In re Pinson
| Decision Date | 26 February 2018 |
| Docket Number | No. 1:17-cv-00584,1:17-cv-00584 |
| Parties | JEREMY V. PINSON, Plaintiff v. UNITED STATES, et al., Defendants |
| Court | U.S. District Court — Middle District of Pennsylvania |
(Judge Rambo)
Plaintiff, Jeremy Pinson, an inmate currently confined at the Federal Medical Center in Rochester, Minnesota ("FMC-Rochester"), filed this current action pursuant to the Federal Tort Claims Act ("FTCA") and Bivens v. Six Unknown Named Agents of Fed. Bureau of Narcotics, 403 U.S. 388 (1971) on April 3, 2017. (Doc. No. 1.) Plaintiff subsequently filed an amended complaint on May 1, 2017. (Doc. No. 11.) Plaintiff asserts that she is a male to female transgender inmate and that Defendants wrongly denied her request for sex reassignment surgery and were negligent when they left a razor blade with her knowing that her gender dysphoria led her to cutting and self-mutilation.
Presently before this Court is Defendants' motion for summary judgment (Doc. No. 20), filed on July 18, 2017. Although Plaintiff has filed a second motion for discovery seeking a stay of the briefing deadlines on Defendants' motion for summary judgment (Doc. No. 42), Plaintiff's motion has been rendered moot given Defendants' subsequent supplemental discovery filings served on Plaintiff and Plaintiff's subsequent filing of her brief in opposition to Defendants' motion for summary judgment (Doc. No. 47).
Defendants have filed a brief in support of their motion for summary judgment (Doc. No. 29), as well as their statement of material facts (Doc. No. 31). Plaintiff has filed her brief in opposition to Defendants' motion for summary judgment along with a counterstatement of material facts (Doc. No. 47.) Defendants filed a reply brief. (Doc. No. 52.) Accordingly, this matter is ripe for disposition.
Pinson was incarcerated at USP-Allenwood from March 10, 2016 through July 18, 2016. (Doc. No. 31 ¶ 1.) Upon arrival, Pinson received an intake screening by the Psychology department and a medical intake screening by aregistered nurse. (Id. ¶¶ 29, 32.) The psychology screening notes indicate that Pinson had an extensive history of mental illness dating back to the age of 10. (Id. ¶ 30.) Pinson was housed in the Special Housing Unit ("SHU") on arrival. (Id. ¶ 2.)
While at USP-Allenwood, Pinson received both psychological and medical treatment. (Id. at 7.) In Pinson's psychology screening notes, the psychologist noted that Pinson was diagnosed with gender dysphoria on June 2, 2015, prior to her incarceration at USP-Allenwood. (Id. ¶ 33.) Pinson's psychological treatment included therapy sessions focused on depressive issues related to gender dysphoria as well as improving dialectical behavior therapy ("DBT")2 skills. (Id. ¶ 34.) The psychologist noted that throughout Pinson's incarceration in the Bureau of Prisons ("BOP"), she regularly received individual counseling and has continued to engage in self-harm (cutting wrists, swallowing pills, injuring vessels in nose, cutting testicles). Id. ¶ 35.) Pinson denied suicidal ideation and any thoughts of self-harm or significant distressing emotions. (Id. ¶ 36.) The psychologist noted her current concerns as Pinson engaging in self-harm due to poor distress tolerance and perceived lack of control. (Id. ¶ 37.) The psychologist also noted two occasions prior to Pinson's arrival at USP-Allenwood, where Pinson engaged in genitaliamutilation for being distressed over having a penis rather than a vagina. (Id. ¶ 38.) The psychology screening notes indicate that it was recommended that Pinson was cleared for general population, but that she was being placed in the SHU until cleared by custody. (Id. ¶ 39.) It was also recommended by the psychologist that Pinson have a cellmate as a protective factor. (Id. ¶ 40.)
Pinson was determined to be a care level 3 mental health inmate, and per policy, was required to be seen weekly and in a private session. (Id. ¶¶41, 42.) The psychologist noted that she frequently saw Pinson more than once a week and that Pinson would often claim suicidal thoughts in order to be seen by the psychologist but then would focus on things such as personal property or hygiene items. (Id. ¶ 43, 44.) The psychologist concluded in these instances that there were no genuine suicidal thoughts or intent to self-harm, but rather, attempts to manipulate staff in order to obtain things Pinson wanted, noting that a true suicidal inmate would not have concerns about hygiene items or personal property items. (Id. ¶¶ 45, 46.)
