Balsewicz, John v. Kallas, M.D., Kevin

CourtDistrict Court, W.D. Wisconsin
DecidedDecember 8, 2022
Docket3:19-cv-00806
StatusUnknown

This text of Balsewicz, John v. Kallas, M.D., Kevin (Balsewicz, John v. Kallas, M.D., Kevin) is published on Counsel Stack Legal Research, covering District Court, W.D. Wisconsin primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Balsewicz, John v. Kallas, M.D., Kevin, (W.D. Wis. 2022).

Opinion

IN THE UNITED STATES DISTRICT COURT FOR THE WESTERN DISTRICT OF WISCONSIN

JOHN H. BALSEWICZ, a.k.a MELISSA BALSEWICZ,

Plaintiff, OPINION AND ORDER v. 19-cv-806-wmc KEVIN KALLAS and CYNTHIA OSBORNE,

Defendants.

Pro se plaintiff John Balsewicz, also known as Melissa Balsewicz, is a transgender inmate at Kettle Moraine Correctional Institution.1 She alleges that (1) defendants Kevin Kallas and Cynthia Osborne unconstitutionally deferred her hormone treatment and (2) Kallas did so because of Balsewicz’s lawsuits against various Department of Corrections staff.2 The parties filed cross-motions for summary judgment. (Dkt. ##36, 40, 45.) For the following reasons, the court will grant defendants’ motions for summary judgment and dismiss this case.

1 Balsewicz is a transgender woman. Accordingly, per her preference, the court uses female pronouns in referring to Balsewicz.

2 At various points in her summary judgment briefing, Balsewicz appears to be pursuing a Monell- type claim against defendants, by contending that the named defendants were following an unwritten policy or practice of denying or delaying treatment for transgender inmates, and by claiming that her psychotherapy treatment at Waupun Correctional Institution was inadequate due to staffing shortages. (Dkt. #37 at 16-20.) However, the court will not address those claims, given that Balsewicz was not granted leave to proceed on any such claims, and even if she could state them, it is far too late to introduce those claims now. See Anderson v. Donahoe, 699 F.3d 989, 998 (7th Cir. 2012) (a plaintiff may not amend her complaint through a summary judgment brief). UNDISPUTED FACTS3 Balsewicz has been diagnosed with gender dysphoria, depression, and personality disorders. At all times relevant to this case, she was incarcerated either at Waupun

Correctional Institution or at the Wisconsin Resource Center (“WRC”), which is a facility that treats inmates who need specialized mental health services.

A. WPATH standards of care for gender dysphoria The World Professional Association for Transgender Health (“WPATH”) publishes its Standards of Care for the Health of Transsexual, Transgender, and Gender-Nonconforming People (7th ed. 2012) to provide guidance to health professionals in the treatment of individuals with gender identity issues. These are authoritative standards of care for treating gender dysphoria, a “field of medicine [that] is evolving.” (Dkt. #43-1 at 47.) The WPATH

standards recognize that hormone therapy “is a medically necessary intervention for many . . . individuals with gender dysphoria,” but caution that treatment must be individualized based on the individual’s goals and other medications and medical conditions, as well as social and economic issues. (Id. at 39-40.) Accordingly, the WPATH standards guide treatment decisions by recommending “flexible clinical guidelines” that a patient should meet before receiving some types of

treatment, which are referred to as “criteria.” (Id. at 8.) The criteria for hormone therapy are:

3 Unless otherwise indicated, the following facts are material and undisputed. The court has drawn these facts from the parties’ proposed findings of fact and responses, as well as the underlying record as appropriate. 1. Persistent, well-documented gender dysphoria; 2. Capacity to make a fully informed decision and to consent for treatment; 3. Age of majority in a given country;

4. If significant medical or mental health concerns are present, they must be reasonably well-controlled. (Id. at 40.) In particular, although “the presence of coexisting mental health concerns does not necessarily preclude access to . . . hormones . . . these concerns need to be managed prior to, or concurrent with, treatment of gender dysphoria.” (Id.)

The WPATH standards explicitly state that they apply “in their entirety” to institutionalized transgender individuals, including inmates. (Id. at 73.) The WPATH standards also explain that clinical departures from the criteria may be justified by “a patient’s unique anatomic, social, or psychological situation; an experienced health professional’s evolving method of handling a common situation; a research protocol; lack of resources in various parts of the world; or the need for specific harm reduction

strategies.” (Id. at 8.) B. Balsewicz’s gender dysphoria diagnosis and treatment

Wisconsin Department of Corrections (“DOC”) policy for treating gender dysphoria and accommodating transgender inmates is managed by its “Transgender Committee,” whose purpose includes evaluating requests for treatment for gender dysphoria and accommodations for transgender inmates. (Dkt. #48-3 at 2-3, 6.) Defendant Kallas is the DOC’s Mental Health Director and a committee member. Kallas oversees mental health care within the DOC, but generally does not provide direct, clinical treatment to inmates. Specifically, if an inmate requests transgender services (such as hormone therapy),

a psychological services staff member conducts an in-person assessment and writes a report about the inmate’s gender issues. Mental Health Director Kallas then reviews the report and decides whether to refer the inmate for further assessment by the DOC’s transgender consultant, defendant Cynthia Osborne. Osborne’s evaluation of an inmate includes review of relevant psychiatric records, pre-sentence investigations, and prison incident

reports, as well as a meeting with the inmate. Osborne does not order treatment for an inmate, but rather prepares a written report with her recommendation for treatment, which Kallas then reviews and relies on in making treatment decisions. In early April 2016, while plaintiff Balsewicz was incarcerated at Waupun, she underwent a gender dysphoria assessment after requesting hormone therapy and gender confirmation surgery. The psychological associate who conducted the initial assessment

gave Balsewicz a provisional diagnosis of gender dysphoria. That assessment, along with a 2012 psychological assessment, was forwarded to Kallas in late September 2016, after Balsewicz was admitted to the WRC for depression.4 Kallas reviewed the assessments and advised the WRC’s clinical director that Balsewicz was an appropriate candidate to see Osborne for further evaluation. Kallas questioned whether “a GD diagnosis [was] firmly established,” and wanted “to be cautious and move slowly with any significant treatment

4 The delay in forwarding the report to Kallas was litigated in a separate lawsuit. Balsewicz v. Blumer, No. 17-cv-360-JPS, 2019 WL 1370105, at *1 (E.D. Wis. March 26, 2019), aff’d, 788 F. App’x 379 (7th Cir. 2019). interventions like hormones” given Balsewicz’s “psychiatric history.” (Dkt. #43-3 at 1.) Still, Kallas recommended placement in a “GD facility.” (Id.) Balsewicz was next placed on the list to see Osborne, who was not available until early 2017. While at the WRC,

Balsewicz expressed frustration that her treatment was not more focused on gender dysphoria. She also apparently attempted suicide three times in December 2016. Osborne evaluated Balsewicz in February 2017 and confirmed the diagnosis of gender dysphoria. However, she recommended in a 26-page assessment that the DOC defer consideration of hormone therapy for at least a year due to Balsewicz’s psychological

and behavioral instability at the time. Specifically, Osborne concluded that Balsewicz’s comorbid psychiatric disorders, including depression and personality disorders, were poorly managed, as was her chronic suicidal ideation.

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