Detransitioner Settles Malpractice Lawsuit Days Before Trial In Oregon
Camille Kiefel sued the two Oregon mental-health professionals who each, she alleged, effectively rubber-stamped for her a referral letter for a mastectomy after a single telehealth appointment.
Camille Kiefel, the prominent detransitioner who sued a pair of Portland, Oregon, area mental health providers who each referred her for a gender-transition mastectomy following a single appointment, has reached a settlement with the defendants.
The malpractice lawsuit, in which Ms. Kiefel, 36, sought $3.5 million, had been set to enter what would have been a historic jury trial in the Circuit Court in Multnomah County, Oregon, in January. But the parties entered a confidential settlement just days before the trial was slated to begin.
The existence of the settlement has not previously been reported.
The lawsuit’s defendants included the two authors of the referral letters for surgery that Ms. Kiefel obtained in 2020: Amy Ruff, a licensed clinical social worker and her employer, Brave Space; and Mara Burmeister, a licensed professional counselor and her employer, Quest Center for Integrative Health. The suit alleged malpractice, intentional infliction of emotional distress and fraudulent misrepresentation.
A July 2025 amended complaint filed with the court alleged that Ms. Ruff and Ms. Burmeister effectively rubber stamped Ms. Kiefel’s request for a referral letter, in each case following a single telehealth appointment lasting under an hour. The lawsuit alleged that each of these mental-health professionals failed to adhere to their employers’ training for providing such a letter, which the suit suggested already set quite a low bar and was in conflict with the care guidelines set by a major transgender-medicine organization.
Ms. Kiefel underwent a mastectomy in August 2020, at age 30. At the time, she identified as nonbinary, but has since reverted to identifying as a woman. The legal complaint detailed a lengthy history of serious mental-health problems on Ms. Kiefel’s part dating back to childhood, which ultimately rendered her unable to maintain employment and put her on long-term disability. Her litany of diagnoses included generalized anxiety disorder, major depressive disorder, post-traumatic stress disorder, ADHD and other-specified personality disorder with mixed borderline and dependent features.
Amid the raging national political fight over the care of minors with gender dysphoria, Ms. Kiefel’s case raises complicated questions about who is ultimately responsible if an adult undergoes gender-transition treatment or surgery and ultimately comes to conclude that the intervention was harmful, in particular if they have serious mental health problems.
According to her website, Ms. Kiefel “once believed a non-binary double mastectomy would finally provide relief where 20 years of talk therapy with conventional modalities hadn’t; she lives with physical health issues from the surgery.”
“Gender affirming treatments are experimental, risky and distributed inconsistently,” Ms. Kiefel stated on her web site. “Before we consider invasive surgeries, we must first look at all low-risk alternative treatments that address the physical health of the individual.”
Ms. Kiefel also sued the plastic surgeon who performed her mastectomy, Dr. Tina Jenq, and her employer, Oregon Cosmetic and Reconstructive Clinic. That case was dismissed due to the statute of limitation running out. Ms. Kiefel and her attorneys did not pursue it further.
In recent years, adult transgender care in particular has increasingly moved toward what is known as an informed-consent model, in which there are minimal barriers for patients to cross when seeking gender-transition treatment or surgeries. Ms. Kiefel’s legal complaint asserted that both Brave Space and Quest had established systems that facilitated patients’ desires for such medical interventions with a relatively minimal amount of so-called gatekeeping.
In the emerging field of detransition litigation, Ms. Kiefel’s settlement marks the first of its kind, given she and the defendants entered into the agreement at the 11th hour before a jury trial. At least two other such lawsuits have been dismissed pursuant to a settlement, but without having scheduled a trial.
The lawsuit called into question whether such a minimal-gatekeeping care model might leave care providers exposed to legal liability, especially given the recent surge of transgender identification among adolescent and young-adult biological girls and women in particular. This population has a high rate of psychiatric comorbidities and autism, which may complicate any process of assessing them for gender-transition interventions. There is considerable conflict within the transgender-care community over whether even severe mental-health conditions serve as a contraindication for such interventions.
