Appeals Court rules in favor of trans woman denied hormone therapy in custody

Even on parole, she was forced to dress like a man.

CREDIT: Cristian Ibaez / EyeEm via Getty Images
CREDIT: Cristian Ibaez / EyeEm via Getty Images

The U.S. Court of Appeals for the Seventh Circuit ruled earlier this month in favor of a transgender woman who was denied hormone therapy while in the custody of the state of Wisconsin. Reversing a lower court decision dismissing her lawsuit, the three-judge panel agreed that her case could continue.

Lisa Mitchell was first diagnosed with gender dysphoria back in 2008, but when she was convicted of a crime in late 2011, Wisconsin’s Department of Corrections (DOC) refused to provide her with hormone therapy. It took over a year for various clinicians and outside consultants to assess her and she also had to provide references. In the meantime, her mental health significantly deteriorated.

Mitchell’s clinicians strongly recommended that she “is an excellent candidate for hormone therapy” and that the treatment would very likely improve her “functional stability and sense of psychological well-being.” On January 2, 2013, however, the DOC’s Mental Health Director, Dr. Kevin Kallas, told her that she was not eligible for the treatment because she was due to be released that month. He insisted that inmates can only start hormone treatment if they have at least six months left on their sentences because of the period necessary to stabilize the dosage.

Kallas did provide her with the clinician’s report as well as information about community providers, but this did not help. After she was released, Mitchell’s parole officers forbade her from seeking hormone therapy and even required her, as a condition of her parole, to dress and present as a man.

Mitchell sued both her DOC care providers and parole officers, but a district court dismissed her complaint.

The Appeals Court, however, noted that if the prison medical staff “exhibit deliberate indifference to an inmate’s serious medical condition, they subject her to unnecessary and wanton pain and suffering and thereby run afoul of the Eighth Amendment.” This can include “failing to provide care for a non-medical reason” as well as “inexplicable delays in treatment where the delays serve no penological purpose.”


In particular, Kallas, the DOC Mental Health Director, had no foundation for his claim that Mitchell was ineligible to start treatment because of her imminent release. “The first problem is that this requirement appears nowhere in DOC’s written policy on gender dysphoria,” the Court explained. The DOC had just established a new policy for providing care to transgender inmates and there was absolutely nothing in it about sentences lasting at least another six months. The Court was particularly concerned about whether the same standard were applied to treating other serious medical conditions:

We have no reason to doubt that hormone therapy poses a health risk if not properly controlled. But the same could be said about medications for countless other conditions. It seems exceedingly unlikely that DOC would refuse to commence a course of treatment for an inmate who was about to leave, just because continuity of care protocols would require a hand-off to a different provider. Would it really refuse to address breathing problems, or cardiac problems, or even a broken leg, just because one doctor begins the treatment and another completes it?

The question as to how accountable parole officers can be held is an open one, but the panel still felt the lower court erred in dismissing Mitchell’s complaint against them. “Though parole officers may have no duty…to provide a parolee with medical care or ensure that she receives it, they at least may be constitutionally obligated not to block a parolee who is trying to arrange such care for herself without any basis in the conditions of parole,” they wrote. “From that perspective, Mitchell pleaded enough to proceed on the theory that the parole officers acted with deliberate indifference to her gender dysphoria by blocking her from getting care.”

The decision is not a final ruling for Mitchell. Instead, it sends the case back to the lower court for proper consideration. But with courts across the country ruling inconsistently about whether transgender people have the right to proper medical treatment when they’re in the care of the state, the decision is nevertheless a promising development. Transgender people suffer exorbitant amounts of abuse within the prison system, and the Trump administration recently rolled back protections that allowed them to be housed according to their gender identity.