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PROVIDENCE, R.I. — A federal judge has blocked the Trump administration’s sweeping demands for confidential transgender patient information from Rhode Island’s largest hospital that provides gender-affirming care to minors.

U.S. District Judge Mary McElroy’s Wednesday ruling is the latest setback for the U.S. Department of Justice, where at least seven other federal courts have agreed to quash or limit the expansive civil subpoenas sent to more than 20 doctors and hospitals last summer.

McElroy’s decision also echoed similar concerns raised by judges surrounding the expansive scope of the subpoenas, describing the Justice Department as having “immense prosecutorial authority and discretion” but no longer trustworthy it will enforce its power fairly and honestly.

“DOJ has proven unworthy of this trust at every point in this case,” McElroy wrote.

A Justice Department spokesperson said Thursday that it would appeal and continue with its investigations.

“The Rhode Island court’s attack on the professionalism and integrity of DOJ attorneys is outrageous and unjustified,” the department said.

According to the subpoenas, the Justice Department had demanded Rhode Island Hospital hand over the birth dates, Social Security numbers and addresses of every patient who received transgender care over the past five years. It also included instructions to provide all documents detailing adverse side effects in minor patients who received gender-related care, assessments that formed the basis for prescribing puberty blockers or hormone therapy, as well as patient intake forms and guardian authorization.

The Justice Department has repeatedly argued that the information sought in the subpoenas is needed to investigate possible fraud or unlawful off-label promotion of drugs. Most recently during a hearing in Rhode Island, the DOJ said that the investigation was taking place in the Northern District of Texas, where the court’s chief judge ordered Rhode Island Hospital to comply with the subpoena before McElroy’s decision voided the subpoena.

Assistant U.S. Atty. Brantley Mayers told McElroy during the hearing that the Justice Department is investigating potential “misbranding” of drugs approved by the U.S. Food and Drug Administration, such as puberty blockers for young people. While off-label prescribing is legal, Mayers said that the DOJ is concerned that pharmaceutical companies are providing “financial incentives” to Rhode Island doctors to prescribe the drugs.

The subpoenas were crucial in getting the names of children and their families so the Justice Department could interview them.

McElroy rejected that argument.

“The administration has publicly characterized gender-affirming care for minors as abuse, directed the DOJ to bring its practice to an end, and celebrated when hospitals curtailed such programs as a result of this subpoena campaign,” McElroy wrote.

The Rhode Island decision is the latest development in the fight over transgender youth health records. Earlier this week, 11 families filed a class-action lawsuit seeking to block the Justice Department from obtaining the documents. The lawsuit, filed in Maryland’s federal court, is backed by families with transgender children who have received care from hospitals across the U.S.

And separately, a New York hospital announced that it received a grand jury subpoena from federal prosecutors in Texas seeking information about children who received gender-affirming care and the medical providers who administered it.

NYU Langone is the first hospital system to publicly acknowledge receiving a subpoena for such records as part of a federal criminal investigation. But the institution said in its statement Tuesday it was one of several that received a subpoena out of the Northern District of Texas on May 7. It said it was deciding on how to respond.

“The government cannot use its subpoena power to intimidate families out of seeking lawful medical care. To trans and gender-diverse children and their families, we want you to know that you are valued, you are not alone,” Kevin Love Hubbard, an attorney with the Lawyers’ Committee of Rhode Island, who represented the plaintiffs in the case, said in a statement.

Gender-affirming care includes a range of medical and mental health services to support a person’s gender identity, including when it’s different from the sex they were assigned at birth. It may include counseling, medications that block puberty, hormone therapy to produce physical changes or surgeries to transform chests and genitals, although those are rare for minors.

Most major medical groups say access to the treatment is important for those with gender dysphoria and see gender as existing along a spectrum.

At least 27 states have adopted laws restricting or banning the care for minors, while several others have adopted laws or policies protecting access to transgender healthcare.

Kruesi writes for the Associated Press.

LOGAN, Utah — President Trump’s administration took the unusual step this week of sending a government plane to Cuba to return a 10-year-old from Utah who is at the center of a complicated and contentious custody fight involving the child’s gender identity.

The child’s parent, Rose Inessa-Ethington, a transgender woman, is accused of taking the child to Cuba without the permission of the biological mother. Federal and state authorities sought the return of the child after a family member expressed concern that Inessa-Ethington went to Havana to get the child gender transition surgery.

