White v. Farrier

• Decision Date: 13 June 1988
• Docket Number: No. 87-2107,87-2107
• Citation: 849 F.2d 322
• Parties: Thomas L. WHITE, Appellee, v. Harold FARRIER; Crispus C. Nix, Appellants.
• Court: U.S. Court of Appeals — Eighth Circuit

Page 322

849 F.2d 322

Thomas L. WHITE, Appellee, v. Harold FARRIER; Crispus C. Nix, Appellants.

No. 87-2107.

United States Court of Appeals,

Eighth Circuit.

Submitted Feb. 26, 1988.

Decided June 13, 1988.

Lucille M. Hardy, Des Moines, Iowa, for appellants.

Anne Marie Herr, Clinical Law Program-Student, Iowa City, Iowa, for appellee.

Before BOWMAN, WOLLMAN, and MAGILL, Circuit Judges.

WOLLMAN, Circuit Judge.

Warden Crispus C. Nix and Director of Corrections Harold Farrier (prison officials) appeal from the district court's order granting summary judgment to Thomas L. White a/k/a Tammy Lynn White in his civil rights action under 42 U.S.C. Sec. 1983. We agree with the prison officials that they raised genuine issues of material fact from which a jury might reasonably conclude that they were not deliberately indifferent to White's allegedly serious medical need, transsexualism. We reverse the district court's grant of summary judgment in favor of White and remand for further proceedings consistent with this opinion.

White is serving a ten-year sentence at the Iowa State Penitentiary at Fort Madison, Iowa, for armed robbery. In his original complaint, filed pro se, White alleged that he suffers from a mental disorder known as gender dysphoria or transsexualism and that prison officials were deliberately indifferent to his condition. Although anatomically male, White believes that he is a woman cruelly imprisoned in a man's body. White maintained that the only adequate treatment for transsexualism is radical sexual reassignment surgery. He requested electrolysis, cosmetic surgery, hormone therapy, a sex change operation, female clothes and cosmetics, and a transfer to a women's prison. After the court appointed the Prisoner Assistance Clinic, College of Law, University of Iowa, to represent White, he filed an amended complaint requesting a permanent injunction that would require prison officials to provide him adequate medical care and an appropriate classification to protect his right to existence in the feminine gender.

White had made various demands to prison officials prior to filing this action. In late 1983, White wrote Warden Nix a letter requesting female clothes. Warden Nix responded:

Female clothing is not permitted for inmate wear in this male facility. Though you may be mixed up as to what your sexual preference is, we will still treat you as a male. Some of the staff are baffled as to why you want perfume, cosmetics and women's clothing when you are wearing a mustache. A mustache does not accent your femininity.

Plaintiff's Exhibit No. 1 at 10.

White's request for female hormones was referred to Dr. Loeffelholz, a psychiatrist and medical consultant to the Iowa Department of Corrections. After reviewing White's records from a previous incarceration in the Iowa prison system, Dr. Loeffelholz advised White to behave in a manner to earn the earliest possible work release or parole so that he could "do his own thing" as a free citizen. Dr. Loeffelholz concluded that no medical or psychiatric condition existed that required any specific treatment from health professionals in the Department of Corrections. Designated Record at 69-70.

White later went on hunger strikes, threatened to commit suicide, and attempted to castrate himself on four different occasions, using a razor, a sharpened metal cup, glass from his smashed television set, and glass from his radio. In response, prison officials provided medical care for his physical injuries and placed him in protective custody or administrative confinement.

After White filed this section 1983 action, his attorneys arranged for four different experts to diagnose his condition. Dr. D.W. Black of the University of Iowa Psychiatry Department concluded that although White was possibly a transsexual, he was unable to make an unequivocal diagnosis because White's complete medical and psychiatric history was not available to him. The other three experts all diagnosed White as a transsexual. Karleatha Fisher, a social worker who works with transsexuals, interviewed White and concluded that he was mentally and emotionally totally female. She recommended that White receive hormone therapy in a medical environment. Dr. Howard J. Ruppel, a certified sexologist at the School of Social Work at the University of Iowa and Director of the Center for Sexual Growth and Development in Mt. Vernon, Iowa, diagnosed White as a transsexual and recommended that "Tammy" be placed in an environment where "she" could receive counseling from a professional who follows the Harry Benjamin International Gender Dysphoria Association standards of care. He also recommended that White be allowed to fully explore the ramifications of a permanent sex change, and to express "her" feminine self by wearing female apparel and makeup.

