Boone v. Carvajal
| Decision Date | 28 June 2022 |
| Docket Number | Civil Action 6:21-3053-JD-KFM |
| Parties | Gary Boone, aka Valerie Boone, Plaintiff, v. Michael Carvajal, Director of Federal Bureau of Prisons; A. Mendoza, Warden of FCI Williamsburg; K. Nolte, Health Service Administrator at FCI Williamsburg; S. Hoey, Medical Provider at FCI Williamsburg; C. Davis, Nurse Practitioner at FCI Williamsburg; Dr. Figueroa, Chief Psychologist at FCI Williamsburg; and Dr. Laxton, Psychologist at FCI Williamsburg, Defendants. |
| Court | U.S. District Court — District of South Carolina |
REPORT OF MAGISTRATE JUDGE
This matter is before the court on the defendants' motion to dismiss pursuant to Federal Rule of Civil Procedure 12(b)(6) (doc. 29). The plaintiff, a federal prisoner proceeding pro se and in forma pauperis, seeks relief pursuant to Bivens v. Six Unknown Named Agents of the Fed. Bureau of Narcotics, 403 U.S. 388 (1971).[1] Pursuant to the provisions of 28 U.S.C § 636(b)(1)(A) and Local Civil Rule 73.02(B)(2) (D.S.C.), all pretrial matters in this case were referred to the undersigned United States Magistrate Judge for consideration.
The plaintiff is a 72-year-old transgender woman and is currently serving a life sentence at Federal Correctional Institution Butner ("FCI Butner") in Butner, North Carolina (docs. 1, compl. ¶ 12; 29 at 8; 27). During the events in question, however, the plaintiff was incarcerated at Federal Correctional Institution Williamsburg ("FCI Williamsburg") in Salters, South Carolina . The plaintiff filed suit against officials at FCI Williamsburg based on the lack of medical treatment she[2] has received for her gender dysphoria ("GD") (doc 1, compl.).
The Bureau of Prisons ("BOP") has promulgated several program documents that govern the placement and provision of care of transgender inmates, including the T ransgender Offender Manual ("Manual"), which ensures that the BOP "properly identifies, tracks, and provides services to the transgender population," and the Medical Management of Transgender Inmates Guidance ("Medical Management Guidance"), which "provides recommendations for the medical management and treatment of transgender inmates" (docs. 29-1; 29-2).
The Manual notes that GD, which was previously known as gender identity disorder ("GID"), is " (doc. 29-1 at 3). "Not all transgender inmates will have a diagnosis of GD" (id.). The Manual also outlines the different groups within the BOP responsible for addressing various aspects of transgender inmates' needs (id. at 4-6). For example, the Transgender Executive Council ("TEC") "is the agency's official decision-making body on all issues affecting the transgender inmate population" and is comprised of staff members from the BOP's Women and Special Populations Branch, the Psychology Services Branch, the Health Services Division, and the Designation and Sentencing Computation Center (id. at 5). The TEC is responsible for "meet[ing] a minimum of monthly to offer advice and guidance on unique measures related to treatment and management needs of transgender inmates and/or inmates with GD, including training, designation issues, and reviewing all transfers for approval" (id.).
The Manual also contains provisions concerning housing and programming assignments for transgender inmates who desire to transfer facilities as a part of their transition:
In situations where the transfer request is related to progressing the individual inmate's transition (i.e., transfer to a different sex facility)[,] the TEC will consider the case. Prior to considering the case, the Warden will submit documentation to the TEC showing the inmate has met the minimum standards of compliance with programs, medications and mental health treatment, and meeting hormone goal levels. Ordinarily, inmates will not be submitted to the TEC for consideration until they have maintained one year clear conduct for 100 and 200 series incident report sanctions, though they may be considered for submissions on a case-by-case basis by the Warden, as appropriate.
