By Cindy Alia 6/20/25
The call for administrative law reform:
Washington State Statutes Reveal the Need for Administrative Law Reform in a hypothetical situation of a Ban on Gender Affirming Care as Determined in the Supreme Court’s 6-3 decision in United States v. Skrmetti, as well as in Current Statute in Washington State which Allow for Gender Affirming Care.
The Supreme Court’s 6-3 decision in United States v. Skrmetti (June 18, 2025) upheld Tennessee’s Senate Bill 1, which bans puberty blockers and hormone therapy for minors to treat gender dysphoria, while allowing these treatments for other medical conditions. Tennessee defended the law as protecting minors from unproven treatments with risks like fertility loss.
Challengers argued it violates the Fourteenth Amendment’s Equal Protection Clause by discriminating based on sex and transgender status, as it permits treatments for cisgender but not transgender minors. The majority applied rational basis review, finding the law neutral and tied to regulating medical uncertainty. The dissent called for heightened scrutiny due to sex-based distinctions. This ruling, engaging Equal Protection, Fifth Amendment due process, and Seventh Amendment jury trial protections, raises questions about how a similar ban in Washington State would interact with its Administrative Procedure Act (APA, RCW 34.05) and laws on minors’ medical consent.
This is how a ban would be adjudicated and regulated administratively:
Washington’s APA governs agency actions, including rulemaking and adjudications by the Office of Administrative Hearings (OAH). If Washington enacted a ban on gender-affirming care for minors, the Department of Health (DOH) would likely lead enforcement, issuing rules defining prohibited treatments and imposing penalties (e.g., fines, license suspensions) through OAH hearings conducted by administrative law judges (ALJs) (RCW 34.05.425). The Health Care Authority (HCA) could also issue rules excluding such care from Medicaid coverage (RCW 74.09). The APA’s reliance on ALJ hearings without juries could conflict with the Seventh Amendment in federal courts for legal remedies like fines, as well as Washington’s Constitution (Article I, Section 21), which guarantees jury trials in civil cases. Agency-controlled ALJs may also raise Fifth Amendment due process concerns if perceived as biased, combining prosecutorial and adjudicatory roles.
Washington’s laws, such as RCW 71.34.530 (allowing minors aged 13+ to consent to mental health treatment, including for gender dysphoria) and RCW 70.24.110 (allowing 14+ to consent to STI treatment), grant minors autonomy in medical decisions without parental consent. A ban enforced via APA tribunals would clash with these statutes, as providers could face penalties for following minors’ legal consent. For example, a physician providing hormone therapy to a consenting minor could face a DOH fine, adjudicated through an OAH hearing. Challenges could argue the ban exceeds statutory authority or violates due process by limiting fair hearings for providers or minors. The APA’s record-based appeals (RCW 34.05.514), without jury trials, amplify these constitutional concerns.
Administrative law would be central to enforcing such a ban, with APA-governed tribunals resolving disputes. Challenges could focus on conflicts with minors’ consent laws, Seventh Amendment jury trial rights, and Fifth Amendment due process protections. Skrmetti’s deference to state regulation suggests equal protection challenges may struggle, but administrative enforcement in Washington could face significant scrutiny under federal and state constitutional frameworks.
This tension highlights the need for public and legal scrutiny of how administrative processes balance state authority with individual rights in regulating medical care for minors.
This is how current statute would be adjudicated and regulated administratively:
Washington State laws facilitate access to gender-affirming care, such as mental health counseling, hormone therapy, or puberty blockers, for minors without requiring parental involvement, particularly for those 13 and older. Unlike Tennessee’s ban upheld in Skrmetti, Washington currently has no statutory prohibition on gender-affirming care for minors, emphasizing autonomy and access.
Washington’s current statutes (RCW 71.34.530, RCW 70.24.110, SB 5599) allow minors to access gender-affirming care without parental consent, supported by Medicaid coverage (RCW 74.09). The APA governs agency actions, with the DOH regulating providers, the HCA managing coverage, and DCYF overseeing shelter cases.
Disputes, such as provider discipline or coverage denials, are resolved through OAH hearings under the APA, which exclude juries and could raise Seventh Amendment concerns for penalties and Fifth Amendment due process issues for bias. Unlike Skrmetti’s restrictive context, Washington’s administrative law facilitates care access but faces similar constitutional risks in its adjudication processes, warranting attention to ensure fairness and compliance with federal and state protections.
Clearly, Washington State Legislative Statute is negligent in allowing for, in law, the Administrative State far too much authority in rule making and adjudication in enforcement and management of legislation. It matters little which side of this issue one aligns themselves with, the APA and the over-reach of authority it allows is interfering with legislative intent and the will of the people in their agreement or opposition to statute in the state. A scaling back of Administrative Law and adjudication in a court of law would facilitate a better representation of both statute and individual rights.
June 21, 2025