CHICAGO – Transgender individuals in the custody of Illinois prisons seeking treatment for gender dysphoria won a major victory after a four-day trial in East St. Louis last week. A federal court ordered the Illinois Department of Corrections (IDOC) to take immediate steps to improve how it treats prisoners who have gender dysphoria while leaving the door open for additional relief, including the appointment of a monitor.

U.S. District Court Judge Nancy Rosenstengel issued a stinging rebuke of IDOC’s failure to improve care for this population since it was first ordered to do so in December 2019. In a rare oral order delivered from the bench upon the conclusion of the trial, Judge Rosenstengel rejected as “nonsense” and a red herring IDOC’s arguments that the harmfully slow process of providing transgender prisoners with appropriate medical care was due to concerns over non-transgender “predators.” Similarly, the court brushed aside claims that the COVID pandemic justified ongoing delays that have caused ongoing harms to the Plaintiff class.

The Judge concluded that she was no longer willing to trust IDOC, saying “I don't have faith to simply, quote, let the process play out” as the Defendants requested. “I acknowledge that COVID understandably caused delays. But, COVID does not authorize inadequate medical care and treatment.”

The ruling followed extensive testimony from prisoners who were able to directly express to the court the way in which they suffer because of the denial of access to basic treatment, including hormone therapy. Sora Kuykendall testified that “during strip searches I would break down and cry and shake, and when I would get back to my cell I would do the same,” and explained that she has refused visits from her mother since December 2019 because as a woman Sora refuses to be subjected to strip searches by male guards. Describing her experience of being a woman in a male prison, Marilyn Melendez explained that “(i)t’s humiliating and they are disrespectful. You know, you have me surrounded by men, I have to go to yard with men, I have to be surrounded by men, go to eat with men, I have to go to counseling with men. I am being subject to be around them 24/7, even if I am in a cell by myself. . . I’m not male. . . (N)o woman should be forced to be around a man in prison.”

Another class member, London Fulton, described the constant roadblocks since May 2019 to resuming hormones – which she had been prescribed by IDOC during a previous incarceration. “I felt heartbreak, I felt pain, I felt sadness, and felt like -- like, to be honest, I really feel like I was really being overlooked and not being taken seriously for my transgender treatment.”

Prior to last week’s trial, IDOC made repeated promises to make care more available. But testimony in court made clear that the changes in written policy have been slow and ineffective in actually improving the care patients receive. It was clear that some members of the class in the case – Monroe v. Jeffreys – were still being denied hormone treatment and were not being properly monitored when hormones were prescribed. And the testimony made clear that IDOC rushed in the weeks before trial to transfer a small number of transgender women to the female prison and selected a handful of prisoners for an initial meeting with a surgeon, while plans for actually scheduling surgeries remain elusive.

Judge Rosenstengel also was highly critical of how IDOC was deciding who qualified for transfers or surgery, stating that “I likewise cannot understand why an inmate who recently requested surgery would be approved so quickly when others have been waiting for years and all the while getting the runaround.”

“Our clients have endured years of suffering, waiting for IDOC to simply provide basic health care,” said John Knight, LGBTQ & HIV Project Director at the ACLU of Illinois, who represents the prisoners in this case. “The court recognized that IDOC’s promises of better treatment and the other steps it has taken on the eve of trial have failed to result in any meaningful improvement in the care provided. We must do better to end the human suffering our Illinois prisons are causing transgender Illinoisans by continuing to provide them an abysmal level of care.”

“Our clients’ voices were heard in this trial, and the obvious need for court intervention was made clear.”

In particular, Judge Rosenstengel ordered the following steps be taken by IDOC, among others:

  • Members of the class who requested hormone therapy previously must get blood testing within 21 days and start hormone therapy within 14 days thereafter, with follow-up blood work at least every three months until the levels are within an appropriate range;
  • Members of the class who currently receive hormone therapy must be given blood tests to assess proper hormone and other levels that must be monitored within 14 days. Hormone levels must then be adjusted as necessary based on the blood work. This process must be repeated every three months until the levels are within an appropriate range, and all class members receiving hormone therapy shall get blood work done at least once a year;
  • Class members whose hormone levels are within the appropriate range and who have requested evaluation for gender-affirming surgery shall be evaluated for such surgery within 120 days, with class members being evaluated in chronological order of the date of their original request for surgery;
  • Class members shall be allowed to choose the gender of their correctional officer who will conduct the search;
  • Class members who have requested transfer to a facility matching his or her expressed gender shall be evaluated for transfer within 120 days of the date of the order, with class members being evaluated in chronological order of the date of their original request for transfer;
  • Class members shall immediately be provided with access to gender affirming items in the commissary and shall immediately be provided with a list of available gender affirming items;
  • IDOC shall immediately ensure that medical care and mental health treatment of class members shall be conducted only by medical staff and mental health professionals who have taken the WPATH training and are committed to continuing education on issues of transgender health;
  • IDOC shall immediately ensure that transgender prisoners are allowed access to a private shower.

The court also ordered Defendants to finalize the various projects they claimed at trial were “in the works” within 120 days.

The trial was the culmination of a class action lawsuit filed in January 2018 on behalf of five women – Janiah Monroe, Marilyn Melendez, Lydia Heléna Vision, Sora Kuykendall and Sasha Reed as well as a class of all transgender prisoners in IDOC custody who have requested evaluation or treatment for gender dysphoria.

In December 2019, Chief Judge Rosenstengel granted a preliminary injunction ordering IDOC to overhaul the way that health care for those with gender dysphoria was provided in prisons across the state. The court ordered IDOC to end the practice of using a committee of non-experts to make decisions about medical care for transgender prisoners and to provide medically necessary hormone therapy and social transition treatment, including ceasing the practices of routinely placing transgender prisoners in facilities based on their genitalia or size and forcing transgender prisoners to undergo cross-gender strip searches. But none of those changes were implemented in any meaningful way.

Lawyers from the ACLU of Illinois are joined on the trial team by lawyers from the Chicago offices of Kirkland & Ellis and King & Spalding.