The Oregon trial had been slated to begin only days following the launch of the three-week trial in White Plains, New York, in which Fox Varian, 22, became the first detransitioner to bring a malpractice lawsuit before a jury. Ms. Varian sued her Westchester County-area psychologist and plastic surgeon over the gender-transition mastectomy she underwent at age 16. She was awarded $2 million by the jury on January 31. (I was the sole reporter to attend the entire trial.)
My appearance on CBS News to discuss the Varian case:
Had Ms. Kiefel’s case gone before a jury, it would have been the first trial in which a detransitioner had sued their care providers over a gender-transition intervention they received as an adult.
In stark contrast to Ms. Varian, who has tightly guarded her privacy regarding her lawsuit, Ms. Kiefel has maintained a public profile as a detransitioner. She is among a small group of such individuals who have testified in state legislatures arguing for greater institutional support for detransitioners or on behalf of restrictions on pediatric gender medicine. The most common such advocate is Chloe Cole, who has sued Kaiser Permanente in California over the gender-transition treatment and surgery she received during her adolescence. Ms. Cole’s trial is slated for next year, and, given her high profile, should provoke a media bonanza.
In a joint statement, two of Ms. Kiefel’s attorneys, Josh Payne, of Campbell Miller Payne, and Zac Hostetter, of the Oregon-based Hostetter Law Group, told me: “We are proud to have represented Camille Kiefel in her pursuit of justice. It was our privilege to fight for her, and we are pleased the parties were able to resolve the matter shortly before the trial was set to begin. We are not at liberty to disclose the terms of the settlement as they are confidential.”
Attorneys for the defendants did not return my request for comment.
There are 27 known detransitioner lawsuits that have been filed in the United States since 2022, a figure that includes both those who underwent gender-transition interventions as minors and those who did so as adults (the oldest I have documented was 32 at the time of the intervention). A number of these cases have run into obstacles related to statutes of limitation, including the lawsuit against prominent pediatric gender medicine physician Dr. Johanna Olson-Kennedy. The plaintiff’s attorneys in that case have filed an appeal.
Isabelle Ayala in 2023 sued Dr. Jason Rafferty, a Brown University pediatrician who wrote the American Academy of Pediatrics’ influential—and highly contested—2018 policy statement on the gender-affirming care method, over the testosterone treatment she received as a minor. Ms. Ayala also sued the AAP itself. Her case has been dismissed pursuant to a settlement.
Ms. Ayala is represented by Campbell Miller Payne, a Dallas firm established for the sole purpose of representing detransitioners. The firm’s leadership has recently undergone major changes. Founding partner Jordan Campbell left in 2025 to lead a unit Department of Justice devoted to targeting the field of pediatric gender medicine. And another founding partner, Ron Miller, died of cancer earlier this year at age 38. Mr. Payne is the sole remaining founding partner.
A representative for the firm declined to comment on Ms. Ayala’s case.
The other known lawsuit to be dismissed pursuant to a settlement was waged by Christopher Miller, who in 2024 sued Identity Hormones in Arizona over estrogen treatment he received as an adult. Mr. Miller’s attorney did not return a request for comment.
Erin Friday, a California attorney and outspoken activist campaigning against all forms of medicalized gender transitions, told me in a statement that she hoped that Ms. Kiefel’s settlement, however confidential the terms, might send a chilling effect across the field of transgender medicine.
“For some medical providers, moral arguments and lack of efficacy of the treatments is sufficiently compelling, but for others it is only the fear of malpractice suits that will stop them,” Ms. Friday said.
Adam Deutsch, a partner at Fiedler Deutsch in White Plains and Ms. Varian’s attorney, told me that since his victory in her case, he thought that care providers and insurance carriers “are taking a harder look at the exposure these detransitioner cases present.” The Varian case, he said, “showed these claims can carry real litigation and reputational risk, which makes pretrial settlement a more attractive option. In my view, as more of these cases are filed and better understood, we’re likely to see more of them resolve before trial.”
Ms. Kiefel’s case
Ms. Kiefel’s 2025 legal complaint characterized her as severely burdened by a constellation of mental-health conditions that left her in a poor position to decide upon whether to undergo surgery to remove her breasts, even well into adulthood. The complaint further suggests that gender dysphoria—the mental health diagnosis that doctors typically require to provide gender-transition interventions—did not play a major role in her mental health struggles during the years leading up to the surgery.
