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“She cannot get back the life that was stolen from her.”

And that’s why Amanda Stewart of Jaffrey is suing her former endocrinologist Dr. John Turco, along with Dartmouth-Hitchcock Health and others, who she says misled her into inappropriate “gender-affirming” surgeries and treatments that left her in pain and have ruined her life.

“Instead of protecting and properly treating Amanda, who was and remains an extremely vulnerable and unstable individual, these doctors and health care providers, and the organizations and facilities at which they worked, harmed her deeply under the pretense of providing so-called ‘gender-affirming  care,’” according to the lawsuit filed in Hillsborough Superior Court — South last week.

The suit names Turco, Dartmouth-Hitchcock, St. Joseph’s Hospital, Cheshire Medical Center, Monadnock Family Services, and several individual doctors for years of alleged malpractice Stewart says have “harmed her deeply.”

“She will never be able to conceive and bear a child. Even if she could conceive a child, she would never be able to breastfeed her child. She lives in daily pain from the effects of the unnecessary surgeries and years of taking enormous amounts of cross-sex hormones,” according to the lawsuit. “She will never look the same and has to deal daily with severe alterations to her female body, such as bone structure and unwanted body and facial hair. She cannot get back the life that was stolen from her.”

Josh Payne, with the Texas law firm Campbell Miller Payne, said Stewart wants the healthcare system held accountable for misleading her for more than a decade and changing her life for the worse.

“Amanda’s story is a heart-wrenching representation of the negligence and lack of proper procedure in the practice of so-called ‘gender-affirming care,’” Payne said.

Stewart had a troubled early life, starting when her mother died when she was 14. Stewart, who is autistic, struggled with anxiety, depression, and loneliness throughout her teen years, according to the lawsuit. That was made worse when she ended up in a group home for a period of time, according to the lawsuit.

She started seeing Turco in 2007 when she was 22, and he immediately started pushing gender-affirming care without proper consent or full disclosure of the potential impacts, according to the lawsuit. Start’s lawsuit claims Turco never gave her any other choice.

“Defendants recognized that Amanda was mentally fragile and suffering, such that she would not be an appropriate candidate for so-called gender transition medicalization under any criteria, but they proceeded to medicalize and operate on her anyway,” the lawsuit states. “Indeed, on or about December 11, 2007, Dr. Turco wrote to a counselor Amanda had seen and a primary care doctor for Amanda, stating, ‘I am really worried that [Amanda] does mostly suffer at the present time from some psychological issues other than [her] gender identity issues.’”

But Turco soon had her taking massive quantities of testosterone, bringing her level far above those of biological men, according to the lawsuit. 

“[I]n July 2011, Dr. Turco noted that Amanda’s testosterone level was ‘very high at 2,640 ng/dl with the normal adult male range being 241-827,’” the lawsuit states.

Stewart suffered several mental health crises, some resulting in stays in the New Hampshire Hospital, as her physiological symptoms worsened while taking testosterone, the lawsuit states. Throughout her time with Turco, he made several notes that her symptoms improved when she stopped taking the hormone, and yet he continued to prescribe it in high dosages, according to the lawsuit. 

She would go on, under Turco’s care, to get a double mastectomy as well as a hysterectomy and oophorectomy, to remove her uterus, ovaries, and fallopian tubes. She also had a procedure to close her vagina, according to the lawsuit.

Turco is known as a progressive advocate promoting sex reassignment procedures, receiving a “Lifetime Achievement Award” for social justice from Dartmouth last year.

But according to the lawsuit, Turco and other doctors who saw Stewart ignored the medical standards for gender-affirming care, such as the “Benjamin criteria,” which state cross-sex hormones “should not be administered without adequate psychological and medical assessment before and during treatment” and that problems should be well-controlled. 

“Yet these criteria were not remotely met in Amanda’s case according to the medical records produced prior to Plaintiff filing this lawsuit. “Amanda was not receiving testosterone with adequate psychological and medical assessment before and during treatment, and her problems were not well-controlled,” the lawsuit states.

These procedures were done without the psychological referrals necessary under the Benjamin criteria standards, according to the lawsuit. In fact, both surgeons who performed the procedures noted her impaired mental state when they saw her prior to the surgeries, according to the lawsuits.

Turco did not begin to question if Stewart was mentally competent to make decisions about her gender until 2016, after years of testosterone treatment and the surgeries. That was when Stewart had stopped taking the testosterone and stopped identifying as a man.

“Dr. Turco also noted that Amanda was not then living as a ‘transmale.’ Dr. Turco noted his belief that Amanda’s ‘underlying psychological issues’ made it ‘very hard for [her] to understand, evaluate and implement exactly what is [her] gender identity.’ Despite these observations, Dr. Turco continued to prescribe testosterone to Amanda,” the lawsuit states.

