D.F. brought this Article 78 proceeding to challenge an act by the Administration for Children’s Services (ACS), New York City’s child welfare agency. In New York, an Article 78 proceeding may be used to challenge the activities of an administrative agency in court. D.F. is a 20-year-old transgender woman in the care of ACS. She has been diagnosed with gender dysphoria, meaning she experiences distress “between her expressed gender and the gender she was assigned at birth,” and has a strong desire to adopt the characteristics of her expressed gender. In October 2013, ACS determined that D.F. was not eligible for ACS’s payment for medical procedures that would allow her to conform her appearance to her female gender identity. Ultimately, the Supreme Court in New York County found that ACS’s decision was “arbitrary and capricious,” annulled the decision, and ordered ACS to pay for the requested procedures.
During the proceeding, ACS argued that its decision to deny payment was based on the belief that D.F.’s behavior, specifically her chronic absences from her foster home placements, indicated there was a risk she would not comply with necessary postoperative procedures. While the court recognized that ACS’s denial had facial validity, it found that the decision was nonetheless arbitrary and capricious for several reasons. First, the court stated that D.F.’s chronic absences have no bearing on whether she will comply with post-operative procedures. All of the mental health professionals who supported D.F.’s application knew of her absences, yet still asserted that she should have the procedures. Second, D.F.’s medical records showed that she had “demonstrated commitment and maturity in dealing with her health care.” Third, ACS failed to follow several of its own procedures. It failed to adhere to its own payment request review procedure in reaching its decision. The Standards of Care for the Health of Transsexual, Transgender, and Gender Nonconforming People by the World Professional Association for Transgender Health (WPATH), which ACS purports to follow, state that requests for this type of procedure should be assessed by a mental health professional. ACS arranged for D.F.’s request to be assessed by a pediatrician only. The pediatrician did not meet with D.F. once, another deviation from WPATH’s standards of care. The court found that the ACS’s procedure itself contained a fundamental flaw by giving unfettered discretion over the final decision to one individual – ACS’s Deputy Commissioner. ACS’s denial completely disregarded D.F.’s inability to pay for the procedures herself, as she was estranged from her family and would be unlikely to pay for the procedures on her own in the near future. For these reasons, the court found ACS’s denial of payment to be “arbitrary and capricious,” and thus annulled the decision and ordered ACS to pay for all of D.F.’s requested procedures.