Lange v. Hous. Cnty.
| Decision Date | 02 June 2022 |
| Docket Number | CIVIL ACTION NO. 5:19-cv-392 (MTT) |
| Citation | 608 F.Supp.3d 1340 |
| Parties | Anna LANGE, Plaintiff, v. HOUSTON COUNTY, GEORGIA, et al., Defendants. |
| Court | U.S. District Court — Middle District of Georgia |
Kenneth E. Barton, III, Macon, GA, Michael Devlin Cooper, Macon, GA, Alejandra Caraballo, New York, NY, Catherine Fata, New York, NY, David Brown, New York, NY, Jill K. Grant, New York, NY, Mary Eaton, New York, NY, Noah E. Lewis, New York, NY, Noah Ethan Lewis, New York, NY, Wesley Powell, New York, NY, Z. Gabriel Arkles, New York, NY, Kevin Barry, Hamden, CT, Sarah Matlack Wastler, Washington, DC, for Plaintiff.
Sharon P. Morgan, Atlanta, GA, Patrick L. Lail, Atlanta, GA, William Drummond Deveney, Atlanta, GA, Richard Read Gignilliat, Elarbee, Thompson LLP, Atlanta, GA, for Defendants Houston County Georgia, Sheriff Cullen Talton.
Tyler P. Bishop, Atlanta, GA, for Defendant Blue Cross Blue Shield Healthcare Plan of Georgia Inc.
Plaintiff Anna Lange—a transgender woman and sworn deputy with the Houston County Sheriff's Office—brings this action against her employer Defendant Sheriff Cullen Talton in his official capacity and Defendant Houston County, Georgia. Doc. 56. The County's health insurance plan, which Sheriff Talton elected to provide to his employees, excludes coverage for "sex change" surgery, which Lange contends violates Title VII of the Civil Rights Act of 1964, 42 U.S.C. § 2000e et seq. ; the Equal Protection Clause of the United States Constitution; and Title I of the Americans with Disabilities Act ("ADA"), 42 U.S.C. § 12101 et seq. Id. Sheriff Talton, the County, and Lange have moved for summary judgment on all claims. Docs. 136; 137; 140. For the following reasons, the parties’ motions are GRANTED in part and DENIED in part . Lange is entitled to partial summary judgment on her Title VII claim against both Sheriff Talton and the County. Lange's equal protection claim shall proceed against the County, and to the extent that Lange seeks prospective relief against Sheriff Talton under the Equal Protection Clause, that claim too shall proceed.
Lange's ADA claim fails on the merits because she has not come forward with sufficient admissible evidence that her gender dysphoria
is the result of a physical impairment.
Unless noted, the parties agree the following facts are undisputed.
and Gender Transition
Lange is a twenty-five-year law enforcement veteran, the past fifteen of which have been with the Houston County Sheriff's Office. Docs. 179-3 ¶ 28; 195 ¶ 28. By all accounts, Lange is an exceptional employee who "has performed her duties as an investigator very well" throughout her tenure as a sheriff's deputy. Id. Lange is also a transgender woman, meaning that although she was assigned a male sex at birth, her internal knowledge of herself has always been that she is female. Docs. 179-3 ¶ 29; 195 ¶ 29. In medical parlance, this condition is called gender dysphoria
. Docs. 179-3 ¶ 3; 195 ¶ 3. Left untreated, gender dysphoria can lead to clinically significant personal suffering and comorbidities, including anxiety, depression, self-harm, and suicidality. Docs. 179-3 ¶ 6; 195 ¶ 6.
Lange began her gender transition
in 2017 after she was diagnosed with gender dysphoria. Docs. 179-3 ¶ 31; 195 ¶ 31. Lange now lives fully and consistently as a woman. Docs. 179-3 ¶ 33; 195 ¶ 33. To facilitate her transition, Lange receives hormone replacement therapy and has had "top surgery" to feminize her chest. Docs. 179-3 ¶¶ 34-35; 195 ¶¶ 34-35. Notwithstanding that treatment, Lange alleges she continues to suffer significant distress and anxiety due to the incongruence between her female gender identity and her remaining male physical characteristics, including her genitalia. Docs. 179-3 ¶ 36; 195 ¶ 36 (). When such symptoms persist, gender-confirming surgery is considered "medically necessary." Docs. 179-3 ¶ 14; 195 ¶ 14. Following the recommendations of her endocrinologist, two psychologists, and a surgeon, Lange determined that a vaginoplasty, also known as "bottom surgery," was the next step in the treatment of her gender dysphoria. Docs. 179-3 ¶ 37; 195 ¶ 37.
Pursuant to an informal intergovernmental agreement between the Sheriff and the County, the Sheriff's Office has participated in the County's health insurance plan since 1973. Docs. 179-3 ¶ 60; 195 ¶ 60. As a Sheriff's deputy, Lange participates in the County's plan—which has about 1500 members in total—and contributes monthly premiums for the coverage. Docs. 179-3 ¶¶ 67, 70, 71; 195 ¶¶ 67, 70, 71. The health insurance plan is a self-funded or Administrative Services Only ("ASO") plan, which means that Anthem Blue Cross Blue Shield, the County's third-party administrator, administers claims using funds provided by the County and employee contributions. Docs. 179-3 ¶ 69; 195 ¶ 69.
