Wisconsin's Ban On Effective Treatment For Gender Identity Disorder Is Unconstitutional
FIELDS v. SMITH (August 5, 2011)
Andrea Fields, Matthew (a.k.a. Jessica) Davison, and Vankemah Moaton are all inmates in the Wisconsin Department of Corrections system and are all male-to-female transsexuals. They have each been diagnosed with Gender Identity Disorder, a condition in which an individual identifies with the gender that does not match his or her own physical characteristics. Prior to 2010, each had been receiving hormonal therapy. Then Wisconsin adopted the Inmate Sex Change Prevention Act, which prohibited the Department of Corrections from using any funds to provide hormonal therapy or sexual reassignment surgery. Fields and the others brought a class action challenging the Act’s constitutionality. Chief Judge Clevert (E.D. Wis.) denied class certification but conducted a trial on the individual claims. After hearing substantial expert testimony, the court concluded that the Act violated the Eighth Amendment, both as applied and on its face. Defendants appeal.
In their opinion, Seventh Circuit Judges Rovner and Wood and District Judge Gottschall affirmed. The Eight Amendment prohibits cruel and unusual punishment. Prison officials violate it when they display "deliberate indifference" to prisoners' medical needs. The Court conceded that two cases, one from 1987 and one from 1997, provide some support for defendants’ views that hormone therapy and sexual reassignment surgery are not required by the Eighth Amendment. The Court noted, however, that the support came from dicta or short comments that were based on certain assumptions pertaining to cost and the availability of alternative treatments. Now, years later, the district court heard expert testimony concerning those assumptions. The defendants concede that GID is a serious medical condition, do not contend that the Act’s prohibitions are defensible on a cost savings basis, and they presented no evidence that an alternative treatment could accomplish similar results. The trial evidence established that hormone therapy was the only effective treatment for plaintiffs' condition. Denying the only effective treatment for a serious medical condition violates the Eighth Amendment. The Court also rejected the defendants’ argument that prison security was a sufficient reason to ban the treatments. Finally, the Court concluded that the district court did not abuse its discretion in finding the Act facially unconstitutional.
Anthony Smith was incarcerated in 
Michael McGowan was incarcerated in an Illinois prison in 2006. He filed a pro se lawsuit pursuant to state law and § 1983 against a dentist and the prison's dental director alleging the following facts: In November of 2006, his tooth began to hurt. His pleas for assistance finally resulted in an appointment with a dentist in late January 2007. The dentist refused to provide a filling but agreed to extract the tooth. The procedure did not go well. McGowan was in severe pain, the tooth broke apart, and the dentist had to remove pieces of the tooth from his mouth with an ice pick. After the procedure, the pain increased, a mass of tissue developed, and he developed a sinus perforation. Other than pain relievers and temporary fixes, McGowan received no treatment until August, months after the extraction. The complaint alleges detailed facts regarding his requests for treatment and the delay occasioned at least in part by the prison dental director. Judge Herndon (S.D. Ill.) dismissed the case with prejudice for failure to state a claim pursuant to the § 1915A screening. The court acknowledged the long delay in treatment but concluded that it did not amount to deliberate indifference. The court did not address the state law negligence claims. McGowan appeals.