B.C. doctor fined $28,000 for refusing to inject trans-identifying teen with puberty blocker

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According to the tribunal decision, Ajaero, who is from Nigeria, is a Christian who attends church every Sunday with his family and whose religion “is an important part of his life.”

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During the period of the complaint, he ran a busy family practice. He became Child Q’s family doctor in 2017. Child Q came out as trans in the spring of 2020.

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In the tribunal hearing, “she described herself as an ‘early bloomer,’” according to the ruling. “As her endocrinologist later noted, she was ‘dramatically affected by her progression through puberty.’”

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“I had begun puberty fairly early on, so I was already feeling a lot of the effects of testosterone and what testosterone was doing to my body,” Child Q said in her evidence. “I can’t describe in words the amount of pain that caused me.”

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Child Q was referred to a youth gender clinic. Ajaero agreed to make the referral, according to the ruling.

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Throughout his treatment of Child Q, Ajaero and clinic staff “continued to use he/him pronouns and (Child Q’s) deadname,” which the tribunal said “demonstrates a lack of care, understanding and sensitivity towards a vulnerable trans child.”

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In her written decision, Cousineau said she “corrected Dr. Ajaero’s chart notes to properly reflect Child Q’s gender.”

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The youth’s mental health worsened. “She was self-harming. She had suicidal thoughts, with a plan,” and was hoarding Tylenol, according to the ruling.

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Ajaero said he only discovered the day of the March 2021 appointment that the visit was for a Lupron injection. Mom and child were kept waiting nearly two hours.

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“He understood — wrongly — that this was part of a process for ‘gender assignment therapy,’” according to the decision. He said he had no experience with that branch of medicine and that, because of his religion, found it “conflicting and difficult” to be involved.

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He asked if Child Q’s mother was “OK” with his decision. “Mother Q said it was not OK, and they needed to get the shot that day,” according to the ruling. “Mother Q asked if there was someone else who could do it, and Dr. Ajaero said no.

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“Mother Q stormed out. She told Child Q they were leaving, and they left. They never spoke to Dr. Ajaero again outside legal proceedings.”

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Child Q received the injection later that day at a walk-in clinic.

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The tribunal said intramuscular injections fall within a family doctor’s everyday scope of practice and that Ajaero was prepared to administer the shot “until he learned what it was for.” Although Lupron is part of gender affirming care, “it was not a treatment for ‘gender reassignment.’”

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Ajaero runs a busy practice with around 2,800 patients and “made a quick decision in the context of a busy day” during the height of the pandemic and with “incomplete information,” according to the decision. He felt uncomfortable and unprepared administering Lupron, and the tribunal accepted that his decision wasn’t based on an intention to discriminate against her.

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However, in addition to not being persuaded that Lupron fell outside his scope of medical practice, Cousineau said she was not convinced that Ajaero had a bona fide and reasonable religious justification for denying Child Q the injection.

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Ajaero told the tribunal, “I believe in God created man and woman. And I find it difficult to be involved in anything against that.”

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But Cousineau found that the evidence “does not establish that refusing to administer medication whose purpose is to suppress puberty in trans youth is a particular line of conduct called for by Dr. Ajaero’s religious custom or connection to God.” Puberty suppression, she said, “does not, on its own, conflict with Dr. Ajaero’s stated religious belief that ‘God created man and woman.’”