Wisconsin Law Prohibiting Hormone Treatment for Prisoners with Gender Identity Disorder Found Unconstitutional
On May 13, 2010, a Wisconsin federal court issued a 68-page decision holding that a Wisconsin state law prohibiting hormone therapy for prisoners with gender identity disorder (GID) was an unconstitutional violation of their equal protection and Eighth Amendment rights.
Andrea Fields, Matthew Davidson (aka Jessica Davidson) and Vankemah D. Moaton, Wisconsin prisoners with male-to-female GID, brought a civil rights action under 42 U.S.C. § 1983 against Wisconsin Department of Corrections (WDOC) officials after their feminizing hormone therapy was discontinued without medical justification. In 2005, the state legislature passed Act 105, which prohibited hormone treatment and sex reassignment operations for prisoners with GID (Wis.Stat. § 302.386(5m)). Fields, Davidson and Moaton challenged Act 105’s constitutionality.
The district court recognized that GID, sometimes referred to as transsexualism, is a serious medical need. It is classified as a psychiatric disorder in the current Diagnostic and Statistical Manual of Mental Disorders (DSM-IV). The plaintiffs’ experts testified that if left untreated, GID can cause serious psychiatric consequences such as anxiety, sleeplessness, inability to concentrate, depression, genital self-mutilation and suicidal thoughts. One in 11,900 genetic males has GID. It is less common among genetic females.
The court noted that the legislative justification for Act 105 was to save money, though the per-prisoner annual cost for hormone therapy ($300-1,000) was less than the amount commonly paid by the WDOC for treatment using antipsychotics Quetiapine ($2,555-2,920) or Risperidone ($2,555).
Likewise, the cost of sex reassignment surgery (about $20,000) was less than that of coronary bypass surgery ($37,244), kidney transplant surgery ($32,897) and other surgeries provided by the WDOC. One expert noted that people with untreated GID will cost additional money due to the serious psychiatric consequences of not treating their condition.
Because the WDOC prohibits prisoners from paying for their own health care, Act 105 prevented them from receiving hormone therapy or reassignment surgery for GID by the only method available to them. The plaintiffs’ experts testified that although not all people with GID were good candidates for hormone therapy or sex reassignment surgery, GID would not go away and was not effectively treatable with psychotherapy alone.
Prison officials presented no GID experts as witnesses. The WDOC’s experts, including WDOC Medical Director Dr. David Burnett, testified that they believed Act 105 was medically inappropriate because it interfered with a health care provider’s ability to appropriately treat patients.
All three plaintiffs had received hormone therapy before coming to prison and during their incarceration prior to the enactment of Act 105. They had various medical problems after their hormone therapy was terminated following the passage of Act 105, and those problems abated after the court temporarily enjoined the enforcement of the Act. [See: PLN, Aug. 2006, p.28].
The district court found that Act 105 violated the plaintiffs’ Eighth Amendment right to adequate medical care. It also violated their Fourteenth Amendment equal protection rights, because it targeted prisoners with GID while no other legislation was passed to prohibit medical treatment for any other group of prisoners. Further, although WDOC officials alleged that having feminized male prisoners in the prison population would disrupt security and lead to assaults on those prisoners, they were unable to show any rational connection between Act 105 and prison security.
Therefore, the court held the plaintiffs were entitled to a permanent injunction barring the enforcement of Act 105, which was found to be unconstitutional and invalid. The parties have since filed cross-appeals. See: Sundstrom v. Frank, U.S.D.C. (E.D. Wis.), Case No. 2:06-cv-00112-CNC.
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Related legal case
Sundstrom v. Frank
|U.S.D.C. (E.D. Wis.), Case No. 2:06-cv-00112-CNC