Procedural Posture

The district court invalidated a Wisconsin state statute prohibiting the Wisconsin Department of Corrections from providing transgender inmates with certain medical treatments, including hormonal therapy and sexual reassignment surgery.  The district court had concluded that this ban violated the Federal Constitution’s prohibition on cruel and unusual punishment and guarantee of equal protection.  The district court had granted an injunction barring the defendants from enforcing the Inmate Sex Change Prevention Act.

Facts

The lawsuit was brought as a class action by a number of inmates.  The district court had denied class certification but permitted the case to proceed to trial on the individual claims of three plaintiffs.  Andrea Fields, Matthew Davison and Vanemah Moatan are all male-to-female transsexuals and  have each been diagnosed with Gender Identity Disorder, which is classified as a psychiatric disorder in the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV).

Issue

Whether to uphold the district court’s grant of injunctive relief.

Domestic Law

Inmate Sex Change Prevention Act

Constitution, Eighth Amendment (cruel and unusual punishment), Fourteenth Amendment (equal protection)

Estelle v. Gamble, U.S. Supreme Court 1976 (holding that “deliberate indifference to serious medical needs of prisoners constitutes the unnecessary and wanton infliction of pain proscribed by the Eighth Amendment”).

Merriwether v. Faulkner, U.S. Court of Appeals for the Seventh Circuit 1987 (noting that plaintiff did not have the right to any particular treatment, but that prison officials had acted with deliberate indifference in refusing all treatment).

Maggert v. Hanks, U.S. Court of Appeals for the Seventh Circuit 1997 (noting that the Eighth Amendment does not require the provision of “esoteric” treatments like hormone therapy and sexual reassignment surgery which are protracted and expensive; the Eighth Amendment requires only minimum health care for prison inmates).

Reasoning of the Court

Prison officials violate the Eighth Amendment’s proscription against cruel and unusual punishment when they display deliberate indifference to serious medical needs of prisoners.  The district court had found that the plaintiffs suffered from a serious medical need, namely GID, and that they knew of the serious medical need but refused to provide hormone therapy.  The defendants argued that the state legislature has the power to prohibit certain medical treatments when other treatment options are available and that the Act was justified by a legitimate need to ensure security in state prisons.

The defendants relied on the cases of Merriwether v. Faulkner and Maggert v. Hanks.  However, the Court found that the treatment of hormone therapy and sex reassignment surgery in those cases was based on certain empirical assumptions, namely that the cost of the treatment was high and that adequate alternatives existed.  That assumption has been called into question by the evidence and in fact the defendants disavowed any reliance on cost savings to justify the Act.

More importantly, the Court emphasized, defendants “did not produce any evidence that another treatment could be an adequate replacement for hormone therapy.”  Witnesses for the plaintiffs repeatedly made the point that hormone therapy “is the only treatment that reduces dysphoria and can prevent the severe emotional and physical harms associated with it.”

Quoting Estelle v. Gamble, the Court observed that it was well established that the Constitution’s ban on cruel and unusual punishment does not permit a state to deny effective treatment for the serious medical needs of prisoners.  The Court stated: “Surely, had the Wisconsin legislature passed a law that DOC inmates with cancer must be treated only with therapy and pain killers, this court would have no trouble concluding that the law was unconstitutional.  Refusing to provide effective treatment for a serious medical condition serves no valid penological purpose and amounts to torture.”  In this case, the Act provided plaintiffs with some treatment but not with hormone therapy.  Yet evidence at trial had indicated that the plaintiffs could not be effectively treated without hormones.

Because the Court of Appeals found that the district court properly held that the Act violated the Eighth Amendment, it did not address the alternate holding that the  law violated the Equal Protection Clause.

Andrea Fields v. Judy Smith, U.S. Court of Appeals for the Seventh Circuit (5 August 2011), (full text of judgment, PDF)