None of the doctors or counselors who saw Stewart questioned the care until she saw psychologist Dr. Carey Bluhm in 2019. At the time, Turco and staff at Dartmouth were pushing her to get more surgery.

“Dr. Bluhm expressed to Dr. Turco’s office his concerns that Amanda had Asperger’s and admitted to having ‘delusional events.’ Dr. Bluhm also expressed ‘reservations’ about additional plastic surgery procedures Dartmouth-Hitchcock staff had been meeting with Amanda about,” the lawsuit states.

Turco began acknowledging in 2021 that Stewart is, in fact, a woman despite the surgeries. In 2022, after she was taken to the hospital with suicidal ideation, Turco noted the testosterone treatments had “complications.”

Dartmouth Health did not respond to a request for comment. 

A Black student expelled from Dartmouth College’s Geisel School of Medicine claims a racially biased administrator pushed a flawed sexual assault investigation that ended his studies.

Now, the student, who is using the pseudonym “John Doe” in the lawsuit, is suing the Ivy League school in the United States District Court in Concord in hopes of graduating. Doe was one credit shy of completing his studies when he was expelled.

According to the lawsuit, Dartmouth’s all-White Title IX Hearing Panel found he had violated the college’s Sexual and Gender Based Misconduct Policy, or SMP, and ordered him expelled. Doe is accused of raping a woman he met through a dating app. He has never been charged criminally. Doe maintains the sex was consensual. 

Doe’s lawsuit claims not only did administrators violate the SMP rules for investigations, but the panel operated as a kangaroo court that denied him due process and relied on dodgy evidence.

Doe’s legal advisor for the Dec. 7, 2023  final hearing was not given access to the evidence until Dec. 6. At the last minute, the panel rescheduled the hearing to Dec. 8, according to the lawsuit. 

The panel ignored the results of a rape kit, which found the alleged victim did not suffer any trauma from the sexual encounter, the lawsuit states. The panel also did not question a video the woman presented as being from the sexual assault. According to Doe’s lawsuit, the video is almost completely dark and does not show him present. Instead, the woman — who is also not visible in the video — is heard saying stop. The video was posted to social media a month and a half after their sexual encounter, Doe claims.

Doe puts much of the blame on Dartmouth’s Title IX Coordinator, Kristi Clemens. Clemens is Dartmouth’s Assistant Vice President for Equity and Compliance and has a history of being involved in a racist incident involving Doe, according to the lawsuit.

In 2015, when he was an undergraduate, Doe said he was falsely accused of threatening a professor. In a subsequent meeting with Clemens, she told him he posed a threat because he is “big, tall, and Black,” the lawsuit states.

Doe was later targeted for racial harassment and threats by other students in 2016, but those complaints were ignored when he reported them to Clemens and other administrators, the lawsuit states.

Dartmouth did not respond to NHJournal’s request for comment.

It was Clemens who decided in December of 2022 to pursue an SMP investigation against Doe, even though the accusation did not fall under the scope of the school’s policy, according to the lawsuit.

Doe’s story is that he met a woman, referred to as Sally Smith in the lawsuit, through a dating app in late October 2022. The woman was not a Dartmouth student or employee, nor was she taking part in any college program. Smith told Doe she was single, and Doe says the two talked about seeking long-term relationships.

The pair hit it off, and a few days later, on Nov. 3, they had a sexual encounter at his apartment in Vermont.

Days later, on Nov. 9, Doe says Smith accused him of rape via a text message. Doe was stunned by the accusation and cut off contact with the woman. In the following weeks, Doe began getting threatening messages via text from a man he did not know, according to the lawsuit. The threats included statements to the effect he knew where Doe lived.

On Dec. 9, Doe was contacted by Vermont State Police Detective Chris Pilner, who was investigating Smith’s rape accusation. According to the lawsuit, Doe learned from Pilner that, much to his surprise, Smith is married. 

According to Pilner, Smith’s husband was now angry with Doe, and police had information he wanted to hurt Doe. Pilner went on to tell Doe that Smith reported the rape in November of 2022 but had stopped responding to police in the ensuing weeks.

Doe was never charged with a crime related to Smith’s accusations. However, weeks after Pilner interviewed him, Clemens informed Doe she was starting an SMP investigation based on a complaint from Smith. 

Doe’s lawsuit states the investigation went forward even though the incident in question did not occur within the bounds of Dartmouth’s jurisdiction. The encounter did not occur in a Dartmouth-owned building or involve student accusers and accused, nor was it in any way connected to any Dartmouth-sponsored program as the SMP normally requires to open an investigation.

