Long v. Nix, 95-1613

Citation86 F.3d 761
Decision Date15 July 1996
Docket NumberNo. 95-1613,95-1613
PartiesMerlin C. LONG, Appellant, v. Crispus C. NIX; Sally Chandler-Halford, as Director of the Iowa Department of Corrections; Thomas Hundley, Warden of ISP; Paul W. Grossheim; Paul W. Loeffelholz; Appellees.
CourtUnited States Courts of Appeals. United States Court of Appeals (8th Circuit)

Pamela Frasher, Student Legal Intern, Iowa City, IA, argued (John B. Whiston, Steven Heim, and Theresa Hodnett, on the brief), for appellant.

William A. Hill, Asst. Atty. Gen., Des Moines, IA, argued for appellee.

Before BOWMAN, LOKEN, and HANSEN, Circuit Judges.

BOWMAN, Circuit Judge.

Merlin C. Long is serving a life sentence at the Iowa State Penitentiary (ISP) for the brutal murder of a woman. See Long v. Brewer, 253 N.W.2d 549, 551 (Iowa 1977). He filed this 42 U.S.C. § 1983 (1994) lawsuit against officials of the Iowa Department of Corrections seeking, among other things, treatment for a gender-identity disorder and damages for the defendants' alleged deliberate indifference to his gender-identity disorder. Based on the evidence introduced during a one-day bench trial, the District Court 1 held that (1) the extent of Long's gender-identity disorder does not constitute a serious medical need, (2) even if Long has a serious medical need, the defendants were not deliberately indifferent to that need, and (3) the defendants were entitled to qualified immunity from Long's claim for damages. Long v. Nix, 877 F.Supp. 1358, 1365-67 (S.D.Iowa 1995). Long timely appeals from the judgment of the District Court, and we affirm.

I.

Long began his stay at ISP in 1964. He arrived in full drag, but initially prison officials refused to let him wear women's clothes. Following a hunger strike that began shortly after his arrival, Long was allowed to wear women's clothes and make-up on a regular basis. This privilege, however, was revoked in 1981 after a member of the Iowa Parole Board complained to prison officials about Long's attire. Since 1981 Long repeatedly has sought permission to wear women's clothing and make-up. ISP officials have denied his request each time. He also has requested hormone therapy and sex-change surgery. Aside from these requests, however, Long has not sought, nor have prison health services employees ordered, any treatment for a gender-identity disorder. In fact, Long has repeatedly refused to cooperate with prison psychologists and psychiatrists over the past twenty years. See Long, 877 F.Supp. at 1362; see also Program Review Committee Pre-Parole Evaluation (Feb. 3, 1978); Psychiatric Consultation (Apr. 24, 1981); Psychiatric Evaluation (Feb. 15, 1986).

As the District Court found, Long's 1990 evaluation was unproductive because Long presented himself in a "hostile and belligerent," "verbally abusive and abrasive manner." Long, 877 F.Supp. at 1362. During his 1991 psychological evaluation, all Long requested was "what he deserves": a transfer from ISP to a less structured setting. Id. The psychologist concluded that "[a]t this point in time there are no psychological or psychiatric issues that need to be addressed." Psychological Evaluation (Jan. 30, 1991). In 1992, Long "indicated no mental health issues or problems," and the psychologist concluded that there were no psychological issues that needed to be addressed. Psychological Evaluation (Jan. 29, 1992). In 1993, Long refused to participate in a psychological interview and "no meaningful psychological report" was submitted. Long, 877 F.Supp. at 1362. In contrast to Long's behavior, the record shows that prison officials have been responsive to Long's requests for treatment when they were reasonable. In 1982, for example, Long requested "treatment and evaluation" at the Iowa State Medical Facility (ISMF). ISMF Referral (Feb. 12, 1982). His request was granted, and he was transferred to ISMF. Later that same year he was transferred at his own request to a Missouri maximum security prison where he was allowed to wear women's clothing at all times. In 1986 he returned to ISP. His complaints to a member of the medical staff at that time "center[ed] around the fact that he will not be allowed to have the numerous articles of female clothing which he owns." Psychiatric Evaluation (Feb. 15, 1986). Long, however, never has shown a continued interest in psychiatric evaluation or treatment either for depression or his gender-identity disorder. "In 1994, Long [again] declined to be interviewed for his annual psychological evaluation. Long explained that he is apprehensive about meeting with ISP staff members because they are unsympathetic and because he thinks it is unlikely that he will be paroled." Long, 877 F.Supp. at 1362.

