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President Donald Trump addresses the press as he attends a meeting with the House Republican Conference at the Capitol on Tuesday, May 20, 2025, in Washington (AP Photo/Rod Lamkey, Jr.).
A judge in Massachusetts issued an order on Friday for the Trump administration to restore medical research papers that had been removed from a government website due to language such as “LGBTQ” and “transgender.”
On March 12, two doctors from Harvard Medical School initiated a 29-page legal complaint regarding the deletion of “peer-reviewed articles by private doctors” from Patient Safety Network (PSNet). PSNet is an online platform that provides articles, tools, and resources to support future research work, impact hospital practices, and educate providers and patients about best practices for ensuring patient safety.
In April, the plaintiffs moved for a preliminary injunction where the government “need only republish the censored content.”
Now, U.S. District Judge Leo T. Sorokin, a Barack Obama appointee, has granted that requested relief in a 28-page order.
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“The plaintiffs are likely to succeed in proving that the removal of their articles was a textbook example of viewpoint discrimination by the defendants in violation of the First Amendment,” the judge wrote.
The Trump administration – by way of the obscure Agency for Healthcare Research and Quality (AHRQ) which was itself acting on guidance issued by the Office of Personnel Management (OPM) – explicitly removed the articles in question because of the verboten words.
The OPM guidance was issued to effectuate the Jan. 20, executive order issued by President Donald Trump directing administrative agencies to “remove all statements, policies, regulations, forms, communications, or other internal and external messages that promote or otherwise inculcate gender ideology.”
After the doctors were apprised of the censorship by PSNet’s editorial team – led by Dr. Patrick Romano – they were allegedly given a choice.
“AHRQ stated that it would republish the articles only on the condition that the doctors agree to remove the forbidden terms,” the original petition explains.
The lawsuit delves into this claimed discussion, at length:
On February 6, 2025, Dr. Romano informed Dr. [Gordon] Schiff and his co-authors and Dr. [Celeste] Royce and her co-author by email that AHRQ could republish censored versions of their pieces on the “non-negotiable” condition of the “removal of the problematic words—i.e., the words ‘transgender’ and ‘LGBTQ.’”
Dr. Romano wrote, “In the case of [Dr. Schiff’s] commentary, this entails simply editing out just three words from a list of risk factors for suicide.” …
Dr. Romano conveyed that, if they agreed to these changes, the authors could also include an editor’s note indicating that the article was updated to comply with the Gender Ideology EO, but that the editor’s note could not identify the specific words excised.
Dr. Schiff rejected the option to republish a censored version of Suicide Risk Assessment that omitted “transgender” and “LGBTQ” from the list of high-risk groups because to do so would be factually inaccurate, unethical, and run contrary to the purpose of the article, which was to identify risk factors for suicide.
In their lawsuit, the plaintiffs complained the editorial decisions ran afoul of both the First Amendment’s guarantee of speech and various aspects of the Administrative Procedure Act (APA), the broad statute governing agency actions.
In their motion for a preliminary injunction, the plaintiffs honed in on those arguments – highlighting the government-create nature of PSNet. This, they say, implicates the public forum doctrine.
The U.S. Supreme Court’s public forum doctrine centers around the notion that certain places — either physical or digital — have, by tradition or practice, been used for First Amendment purposes and should remain free of government interference. Under high court jurisprudence, there are three types of forums: traditional or quintessential, designated or limited, and closed or nonpublic.
Here, the doctors say PSNet is a limited public forum – and therefore one where content-based restrictions are permissible so long as they are not based on enforcing or shutting down a particular viewpoint.
“When the government creates a forum for private speech, it cannot engage in viewpoint-based discrimination,” the motion for a preliminary injunction reads. “The First Amendment forbids such discrimination in all fora, but the necessity for the rule is perhaps most obvious in a case like this—where the speech at issue constitutes the scientific, medical views of experts tasked with identifying errors, indicators, and populations that others are most likely to overlook in their medical practice for the purpose of enhancing patient safety.”
The court agreed with the plaintiffs.
Sorokin rubbishes the government’s position, at length:
[T]he defendants mostly focused on arguing that the defendants had imposed reasonable restrictions on speech that were required by the [executive order]. Their reasonableness argument is a nonstarter. Even if it were right—and it is not, for reasons the Court will mention in a moment—that would not diminish the plaintiffs’ likelihood of success. The record establishes that the defendants’ implementation of the [executive order] produced restrictions on speech that are not viewpoint neutral. The defendants made no meaningful argument to the contrary in their papers, and they admitted at the motion hearing that AHRQ’s actions in response to the Takedown Directive amounted to viewpoint discrimination.
…
The commentaries were removed from PSNet because of their expressive content. … Deletion of the offending words or sentences was a nonnegotiable prerequisite for reposting. Even passing references to people who identify themselves as transgender were deemed contrary to the perspective regarding gender identity set forth in the EO. Because the plaintiffs refused to change the content of their commentaries by removing words that acknowledged the existence of people who identify themselves as transgender, the defendants did not repost them.
The judge goes on to note that the government essentially admitted the removals were a First Amendment restriction.
“Given these facts, it is difficult to imagine how Drs. Schiff and Royce will not prevail in proving their constitutional claim,” Sorokin goes on. “They have established—and, during the motion hearing, the defendants conceded—government conduct that constitutes viewpoint discrimination. This is a flagrant violation of the plaintiffs’ First Amendment rights as private speakers on a limited public forum. The defendants’ only response on this point is an assertion that ‘the requirement of viewpoint neutrality is not absolute.’ Essentially, as the motion hearing crystallized, the defendants urge the Court to find that their admitted viewpoint discrimination did not rise to the level of a constitutional violation here. They offer no authority supporting this position, because there is none.”
The judge also tersely notes that the “powerful” nature of the constitutional violation all-but short circuits an inquiry into reasonableness. But, even there, the court says, the government fails because “the record suggests their removal, and the revisions required as a condition of reposting, undermine patient safety.”
In a separate order detailing the decision, Sorokin gave the government seven days to republish the articles in question on PSNet.
