Doe v. Ga. Dep't of Corr.

• Docket Number: Case No. 1:23-cv-5578-MLB
• Decision Date: 17 April 2024
• Citation: Doe v. Ga. Dep't of Corr., 730 F.Supp.3d 1327 (N.D. Ga. 2024)
• Parties: Jane DOE, Plaintiff, v. GEORGIA DEPARTMENT OF CORRECTIONS, et al., Defendants.
• Court: U.S. District Court — Northern District of Georgia

730 F.Supp.3d 1327

Jane DOE, Plaintiff, v. GEORGIA DEPARTMENT OF CORRECTIONS, et al., Defendants.

Case No. 1:23-cv-5578-MLB

United States District Court, N.D. Georgia, Atlanta Division

Signed April 17, 2024

Christopher James Murell, Meghan K. Matt, Murell Law Firm, New Orleans, LA, D. Dangaran, Pro Hac Vice, Miriam R. Nemeth, Pro Hac Vice, Rights Behind Bars, Washington, DC, Ronald Scott Novak Jr., Pro Hac Vice, Sterling Andrew Marchand, Pro Hac Vice, Baker Botts, LLP, Washington, DC, David Utter, The Claiborne Firm, Atlanta, GA, Francesca Eick, Pro Hac Vice, Katherine Elise Jeffress, Pro Hac Vice, Baker Botts LLP, Austin, TX, Hannah Roskey, Pro Hac Vice, Baker Botts, LLP, Houston, TX, Nicholas Frank Palmieri III, Pro Hac Vice, Baker Botts, LLP, New York, NY, for Plaintiff.

Jeffrey Matthew Harris, Pro Hac Vice, Rachael Tucker, Pro Hac Vice, Thomas Samuel Vaseliou, Pro Hac Vice, Consovoy McCarthy PLLC, Arlington, VA, Roger A. Chalmers, Georgia Department of Law Office of the Attorney General, Atlanta, GA, Stephen John Petrany, Georgia Department of Law, Dunwoody, GA, for Defendants Georgia Department of Corrections, Commissioner Tyrone Oliver, Randy Sauls, Sharon Lewis, DeShawn Jones, Chad I. Lohman.

Rachael Tucker, Pro Hac Vice, Thomas Samuel Vaseliou, Pro Hac Vice, Jeffrey Matthew Harris, Consovoy McCarthy PLLC, Arlington, VA, for Defendants Sergeant Jamal Kinte Roberts, Dr. Anthony Mulloy.

Lindsey Cassimus, Michael Geoffrey Frankson, Huff, Powell & Bailey, LLC, Atlanta, GA, for Defendants MHM Correctional Services, LLC.

Alexander Collins Vey, Nora M. Jackson, Michael Geoffrey Frankson, Lindsey Cassimus, Huff, Powell & Bailey, LLC, Atlanta, GA, for Defendants Rhonda Billings, Dr. Sherri Skibinski, Dr. Cathleen Cleary, Dr. Donald Bowling, Sidney Moore, Dr. Wil Ausborn, Jeremy Lane.

Beth Boone, Tiffiny Montenegro, Hall Booth Smith, Brunswick, GA, for Defendants Wellpath LLC, Latonya James, Jewellann Clarke.

Aileen Bell Hughes, Office of the United States Attorney, Atlanta, GA, for Amicus United States.

Melissa Lorraine Fox, Eversheds Sutherland (US) LLP, Atlanta, GA, for Amicus Network for Victim Recovery of DC (NVRDC).

Brian Spielman, Robert C. Khayat Jr., Khayat Law Firm, Atlanta, GA, for Amicus ACLU of Georgia.