Dr. Collier Cole, a clinical psychologist and professor at the School of Allied Health Sciences and the Department of Psychiatry and Behavioral Sciences at the University of Texas Medical Branch, Galveston, interviewed White and reported that he saw no evidence of a major thought disorder such as schizophrenia that would preclude a diagnosis of transsexualism. In Dr. Cole's opinion, the prison had not provided White with the minimal standard of current and accepted treatment for his condition. He recommended that White be allowed to cross-dress, enter vocational rehabilitation to enable him to re-enter society as a female, and eventually begin hormone therapy. He considered transsexualism to be a serious medical condition and noted that it is listed in the Diagnostic and Statistical Manual, Third Edition of the American Psychiatric Association (DSM-3), as a major mental disorder. ¹

Relying on the opinions of Dr. Cole, Dr. Ruppel, Dr. Black and Ms. Fisher, White filed a motion for summary judgment. The prison officials responded with a cross-motion for summary judgment. The magistrate concluded that the prison officials had been deliberately indifferent to White's serious medical need and recommended that the district court grant White's motion for summary judgment. The magistrate found that the prison officials' response to White's numerous castration attempts--placing him in lock up--was an arbitrary administrative decision and not treatment. The magistrate faulted the prison officials for not articulating a reason for not transferring White to a medical environment where White could receive counseling and "some understanding for his circumstances." Mem. op. at 20. Although the magistrate concluded that White does not have a right to preoperative hormone treatment and sex reassignment surgery while he is incarcerated, he recommended that an independent expert in the area of gender dysphoria diagnose White and determine a minimal treatment plan.

The district court accepted the magistrate's recommendations but ruled that a minimal treatment plan should not necessarily preclude hormone therapy. The court ordered that "if the diagnosis made by the independent expert establishes that plaintiff has a medical need in the nature of gender dysphoria, that defendants provide plaintiff with whatever minimal treatment plan the independent expert recommends, which may include hormonal therapy." Mem. op. at 3. On appeal, the prison officials argue that the district court erred in granting White's motion for summary judgment. They contend that White did not prove that he is a transsexual or that transsexualism is a serious medical need to which they were deliberately indifferent.

I.

Summary judgment is appropriate only when there is no genuine issue as to any material fact and the case may be decided on purely legal grounds. Fed.R.Civ.P. 56(c); AgriStor Leasing v. Farrow, 826 F.2d 732, 734 (8th Cir.1987). The substantive law of the case determines which facts are material or critical, and a dispute about a material fact is genuine if a reasonable jury could return a verdict in favor of either party. Anderson v. Liberty Lobby, Inc., 477 U.S. 242, 106 S.Ct. 2505, 2510, 91 L.Ed.2d 202 (1986). A judge's function in ruling on a summary judgment motion is not to weigh the evidence but to determine whether a genuine issue exists that can be resolved only by the trier of fact at trial. Id. 106 S.Ct. at 2511; see also Fields v. Gander, 734 F.2d 1313, 1314-15 (8th Cir.1984). The court must view the evidence in the light most favorable to the nonmoving party, giving him the benefit of all reasonable factual inferences. Holloway v. Lockhart, 813 F.2d 874, 878 (8th Cir.1987). The court must grant a defendant's motion for summary judgment when the plaintiff has failed to make a sufficient showing on an essential element of his case. Celotex Corp. v. Catrett, 477 U.S. 317, 106 S.Ct. 2548, 2553, 91 L.Ed.2d 265 (1986).

II.

Prison officials' deliberate indifference to a prisoner's serious medical need constitutes cruel and unusual punishment in violation of the eighth amendment. Estelle v. Gamble, 429 U.S. 97, 104, 97 S.Ct. 285, 291, 50 L.Ed.2d 251 (1976). Although the drafters of the eighth amendment were primarily concerned with proscribing torture and other barbarous methods of punishment, the Court has expanded the reach of the eighth amendment to parallel society's evolving standards of decency. Id. at 102, 97 S.Ct. at 290. Denial of medical care that results in unnecessary suffering in prison is inconsistent with contemporary standards of decency and gives rise to a cause of action under 42 U.S.C. Sec. 1983. Id. at 103-05, 97 S.Ct. at 290-92. Actions without a penological justification may constitute an unnecessary infliction of pain. Jorden v. Farrier, 788 F.2d 1347, 1348 (8th Cir.1986). Mere negligence in diagnosing or treating a medical condition, however, is not a constitutional violation simply because the patient is a prisoner. Estelle v. Gamble, 429 U.S. at 106, 97 S.Ct. at 292. Instead, prison officials must act with deliberate indifference to the prisoner's serious...