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Settlement Obligates Washington DOC to Provide Gender-Affirming Care to Trans Prisoners

On October 10, 2023, a settlement was reached in a suit filed by Disability Rights Washington (DRW), a federally funded agency that advocates for the rights of people with disabilities, accusing the Washington Department of Corrections (DOC) of violating the rights of transgender prisoners by denying medical and mental health care.

DRW was the sole plaintiff in the complaint, which accused prison officials of denying gender-affirming treatment to trans prisoners; discriminating against them due to disabilities including gender dysphoria; and subjecting them to routine cross-gender strip and pat-down searches—all alleged violations of their Eighth Amendment guarantee of freedom from cruel and unusual punishment, as well as the Americans with Disabilities Act, 42 U.S.C. ch. 126, § 12010 et seq., and the Rehabilitation Act, 29 U.S.C. § 701 et seq. DRW and DOC had entered into a negotiated pre-litigation agreement in 2019, which culminated in the complaint filed concurrently with the settlement.

The complaint notes that the suit was prompted by DOC’s failure to provide adequate gender-affirming care to transgender, non-binary and intersex prisoners—including hormone replacement therapy, facial hair removal, voice therapy and counseling. Further, prison medical staff “discouraged people from seeking medical care related to their gender identity” and even “encouraged transgender people in their care to de-transition or not pursue gender-affirming [G-A] care.” Medical providers delayed or denied hormone therapy for years in some cases.

Additionally, DOC “maintained an effective ban on [G-A] surgery to treat gender dysphoria” until 2020, after it entered into negotiations with DRW. Prison officials had contracted with a consultant, Stephen Levine, to evaluate trans prisoners for surgery, despite criticism from a federal court in a prior case that found he had misrepresented the standards of care and was not credible. See: Norsworthy v. Beard, 87 F.Supp.3d 1164 (N.D. Cal. 2015).

Transgender prisoners were denied adequate means of expressing their gender identity, as DOC often did not allow them access to “shaving and grooming tools, undergarments, gender-affirming clothing and religious garments, and prostheses,” the complaint continued. The lack of G-A medical and mental health treatment caused some trans prisoners to engage in “self-harm incidents and suicidal ideation.”

DOC agreed to settle the case by implementing a number of policy changes, including designating a statewide G-A Mental Health Community Consultant, G-A Medical Specialist and back-up Medical Specialist, as well as a G-A Mental Health Specialist at each major state prison. Further, the agency agreed to deliver G-A “medical and mental health care according to the Guidelines for Healthcare of Transgender Individuals, consistent with the state’s HCA Transhealth Program,” and to provide trans prisoners with G-A “clothing, medical and hygiene items.” The agreement also obligates DOC to ensure privacy protections for the status and gender history of transgender prisoners. Prison staff must also ensure that trans prisoners are searched by a guard of the gender the prisoner formally requests, with any cross-gender searches approved by the facility’s superintendent, duty officer or community corrections supervisor.

DOC will be responsible for collecting quality assurance data concerning trans prisoners, including strip searches, provision of G-A clothing and other items, staff training, and medical and mental health treatment. This data will be shared at least quarterly with DRW, which will monitor compliance with the settlement terms for three years while the district court retains jurisdiction over the case.

As part of the settlement, DOC will pay DRW $300,000 annually during the monitoring period. DRW also received $1.5 million in attorney fees and costs. According to staff attorney Ethan Frenchman, the settlement was “one of the best and most comprehensive consent decrees in the country concerning the treatment of transgender people in prison or jail.” See: Disability Rights Wash. v. Wash. Dep’t of Corr., USDC (W.D. Wash.), Case No. 2:23- cv-01553.


Additional source: KUOW

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Related legal case

Disability Rights Wash. v. Wash. Dep’t of Corr.