Veronica-May v. Quiros
| Docket Number | 3:19-cv-00575-VLB |
| Decision Date | 15 September 2023 |
| Parties | VERONICA-MAY (Nee Nicholas Clark) Plaintiff, v. ANGEL QUIROS, DR. GERALD VALLETTA, RICHARD BUSH, AND BARBARA KIMBLE-GOODMAN, Defendants. |
| Court | U.S. District Court — District of Connecticut |
Veronica-May Clark is a transgender woman serving what is essentially a life sentence in prison. Ms. Clark informed prison officials that she was a transgender woman while serving her sentence. Thereafter, she was diagnosed with gender dysphoria (“GD”)-psychological distress resulting from an incongruence between one's sex assigned at birth and one's gender identity. Less than two months after her diagnosis, Ms. Clark attempted self-castration by using a pair of nail clippers to remove her testicles. Ms. Clark removed one of her testicles from her scrotum before stopping due to the excruciating pain. She was hospitalized and then transferred to another prison. After her self-castration attempt, Ms. Clark sought treatment for gender dysphoria. In response, the prison physician with the duty to treat Ms Clark told her that he would not facilitate any hormone therapy because of a purported policy against providing inmates with hormone therapy unless they were receiving it prior to incarceration. Ten months later and after threats of litigation were lodged, the prison physician referred Ms. Clark to an outside endocrinologist for evaluation and potential hormone therapy treatment. The endocrinologist recommended the prison physician prescribe Ms. Clark a starter dose of hormone medication and return Ms. Clark for a follow-up appointment in three months. The medication was prescribed, but Ms. Clark was not returned to the endocrinologist for her first three-month follow-up appointment for 22 months. Eventually, Ms. Clark's hormone therapy was successful in matching the hormone level for her gender identity. For years after her diagnosis, the only other treatment Ms. Clark received was talk therapy from mental health providers who had no experience or expertise in treating someone with GD, and anti-depressants.
Ms. Clark sues Dr. Gerald Valetta, a prison primary care physician; LCSW Richard Bush and APRN Barbara Kimble-Goodman, prison mental healthcare providers (collectively, the “Provider-Defendants”); and Connecticut Department of Correction (“DOC”) Commissioner Angel Quiros (collectively with the ProviderDefendants, the “Defendants”). Ms. Clark raises a deliberate indifference claim, alleging that the Defendants' failure to adequately treat her gender dysphoria constitutes a violation of her right against cruel and unusual punishment. (Am. Compl., Count I, ECF No. 84.) Ms. Clark also raises a claim of intentional infliction of emotional distress against the Provider-Defendants. (Am. Compl., Count II.)
Before the Court are cross-motions for summary judgment. (Def.s' Mot. for Summ. J., ECF No. 128; Pl.'s Mot. for Summ. J., ECF No. 133.) Ms. Clark seeks summary judgment on her claim of deliberate indifference. (Pl.'s Mot. for Summ. J.) The Defendants seek summary judgment on all claims. (Def.s' Mot. for Summ. J.) For the reasons set forth below, the Defendants' motion is DENIED, and Ms. Clark's motion is GRANTED.
The Plaintiff, Veronica May (Nee Nicholas) Clark, has been in the custody of the Connecticut Department of Correction (“DOC”) since 2007. (Pl.'s 56(a)2 at ¶ 1; Ex. M, ECF No. 128-15, at 1-2.) She was convicted of murder, assault, burglary with a deadly weapon, and violation of protective order and is serving a sentence of 75 years without the possibility of parole. (Pl.'s 56(a)2 at ¶ 2.)
This case involves Ms. Clark's health care while in DOC custody. Incarcerated people in DOC custody cannot choose the medical or mental health personnel who provide their care. (Id. ¶ 9.) However, there are onsite health care providers who can refer patients to outside health care specialists when necessary. (Ex 2 at 63:15-66:8.) The providers can make direct referrals or use other physicians within the DOC chain of command to facilitate referrals to specialists. (Id.)
The DOC uses a classification system to categorize inmates based on the individuals' risk and vulnerabilities. (Ex. 2, ECF No. 133-4 at 48:7-17.) An inmate category can be between 5 (being the most severe) and 1 (being the least severe.)
(Id.) The inmate score impacts a person's housing, the frequency about which someone would need to be seen for medical care, and the intensity of care that surrounds them. (Id.) Even though the DOC has a classification system, it does not have a process or system for tracking complex patient cases. (Ex. 2 at 59:1260:22.) Notwithstanding the lack of formalized tracking, the DOC Central Office is usually involved in facilitating referrals and treatments, gaining awareness of complex cases. (Id.)
