North Carolina Prison Officials Run Out the Clock On Trans Prisoner’s Vulvoplasty
Even as some states successfully move to strip hormone therapy and other gender-related care from trans prisoners, the U.S. District Court for the Western District of North Carolina twice ruled against state prison officials trying to deny gender-affirming surgery to state prisoner Kanautica Zayre-Brown. The state Department of Adult Correction (DAC) asked the U.S. Court of Appeals for the Fourth Circuit to stay the district court’s injunction while they appealed it, but that request was rejected, too. The state succeeded in delaying the action, and by the time the appellate court was ready to rule in November 2024, the prisoner had been released, saving the cost of her vulvoplasty. But that also set up a fight over attorneys fees, which the parties told the district court remained unresolved on September 24, 2025.
Zayre-Brown, 43, was diagnosed with gender dysphoria (GD) in 2010. She began hormone replacement therapy (HRT), living and presenting herself socially as a woman and undergoing related psychotherapy. By 2017, she had also undergone several gender-affirming surgeries, including testicle removal. But when incarcerated by the DAC on a 119-month sentence for insurance fraud, she was housed in a men’s prison—until attorneys with the state chapter of the American Civil Liberties Union (ACLU) got involved. In 2019, she became the state’s first male-to-female trans prisoner moved to a women’s prison.
However, her request for a vulvoplasty—creating a vagina—to affirm her gender identity and relieve her GD was denied by DAC Chief Medical Officer Dr. Arthur Campbell. Zayre-Brown then filed suit in 2022, and the district court issued an injunction in April 2024 requiring DAC to re-evaluate her request. DAC appealed the injunction, asking for a stay during the appeal’s pendency. But the Fourth Circuit denied that request on July 25, 2024, over the vigorous dissent of Judge Allison J. Rushing, who fretted that the Court had abandoned the DAC to a lower court order that forced it spend money on a surgery which might later be deemed legally unnecessary. See: Zayre-Brown v. N.C. Dep’t of Adult Corr., 2024 U.S. App. LEXIS 18364 (4th Cir.).
Judge Rushing needn’t have worried; DAC completed its re-evaluation and, unsurprisingly, again denied the request. Zayre-Brown returned to the district court, which ruled on November 22, 2024, that DAC was out of compliance with the injunction.
That injunction had required the state Department of Public Safety, DAC’s parent agency, to submit the prisoner’s request to experts other than Dr. Campbell, because he was on the record opining that surgery was never necessary to treat GD—so the district court found his testimony about the necessity of surgery for Zayre-Brown was “not credible.” DAC had then recruited a pair of experts, who both agreed that surgery was not necessary, but only because they thought Zayre-Brown would do better to wait until after her release.
The district court said that was beside the point. “In considering whether the … Eighth Amendment has been violated, courts ask whether a prisoner is suffering harm that could have been prevented by timely treatment,” the court noted. So the new experts’ opinion that she didn’t need surgery now was “not relevant to whether Defendants wrongfully refused to provide her surgery in February 2022, more than two years before her release from prison … and at a time when her suffering was obvious.” Accordingly, the DAC was found out of compliance with the injunction and ordered to re-evaluate Zayre-Brown’s request. See: Zayre-Brown v. N.C. Dep’t of Pub. Safety, 2024 U.S. Dist. LEXIS 213579 (W.D.N.C.).
Three days later, the Fourth Circuit issued a very short order vacating the original injunction and dismissing the state’s appeal. The day after that, on November 26, 2024, the appellate court issued a new ruling clarifying that it was dismissing the appeal because it had been mooted by the prisoner’s release. See: Zayre-Brown v. N.C. Dep’t of Adult Corr., 2024 U.S. App. LEXIS 30084 (4th Cir.).
That set up a squabble over who was the “prevailing party” and entitled to attorneys fees, a dispute which remains unresolved. Meanwhile, Zayre-Brown established a GoFundMe page to raise money for a surgery scheduled for July 2025. It was unclear if that happened.
It was noteworthy that the district court’s injunction order called “a blanket policy (or de facto ban) … which does not allow for the consideration of an inmate’s particular medical needs” something that a “majority of courts” had found “could violate the Eighth Amendment.” It remains to be seen how that ends up being squared with de facto bans on gender-affirming care for prisoners, like a ban in Kentucky that a prisoner there challenged and lost, as reported elsewhere in this issue. [See: PLN, Nov. 2025, p.13.]
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Related legal case
Zayre-Brown v. N.C. Dep’t of Adult Corr
| Year | 2024 |
|---|---|
| Cite | 2024 U.S. App. LEXIS 30084 (4th Cir.) |
| Level | Court of Appeals |