ORDER

MICHAEL L. BROWN, UNITED STATES DISTRICT JUDGE

Plaintiff—a transgender woman incarcerated by the Georgia Department of Corrections ("GDC")—claims Defendants are violating her constitutional rights, the Americans with Disabilities Act, and the Rehabilitation Act by refusing to provide her medical care necessary to treat her gender dysphoria. (Dkt. 1.) Plaintiff seeks preliminary injunctive relief, asking the Court to order Defendants immediately to provide her (1) an evaluation for gender-affirming surgery (and, if indicated, the surgery itself), (2) adequate hormone replacement therapy, (3) gender-affirming commissary items, and (4) a transfer to a women's prison. (Dkt. 2-1 at 1-2.)¹ Defendants oppose. (Dkt. 86.) The Court grants Plaintiff's third request in part but denies her other requests.

I. Background

Plaintiff has been serving a life sentence in GDC custody since 1992. (Dkts. 4-2 at 8-9; 86-2 ¶ 26; 109-4 at 3-4.) In 1993 and 1994, a GDC clinical director diagnosed her with a "gender identity disorder" and a GDC psychiatrist found she had a "history of 'transsexualism.' " (Dkt. 4-2 at 11.) From 1992 until 2015, Defendant provided Plaintiff only individual and group psychotherapy for the "anxiety and distress" associated with her discordant gender identity. (Dkt. 4-2 at 11.) Plaintiff attempted self-castration in 1992 and suicide in 1998, 1999, and 2017. (Dkt. 4-2 at 12, 18, 23.)

In 2015, Plaintiff's treating psychologist diagnosed her with gender dysphoria. (Dkt. 4-2 at 12-13.) She then "notified medical staff of [her] desire to start" hormone replacement therapy ("HRT"). (Dkt. 4-2 at 13-14.) Medical staff referred her to an endocrinologist and allowed her to begin some HRT "right away." (Dkt. 4-2 at 13-14.) In January 2016, she met with Dr. Anthony Mulloy, an endocrinologist treating GDC inmates. (Dkts. 4-2 at 18; 86-3 ¶ 1.) Dr. Mulloy prescribed Plaintiff 2 mg of estradiol (a feminizing hormone) and 50 mg of spironolactone (a testosterone blocker). (Id.) He raised the dosage gradually until 2019, ultimately prescribing 10 mg of estradiol every other week and 200 mg of spironolactone daily. (Dkt. 4-2 at 14.) As a result of that treatment, Plaintiff "developed breasts," her "baldness slowed," her "facial and body hair was suppressed," "fat redistributed around [her] thighs, hips, and buttocks," and her "penis and testicles reduced in size." (Dkt. 4-2 at 16.) Plaintiff testified by declaration that her distress lessened because of those changes to her body. (Id.)

In June 2019, Plaintiff's primary care physician discontinued her HRT. (Dkts. 4-2 at 18; 86-3 ¶ 9.) According to Plaintiff, her physician was "concerned about exacerbations to [her] hypertension as well as [her] age and the effect that . . . [e]stradiol was having on [her] health." (Dkt. 124 at 19.) Plaintiff "reluctantly . . . discontinued use" of HRT. (Dkt. 124 at 19-20.) Her "secondary sex characteristics, including [her] breasts, were significantly reduced." (Dkt. 124 at 21.) All the feminization she had achieved through HRT "inverted," and she "no longer looked effeminate." (Dkt. 124 at 21-22.) This caused her severe "depression, anxiety, [and] thoughts of suicide." (Dkt. 124 at 22.) Plaintiff testified she began "banging [her] head and [her] arms on lockboxes and the walls to reduce the stress that [she] was under to take [her] mind off of self-castration." (Id.) Experiencing what she described as "deep, dark, all-consuming depression" and "unbearable" emotional pain from "how [she] felt when [she saw] her body," Plaintiff attempted suicide a fourth time in December 2019. (Id.) Plaintiff asked to restart HRT in March 2020, but her regular physician denied that request. (Dkts. 4-2 at 21-22.) Plaintiff suffered more depression and engaged in more self-injurious behavior. (Dkt. 4-2 at 23-24.)

