July 23, 2018 – A three-judge panel for the U.S. Court of Appeals for the Seventh Circuit has ruled that Wisconsin prison officials violated the constitutional rights of a transgender inmate by prohibiting her from taking hormones, reversing the lower court’s ruling.
“If prison medical staff exhibit deliberate indifference to an inmate’s serious medical condition, they subject her to unnecessary and wanton pain and suffering and thereby run afoul of the Eighth Amendment,” wrote Chief Judge Diane Wood.
The panel concluded that Lisa Mitchell’s case can proceed because the defendants did not dispute that gender dysphoria is a serious medical condition and a jury must decide whether there was deliberate indifference of that condition by prison officials.
“The only limitation is that the condition be serious enough to trigger constitutional protection; otherwise the nature of the disorder is irrelevant,” Chief Judge Wood wrote in Mitchell v. Kallas et al., No. 16-3350 (July 10, 2018).
Following her request for hormone treatments, prison officials at the Columbia Correctional Institution referred Mitchell to a social worker who specializes in gender dysphoria evaluations, but the process took a year. The social worker said Mitchell was an excellent candidate for hormone therapy but by then, she was close to release.
Thus, the prison’s mental health director withheld hormone therapy, after a year of delay. Mitchell’s psychological health deteriorated while she waited for treatment in prison, and then the terms of her parole did not allow her to take hormones – her parole officers prohibited hormone treatment and she was required to dress like a man.
Mitchell sued the prison doctor, the parole officers, and other prison officials under 42 U.S.C. § 1983, which allows plaintiff to seek redress for constitutional violations.
The district court ultimately dismissed the case on summary judgment for the defendants, concluding the mental health director was immune from the lawsuit.
But the appeals court panel ruled that qualified immunity did not apply – with respect to withholding treatment – rejecting the mental health director’s claim that Mitchell’s constitutional rights to health care in prison were not clearly established.
“Because circuit precedent clearly established that a total absence of treatment for the serious medical needs created by gender dysphoria is unconstitutional, Dr. Kallas may not claim qualified immunity for the denial of Mitchell’s request for care,” Wood wrote.
But the panel ruled that the mental health director did have immunity on Mitchell’s claim of unreasonable delay, since the doctor was not on notice considering the delay.
“That is not to say that this delay cannot be criticized,” Chief Judge Wood wrote. “Far from it. The lack of any sense of urgency, or even the need for prompt follow-through, is quite disturbing. But on these facts, no clearly established law would have signaled to Dr. Kallas that this delay amounted to deliberate indifference.”
The panel also ruled that summary judgment was not appropriate because a jury should decide whether prison officials were deliberately indifferent to Mitchell’s medical needs.
“[E]ven if the therapy sessions addressed Mitchell’s gender dysphoria to a degree, she may still recover if they did nothing actually to treat her condition,” Chief Judge Wood wrote. “Mitchell has presented enough evidence to move forward.”
A delay in treatment, the panel explained, could amount to deliberate indifference depending on the “seriousness of the condition and the ease of providing treatment.”
“[T]he serious nature of gender dysphoria is not disputed. But the ease of evaluating the appropriateness of hormone therapy remains to be considered,” Wood noted.
Finally, the panel ruled that Mitchell’s parole officers were improperly dismissed from the case because Mitchell’s pro se complaint sufficiently stated a claim against them, and the differing claims may proceed without a second lawsuit.
“Mitchell pleaded enough to proceed on the theory that the parole officers acted with deliberate indifference to her dysphoria by blocking her from getting care,” Wood noted.
“[H]andling the claims against both sets of defendants in one case minimizes the risk of unfairness from such inconsistent defenses succeeding in separate trials.”