Monroe v. Meeks
| Decision Date | 07 February 2022 |
| Docket Number | Case No. 3:18-CV-00156-NJR |
| Citation | 584 F.Supp.3d 643 |
| Parties | Janiah MONROE, Marilyn Melendez, Lydia Heléna Vision, Sora Kuykendall, and Sasha Reed, individually and on behalf of a class of similarly situated individuals, Plaintiffs, v. Steve MEEKS, Melvin Hinton, and Rob Jeffreys, Defendants. |
| Court | U.S. District Court — Southern District of Illinois |
John A. Knight, Camille E. Bennett, Carolyn M. Wald, Ghirlandi Guidetti, Joshua Daniel Blecher-Cohen, Roger Baldwin Foundation of ACLU, Inc. ACLU of Illinois, Amelia H. Bailey, Anne J. Hudson, Cameron N. Custard, Catherine L. Fitzpatrick, Erica B. Zolner, Jonathan D. Fish, Matthew John Smart, Samantha G. Rose, Scott H. Lerner, Thomas J. Leahy, Timothy C. Pickert, Kirkland & Ellis LLP, Brent P. Ray, Pro Hac Vice, King & Spalding LLP, Megan M. New, Barnes & Thornburg LLP, Chicago, IL, Abby L. Parsons, King & Spalding LLP, Houston, TX, Lena Colin, King & Spalding LLP, Austin, TX, Sarah Jane Hunt, Thomas E. Kennedy, III, Kennedy Hunt P.C., St. Louis, MO, for Plaintiffs Janiah Monroe, Marilyn Melendez, Lydia Helena Vision, Sora Kuykendall, Sasha Reed.
Lisa A. Cook, Christopher L. Higgerson, Illinois Attorney General's Office, Springfield, IL, Carla G. Tolbert, Illinois Attorney General's Office, Belleville, IL, for Defendants.
On August 5, 2021, at the conclusion of a four-day bench trial, the undersigned issued a verbal ruling for specific preliminary injunctive relief in this case, later set forth in the written Order/Preliminary Findings of Fact and Conclusions of Law dated August 9, 2021. (Doc. 331; Doc. 349, pp. 972-92).2 That Order noted that the previous (December 2019) Preliminary Injunction continues in force. (Doc. 212). And, of course, at this time the injunctive relief issued in August 2021 remains in effect.
This Memorandum and Order more fully summarizes the August 2021 bench trial testimony and the depositions and exhibits submitted at trial, factual findings, and conclusions of law supporting the preliminary injunctive relief previously ordered. See Docs. 331, 332, and 336. The Court does not repeat all of its findings from August 2021 because they are incorporated into this Memorandum and Order. The preliminary injunctive relief is set forth again below; of course, certain deadlines have already passed. The Court will summarize progress made to date toward compliance with the ordered injunctive relief, as well as areas where compliance has not yet been achieved. And, as discussed below, in light of the parties’ supplemental filings, the Court finds further injunctive relief is warranted.
This litigation was brought on behalf of a class of Plaintiffs, consisting of all prisoners in the custody of the Illinois Department of Correction ("IDOC") who have requested evaluation or treatment for gender dysphoria. (Doc. 213). The named Plaintiffs are transgender women currently incarcerated in IDOC facilities. The named Defendants are, respectively, the IDOC Chief of Health Services, IDOC Chief of Mental Health, and the IDOC Director, all sued in their official capacity.
Plaintiffs assert that Defendants’ policies and practices subject the class to a substantial risk of serious harm and injury from inadequate and delayed evaluation and treatment of gender dysphoria, in violation of their rights under the Eighth Amendment. (Doc. 1, p. 36). They seek injunctive relief to remedy the flaws in IDOC's treatment of transgender inmates.
(Doc. 1, pp. 36-38). Problems include: IDOC's use of a committee of unqualified officials to make decisions regarding the medical treatment, security, and placement of transgender inmates; widespread delays or denials in evaluating prisoners for gender dysphoria and in providing hormone therapy and hormone monitoring; failure to consider or provide gender-affirming surgery as part of medically necessary treatment for gender dysphoria ; failure to accommodate and facilitate social transition for individuals with gender dysphoria, such as failing to allow access to gender-affirming clothing and grooming items, failing to make individualized housing placement decisions, and permitting cross-gender strip searches; and failing to provide access to medical and mental health providers competent to treat gender dysphoria.
After a two-day evidentiary hearing completed on August 1, 2019, the Court granted preliminary injunctive relief. . The class, defined as "all prisoners in the custody of IDOC who have requested evaluation or treatment for gender dysphoria," was certified in an order dated March 4, 2020. (Doc. 213).