According to the complaint, the borderline features of her personality disorder included an “unstable sense of self, impulsivity, recurrent suicidal gestures, affective instability due to reactivity in mood, and chronic feelings of emptiness.” The complaint further asserted: “Kiefel’s dependent features include difficulty making decisions, the need for others to assume responsibility for major areas of life, and difficulty initiating projects.”
Brave Space and Quest, the complaint suggested, had engineered the transgender-care assessment process such that patients with complex psychological profiles were at risk of falling through the cracks, given how much these organizations favored lowering guardrails over protecting patients from medical interventions that might not be in their best interest.
Both Brave Space and Quest, the complaint alleged, sought to “eliminate barriers” for patients seeking gender-transition surgeries.
The complaint alleged that Ms. Ruff’s employer, Brave Space, “eliminated safety barriers for transgender individuals seeking ‘gender-affirming’ surgeries, such as the requirements of a valid mental health diagnosis and a valid mental health assessment before such surgeries.”
Ms. Burmeister, the complaint alleged, “wholly failed to provide Kiefel an adequate mental health assessment before filling in blanks on a form letter to a plastic surgeon so that Kiefel could receive ‘gender affirming’ surgery.”
Ms. Kiefel adopted a nonbinary identity in 2015, when she was in her mid-twenties. She was ultimately diagnosed with gender dysphoria by a therapist.
Three years later, she underwent a major depressive episode and, according to her legal complaint, “became unable to work or drive, went on short-term disability, and applied” for medical leave from her job. She ultimately went on long-term disability due to her mental-health struggles.
She underwent mental-health treatment from various providers from the fall of 2018 to the spring of 2020. During that period, she was not diagnosed with gender dysphoria, per her legal complaint.
In April 2020, she told her primary care provider, Dr. Ewen Harrison, of the Providence Medical Group in Clackamas, Oregon, that she thought she needed a breast reduction. Dr. Harrison, who did not diagnose Ms. Kiefel with gender dysphoria at the time, wrote in his notes that she identified as nonbinary and that she did “not require masculinizing surgery, but would be comfortable with reduction only, no surgery to nipples or areolae.”
Dr. Harrison then referred Ms. Kiefel to Dr. Jenq. One of Ms. Kiefel’s mental health providers, meanwhile, referred her to Brave Space to obtain a referral letter for gender-transition surgery.
The referrals
In an August 2025 deposition, Ms. Kiefel stated that she thought the purpose of the assessment with the mental-health providers was to determine “whether or not I was truly nonbinary.”
Ms. Ruff and Ms. Burmeister seem to have been trained, on the contrary, as facilitators of gender-transition interventions, not as gender-identity auditors.
Ms. Kiefel’s legal complaint suggested that the providers did not properly obtain her informed consent for the operation. The complaint alleged that neither Ms. Ruff nor Ms. Burmeister “assessed Kiefel’s knowledge regarding the impacts of surgery would have on parenting, the potential for revision [surgery and] the possibility of regrets or later detransitioning.” Nor did they discuss with her “other, non-surgical ways to manage gender dysphoria.” Nor did they address how the surgery might impact sexual intimacy.
Ms. Ruff’s Zoom session with Ms. Kiefel, held May 13, 2020, lasted less than an hour. Ms. Ruff wrote the referral letter for the mastectomy to Dr. Jenq that same day. The letter, referring to Ms. Kiefel with gender-neutral pronouns, stated that “they do not identify with either gender and thus are not interested in transition.”
At that point, Ms. Kiefel was still on disability. Nevertheless, Ms. Ruff’s mental-health examination put her “within normal limits” for all related categories. Ms. Ruff’s referral letter, according to the legal complaint, did not include any diagnostic assessments for Ms. Kiefel and how those mental health conditions might have adversely impacted her capacity to provide informed consent for the surgery. The complaint alleged that Ms. Ruff falsely asserted in the letter that Ms. Kiefel’s mental-health conditions were “successfully managed.”
The World Professional Association for Transgender Care, or WPATH, publishes widely observed transgender care guidelines known as the Standards of Care. Even after these guidelines have been considerably liberalized in recent years, some in the trans-care community who favor greater bodily autonomy for transgender people still find them overly restrictive.
This appeared to include Brave Space and Ruff.
