Senate District 7, which covers most of New Hanover County, is one of the most hotly contested senate seats in the General Assembly, and campaigns for the district can be notoriously tough, costly, and dirty.
In 2016, Republican incumbent Michael Lee defeated Democratic challenger Andrew Barnhill after a notably negative campaign that left both candidates frustrated. As Lee told the StarNews at the time, "Nobody likes for people to say things that aren't true about them. Attack me on my positions, not on what you've made up."
During the 2022 election season, Lee and Democratic challenger Marcia Morgan collectively spent over $3 million in an aggressive campaign. Morgan’s ads crossed a line that triggered a defamation lawsuit. She eventually admitted the ads were “not based in actual fact” and settled with Lee last year.
This year, Lee has raised over $800,000, with an additional $2.3 million in ad buys from the North Carolina Senate Majority Fund. Democrat Dr. David Hill, a pediatrician known by some for his role opposing Titan Cement, has raised close to $400,000 — and it’s likely the state Democratic party will help bolster that.
Lee’s campaign targets Hill’s views on transgender issues
In the last few weeks, as campaign spending has ramped up, Lee’s campaign launched a series of attack ads targeting Hill’s views on several transgender-related issues, including students who want to change their pronouns at school, transgender athletes, and gender-affirming care for minors.
Hill has repeatedly spoken in favor of gender-affirming care for children as the cohost of the Pediatrics on Call podcast, produced by the American Academy of Pediatrics (AAP), where Hill has had several leadership roles. Hill’s views are consistent with the AAP’s support for gender-affirming care, which it established with a policy statement in 2018 and reaffirmed last year.
One ad painted Hill’s perspective on gender as condescending, citing a 2021 Medium blog post where Hill detailed what he’s learned about gender as a pediatrician examining infants. Hill noted that, setting aside gender dysphoria, for about 1 in 5,000 people assigning gender is complicated, for a variety of genetic or developmental reasons.
“In my small southern city of 200,000, there are likely at least 40 people who had no gender assigned at birth,” Hill wrote, later concluding, “So, when you hear someone assert that gender is either one thing or another, and they’re ready to pass laws to police how gender is treated, you can bet that they don’t understand the basics of endocrinology, genetics, or physical and psychological development.”
Lee’s ad distilled Hill’s post this way:
- Do you believe there are 2 genders?
- That boys shouldn’t play girls’ sports?
- That gender reassignment surgeries for children are wrong?
- Then State Senate Candidate David Hill says you are ignorant.
Another ad focuses more narrowly on the issue of gender-reassignment surgery. Lee’s ads claim that Hill “strongly supports sex change surgery for kids.” Unlike Lee’s other ad, this one notably uses outdated language — “sex change” as opposed to “gender-affirming surgery.” The ad exploits the nuanced medical guidance around gender-affirming surgery and Hill’s own refusal to categorically weigh in on the issue to portray him as a threat.
As Lee wrote on X, “My opponent’s support for radical gender policies, including sex-change surgeries for minors, is deeply concerning [...] I will continue to fight for the protection of North Carolina’s children and families.”
Lee’s campaign also launched a companion television ad, focusing on the same transgender issues, calling them “radical” and “too extreme.” The ad ends with a pronouncement, “Dr. David Hill–he doesn’t know best. He’s just a quack liberal,” and the sound of a duck quacking.
Hill’s campaign files cease and desist
On Tuesday, Hill’s campaign sent a cease and desist letter to Lee’s campaign and the Senate Majority Fund, alleging that these advertisements were false, defamatory, and potentially libelous and asking that the ads cease running, whether by mail, online, or “through any other media.” While not a legal action in and of itself, the letter lays out some framework for potential litigation in the future.
The letter, sent by Pressley Millen from the Womble Bond Dickinson, LLP law firm, focuses on the language used in the claim that Hill “strongly supports sex change surgery for kids.”
The letter argues this claim is false and misleading, and notes the only source the ad cited — a post on Hill’s BeingWell blog — which discusses “'surgical emergencies' relating to intestinal blockages and for the rare condition of hypospadias.” Millen writes that “in no circumstances could the statements in the article be read as supporting ‘sex change surgery for kids’ in either a medical or common-language sense.”
Millen also notes Lee’s “quack” ad, writing that “when the false statements are directed at a candidate in his professional capacity, the potential for defamation remedies increases substantially,” an unsubtle suggestion of potential civil claims.
In addition to requesting that Lee’s campaign and the Senate Majority Fund cease and desist running the ads, Millen’s letter demands they “issue a written retraction regarding the libelous claim that Dr. Hill supports ‘sex change surgery for children.’”
[Note: You can find the full letter at the end of this article.]
Response from Lee’s campaign
Lee’s campaign and the Senate Majority Fund were represented by Craig Schauer of the Dowling PLLC law firm, who responded defiantly to Hill’s cease and desist on Thursday, denying the ads in question contained any false statements or defamation.
Schauer argues that the “sex change surgery” mailer cited Hill’s blog post to support its claim that he was condescending, not to support its claim that Hill supports gender-affirming surgery.
“Your assertion seems to be based on a misunderstanding that the mailer’s citation to Dr. Hill’s blog post was intended to be evidence of his support for minors having sex-change surgeries. To the contrary, the blog post was cited as the source for Dr. Hill’s quote that belittles parents who disagree with his liberal ideology. It is regrettable that your letter does not disavow—much less apologize for—Dr. Hill’s offensive characterization of those who do not share his liberal views on gender,” Schauer writes.