The DOC has written policies and procedures called “Administrative Directives” (“AD”). AD 8.9 covers Health Service Administrative Remedies, which has the stated purpose of “enabl[ing] an inmate to seek formal review of any health care provision, practice, diagnosis or treatment.” (Ex. 8, ECF No. 133-10.) AD 8.9 identifies two types of health services administrative remedies: one for diagnosis and treatment issues and another for administrative issues (such as a practice, procedure, administrative provision or policy, or an allegation of improper conduct by a health services provider). (Id. § 6.a.) When an inmate seeks review, they are to first make a verbal request for informal resolution. (Id. § 6.b.ii.) If verbal informal resolution fails, the inmate is to submit a written “informal” request using an Inmate Request Form. (Id.) If the inmate is not satisfied with the response, they can submit a Level 1 Grievance, which is generally reviewed by the health care provider responsible for the inmate's care. (Id. § 6.c.i.-ii.) There are two additional levels of grievances thereafter. (Id. § 6.c.iii-iv.)
A person's gender identity is their internal sense of whether they are male, female, or non-binary. (Defs.' 56(a)2 ¶ 1.) A transgender individual is a person whose gender identity is different from their designation at birth. (Defs.' 56(a)2 ¶ 2.) In a related manner, gender dysphoria is clinically significant distress-i.e., distress that interferes with a person's livelihood-associated with an incongruence between a person's gender identity and assigned sex at birth. (Ex. 1, ECF No. 133-3 at ¶ 44 (Pl.'s Expert); Ex. E at ¶ 17 (Defs.' Expert)). In April 2016, Ms. Clark informed a DOC clinician that she is a transgender woman and expressed her belief that she was suffering from gender dysphoria. (Defs.' 56(a)2 ¶ 19.) Thereafter, around May 2016, a DOC health care provider formally diagnosed Ms. Clark with gender dysphoria. (Defs.' 56(a)2 at ¶ 20.)
The parties have each hired an expert to provide their opinion on, inter alia, what is gender dysphoria and how it is treated. Ms. Clark's expert, Dr. George R. Brown, is a medical doctor who is Board Certified in Psychiatry. (Ex. 1 at ¶ 4.) Dr. Brown is a faculty member and professor of psychiatry at East Tennessee State University Quillen College of Medicine. (Id.) For over thirty years, Dr Brown's research has focused principally on the study of transgender health, particularly with adults with gender dysphoria. (Id. at ¶ 5.) He has served on the World Professional Association for Transgender Health (WPATH) Committee to Revise the Standards of Care since 1990. (Id. at ¶ 6.) According to Dr. Brown, WPATH Standards of Care are authoritative for the evaluation and treatment of gender dysphoria. (Ex. 1 at ¶ 49.) WPATH Standards of Care are guidelines that can be modified based on individual patient circumstances and their health care professional's clinical judgment. (Id.) Treatment of gender dysphoria under the WPATH Standards of Care are individualized for patients and may include one or more of the following modalities: gender-informed psychotherapy, gender confirming hormonal treatment, voice therapy, and gender confirming surgeries.[2](Ex. 1 at 29 ¶ 43; Defs.' 56(a)2 at ¶ 7.) According to Dr. Brown, the consequences of denying gender conforming surgery may include auto-castration, depression, and possible suicide. (Ex. 1 at 37-38 ¶ 62.)
The Defendants' expert, Dr. Stephen Levine, is also a medical doctor who is Board Certified in Psychiatry. (Ex. E at ¶ 3.) Dr. Levine is a clinical professor of psychiatry at Case Western Reserve University School of Medicine. (Ex. E at ¶ 2.) Since 1973, Dr. Levine has been a practicing psychiatrist who has treated hundreds of patients, including many with gender dysphoria. (Ex. E at ¶ 3.) He has served as a psychiatry consultant for departments of corrections for several states throughout the country and has spoken at seminars for correctional staff members on topics involving transgender inmates. (Ex. E at ¶ 4.) Dr Levine was a member of WPATH, once serving as the chairman of the writing group that created the fifth edition of the WPATH Standard of Care for People with Gender Dysphoria that was published in 1999. (Ex. E. at ¶ 5.) Dr. Levine criticizes the WPATH Standards of Care as not based on scientific outcomes, but he recognizes that many institutions use them for treating patients with gender dysphoria. (Ex. N, ECF No. 153-4 at 58 69.) Dr. Levine did not provide an expert opinion on what are the standards of care for treating patients with gender dysphoria. Rather, Dr. Levine noted that treatment comes in various forms including talk therapy, psychotherapy, hormone therapy, and surgical...
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