By Colleen Jenkins
A South Carolina couple sued doctors and state social workers on Tuesday for subjecting a 16-month-old child born with both male and female genitalia to what they say was medically unnecessary and irreversible sex-assignment surgery while the toddler was in foster care.
The state and federal lawsuits - believed by the couple's lawyers to be the first of their kind in the United States - argue that doctors should not have performed surgery to make the child's body appear to be female when they knew they could not predict how gender would develop.
The child, now 8, has shown strong signs of identifying as male and recently began living as a boy, according to Pam and Mark Crawford, who adopted him after the surgery.
The couple, a psychiatrist and stay-at-home dad, said they are taking legal action in the hopes of helping other children who face similar medical conditions.
"We feel very strongly that these decisions to permanently alter somebody's genitalia and their reproductive ability for no medical reason whatsoever is an abhorrent practice and can't be continued," Pam Crawford said in a phone interview.
"It is too late for our son," she added. "The damage has been done to him."
The lawsuit filed in state court in Columbia names the South Carolina Department of Social Services, Greenville Hospital System and Medical University of South Carolina as defendants.
Spokeswomen for the state department and the hospital system said they could not comment on the pending litigation, which alleges gross negligence and medical malpractice based on a lack of informed consent.
A spokeswoman for the Medical University of South Carolina - where the surgery took place - said the suit would be reviewed by the hospital's leadership and general counsel.
The child, identified only as M.C., was born in South Carolina in November 2004 and entered the state's foster care system in February 2005 after being removed from the custody of his biological parents.
Shortly after he was born, doctors noted that he had "ambiguous genitals" and both male and female reproductive organs, the lawsuits said.
Though doctors determined that he could be raised as either a boy or a girl, they opted for genital surgery that made the child's body look female - a decision the Crawfords say was premature because his dominant gender identity had not yet emerged.
"The surgery eliminated M.C.'s potential to procreate as a male and caused a significant and permanent impairment of sexual function," according to the filings in state court.
"The doctors knew that sex assignment surgeries on infants with conditions like M.C.'s poses a significant risk of imposing a gender that is ultimately rejected by the patient," the lawsuit says.
The federal lawsuit, filed in U.S. District Court in Charleston, South Carolina, says the surgery violated the child's constitutional rights.
Risks not fully explained
Sex-assignment surgeries on infants with intersex conditions, previously called hermaphroditism, have been performed since the 1950s, according to the Southern Poverty Law Center and Advocates for Informed Choice, which are helping represent the Crawfords and their child.
The medical procedures often are performed without the risks being fully explained, the groups said.
"Doctors often assume they have to do surgery to make their bodies fit the stereotypes," said Anne Tamar-Mattis, executive director of Advocates for Informed Choice, a legal advocacy group for children born with variations of reproductive or sexual anatomy. In the case of the Crawfords' child, "the doctors knew from the beginning that there was a strong probability that this child would be a boy."
The Crawfords, who live in Columbia, said they initially raised M.C. as a girl after gaining custody when the toddler was about 20 months old.
But they said they soon noticed M.C. tended toward interests typically associated with males and preferred boys' clothing. As he grew older, he asked for his hair to be cut short like his father's and wanted to join a gymnastics class as a boy, they said.
"He's always been able to amuse himself with a toolkit," Mark Crawford said. "He's more likely than any of our other children to be climbing trees, wanting to ride bikes, flying model airplanes."
A couple of months ago, in consultation with their pediatrician, the Crawfords said their son made the transition to live as a boy and has been accepted as one by his friends.
But they added that the long-term consequences of the surgery are heartbreaking to try to explain to him.
"It's really tough because he's now asking the questions about how he can be like everybody else," Pam Crawford said.