Plaintiff testified that once she "received a contraindication for HRT," she "doubled down in [her] efforts to obtain gender-affirming surgeries in an attempt to maintain [her] feminine gender expression." (Dkt. 4-2 at 24.) From mid-2019 to early 2022 (while housed at Georgia State Prison), Plaintiff repeatedly asked her mental health counselors to restart HRT and let her speak with doctors about gender-affirming surgery. (Id.) They refused those requests. (Id.) GDC transferred Plaintiff to Ware State Prison in early 2022. (Dkt. 4-2 at 25.) According to Plaintiff, there was "some movement" after she filed requests at that facility—specifically an evaluation by a psychiatrist with Defendant MHM Correctional Services, Inc. ("MHM") (a company that provides mental health services to inmates in GDC facilities) who referred her back to Dr. Mulloy. (Id.) That did not happen immediately because "GDC did not properly schedule [her] to see" him. (Dkt. 4-2 at 25.)

Plaintiff testified that, in March 2022, doctors at "multiple facilities across Georgia" met to discuss her treatment plan. (Dkt. 4-2 at 26-27.) She says her psychiatrist then told her the psychiatrist "could not conduct a clinical assessment and referral for the surgeries [Plaintiff] had requested because the higher ups at MHM forbid them from performing psychological assessments for gender-affirming surgery." (Dkt. 4-2 at 27.) After receiving that news, Plaintiff continued her self-injurious behavior, including slamming her head against the wall. (Id.)

GDC subsequently evaluated Plaintiff's mental health and "enhanced [her] level of mental health services to Level III, 'inpatient, supportive living.' " (Id.) As a result, GDC transferred her to Phillips State Prison in April 2022, admitted her to the medical crisis stabilization unit, and placed her on long-term suicide prevention status. (Dkt. 4-2 at 27-28.) GDC has determined Phillips is the "best placement" for Plaintiff based on her security profile and mental health status. (Dkt. 86-1 ¶¶ 21-22, 26.) Since arriving there, Plaintiff has been housed in "Administrative Segregation," which she describes as "solitary confinement conditions." (Dkts. 4-2 at 28; 86-1 ¶ 19; 86-2 ¶ 30.) At Phillips, Plaintiff submitted medical requests for gender-affirming surgeries and feminizing commissary items like breast and buttock pads, hair removal cream, and a wig. (Dkt. 4-2 at 25.) Officials denied those requests. (Dkt. 124 at 25.)

Between April and July 2022, Plaintiff tried to tell GDC officials about her "severe gender dysphoria and thoughts of self-castration, . . . emphasizing [her] need for gender-affirming surgery." (Dkt. 4-2 at 26-30.) While several people did not respond, Plaintiffs claims a nurse and an attending psychologist at Phillips told her GDC was unwilling to provide gender-affirming surgeries. (Id.) Plaintiff filed grievances with Warden DeShawn Jones, but he denied them. (Dkts. 4-2 at 29-30; 4-4 at 19-27.) In his response to one of them, Warden Jones explained that "[d]ue to the Georgia Department of Corrections not having a contract to provide cosmetic surgery, this grievance is denied . . . ." (Dkt. 4-4 at 26.) Plaintiff appealed Jones's decisions, but GDC denied her appeals. (Id.)

On June 21, 2022, Plaintiff met with Dr. Donald Bowling, a psychologist and clinical director at Phillips, requesting assessment for surgery. (Dkt. 4-2 at 28-29.) Dr. Bowling purportedly told Plaintiff he was "not qualified to assess" her for "emasculation surgery and breast augmentation." (Dkt. 4-2 at 30.) He also allegedly told her, "If you were to attempt self-castration again, maybe while at the hospital, they'll just go ahead and cut your gonads out." (Id.) After the meeting, Plaintiff wrote letters "to those [she] thought could review Dr. Bowling's statements," including MHM staff and MHM's parent company. (Dkt. 4-2 at 31.) No one responded. (Id.) A few...