Inessa-Ethington, who had run a popular Utah political blog in the 2010s, was arrested along with her partner, Blue Inessa-Ethington, and charged in the U.S. with international parental kidnapping.

The couple traveled with the child to Canada ostensibly for a camping trip in late March with Blue’s 3-year-old child. However, the two adults turned off their phones after telling the older child’s mother they had arrived in Canada. They flew from Vancouver to Mexico and then to Cuba on April 1, according to a criminal complaint filed Monday in federal court in Utah.

The charges don’t say if the couple actually planned on getting the child gender-affirming surgery in Cuba or how they would get it because that surgery isn’t legal for children in Cuba.

The FBI said that Blue Inessa-Ethington withdrew $10,000 from her checking account before leaving. Agents also found at their home a note with instructions from a mental health therapist in Washington, D.C., “to send the therapist the $10,000.00 and instructions on gender affirming medical care for children.” That note didn’t mention Cuba.

The use of the Department of Justice plane in a parental kidnapping investigation comes after the Trump administration sought to block access to gender-affirming care for minors and pressured healthcare providers over the issue.

The Associated Press left telephone and email messages with the court-appointed attorneys who represented Blue and Rose Inessa-Ethington in Virginia. The defendants will be returned to Utah to face one count each of international parental kidnapping, according to court filings.

Search began after child wasn’t returned as scheduled

The search for the child began on April 3 when they were not returned to the mother in Utah as scheduled, court documents show.

The 10-year-old’s mother, who was divorced from Rose Inessa-Ethington and had shared custody of the child, filed a missing-person report with police in Logan, Utah, a college and dairy farming town about 70 miles north of Salt Lake City.

Logan City Police Chief Jeff Simmons said his department’s initial focus was on the custodial interference allegations in the case, and he said investigators did not learn until later about concerns over gender-affirming surgery.

Logan police spokesperson Sgt. Brandon Bevan said those concerns were raised by one family member. He declined to say who.

“They just had the concern about it, no actual physical evidence,” Bevan said.

A Utah state judge ordered the return of the 10-year-old to the child’s mother on April 13. Three days later, a federal magistrate judge issued an arrest warrant for the Inessa-Ethingtons. On the same day, Cuban law enforcement located the group. They were deported to the U.S. aboard the government plane Monday and arraigned in federal court in Richmond, Va.

The 10-year-old was returned to the child’s biological mother, First Assistant U.S. Atty. Melissa Holyoak in Utah indicated in a statement. Representatives of the FBI and U.S. attorneys office in Utah declined to say what happened to the 3-year-old child who had been with the group.

Parents engaged in custody dispute

The custody dispute between the parents does not appear to be a new development. An online fundraiser created five years go by Blue Inessa-Ethington titled “Help a Trans Mother Keep Custody of Her Child” raised $9,766.

“Last week, Rose’s ex relocated several counties away, negatively impacting Rose’s parent-time with the child,” she wrote on the fundraising page. She said the money would be used to seek a court order that would keep the child “safe and stable throughout this process.”

Anyone who has spent time with Rose knows “how much care and thought she puts into parenting her gender open child,” she wrote.

Family members said the child was assigned male at birth but identifies as a girl because of what they believed to be “manipulation” by Rose Inessa-Ethington, according to an April 16 affidavit from FBI Special Agent Jennifer Waterfield.

Gender-affirming care for minors has been limited

The Trump administration moved in December to cut off gender-affirming care for minors, prompting a third of states to sue.

It was the latest in a series of clashes between an administration that says transgender healthcare can be harmful to children and advocates who say it’s medically necessary.

Gender-affirming surgery is rare among U.S. children, research shows. Guidance from several major medical organizations calls for caution around surgery for minors and says decisions about treatments are case-by-case. Fewer than 1 in 1,000 U.S. adolescents receive gender-affirming medications, such as hormones or puberty blockers.

In Cuba, gender-affirming surgeries are banned for minors and performed only for adults through the public health system under strict supervision in designated public hospitals for Cuban citizens. They must be authorized by a medical commission after a comprehensive review of the patient’s file. That process often takes years because it requires a wide range of medical and psychological evaluations.

Brown, Boone and Schoenbaum write for the Associated Press. Brown reported from Billings, Mont., and Boone from Boise, Idaho. AP journalists Eric Tucker in Washington, Cristiana Mesquita in Havana and Devi Shastri in Milwaukee contributed to this report.