Ms. Kiefel’s legal complaint alleged that “Brave Space and Ruff purport to follow” WPATH’s Standards of Care. “In reality,” the complaint countered, “Brave Space and Ruff rejected the WPATH standards of care, and maintained that the WPATH standards of care create barriers for individuals seeking gender-affirming care.”
The complaint continued: “Brave Space and Ruff believe the transgender community should actively participate in developing clinical practice guidelines and standards of care for transgender individuals, that transgender individuals are the experts and that they should self-determine what medical therapies and surgeries are right for them.”
The lawsuit suggested that such a liberal philosophy was ill-suited for a patient with needs as complex as Ms. Kiefel.
Soon after obtaining the letter from Ms. Ruff, which cleared her as essentially mentally stable, Ms. Kiefel told another mental-health provider that she had “chronic thoughts of death” and that she “might be taking on to [sic] much right now,” per the legal complaint.
After Dr. Jenq’s office told Ms. Kiefel that she needed a second referral letter for the mastectomy, she attended a Zoom session with Ms. Burmeister on July 1, 2020. During that approximately 40-minute session, the legal complaint asserted, Ms. Kiefel described her struggles with her mental health conditions “and disclosed that her treatments of those conditions had not been successful.”
Nevertheless, Ms. Burmeister wrote the referral letter for surgery the following day. According to the legal complaint, the letter violated Quest’s own policies in myriad ways. These included Ms. Burmeister’s omission of “any documentation to support a DSM 5 diagnosis that was the medically appropriate reason for services in question.” Nor did Ms. Burmeister “adequately address Kiefel’s mental health conditions.” She also falsely referred to Ms. Kiefel as male (she identified as nonbinary at the time), characterized her mental-health symptoms as mild, and wrote that her “only instance of suicidal ideation was a couple of months ago.”
The complaint faulted Ms. Burmeister for not obtaining or reviewing Ms. Kiefel’s medical or mental health treatment records or consulting with her other care providers. (This was a key sticking point in the Varian case. Ms. Varian’s psychologist never sought the notes from another mental-health-care provider with whom the girl was more candid about her ambivalence over her gender identity.) Nor did Ms. Burmeister alert Dr. Jenq that she had not engaged in such due diligence, which the legal complaint asserted was in violation of Quest’s policies.
On July 21, 2020, Dr. Harrison noted that Ms. Kiefel was experiencing increasing symptoms of depression, anxiety and insomnia, and, per the legal complaint, that she “had poor self-care at home, and inability to drive as she felt too unstable to keep appointments.”
Ms. Kiefel underwent the mastectomy, including the removal and repositioning of her nipples, on August 27, 2020.
According to the complaint, Ms. Kiefel has since suffered from feelings of “betrayal by and mistrust in health professionals,” as well as “humiliation, distress and anxiety” over losing her breasts. This includes “deep feelings of regret over unnecessarily and permanently losing her choice ever to breastfeed a child, and fears and anxiety over finding a life partner sexually and romantically attracted to a woman without breasts.”
I am an independent journalist, specializing in science and health care coverage. I contribute to The New York Times, The Guardian, NBC News, The Free Press and The New York Sun. I have also written for the Washington Post, The Atlantic and The Nation, among many others. Follow me on X: @benryanwriter. Visit my website: benryan.net
Thanks Ben for staying on top of these lawsuits and for helping to amplify these stories of iatrogenic harms that represent entirely predictable outcomes of activist-led movement to effectively eliminate appropriate assessment, mental health care and evolving body of scientific evidence from the practice of medicine
Glad to hear there is also now recognition that adults too require the same careful consideration as youth who may seek these treatments in a misguided way, and that many do not have capacity to consent, which is such an important part of ethically grounded consent procedures in medicine as well as being given information about less invasive alternatives and all of the potential harms as your coverage of this case highlights
My question to you is do you know why statute of limitations prevented her from pursuing her case against the surgeon but not the therapists who write her letters of referral? Assuming they both occurred in similar timeframe I didn’t understand that part
'In an August 2025 deposition, Ms. Kiefel stated that she thought the purpose of the assessment with the mental-health providers was to determine “whether or not I was truly nonbinary.”'
Was their Nonbinary Detector broken? I bet they let the warranty expire.