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Seventh Circuit Upholds Injunction Against Wisconsin Transgender Prisoner Treatment Ban

The Seventh Circuit Court of Appeals affirmed a district court’s injunction barring the application of a Wisconsin law that prohibits certain types of medical care for transgender prisoners.

Several Wisconsin Department of Corrections (WDOC) prisoners have been diagnosed with Gender Identity Disorder (GID), a psychiatric condition in which an individual identifies “strongly with a gender that does not match their physical sexual characteristics.”

GID is a recognized condition in the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM IV); it is treated with psychotherapy, hormone therapy and, in severe cases, sexual reassignment surgery.

The WDOC GID prisoners were prescribed hormone therapy for their condition. However, in 2005 the Wisconsin legislature enacted the “Inmate Sex Change Prevention Act” (Act 105), which prohibited the WDOC from paying for “hormonal therapy or sexual reassignment surgery” for prisoners diagnosed with GID. See: 2005 Wis.Act 105, codified at Wis.Stat. § 302.386(5m)(2010).

WDOC prisoners are not allowed to seek outside health care and thus must rely on the prison system for medical treatment. However, the “defendants did not produce any evidence that another treatment could be an adequate replacement for hormone therapy” for prisoners with GID.

Following passage of Act 105, the WDOC discontinued hormone therapy for all GID prisoners. “When hormones are withdrawn from a patient ... severe complications may arise. The dysphoria and associated psychological symptoms may resurface in more acute form,” the Seventh Circuit wrote. Additionally, the patient may suffer “severe physical effects such as muscle wasting, high blood pressure, and neurological complications.” GID prisoners experienced some of these symptoms when their hormone treatment was discontinued.

Several GID prisoners filed lawsuits to enjoin the provisions of Act 105, alleging that the law violated the Eighth Amendment’s prohibition against cruel and unusual punishment and the Equal Protection Clause of the Fourteenth Amendment. The federal courts agreed, first issuing a preliminary injunction in 2006 [see: PLN, Aug. 2006, p.28], then finding in another case that the statute was unconstitutional both facially and as applied. See: Fields v. Smith, 712 F.Supp.2d 830 (E.D. Wis. 2010). In the latter case the court enjoined enforcement of Act 105.

On appeal, the Seventh Circuit noted that the “Defendants do not challenge the district court’s holding that GID is a serious medical condition,” and that “refusing to provide effective treatment for a serious medical condition serves no valid penological purpose and amounts to torture.”

“Just as the legislature cannot outlaw all effective cancer treatments” for prisoners, the Court of Appeals held that “it cannot outlaw the only effective treatment for a serious condition like GID.” The appellate court affirmed the district court’s finding that Act 105 is facially unconstitutional because “any application of Act 105 would necessarily violate the Eighth Amendment.”

The Seventh Circuit also concluded the defendants were barred from arguing that the injunction violates 18 U.S.C. § 3626(a) of the Prison Litigation Reform Act (PLRA).
Rejecting the plaintiffs’ contention that the defendants had waived that argument, the Court of Appeals instead found “the record establishes an admission, not a waiver.” The district court had “asked defendants’ counsel not once, but twice, ‘whether or not the Defense believed the order ... is as narrow as is required’; counsel replied that it was.”

The Seventh Circuit concluded that “[e]valuating the record as a whole, the district court did not abuse its discretion in enjoining the entirety of Act 105.” The plaintiffs were represented on appeal by the Roger Baldwin Foundation of the ACLU of Illinois. See: Fields v. Smith, 653 F.3d 550 (7th Cir. 2011), cert. denied.

Previously, in September 2010, Wisconsin prison officials had settled a federal lawsuit filed by another transgender prisoner, agreeing to provide her with an outside medical specialist and prison-issued bras and female underwear, and to continue her hormone therapy and pay $5,000 in damages, among other provisions. [See: PLN, May 2011, p.31].

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Related legal cases

Fields v. Smith

Fields v. Smith