Schauer argues that the mailer didn’t need to cite its source for Hill’s stance on gender-affirming surgery for minors “because his support for such procedures seems without question.” He goes on to cite two episodes of the Pediatrics on Call podcast, as well as the AAP’s policy on gender-affirming care.
The letter also defends the use of the word “quack,” arguing “the advertisement never labels Dr. Hill a ‘quack,’ but rather uses the word ‘quack’ as an adjective to describe his liberal views” mentioned in the ad.
Schauer argues Lee is “free to express his opinion that Dr. Hill’s radical views are wrong,” and that his campaign ads aren’t defamatory because “liberal views on gender, such as those espoused by Dr. Hill, are not sufficiently based on scientific evidence.”
While Lee did provide his attorney’s response he did not respond to a request for an interview to discuss the issues covered by these ads.
[Note: You can find the full response at the end of this article.]
So, what’s really going on here?
The easiest way to resolve this issue would be for Hill to simply state his stance on gender-affirming surgery for minors, but he has declined to do so. Instead, his campaign issued a statement, which also appeared in the Raleigh News and Observer.
“I believe in families’ and patients' ability to make the best decisions for themselves without interference from the government. Michael Lee is lying to voters about my beliefs and the type of care I provide,” Hill’s statement read in part.
While that leaves Hill’s stance on surgical interventions unclear, the evidence cited by Lee’s attorney is also far from concrete.
Take, for example, the 2021 Pediatrics on Call episode discussing gender-affirming care cited by Schauer, where Hill and his co-host interview Dr. Kathryn Lowe, a member of the executive committee of the AAP Section on LGBT Health and Wellness.
The episode includes a conversation on a recent spate of state laws aimed at blocking gender-affirming care for minors.
“Dr. Hill then interviewed Dr. Kathryn Lowe, who clearly defined laws banning gender-affirming care as laws that prohibit, among other things, ‘surgeries for transgender kids,’” Schauer writes. His argument is that, by framing these laws as harmful — which Hill and Lowe do — they’re advocating for all gender-affirming care, including surgery.
What Lowe actually said on the podcast is more nuanced.
“Many states are trying to ban surgeries for transgender kids, which is ironic, because the guidelines do not recommend surgeries for transgender kids while they are minors – so this is rarely done, only in very rare circumstances, so that’s hardly applicable at all,” Lowe said.
Lowe is apparently referring to the AAP guidelines, which do, as Schauer notes, recommend that insurance plans offer coverage for “medical, psychological, and, when indicated, surgical gender-affirming interventions.”
But those guidelines also note that surgery is “typically” for adults. The AAP guidelines notes that “eligibility criteria for gender-affirmative surgical interventions among adolescents are not clearly defined between established protocols and practice. When applicable, eligibility is usually determined on a case-by-case basis with the adolescent and the family along with input from medical, mental health, and surgical providers.”
And, as Lowe pointed out, these surgeries are very rare – a claim supported by a new study from Harvard’s School of Public Health, which found “little to no utilization of gender-affirming surgeries” by transgender minors. The study also found that cisgender minors and adults “had substantially higher utilization of analogous gender-affirming surgeries than their TGD counterparts,” according to Harvard.
Surgery is one potential part of gender-affirming care. And because of that, it’s easy to conflate Hill’s support for gender-affirming care in general — which he’s been outspoken about – with his support for surgery for minors in particular, which he does not appear to have specifically discussed on any of the platforms cited by Lee’s attorney.
In his letter, Schauer tries to extend the conflation to politics, writing “the list of liberal politicians who have abandoned their support for sex-change surgeries for minors is growing." He cites reporting from the New York Times that a White House spokesperson said “surgeries should be limited to adults," (although Schauer also accuses the Biden Administration of having a "radical transgender agenda").
He then adds, “Dr. Hill may now wish to disavow his prior endorsements of comprehensive gender-affirming care for minors.”
For a layperson, the conflation might very well seem plausible. And it’s easier to blur the distinction since the rarity and patient-specificity of gender-affirming care for minors probably make it difficult for Hill as a medical professional to issue a blanket statement on the practice.
But as a candidate, there’s probably a different calculus to be made, based on how profoundly divisive specific transgender issues can be — even within the Democratic party.
As a 2022 Ipsos/NPR poll found, the “rights of trans female athletes have become a political wedge issue,” with 46% of Democrats supporting transgender women’s rights to compete on women’s and girls' sports teams — but 41% of Democrats opposing them (63% of independent voters opposed those rights).
There was a less stark but still notable divide on laws prohibiting gender-affirming care for minors (the poll didn’t specify granular details like medication vs. surgical interventions). While nearly 60% of Democrats opposed that kind of legislation, 14% supported bans.
Lee’s ads seem calculated to further exploit divisions on the left when it comes to the most divisive topics involving minors — inclusion and sports, ‘safe spaces’ for children to experiment with new pronouns before coming out to their parents, and especially surgery.
For the people who require it, access to gender-affirming medical care is incredibly important. But as a policy issue for state legislation, regulating that care — especially the rare instances of surgery for children — directly concerns just a fraction of North Carolina residents.
If campaign advertising was based on issues that most deeply impacted the broadest segment of the population, you’d expect to see ads talking about education, environmental quality, and economic success — and Lee has spoken about all of those things in a series of Facebook ads. But the big-money spend from the Senate Majority Fund appears to have been funneled into ads targeting these much narrower issues.
Whether undecided voters will be swayed — or see the ads as manipulative and bigoted — remains to be seen.
Below: Cease and desist letter from Hill's attorney; reponse from Lee's attorney.
