Experts say IDOC “lacks expertise and understanding,” makes decisions about life-saving medical care by committee vote 

Transgender prisoners in Illinois prisons are “at risk” owing to gross inadequacies in the medical care offered to prisoners with gender dysphoria by the Illinois Department of Corrections (IDOC).  That judgment – from two experts in treating those with gender dysphoria – is part of filings today by five women who are transgender and detained in Illinois prisons that demonstrate the larger systemic crisis regarding how IDOC treats the hundred or more transgender prisoners in its facilities throughout the state.

“Because IDOC has not given me the treatment I need, my gender dysphoria has gotten worse. I feel depressed, hopeless, and suicidal,” said Janiah Monroe, a plaintiff in the lawsuit. “I often feel that I would rather be dead than continue living with this body. I have tried to kill myself many times, including in the past year.”

Unfortunately, the IDOC’s cruel dismissal of Janiah’s need for care is all too common. Janiah waited approximately three years after requesting treatment before her hormone therapy was initiated and the treatment only began after several attempts to treat herself by self-castration. All of the plaintiffs experience significant delays in receiving medically necessary treatment, while some treatments are being denied entirely. You can read their declarations in detail here.

With these filings in Monroe v. Baldwin, plaintiffs seek a preliminary injunction aimed at putting an end to the abysmal quality of medical care for gender dysphoria that IDOC provides to transgender prisoners and the suffering this substandard system of health care imposes on these prisoners.  Plaintiffs also seek certification of a class of all transgender prisoners who have sought care for gender dysphoria in order to secure improvements in the system of transition-related medical care provided to all IDOC prisoners who are transgender. These filings ask the court to require IDOC to reform its medical care system in order to treat transgender prisoners more humanely and consistent with the well-established medical standards for treating gender dysphoria. 

The statements of the experts left little doubt that the care provided by IDOC staff was inadequate and putting the lives of prisoners at risk.  The appalling quality of this care results from the centralized decisions made by an IDOC-created committee of individuals who make the final decision about the diagnosis and treatment of all transgender prisoners who are requesting treatment for gender dysphoria.  The committee however, is comprised of persons who are untrained in treating gender dysphoria and who cast votes to determine if prisoners they have never met or examined actually have gender dysphoria and should receive treatment for the condition.  The committee votes on whether prisoners who have already been diagnosed with gender dysphoria and recommended treatment by the medical staff at the IDOC facilities where they are housed should actually get that treatment.  

“Our clients and other transgender prisoners have been fighting for the care they need to survive. The treatment they are getting is cruel and inhumane. Female prisoners are routinely denied necessary medical care, by categorically denying them surgical care and the ability to socially transition, routinely placing them in male facilities and subjecting them strip searches by male guards in front of other male prisoners.  Even the most basic care – the provision of hormone therapy – is often delayed for months and even years for no medically accepted reason, and then once it is provided, IDOC does so without any regard to well-accepted medical standards.”  

“These problems stem in part from the fact that decisions about care are handled by a committee of persons made up by some people who have no medical training at all and others, who while they have had medical training, have admitted that they are not qualified to provide care to persons with gender dysphoria,” said John Knight, director of the LGBTQ & HIV Project at the ACLU of Illinois. “No other committee exists to decide about medical care for any other medical conditions.”  

“Taken together, the records in this case form a clear pattern: IDOC, through the GID Committee, fundamentally misunderstands the serious medical condition of Gender Dysphoria, and lacks expertise and understanding to provide effective care. The care that is provided falls well outside the range of acceptable treatment, and puts patients’ health in serious danger,” wrote one of the experts, Dr. Randi Ettner, a nationally renowned expert in the field.

The expert testimony details the ways in which prisoners who are transgender suffer extreme harms due to the outright denial of care related to gender dysphoria, inordinate delays in the administration of care when it is provided at all, and systemic failure to follow prevailing medical standards for the treatment of this serious medical condition. The IDOC put these decisions in the hands the GID Committee, who are not specialists in the treatment of gender dysphoria and typically have never examined or even seen or met the prisoners they vote upon. Yet they still make final decisions on hormone therapy, clothing, and housing.

“None of the named plaintiffs has received even a baseline of medical care adequate to alleviate their gender dysphoria. The care, and specifically the hormone therapy, administered by IDOC personnel is grossly inadequate in a number of ways and constitutes a severe departure from guidelines widely accepted by medical professionals in the field for treating patients with gender dysphoria. Not only does this poor treatment fail to treat plaintiffs’ gender dysphoria, it puts their lives at risk,” wrote the other expert Dr. Vin Tangpricha. “Delays of months, or in some cases over a year, in hormone therapy are completely unjustified.”

Even when prisoners are provided hormones, they are often prescribed the wrong type, given inadequate dosages, and inadequately monitored. Social transition and surgery – necessary treatments for some people with gender dysphoria – are also routinely denied for non-medical reasons and women who are transgender are placed in male prisons as a matter of course in contravention of medical recommendations and prevailing legal standards. 

“The expert testimony submitted today illustrates how self-harm and suicide can be significantly diminished with prompt and effective treatment,” added Jordan Heinz, one of the other attorneys for plaintiffs. “Meaningful reform is needed now and the IDOC must act quickly to ensure that all transgender prisoners with gender dysphoria are provided the necessary medical treatment they deserve.”    

In addition to Mr. Knight, Ghirlandi Guidetti, and Carolyn Wald of the ACLU of Illinois, the plaintiffs are represented by Catherine L. Fitzpatrick, Jordan M. Heinz, Erica B. Zolner, Megan M. New, Scott Lerner, Austin B. Stephenson, Sydney L. Schneider, Sam G. Rose, and Cameron Custard of the Chicago office of Kirkland & Ellis LLP. 

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