senate runoff on May 26.

Senator John Cornyn pledged earlier this year to pass the Save Act, and he committed to forcing a talking filibuster to do it. By that afternoon, he had abandoned the commitment. This is not a small thing. The Save Act is the kind of measure that requires sustained pressure over weeks or even months, not a single news cycle, and a senator who cannot maintain a position from breakfast to lunch is not a senator who will maintain one across a Congress. The contrast with Paxton is not rhetorical. It is documented. One man fought for four years to bring a hospital to account for what it did to children. The other could not hold a position for four hours.

Texas does not need another senator who issues statements. It needs one who finishes what he starts. The settlement with Texas Children’s Hospital is what finishing looks like. It is what happens when an officeholder refuses to let a story end at the press release, refuses to let a whistleblower be destroyed by a politicized DOJ, and refuses to forget the children whose injuries were inflicted under the cover of credentialed authority. Paxton did not forget them. He spent four years making sure no one else could either.

The settlement vindicates Dr. Haim, whose courage cost him a year of his life under federal indictment and whose name will now be remembered as the clinician who refused to let an institution lie about what it was doing to children. It vindicates the independent reporting of Christopher Rufo, without whose journalism the disclosures would have died in a desk drawer. It vindicates the parents and former patients who insisted, against the full weight of the medical establishment, that something had gone badly wrong inside one of the country’s most prestigious pediatric hospitals. And it vindicates the office of the attorney general, which used the slow, patient instruments of state law to accomplish what federal authorities under the prior administration actively obstructed.

Send him to Washington. He does not give up.

If you enjoy my work, please subscribe https://x.com/amuse/creator-subscriptions/subscribe.

Sponsored by the John Milton Freedom Foundation, a nonprofit dedicated to helping independent journalists overcome formidable challenges in today’s media landscape and bring crucial stories to you.

READ NEXT: Farmers Will Lose Everything: Trump’s Warning On Chinese Land Bans