(Doc. 29-1 at 7-8). In addition, BOP staff conducts program reviews, in which they review transgender inmates' current housing status and the programming available (id. at 7). These reviews consider "on a case-by-case basis that the inmate placement does not jeopardize the inmate's wellbeing and does not present management or security concerns" (id.).
Moreover, the Manual provides that the BOP's psychologists will provide assessment and treatment services for transgender inmates, as appropriate, including providing information regarding the range of treatment options available in the BOP, a referral to the clinical director or chief psychiatrist, and individual psychotherapy (doc. 29-1 at 10). Further, the Manual provides for hormone therapy as follows:
Hormone therapy or other medical treatment may be provided after an individualized assessment of the requested inmate by institution medical staff. Medical staff will request consultation from Psychology Services regarding the mental health benefits of hormone or other medical treatment. If appropriate for the inmate, hormone treatment will be provided . . . .
(Id. at 9). In addition, the Manual addresses requests for gender-affirming surgery and states that "surgery may be the final stage in the transition process and is generally considered only after one year of clear conduct and compliance with mental health, medical, and programming services at the gender affirming facility," which is a facility for individuals of the inmate's preferred gender (id. at 10). The Manual provides that once the one-year period at the gender affirming facility is complete, an inmate may submit a surgery request to the warden, who will forward the request to the TEC (id.). If the TEC determines that all milestones and goals for surgical consideration are satisfied, the TEC will refer the request to the medical director for medical consideration (id.). The medical director will then make an individualized determination as to whether gender-affirming surgery is appropriate for the individual inmate, and, if so, refer the matter to a surgeon (id.).
The Medical Management Guidance also provides guidance on the appropriate medical treatment of transgender inmates, including mental health treatment, implementation of real-life experience, hormone therapy, and surgery (doc. 29-2 at 14-23). Specifically regarding surgery, the Medical Management Guidance states that "[a]lthough individuals may live successfully as transgender persons without surgery, gender-affirming surgery may be appropriate for some and is considered on a case-by-case basis" (id. at 23). Pursuant to the Medical Management Guidance, "[i]n addition to the eligibility and readiness criteria for hormone therapy, general criteria for consideration of surgery include at least 12 months of successful use of hormone therapy, participation in psychotherapy as clinically indicated, full-time real[-]life experience in their preferred gender, and consolidation of gender identity" (id.).
Additionally, the World Professional Association for Transgender Health ("WPATH"), an independent organization, published Standards of Care ("WPATH Standards of Care"), which purport to provide "flexible clinical guidelines" for "health professionals to assist transsexual, transgender, and gender-nonconforming people with safe and effective pathways to achieving lasting personal comfort with their gendered selves, in order to maximize their overall health, psychological well-being, and self-fulfillment" (doc. 29-3 at 8-9). The defendants submit that while the Medical Management Guidance provides a reference to the WPATH Standards of Care in a footnote labeled "[f]or further consideration," nothing in any BOP manual or policy purports to incorporate or be bound by the WPATH Standards of Care (docs. 29 at 6; 29-2 at 14). However, the Court of Appeals for the Fourth Circuit has relied on the WPATH Standards of Care and recognized it as authoritative in some circumstances. See Grimm v. Gloucester Cnty. Sch. Bd., 972 F.3d 586, 595 (4th Cir. 2020) (citations omitted).
With respect to gender-affirming surgery, the WPATH Standards of Care recognize that genital surgery "is often the last and most considered step in the treatment process for gender dysphoria" (doc. 29-3 at 61). The WPATH Standards of Care outline six criteria for vaginoplasty operations in female transgender patients:
(Id. at 67). The WPATH Standards of Care state that the criteria that transgender individuals live 12 continuous months in a gender role congruent with their gender identity is included "based on expert clinical consensus that this experience provides ample opportunity for patients to experience and socially adjust in their desired gender role before undergoing irreversible surgery" (doc. 29-3 at 67). As the WPATH Standards of Care note, "[t]he duration of 12 months...
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