The Trump administration is investigating the University of Michigan Health system in the case of a physician assistant who claimed she was fired after requesting religious exemptions from providing gender-affirming care to transgender patients.
A spokesperson for the U of M health system confirmed the employee in the case is Valerie Kloosterman, who sued her former employer in 2021. Kloosterman's employment was terminated after she requested a religious exemption from “referring patients for sex-obscuring surgeries or using pronouns that conflicted with human biology,” according to her attorneys.
The U.S. Department of Health and Human Services (HHS) announced on Friday it was investigating the alleged termination of a healthcare worker after she asked for a religious exemption from using "patient pronouns that do not align with the patient’s sex, and from assisting in certain sex trait modification procedures." HHS declined to name the health system to protect an ongoing investigation.
But the U of M Health system confirmed on Monday it received notice from HHS “about a compliance review,” a spokesperson said via email. “We are examining the request and will cooperate fully.”
“We are pleased to learn that the Department of Health and Human Services is taking its responsibility seriously to enforce the federal statutes protecting religious health care providers,” said Kloosterman’s attorney, Kayla Toney of the First Liberty Institute, which handles religious liberty cases.
“Our client Valerie Kloosterman was fired by University of Michigan Health because of her religious beliefs. We will continue to defend the rights of religious health care providers to abstain from participating in procedures that violate their consciences.”
Who is Valerie Kloosterman?
Kloosterman has become a poster child for religious freedoms in the conservative legal world. She started working for Metropolitan Hospital (known then as Metro Health) in Wyoming, Michigan, as a physician assistant in 2004. The hospital became University of Michigan Health-West in 2021.
Kloosterman later filed a complaint with the U.S. District Court for the Western District of Michigan in 2022, alleging the following (all of which the health system’s attorneys have denied in their own legal filings):
Kloosterman was asked by the U of M Health system to participate in diversity training, in which the health system “attempted to compel Ms. Kloosterman to pledge, against her sincerely held religious convictions and her medical conscience, that she would speak biology-obscuring pronouns and make referrals for ‘gender transition’ drugs and procedures,” according to the complaint.
These were, at this point, just hypotheticals: “no patient ever asked her for a referral for such drugs or procedures, and she never used pronouns contrary to a patient’s wishes,” according to the complaint.
But when Kloosterman requested a religious accommodation, she was “summoned to a meeting” with administrators who called her "'evil' and a 'liar,' mockingly told her that she could not take the Bible or her religious beliefs to work with her, and blamed her for gender dysphoria-related suicides," says the complaint, which alleges she was fired in August 2021.
The health system denied all allegations, and its attorneys argued Kloosterman had no right to sue, but instead should have to settle the matter in arbitration, according to the terms of the employee contract with the health system. In April 2024, U.S. District Judge Jane Beckering sided with the health system, and dismissed Kloosterman’s case to proceed to arbitration.
Kloosterman’s team appealed to the U.S. Court of Appeals for the Sixth Circuit, which heard oral arguments in February. Numerous religious organizations, including the Catholic Medical Association and the National Catholic Bioethics Center, have filed briefs in the court supporting Kloosterman.
“Civil rights claims cannot be resolved through arbitration because only federal courts, not arbitration forums, have the power to fashion the broad relief necessary to effectively remedy civil rights violations,” the Religious Freedom Institute argued in announcing its own amicus brief.
Why does the case matter now?
HHS said its Office of Civil Rights (OCR) is investigating whether the health system violated the “conscience protection laws collectively known as the Church Amendments.” Many of those conscience provisions are about abortion and sterilization, and protect health care providers from being compelled to provide them if it conflicts with their religious beliefs.
But those conscience provisions only go so far, said Jay Kaplan, a staff attorney with the ACLU of Michigan. Allowing medical professionals the right to refuse to provide any type of care based on their religious beliefs could endanger patients, he said.
“You don't want to see a situation where a health care provider might refuse to transport a patient because she's in need of an emergency abortion procedure. Or you don't want to see a situation where a health care provider refuses to provide services to a transgender individual because they don't believe that person has a gender identity different from what was assigned at birth,” he said. “Once we open that door, then you can provide a license for discrimination in any context, based on religious belief.”
Kaplan said it’s not surprising the Trump administration is pursuing this type of case now.
“It's part of this full-pronged attack against certain marginalized groups, in particular the transgender community. Even in states like Michigan, where gender-affirming health care is safe and it's legal and it's available. Any way that they can make that more difficult, or have more of a say in terms of how hospitals are run, how university programs are run, it's very clear this is part of a trajectory.”
