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In November 2022, the Attorney General of Tennessee—as part of a Medicaid billing fraud investigation—requested that Vanderbilt University Medical Center (VUMC) release the last five years of its transgender patient medical records. Notably, Tennessee requested the records via a civil investigative demand, which does not require probable cause or a judge sanctioned subpoena. In 2023, it was publicly revealed that VUMC complied with Tennessee’s demand, resulting in VUMC facing intense criticism that it did not do more to legally challenge the demands and protect patient privacy, especially against the backdrop of growing political attacks on the transgender community.

VUMC’s release of sensitive patient records to the government raises ethical issues in medicine, most notably those relating to patient privacy, confidentiality and trust.

The AMA Code of Medical Ethics speaks to issues of patient confidentiality in Opinion 3.1.1, “Privacy in Health Care”, which states that “[p]rotecting information gathered in association with the care of the patient is a core value in health care” and Opinion 3.2.1, “Confidentiality”, which explains that, in general, “patients are entitled to decide whether and to whom their personal health information is disclosed”, however disclosure may be made without specific consent of the patient when the disclosure is to “appropriate authorities when disclosure is required by law.” It was not clear whether the VUMC disclosure to the state was “required by law”, as the state made an initial investigative inquiry without court demand and VUMC did not challenge the demand. Whether it was required by law or not, VUMC’s release of information potentially undermined patient trust, which according to Opinion 1.1.1, “Patient-Physician Relationship,” is the underpinning of a therapeutic relationship.

To further explore the AMA Code of Medical Ethics, please visit


Published on November 20, 2023