The initial Preliminary Injunction ordered Defendants to: cease the policy and practice of allowing the Transgender Care Review Committee ("TCRC") to make medical decisions regarding gender dysphoria ; to develop a policy to ensure that treatment decisions for inmates with gender dysphoria are made by medical professionals qualified to treat gender dysphoria ; to ensure that timely hormone therapy is provided when medically necessary, including the administration of hormone dosage adjustments and routine monitoring of hormone levels; to cease the policy and practice of depriving gender dysphoric prisoners of medically necessary social transition and to develop a policy to allow such transition (including individualized placement decisions, avoidance of cross-gender strip searches, and access to gender-affirming clothing and grooming items); to develop policies and procedures allowing transgender inmates access to clinicians who meet the WPATH3 competency requirements; to allow inmates to obtain evaluations for gender dysphoria upon request or clinical indications; and to advise the Court regarding steps taken to train all correctional staff on transgender issues. (Doc. 212).
A four-day bench trial was held from August 2 to 5, 2021, and culminated in the second order for preliminary injunctive relief. (Docs. 331, 332).4 On August 18, 2021, the Court corrected an error in the Preliminary Injunction. (Doc. 336).
On August 16, 2021, at the Court's direction, Plaintiffs submitted a post-trial brief outlining the deficiencies in IDOC's new Administrative Directives of April 1, 2021, and requested additions/changes to the injunctive relief. (Doc. 335). Defendants responded to that brief on September 7, 2021. (Doc. 346).
Subsequently, Defendants filed status reports setting forth steps they have taken toward compliance with the preliminary injunctive relief ordered by the Court. (60-day Status Reports at Doc. 355 and Sealed Doc. 357; Plaintiffs’ Response at Doc. 359); (120-day Status Report at Doc. 369).
As previously set forth in the first order for preliminary injunctive relief (Doc. 186, pp. 3-6), gender dysphoria is a condition in which a person experiences clinically significant distress stemming from incongruence between one's experienced or expressed gender and one's assigned gender. (Doc. 157, p. 95; Doc. 158, p. 14);5 see also Campbell v. Kallas , 936 F.3d 536, 538 (7th Cir. 2019). Gender dysphoria is considered a serious medical condition with psychiatric components; it has been removed from the mental and behavioral disorders in the World Health Organization Classification of Diseases and the Diagnostic and Statistical Manual of Mental Disorders. (Doc. 158, p. 95; Doc. 325, p. 538-39; Doc. 353, p. 379).
The World Professional Association for Transgender Health ("WPATH") is a professional association dedicated to understanding and treating gender dysphoria. (Doc. 157, p. 98). WPATH dictates medically accepted Standards of Care for treating gender dysphoria. (Id. at 7). According to WPATH, its Standards of Care are "the highest standards of health care" for transgender people. (Doc. 123, Ex. 13, p. 8). IDOC purports to follow the Standards of Care and has updated its mental health standards operating procedure manual to incorporate them. (Doc. 143, Ex. 4, pp. 4, 10). According to WPATH, treatment options for gender dysphoria include social role transition, cross-sex hormone therapy, psychotherapy, and surgery. (Doc. 158, p. 14).
WPATH lists the minimum qualifications a mental health professional must attain in order to assess and treat gender dysphoria. (Id. at 25). Specifically, a person must: hold a master's degree in behavioral science; be familiar with the Diagnostic and Statistical Manual of Mental Disorders ("DSM") or the International Classification of Diseases; have documented supervision in psychotherapy; understand the variations of gender identities and gender expressions; have continuing education in the assessment and treatment of gender dysphoria ; have cultural competence; and be aware of the growing body of literature in the area. (Doc. 158, pp. 25-26). Individuals who are new to the field should work under the supervision of someone with competence who is regarded as an expert in gender dysphoria. (Id. at 26).
Social role transition is living in the gender role congruent to one's affirmed identity. For instance, in the case of a transgender woman, social transition would include wearing a female hairstyle, female clothing, and makeup, and using a feminine name, female toiletries, and a female bathroom. (Doc. 158, p. 16). In a prison setting, social transition would require a transgender woman be afforded the same commissary items that female prisoners can access, have means to safe and effective hair removal, be referred to by a female name, and be permitted to wear makeup or clothing that affirms her gender. (Id. at 17).
Psychotherapy helps individuals become more resilient, deal with stigma, manage family situations, and cope with the social problems that are attendant to gender dysphoria. (Doc. 158, p. 14).
There are different surgical options for transgender individuals, including reconstruction of...
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