Soneeya v. Spencer

Decision Date29 March 2012
Docket NumberCivil Action No. 07–12325–JLT.
Citation851 F.Supp.2d 228
PartiesKatheena SONEEYA f.k.a. Kenneth Hunt, Plaintiff, v. Luis S. SPENCER in his official capacity, Defendant.
CourtU.S. District Court — District of Massachusetts

OPINION TEXT STARTS HERE

Alfred A. Day, Cori A. Lable, Daniel V. McCaughey, Jessica M. Lindemann, Kristin G. Ali, Ropes & Gray, Boston, MA, for Plaintiff.

Joan T. Kennedy, Richard C. McFarland, Department of Correction, Boston, MA, for Defendant.

MEMORANDUM

TAURO, District Judge.

I. Introduction

Katheena Soneeya is a male-to-female transsexual currently serving a natural life sentence in the custody of the Massachusetts Department of Correction (DOC). She 1 has been incarcerated since 1982, and is currently housed at MCI–Shirley, a medium security male prison. She is suing Defendant for violation of her Eighth and Fourteenth Amendment rights under the United States Constitution, and for a violation of her rights under Article 114 of the Declaration of Rights of the Massachusetts Constitution. A bench trial was held on January 29, 2012.

II. BackgroundA. Factual Background

In 1982, Massachusetts Superior court convicted Katheena Soneeya (born Kenneth Hunt) of the murder of two women, and she is currently serving a life sentence without possibility of parole. She has been in the custody of the DOC since her conviction in 1982, and has been housed at a number of different facilities during the term of her incarceration. She is currently housed at MCI–Shirley, a medium security male prison.

Although Soneeya was born a biological male, she has consistently suffered from gender dysphoria, or a sense that her physical body does not match her gender identity. From early childhood on, Ms. Soneeya has felt that she was a “woman.” 2 She has told medical providers that as a child she would wear her mother's clothing or makeup when she could, she preferred female friends, and she and her brother would play a game of mock-sex where she would take the female role.3

This persistent cross-gender identification is intertwined with a personal history characterized by early trauma and sexual development. Ms. Soneeya testified to feeling like a “freak” as she was growing up, and she suffered rejection and ostracization, as well as sexual, physical, and emotional abuse from her parents and others.4 Medical and prison records submitted in to evidence also show that Ms. Soneeya has a history of psychiatric treatment related to “self mutilative behavior and suicidal ideation.” 5 Ms. Soneeya's history also reflects two suicide attempts in Boston when she was between the ages of fourteen and seventeen.6 In 1982, Ms. Soneeya was convicted of the murder of her cousin and another woman, and was sentenced to life in prison without the possibility of parole.

Ms. Soneeya was first diagnosed with gender identity disorder (“GID”) in 1990, while in DOC custody.7 Ms. Soneeya initially sought help from mental health services at Old Colony after she attempted to castrate herself in order to “get rid of the one problem that's been bothering [her for her] whole life.” 8 In a 1990 evaluation, Dr. Judith Power diagnosed Ms. Soneeya with “transsexualism, polysubstance abuse, personality disorder, NOS with histrionic borderline and antisocial features.” 9 Ms. Soneeya testified at trial that she was “stunned” by the diagnosis, and by the realization that, she “grew up suffering with this for [her] whole life and realized that there was treatment around the corner that [she] couldn't get.” 10

Gender Identity Disorder is defined by the “Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, Text–Revised” (“DSM–IV–TR”) as a major mental illness characterized by “a strong and persistent cross-gender identification.” 11 Individuals with GID experience [p]ersistent discomfort with [their] sex or sense of inappropriateness in the gender role of that sex,” and in adults “the disturbance is manifested by symptoms such as preoccupation with getting rid of primary and secondary sex characteristics ... or belief that he or she was born the wrong sex.” 12

The course of treatment for Gender Identity Disorder generally followed in the community is governed by the “Standards of Care” promulgated by the World Professional Association for Transgender Health (“WPATH”).13 A new version of the Standards of Care, the seventh version, was released in September, 2011, afterPlaintiff filed her initial complaint in this case.14 Both the sixth version and the seventh version of the SOC are relevant to the instant proceeding. The sixth provides the standard for Plaintiff's past treatment, and because plaintiff seeks only prospective relief, the seventh version provides the community standard for treatment of GID going forward. The Standards of Care are generally understood to be flexible clinical guidelines, which individual health professionals and programs may modify.15 The Standards of Care explicitly state that, [c]linical departures from the SOC may come about because of a patient's unique anatomic, social, or psychological situation; an experienced health professional's evolving method of handling a common situation; a research protocol ... or the need for specific harm reduction strategies.” 16