The County's health insurance plan has 68 medical exclusions and 29 pharmacy benefit exclusions. Docs. 179-3 ¶¶ 74, 209; 195 ¶¶ 74, 209. Two of those exclusions, which have been in place since 1998, preclude coverage for "sex change" surgery. Docs. 179-3 ¶¶ 75, 76; 195 ¶¶ 75, 76. Specifically, exclusions 26 and 57 ("the Exclusion") exclude coverage for "[d]rugs for sex change surgery" and "[s]ervices and supplies for a sex change and/or the reversal of a sex change." Docs. 179-3 ¶ 76; 195 ¶ 76.
Kenneth Carter is the Director of Personnel for Houston County and responsible for the administration of the County's health insurance plan. Docs. 179-3 ¶ 47; 195 ¶ 47. During the renewal process in late 2016, the County's insurance broker, who acts as a liaison between the County and Anthem, informed Carter of Anthem's "Nondiscrimination in Health Programs and Activities Rule" which stated that "[i]n recognition of regulations issued under PPACA section 1557, the exclusion for Gender Identity Disorders and Sex Change Surgery will be removed from our plans (both Fully Insured and ASO)." Docs. 179-3 ¶¶ 81, 85, 86; 195 ¶¶ 81, 85, 86. Despite Anthem's recommendation to do so, the County chose not to accept the nondiscrimination mandate. Docs. 179-3 ¶ 91; 195 ¶ 91. Accordingly, the Exclusion remained in place.
For health insurance plans that accepted the nondiscrimination mandate and thus removed the exclusion for "sex change surgery," Anthem has a Guideline for when such surgery is "medically necessary" and covered by the plan. Docs. 179-3 ¶ 15; 195 ¶ 15. Under the Guideline, surgery is medically necessary if there is "significant functional impairment AND the procedure can be reasonably expected to improve the functional impairment." Docs. 179-3 ¶ 16; 195 ¶ 16. It is undisputed that Lange's prescribed vaginoplasty
is medically necessary under Anthem's Guideline. Docs. 179-3 ¶ 38; 195 ¶ 38. No evidence disputes Lange's evidence that the prescribed vaginoplasty is medically necessary.
Lange told Carter that she was transgender and intended to live openly as a woman on April 18, 2018. Docs. 179-3 ¶ 93; 195 ¶ 93. The purpose of this conversation was to determine whether Lange's medically necessary gender reassignment surgery
would be covered by the County's health insurance plan. Docs. 179-3 ¶ 94; 195 ¶ 94. Citing the Exclusion, Carter told Lange that her surgery would not be covered. Id.
Later that day, Lange and Carter met with Sheriff Talton and told him Lange was transgender. Docs. 179-3 ¶ 98; 195 ¶ 98. During that meeting, Lange requested permission from Sheriff Talton to wear a female uniform at work and present herself as a female in the office. Docs. 179-3 ¶ 99; 195 ¶ 99. In response, Sheriff Talton looked at Carter and said, "[w]hat the hell is he talking about?" Docs. 179-3 ¶ 100; 195 ¶ 100. Carter then explained to Sheriff Talton that "what Sergeant Lange is trying to tell you is that she would like to start presenting herself as a woman and she wants you to understand that." Docs. 179-3 ¶ 101; 195 ¶ 101. Sheriff Talton initially thought Lange's revelation was a joke. Docs. 179-3 ¶ 102; 195 ¶ 102. Sheriff Talton then told Lange that he doesn't "believe in sex changes." Docs. 179-3 ¶ 103; 195 ¶ 103. Nonetheless, the Sheriff ultimately granted Lange permission to dress as a female but also warned her she would need "tough skin" to deal with her coworkers. Docs. 179-3 ¶¶ 106-107; 195 ¶¶ 106-107.
The following day, Lange came out to her coworkers in the Criminal Investigation Division ("CID") during a meeting chaired by Sheriff Talton. Docs. 179-3 ¶¶ 111, 112; 195 ¶¶ 111, 112. Despite acknowledging that Lange's transition was "sensitive and a serious subject," Sheriff Talton repeated his sentiment that he "didn't believe in all this" during the meeting. Docs. 179-3 ¶ 112; 195 ¶ 112. And perhaps in tacit acknowledgement of the CID's boisterous atmosphere, Sheriff Talton told the group that what Lange did "takes big balls." Docs. 179-3 ¶ 113; 195 ¶ 113.
Anthem initially told Lange that her gender confirmation surgery would be covered if it was "medically necessary" under Anthem's Guideline. Docs. 179-3 ¶ 115; 195 ¶ 115. This, the County contends, was a misunderstanding, due to Anthem's failure to note the County's position on the 2017 plan year renewal document. Docs. 179-3 ¶ 92; 195 ¶ 92. According to Anthem's records, the County had not opted-out of the nondiscrimination mandate. Docs. 179-3 ¶ 126; 195 ¶ 126. In consultation with the County's insurance broker, Carter worked with Anthem to ensure the Exclusion remained intact.1 Docs. 179-3 ¶ 128; 195 ¶ 128. The parties dispute whether this was a...
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Kozak v. CSX Transp.
...persistence of a sense of incongruence makes the diagnoses so similar that gender dysphoria must be included in the statutory exclusion. In Lange, for example, the District of Georgia found that, because gender identity disorders were characterized by a sense of incongruence between anatomi......