A Portland, Oregon, woman who sued a pair of local mental health providers after each referred her for a gender-transition mastectomy following a single, allegedly cursory appointment, has reached a settlement with the defendants.
The malpractice lawsuit, in which Camille 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.
Ms. Kiefel is among a group of nearly 30 so-called detransitioners—people who underwent a medical gender transition only to choose to revert to presenting as their birth sex—to have sued their care providers for malpractice since the first such suit was filed in 2022. In January, a court in White Plains, New York, saw the first detransitioner lawsuit to come before a jury. The case resulted in a $2 million award for Fox Varian, 22, who sued her psychologist and plastic surgeon over the mastectomy she underwent at age 16.
Had the case of Ms. Kiefel, who was 30 when she underwent the mastectomy, gone to trial, it would have been the first of its kind involving a plaintiff who was an adult at the time of their gender-transition intervention.
At least two other detransitioner lawsuits have been dismissed pursuant to a settlement, but without having scheduled a trial.
The defendants in Ms. Kiefel’s case included the two authors of the referral letters for surgery that she obtained in 2020: Amy Ruff, a licensed clinical social worker and Ms. Ruff’s employer, Brave Space; and Mara Burmeister, a licensed professional counselor and Ms. Burmeister’s employer, Quest Center for Integrative Health. The suit alleged malpractice, intentional infliction of emotional distress and fraudulent misrepresentation.
A July 2025 amended complaint 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 care guidelines set by a major transgender-medicine organization.
Ms. Kiefel underwent the mastectomy in August 2020. At the time, she identified as nonbinary, but has since gone back to identifying as a woman. The legal complaint detailed a history of serious and debilitating mental-health problems on Ms. Kiefel’s part dating back to childhood, which ultimately rendered her unable to maintain employment. 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 identifying as transgender, 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.
“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 stated on her web site.
Ms. Kiefel previously 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. However, in the case against the mental health providers, her attorneys managed to file just before the statute of limitation expired—specifically within two years of the date of surgery.
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 methods that facilitated patients’ desires for such medical interventions with a relatively minimal amount of so-called gatekeeping.
The lawsuit called into question whether such a laissez-faire care model might leave care providers exposed to legal liability.
In a joint statement, two of Ms. Kiefel’s attorneys, Josh Payne, of the Dallas firm Campbell Miller Payne, and Zac Hostetter, of the Oregon-based Hostetter Law Group, said: “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 a request for comment.
Erin Friday, a California attorney and activist campaigning against all forms of medicalized gender transitions, said in a statement that she hoped that Ms. Kiefel’s settlement would 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, said that since her victory at trial, 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 suggested that gender dysphoria—a mental health diagnosis involving distress stemming from a conflict between a person’s sex and gender identity, which doctors typically require to provide gender-transition interventions—did not play a major role in her mental-health struggles.
Laura Edwards-Leeper is child and adolescent psychologist who helped establish the field of pediatric gender medicine in the United States two decades ago and who in recent years has become a prominent voice expressing concerns about what she has characterized as the field’s heedlessness.
Dr. Edwards-Leeper, who formerly practiced in Oregon, criticized the transgender-care field at large for, as she saw it, at least sometimes exceptionalizing the care of gender dysphoria such that “it is permissible, even favorable, to bypass all common-sense safeguards.” She said that observing such methods is “dangerous not only for gender-distressed minors, but for adults as well.”
According to the complaint, the borderline features of Ms. Kiefel’s personality disorder included an “unstable sense of self” and “impulsivity.” The complaint further asserted: “Kiefel’s dependent features include difficulty making decisions” and “the need for others to assume responsibility for major areas of life.”
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 social-justice-oriented organizations favored lowering guardrails over protecting at least some patients from medical interventions that might not be in their best interest.
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.”
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. She ultimately went on long-term disability due to her mental-health struggles.
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 did “not require masculinizing surgery, but would be comfortable with reduction only.”
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 appointments 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. Neither Ms. Ruff nor Ms. Burmeister, the complaint alleged, “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.
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 and asserted—falsely, the complaint asserted—that Ms. Kiefel’s mental-health conditions were “successfully managed.” Ms. Ruff’s referral letter, according to the complaint, did not include any diagnostic assessments for Ms. Kiefel and how those mental-health conditions might have compromised her capacity to provide informed consent.
The World Professional Association for Transgender Care, or WPATH, a medical activist organization, publishes widely observed transgender care guidelines. 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 have still found them overly restrictive.
This appeared to include Brave Space and Ruff, which according to Ms. Kiefel’s legal complaint “rejected” WPATH’s guidelines. The organization, the complaint asserted, believed, in conflict with WPATH, “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’s.
Despite Ms. Ruff’s letter clearing her as essentially mentally stable, Ms. Kiefel told another mental-health provider shortly after their appointment that she had “chronic thoughts of death” and that she “might be taking on to [sic] much right now,” per the legal complaint.
Seeking a second referral letter for the mastectomy, Ms. Kiefel attended a Zoom session with Ms. Burmeister on July 1, 2020. During that approximately 40-minute session, the 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. It omitted any documentation to support a gender-dysphoria diagnosis, falsely referred to Ms. Kiefel as male (she identified as nonbinary at the time), and, the complaint asserted, falsely characterized her mental-health symptoms as mild.
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.
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.”
Her apparently fragile mental state notwithstanding, Ms. Kiefel underwent the mastectomy 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.”