When questioned, Clemens told Doe the policy allows for expanding the scope of investigations in “limited circumstances.” Though, according to the lawsuit, Clemens never explained to Doe what the circumstances were in his case. 

Doe is originally from the Democratic Republic of the Congo. Doe and his family struggled for years after they arrived in the United States in 2011, and he was even required to drop out of middle school to support his family for a time. Outside of school, he runs a non-profit that provides healthcare to women and children in his home country. 

Dartmouth’s current Sexual Misconduct Policy is partly a response to accusations the school has turned a blind eye to sexual harassment and assault. In 2020, Dartmouth agreed to a $14 million settlement in the lawsuit brought by several women who say they were harassed and assaulted by Department of Psychological and Brain Science professors Todd Heatherton, William Kelley, and Paul Whalen.

That lawsuit claimed the college facilitated the abuse by looking the other way and allowing for a culture of drinking, rape, and sexual harassment for years in the department.

People with anxiety and depression are disproportionately prescribed painkillers. That’s what new research from the Dartmouth-Hitchcock Medical Center suggests, adding a complex layer to the opioid epidemic ravaging the United States and encouraging calls from New Hampshire’s congressional delegation to not move forward with the repeal of the Affordable Care Act.

The findings, which appear in the July issue of the Journal of the American Board of Family Medicine, show that nearly 19 percent of the 38.6 million American adults with mental health disorders use prescription opioids compared to only 5 percent of those without a disorder. Adults with depression and anxiety receive 51 percent of the 115 million opioid prescriptions distributed each year in the U.S., the study found.

“Because of the vulnerable nature of patients with mental illness, such as their susceptibility for opioid dependency and abuse, this finding warrants urgent attention to determine if the risks associated with such prescribing are balanced with therapeutic benefits,” said Brian Sites, an anesthesiologist at Dartmouth-Hitchcock and one of the co-authors of the study.

Image Credit: Dartmouth-Hitchcock

Opioid prescribing in the U.S. quadrupled between 1999 and 2015, and during that time more than 183,000 people died from overdoses related to prescription opioids, according to the Centers for Disease Control and Prevention.

Sites also notes that because pain is subjective, “the presence of mental illness may influence the complex dynamic between patient, provider, and health system that results in the decision to write an opioid prescription.”

The study does not give a specific reason why people with mental disorders are more frequently prescribed opiates. The study encourages more research on this population to understand opiate addiction.

Those patients may have some form of physical pain, but their mental condition may cause them to feel that pain more acutely or be less able to cope with it, leading to increased requests for something to dull the pain. As a result, doctors trying to be empathetic to their patients’ complaints may tend to overprescribe opioid painkillers, Stiles said.

Research also shows that patients are more likely to take opioids when there aren’t specialists nearby. A study published earlier this year found that the number of seniors in rural America who take at least three prescribed psychotropic drugs ― including opioids and antidepressants ― tripled over a nine-year period. The study found that many of these prescriptions were given without a proper diagnosis.

Being able to identify a subset of the population that could be more likely to use opioids could help providers and policymakers address opioid use. It “suggests that there may be additional patient- and provider-related factors specific to those with mental illness that increase the likelihood of receiving prescription opioids,” the authors wrote.

U.S. Rep. Annie Kuster, D-N.H., was present for a press conference about the study on Monday. She said repealing Obamacare could be disastrous for New Hampshire’s opioid epidemic.

“This is critically important in New Hampshire, as we have gone from second in the nation in deaths from the opioid crisis and heroin to first for fentanyl,” she said. “That’s not what we want to be known as first in the nation for.”

The U.S. Congress is currently in a heated healthcare battle. The Senate is working on legislation to repeal the healthcare law, but a vote on the bill has been delayed due to opposition from Republicans. New Hampshire Democratic Sens. Jeanne Shaheen and Maggie Hassan have both stated their opposition to the healthcare overhaul and have sent many press releases condemning “Trumpcare.”

“This new study is yet another reminder that, to combat the devastating opioid crisis, we must make mental health treatment affordable and accessible,” Shaheen said in a statement.

Hassan said she opposes proposed cuts to Medicaid that would affect coverage of mental health and substance abuse services.

“As we work to combat the horrific substance misuse crisis that is devastating our communities and taking a major toll on our economy in New Hampshire, this study highlights how dangerous Trumpcare, which includes massive cuts to Medicaid, would be for our state,” Hassan said in a statement. “We need a comprehensive, holistic approach to combating this epidemic that addresses the underlying causes of addiction, including mental health issues.”

To address the overprescription problem within the mental health community, Sites has suggested physicians need more access to alternative medicine besides opioids, including acupuncture, massage therapy, physical therapy, and non-opioid pharmaceuticals.

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