The Standards of Care put forth three major areas of therapy for GID, which consist of: (1) hormone therapy; (2) a real-life experience living as a member of the opposite sex; and (3) sex reassignment surgery.17 Not all persons suffering from GID want or require all three types of therapy in order to alleviate their gender dysphoria.18 Ultimately, the level of treatment that a patient requires depends on the severity of their GID diagnosis, and the treatment of gender dysphoria has become more individualized with the adoption of the seventh version of the Standards of Care.19

Under the Standards of Care, initiation of each stage of triadic therapy should only be undertaken once the patient meets certain eligibility and readiness criteria. Initiation of hormone therapy requires that the patient has: (1) persistent, well-documented gender dysphoria; (2) the capacity to make informed treatment decisions; (3) attained the age of majority; and (4) reasonable control over any medical or mental health concerns.20 While sex reassignment surgery is not necessary for all patients, for some, “surgery is essential and medically necessary to alleviate their gender dysphoria.” 21 The seventh version of the Standards of Care asserts that, [t]he vast majority of follow-up studies have shown an undeniable beneficial effect of sex reassignment surgery on postoperative outcomes such as subjective well being, cosmesis, and sexual function.” 22 The sixth version of the standards of care sets forth readiness and eligibility criteria for sex reassignment surgery. The eligibility criteria are:

1. Legal age of majority in the patient's nation;

2. Usually 12 months of continuous hormonal therapy for those without a medical contraindication ...;

3. 12 months of successful continuous full time real-life experience. Periods of returning to the original gender may indicate ambivalence about proceeding and generally should not be used to fulfill this criterion;

4. If required by the mental health professional, regular responsible participation in psychotherapy throughout the real-life experience at a frequency determined jointly by the patient and the mental health professional. Psychotherapy per se is not an absolute eligibility criterion for surgery;

5. Demonstrable knowledge of the cost, required lengths of hospitalization, likely complications, and post surgical rehabilitation requirements of various surgical approaches;

6. Awareness of different competent surgeons.23

The readiness criteria are:

1. Demonstrable progress in consolidating one's gender identity;

2. Demonstrable progress in dealing with work, family, and interpersonal issues resulting in a significantly better state of mental health; this implies satisfactory control of problems such as sociopathy, substance abuse, psychosis, suicidality, for instance.24

With respect to the relevance of other psychiatric diagnoses to a patient's GID treatment, the sixth version of the Standards of Care take the position that [t]he presence of psychiatric comorbidities does not necessarily preclude hormonal or surgical treatment, but some diagnoses pose difficult treatment dilemmas and may delay or preclude the use of either treatment.” 25

At trial, two experts testified regarding treatment for GID in general, and Ms. Soneeya's treatment while in DOC custody in particular. Plaintiff's expert, Dr. Randy Kaufman, Psy.D., is a clinical psychologist and psychotherapist with a private practice in Cambridge, Massachusetts. Her current practice focuses on treatment of individuals with GID and other gender identity issues.

From 1999 through 2005, Dr. Kaufman worked at the Fenway Clinic, the premiere institution in New England for treatment of gender identity issues.26 At the Fenway Clinic, Dr. Kaufman worked primarily with patients with gender identity issues.27 She developed the transgender health program at the Fenway Clinic and started the first two support groups for individuals with GID.28 In 2001, while still at the Fenway Clinic, Dr. Kaufman opened her private practice in Cambridge, Massachusetts, which she maintains today. 29 She currently sees twenty-eight patients with gender identity issues in her private practice, and she has treated three hundred seventy-two patients with gender identity issues over the course of her career.30

Between 2003 and 2005, the Fenway Clinic had a contract with UMass Medical School, for the evaluation of prisoners in the custody of the DOC for gender identity disorder. Pursuant to this contract, Dr. Kaufman evaluated a number of inmates in DOC custody including Ms. Soneeya.31 She has published a number of articles on transgender and gender identity issues, and she previously testified as an expert in the Kosilek...

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