On March 11, 2016, the psychologist saw Pinson at Pinson's request. (Id. ¶ 47.) In the private session, Pinson discussed her belief that she did better having a cellmate (which she was provided upon placement in the SHU), and the psychologist noted that Pinson's thought process was logical, coherent, and goal oriented. (Id. ¶¶ 47, 48.) The psychologist noted that Pinson deniedsuicidal/homicidal, or self-injurious behavior ideation, intention or plan. (Id. ¶ 49.) The psychologist met with Pinson again on March 15, 2017, wherein Pinson's safety concerns regarding entering general population and her desire to remain in the SHU were discussed. (Id. ¶ 50.) Pinson also reported that she wanted to be transferred to another facility and that she wanted her property, mainly her female undergarments. (Id. ¶ 51.) The psychologist discussed coping skills with Pinson and noted that she had a more positive outlook since first arriving at USP-Allenwood. (Id. ¶¶ 52, 54.)
On March 17, 2016, Pinson was seen by Dr. Elisabete Santos (now known as Dr. Stahl), a physician employed by the Federal BOP and the Clinical Director assigned to the Allenwood Federal Correctional Complex (FCC-Allenwood), to assist in co-managing treatment for Pinson's gender dysphoria diagnosis. (Id. ¶¶ 12, 55.) As Clinical Director, Dr. Stahl serves as the primary physician for a range of medical services provided to inmates housed at FCC Allenwood and serves as the clinical supervisor for approximately forty health care staff. (Id. ¶¶ 13, 14.) In addition to administrative duties, Dr. Stahl follows a panel of patients she personally sees for their Chronic Care Clinic evaluations every six to twelve months or more, as clinically indicated. (Id. ¶ 15.)
Dr. Stahl also serves as the Chair of the BOP's Transgender Clinical Core Consultant Team ("TCCT"), which provides guidance/consultation services toBOP clinical staff treating inmates with transgender concerns. (Id. ¶¶ 16, 20.) TCCT members had been educated on the Endocrine Society Clinical Practice Guideline, the only published Trans Health Guideline at the time. (Id. ¶ 17.) Members of the TCCT also attended multiple Trans Health medical conferences to gain the knowledge necessary to develop a BOP Guideline. (Id. ¶ 18.)
In 2014, the BOP released an Interim Resource Guide to help educate all BOP staff in the unique needs of all transgender inmates. (Id. ¶ 19.) However, during the four month period of time Pinson was incarcerated at USP-Allenwood, the BOP did not have any clinical guidelines in place for treating transgender inmates with gender dysphoria. (Id. ¶ 22.) It was not until December 2016 that the BOP Guideline on this subject was released.3 (Id. ¶ 23.)
Community standards considered for treatment were provided to Pinson and included those set forth by the World Professional Association for Transgender Health ("WPATH"). (Id. ¶ 24.) The WPATH standards "are an information resource which may provide guidance on medical and mental health treatment, which may include education, counseling, medical evaluations, hormone treatments, 'real-life' experience, and, in some but not all cases, sexual reassignment surgery." (Id. ¶ 25.) WPATH's eligibility criteria for the sexualreassignment surgery includes a well documented gender dysphoria4, capacity to consent to treatment, age of majority, twelve months of feminizing hormone therapy, and twelve months of continuous living in the gender role that is congruent with one's gender. (Id. ¶ 26.) The WPATH recommends two letters of support from treatment providers to support the surgery, typically one letter from a psychologist/clinical social worker, and one letter from the medical provider. (Id. ¶ 27.) The WPATH recommends that if there are psychological and/or medical problems, these must be "reasonably well controlled" prior to consideration for surgical transitioning. (Id. ¶ 28.)
During the March 17, 2016 meeting with Pinson, Dr. Stahl noted that Pinson was trans-female on an Estradiol patch (a feminizing hormone used to enhance feminine characteristics) that had been started on December 27, 2015 at a previous institution. (Id. ¶¶ 56, 59.) Dr. Stahl also noted that Pinson's subjective description of history including gravitating toward girl activities and her unfamiliarity with the concept of "trans" as a teen and associating it with being homosexual. (Id. ¶ 57.) Pinson also stated having been in prison since the age of 17, which was when she started to cut herself, including genitalia. (Id. ¶ 58.)
Pinson was seen by a psychologist on March 18, 2016, wherein the psychologist notes that Pinson reported no mental health concerns and SHU staff reported no observed mental health problems or issues. (Id. ¶ 60.) On March 22, 2016, Pinson expressed feelings of relief and satisfaction with the current cellmate to psychology, indicating how having a positive cellmate helps avoid self-injurious behavior. (Id. ¶¶ 61, 62.) The psychologist noted that Pinson denied suicidal/homicidal or self-injurious behavior ideation, intention or plan. (Id. ¶ 63.)
An evaluation was also performed by a psychiatrist on March 22, 2016. (Id. ¶ 64.) The psychiatrist documented that Pinson had a history of anxiety and had previously received Ativan. (Id. ¶ 65.) The psychiatrist prescribed Perphenazine for anti-social personality disorder and Trihexyphenidyl used for the side effects of Perphenazine (tremors). (Id. ¶ 66.) Pinson was seen by the psychologist on April 5, 2016...
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