Roy Mitchell, Jr. v. Kevin Kallas

895 F.3d 492
Court of Appeals for the Seventh Circuit·Decided July 10, 2018·No. 16-3350·Published·Cited by 567 cases

Opinion

Wood, Chief Judge.

Lisa Mitchell is a transgender person who has identified as a woman her entire life. After an arrest in Wisconsin, officials from the state's Department of Corrections ("DOC") repeatedly prevented Mitchell from obtaining access to the treatments she needed to express her gender identity. It took DOC over a year to evaluate Mitchell's candidacy for hormone therapy, and even then, nothing happened. Instead, *496 DOC refused to provide Mitchell with the treatment its own expert recommended, on the ground that Mitchell was within a month of release from the prison. Although DOC's Mental Health Director, Dr. Kevin Kallas, encouraged Mitchell to find a community provider to prescribe her hormones, DOC parole officers prevented Mitchell from following this advice. Still under state custody, the terms of Mitchell's parole actually prohibited her from taking hormones or dressing as a woman.

Mitchell sued, contending that the prison doctors and the parole officers violated her constitutional rights. It is well established that persons in criminal custody are entirely dependent on the state for their medical care. Estelle v. Gamble , 429 U.S. 97 , 103, 97 S.Ct. 285 , 50 L.Ed.2d 251 (1976). Prison officials thus have a constitutional duty to provide inmates with the care they require for their serious medical needs. Prison staff cannot bide their time and wait for an inmate's sentence to expire before providing necessary treatments. This affirmative obligation ends when imprisonment does, but state officials may not block a parolee from independently obtaining health care. The only limitation is that the condition be serious enough to trigger constitutional protection; otherwise the nature of the disorder is irrelevant. Because the district court prematurely rejected some of Mitchell's claims, we reverse in part.

I

In 2008, Mitchell received a diagnosis of gender dysphoria. A few years later, she was convicted of a crime and sent to Wisconsin's Columbia Correctional Institution on October 11, 2011, to serve her sentence. On November 25, 2011, Mitchell asked for hormone treatment. Her request initiated a multistep process that DOC outlined in its then-new policy on Health Care Treatment of Gender Identity Disorder. That policy was first implemented on December 19, 2011. Step one under the policy required Mitchell's clinician to conduct a preliminary assessment. She did so, producing a written report about Mitchell on February 10, 2012. Next, the Gender Dysphoria Committee reviewed the report and decided to refer Mitchell's request for hormone therapy to its outside consultant, Cynthia Osborne. Osborne is a social worker and assistant professor at Johns Hopkins University, in Maryland; she specializes in providing gender-dysphoria evaluations. Since Osborne visited the Wisconsin facilities roughly every two months, Dr. Kallas informed Mitchell that she would meet with Osborne in April. That interview did not occur until May 22, 2012, however, nearly six months after Mitchell's initial request for care.

During the months leading up to and following the interview, Mitchell repeatedly inquired about her health care request. She asked Dr. Dawn Laurent, the prison's Psychological Services Unit Supervisor, for an update on April 8, 2012. Dr. Laurent did not respond. Instead, Mitchell's assigned clinician wrote back, promising to follow up. Mitchell also wrote letters to Dr. Kallas. In his October 8 reply, Dr. Kallas informed Mitchell that Osborne's report was "nearly complete" and should be finished "in a matter of days." He explained that Osborne was just trying to get in touch with two people whom Mitchell named as references. Dr. Kallas recognized that "considerable time ha[d] passed" and thanked Mitchell for her patience.

The long delay was not cost-free for Mitchell. While she waited, her psychological health was deteriorating. In May 2012, she reported feeling unsafe with silverware. A clinician's notes from July reflect that she was "not doing well regarding *497 gender identity disorder issues." Though she was receiving periodic counseling services, the notes from these sessions suggest that they focused on her other mental health conditions, such as her post-traumatic stress (the result of a violent hate crime committed against her when she was 18). To the extent Mitchell's gender dysphoria was discussed, the notes primarily refer to the harassment Mitchell experienced and her desire to know the status of her treatment request.

Osborne did not submit a draft of her report until November 15, 2012. Curiously, the report was dated September 27. Mitchell received a copy of the draft on November 28, and the report was finalized on December 2. Though Osborne's conclusions came a full year after Mitchell asked for hormone treatment, her recommendations strongly supported Mitchell's request. Osborne concluded that Mitchell "is an excellent candidate for hormone therapy" and predicted that this treatment would very likely improve Mitchell's "functional stability and sense of psychological well-being." Osborne expected that hormones would help not only with Mitchell's gender dysphoria, but also with her post-traumatic stress as well.

Based on Osborne's unequivocal recommendation, Mitchell resubmitted her request for hormone therapy the same day that she reviewed the draft report. Dr. Kallas turned her down on January 2, 2013. His letter explained that she was not eligible for treatment because she was scheduled to be released that month. As a "point of information," Dr. Kallas said, DOC starts inmates on hormone therapy only when they have at least six months left on their sentences, in order to allow for the several-month process of getting the person stabilized on the medication. Dr. Kallas encouraged Mitchell to seek hormone treatment upon her release; he even offered a copy of Osborne's report and information about community providers.

But Mitchell was thwarted again after her release on January 8, 2013. When she tried to follow up on Dr. Kallas's suggestion, her parole officers flatly forbade her from seeking hormone therapy. Indeed, as a condition of her parole, she was required to dress and present as a man. Though Mitchell provided the agents with a copy of Osborne's report and recommendations, the officers did not relent.

On February 18, 2015, Mitchell filed a pro se complaint in federal court against Dr. Kallas, Dr. Laurent, and DOC parole officers Joseph Ruhnke, Brittany Wolfe, and Nicole Raisbeck. (Mitchell also initially sued two DOC Secretaries, but she has not appealed the dismissal of these defendants.) The district court understood the suit as one under 42 U.S.C. § 1983 alleging deliberate indifference to a serious medical need.

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Roy Mitchell, Jr. v. Kevin Kallas, 895 F.3d 492 (7th Cir. 2018).

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