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Indiana Court of Appeals: Standard of Medical Care Same In and Out of Prison

In an opinion dated November 10, 2014, the Court of Appeals of Indiana overturned a trial court's holding that a lower standard of medical care applied to prisoners and reversed that court's granting of summary judgment.

Dr. Alan Neal Wilson performed male-to-female gender reassignment surgery on Christa Allen in 2002. Part of Allen's post-operative treatment included hormone therapy and the use of a vaginal stent, a soft plastic appliance worn internally like a tampon which prevented closure of the vaginal vault.

Allen was incarcerated from March 2006 through December 2007. While at the Marion County Jail, she was given hormone therapy and allowed to use the vaginal stent. After she arrived at the Indiana Department of Corrections, a prison doctor consulted Wilson on whether the hormones and stent were a medical necessity. He said they were, so Allen was allowed to use the stent and receive the hormones.

Soon thereafter, the prison superintendent told the doctor that the stent was a security breach. The stent was confiscated and the doctor allowed Allen to use a hard vibrator in the infirmary twice daily for ten minutes to dilate her vagina. About six months later, the Correctional Medical Services’ regional director told the doctor that he, the prison Superintendent and the DOC medical director had determined that dilation treatment was "not medically necessary" as it was "only necessary to maintain the integrity of an elective procedure." Allen was not allowed to use the vibrator and was told to use a tampon to maintain vaginal dilation.

Allen filed multiple complaints about blood in the vagina and closure of the vagina to no avail. After her release, she was told that the vaginal vault had closed too much and additional surgery costing $60,000 to $120,000 was required to restore it. She then filed a medical malpractice suit against the prison doctors who had been her health care providers.

The district court granted defendants' motion for summary judgment based, in part, upon the finding that the standard of care for prisoners was lower than for the general community. In doing so, the court disregarded Dr. Wilson's deposition testimony because he testified that he was not knowledgeable about prison medical practices and procedures. The court interpreted this to mean that he did not know the standard of care for prisoners and therefore could not testify about it.

Represented by Crawfordville, Indiana attorney James E. Ayers, Allen appealed. The court of appeals held that the standard of care was the same for prisoners and non-prisoners. Therefore, it held that Dr. Wilson was competent to testify as he was familiar with the standard of care for post-operative transsexuals and had testified that Allen's treatment had not met that standard. Because Dr. Wilson's testimony put into dispute an issue of material fact, the trial court should not have granted summary judgment.

The court of appeals emphasized that prisons could not be compelled to perform elective procedures but may be required to perform procedures made necessary by a pre-incarceration elective procedure. Generalized concerns about security are not sufficient to override this necessity, although it might be appropriate to take into account specific problems of security, budget or other matters when determining whether a doctor breached the standard of care.

The judgment of the trial court was reversed and the case returned to the trial court for further proceedings. See: Allen v. Hinchman, 2015 Ind. App. LEXIS 78, No. 49A02-1311-PL-975.

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Related legal case

Allen v. Hinchman