Transsexual Prisoners

A prisoner serving a 34-year sentence for child sex abuse suffered from gender dysphoria. Biologically male, they identify as female. Correctional medical staff members treated the prisoner’s condition with hormone therapy. While the prisoner repeatedly requested sex-reassignment surgery, national standards of care recommend that patients undertake one year of “real life” experience as a person of their self-identified gender before resorting to irreversible surgery. That presented challenges in a sex-segregated prison. Correctional officials consulted with an outside expert, who determined that the prisoner was a potential surgical candidate if officials developed a safe, workable solution to the real-life-experience problem.

Citing these concerns and department policy, correctional officials denied the surgery request. The prisoner sued for alleged deliberate indifference to her serious medical needs. A federal appeals court found that the defendants were entitled to qualified immunity. Such immunity protects officials from lawsuits for damages unless prior case law clearly puts them on notice that an action is unconstitutional. The Eighth Amendment requires correctional healthcare professionals to exercise medical judgment when making decisions about a prisoner’s treatment, and they cannot completely deny care for a serious medical condition. Those broad principles, the appeals court found, could not have warned these defendants that treating gender dysphoria with hormone therapy and deferring consideration of sex-reassignment surgery violates the Constitution. As they followed accepted medical standards, they were immune from damages liability. Campbell v. Kallas, #18-2075, 2019 U.S. App. Lexis 24655, 2019 WL 3886912 (7th Cir.).

A federal appeals court upheld a permanent injunction based on the trial court’s conclusion that gender confirmation surgery (GCS) was medically necessary for the plaintiff, a male-to-female transgender prisoner in the custody of the Idaho Department of Correction, serving a sentence for the sexual abuse of a 15-year-old male at a house party. The injunction ordered the state to provide the surgery. The record showed that the plaintiff has a serious medical need, that the appropriate medical treatment is GCS, and that prison authorities have not provided that treatment despite their knowledge of the plaintiff's ongoing and extreme suffering and medical needs. Such a denial violates the Eighth Amendment. The court rejected the defendants’ depiction of a “reasoned disagreement” between qualified medical professionals. The court emphasized that its analysis was individual to the plaintiff and based on the record. The court did, however, vacate the injunction to the extent that it applied to the named defendants in their individual, as opposed to official, capacities. According to news reports after the ruling, Idaho’s governor stated that he would seek review of the decision by the U.S. Supreme Court. Edmo v. Corizon, Inc., #19-35017, 2019 U.S. App. Lexis 25330, 2019 WL 3978329 (9th Cir.).