by Casey J. Bastian

Transgender women imprisoned in the Illinois Department of Corrections (DOC) notched another victory in their legal battle for gender dysphoria treatment on December 13, 2021, when the U.S. District Court for the Southern District of Illinois agreed to appoint a Special Monitor to ensure the state complies with the terms of an injunction issued on August 9, 2021.

At that time, in what the state chapter of the American Civil Liberties Union (ACLU) termed a “major victory” following a four-day trial, the Court granted an injunction in favor of plaintiffs in a class-action lawsuit against DOC over its continuing failure to provide requested evaluations and treatments for gender dysphoria.

The decision prompted John Knight, who is the LGBTQ and HIV project director for the ACLU of Illinois, to say that the group’s clients had “endured years of suffering, waiting for (DOC) to simply provide basic health care.” He was referring to plaintiffs in the case, five transgender women held by DOC who originally filed the suit in 2018, later expanded to include all members of the “class of similarly situated individuals.” The class consists of roughly 130 prisoners.

In her August 2021 opinion, Judge Nancy Rosenstengel chastised DOC for failing to heed her Court’s earlier instruction in the case, handed down in December 2019, to improve health care for transgender prisoners. The prison system countered that it had been stymied by the COVID-19 pandemic, but the judge called that excuse “nonsense.”

The transgender prisoners testified that DOC consistently denied basic treatments, including hormone therapies and gender-appropriate hygiene items, and that the inadequate treatment was psychologically devastating. The trans women were housed with men, from whom they feared sexual and physical predation, they said. Worse, they were not allowed to choose the gender of guards conducting required strip-searches, leaving one plaintiff unable to receive visits from her mother.

The five named plaintiffs were Janiah Monroe, Marylin Melendez, Lydia Vision, Sora Kuykendall, and Sasha Reed; a sixth DOC prisoner, Ebony Stamps, was also named in the Court’s order. Each claimed that DOC’s failure to treat them for gender dysphoria was a violation of their Eighth Amendment guarantee of freedom from cruel and unusual punishment.

Gender dysphoria is defined as “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.” It was formerly considered a mental health issue until the diagnosis was redefined as a medical condition in the 10^th Edition of the World Health Organization’s International Classification of Disease in 1992. The Diagnostic Statistical Manual of Mental Disorders has also recognized that gender dysphoria is to be considered a medical condition requiring clinical treatment.

Monroe testified that DOC’s lack of treatment was “excruciatingly painful” and caused her to attempt a variety of self-harming acts, including chewing out veins and attempting suicide.

Melendez told jurors that living without gender reassignment surgery was “upsetting” and “depressing,” causing her to feel “disgust and discomfort” and “like a freak.”

“I was depressed, anxious, and suicidal,” Reed testified.

Kuykendall recalled being repeatedly called “it” by DOC staff, though each of the prisoners testified to similar and chilling examples of DOC staff misconduct, along with a refusal to treat them.

Dr. Randi Ettner, a clinical and forensic psychologist specializing in the treatment of gender dysphoria, was an expert witness for the plaintiffs. Ettner chairs the World Professional Association for Transgender Health, a “professional association dedicated to understanding and treating gender dysphoria.” After reviewing DOC policies and the prisoners’ medical records, Ettner determined that DOC provided “inadequate and inappropriate care,” testifying that this lack of treatment typically results in the types of behaviors described by the prisoners.

Ettner also testified that neither DOC Chief of Psychiatry Dr. William Puga nor the DOC Transgender Committee he oversees is competent to treat gender dysphoria, claiming instead that the Committee’s decisions fall below the Standards of Care and “place inmates at risk.”

As a result of the trial, the Court placed an extensive list of mandates in its August 2021 order, including but not limited to:

• A requirement that each plaintiff be provided the medical treatment they request and qualify to receive, including hormone treatments, hormone level monitoring, gender affirming surgery, hair removal services, and gender-appropriate commissary items;

• A change to DOC policy allowing transgender prisoners to request reassignment to a prison whose population conforms with their gender;

• A series of additional changes to DOC policy, including staff training, written surgical standards for transgender care, and DOC’s transgender identification policy, which must “allow for transgender inmates’ medically necessary social transition...avoidance of cross-gender strip searches, and access to gender-affirming clothing and grooming items.”

“Our clients’ voices were heard,” said Knight after the verdict was announced, “and the obvious need for court intervention was made clear.” See: Monroe v. Meeks, 2021 U.S. Dist. LEXIS 148487.

In its most recent decision to appoint a Special Monitor, the Court conceded the need for “more intensive and regular oversight of Defendants’ actions to comply with” its earlier orders, as well as concluding that—with some 1,700 pages of medical records and reports in the most recent 60-day status report—“the post-trial remedial phase of this matter is sufficiently complex to exceed the Court’s ability to effectively and timely evaluate the records to determine whether Defendants are making adequate progress toward compliance.” See: Monroe v. Meeks, 2021 U.S. Dist. LEXIS 237410. 

Additional source: New York Daily News

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