At trial, Dr. Walter O. Bockting, Ph.D., testified that Long has developed an intense gender dysphoria. His report diagnosed Long as suffering from a gender-identity disorder not otherwise specified, a sexual disorder not otherwise specified, and an antisocial-personality disorder. Dr. Bockting concluded that Long has other emotional problems in addition to his gender-identity disorder, stating that tests indicated that Long "may be demanding, rebellious, hostile, aggressive, antisocial, impulsive, exhibitionistic, and promiscuous." Id. Dr. Bockting suggested that these traits result from the dysfunctional family setting in which Long was raised. Id.

Several of the psychologists and psychiatrists that had worked with Long at ISP also testified at trial. The state's principal expert witness was Dr. Paul W. Loeffelholz, M.D. For the most part, Dr. Loeffelholz did not disagree with Dr. Bockting's diagnoses. As the District Court noted, however, the diagnoses were in conflict on some points. See id. at 1365-66. The main disagreement between the experts was whether Long's gender-identity disorder is his predominate psychiatric condition. Dr. Bockting stated that Long's primary psychiatric condition is his gender-identity disorder. Dr. Loeffelholz testified that Long's gender-identity disorder is intermittent and generally exhibited when Long is under stress, while his "primary psychological problem is his serious antisocial and manipulative behavior." Id. at 1363. At bottom, the difference in diagnoses turns on whether Long primarily wants to wear women's clothing to achieve sexual arousal or to satisfy his desire to be a woman.

Despite his opinion that Long's gender-identity disorder is Long's principal condition, Dr. Bockting admitted that he believes that Long wears women's clothing both to express his feminine identity and for sexual stimulation. Dr. Bockting concluded that, because Long experiences some arousal, he suffers in part from paraphilia (a sexual attraction to an unusual subject or object) and transvestic fetishism (sexual arousal from cross-dressing). As a result, Dr. Bockting stated that Long "does not meet the minimal requirements that would make him eligible" for hormone therapy or sex-change surgery. Id. at 1362. The experts thus agreed that Long is not a transsexual.

In contradistinction to their general agreement on the diagnosis, the experts flatly disagreed about the appropriate treatment for Long's condition. Dr. Bockting recommended psychotherapy for Long's gender-identity disorder combined with tranquilizers for the depression and anxiety that has resulted from his inability to wear women's clothes. If the tranquilizers prove to be ineffective, Dr. Bockting recommended that Long be given limited opportunities to wear women's clothes to relieve his anxiety. Dr. Loeffelholz disagreed and noted that Long has not requested treatment for his anxiety or depression nor has he fully cooperated with prison psychologists so that the staff could properly respond to his anxiety or depression, let alone his gender-identity disorder.

The District Court found that Dr. Loeffelholz had refused to prescribe tranquilizers "[i]n spite of Dr. Bockting's recommendation." Id. at 1363. The District Court nonetheless found that Dr. Loeffelholz's refusal was based on a difference in professional judgment. Id. at 1363, 1366. As a result, the court concluded that "[Dr.] Loeffelholz did not act with deliberate indifference to Long's allegedly serious medical need" and that the other defendants "were justified in relying on the opinions of medical staff." Id.

II.

Long argues, among other things, that the District Court erred when it held that his gender-identity disorder does not constitute a serious medical need and that the defendants were not deliberately indifferent to his gender-identity disorder. 2 Furthermore, Long argues that both the District Court's findings of fact and its conclusions of law are subject to de novo review "in light of the societal values underlying the relevant legal concepts." Appellant's Brief at 2 (citing Falls v. Nesbitt, 966 F.2d 375, 377 (8th Cir.1992)). We first address the standard of review.

A.

In Nesbitt, we stated that "[m]ixed questions of law and fact that require the consideration of legal concepts and involve the exercise of judgment about the values underlying legal principles are reviewable de novo." Id. While we believe that the term "mixed question of law and fact" is confusing and best discarded, Nesbitt cannot be read to permit the de novo review of the factual findings of a district court. First, in Nesbitt, the "operative facts" were "not in dispute." Id. at 376. Second, we began our discussion of the standard of review by stating that "[t]he trial judge's findings of fact will not be set aside unless they are found to be 'clearly erroneous.' " Id. at 377 (quoting Fed.R.Civ.P. 52(a)). The language cited by Long thus stands for the unremarkable proposition that a legal conclusion drawn from established facts is subject to de novo review. Despite Long's invitation, we decline to subject the District Court's findings of fact in this case to de novo review. As usual, we...

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