Questions and Answers
Q: Why did the ACLU file this lawsuit?
A: The ACLU works to defend the Constitution and the basic human dignity of those whom the government detains against their will. The State of Illinois is responsible for providing adequate medical and mental health care for people in the custody of the Department of Corrections. Medical care for people held by the state is required by the United States Constitution, good public policy, and responsive to a basic human need. The State has been failing its responsibility to prisoners in Illinois for many years, including to transgender prisoners who face extreme suffering and other negative health outcomes as a result of being denied basic health care.
Q: What kind of medical care are you talking about here?
A: Many transgender individuals, including those in prison, have a medical condition that causes distress stemming from a mismatch between the person’s core understanding of their gender (“gender identity”) and their assigned gender. This condition is known as gender dysphoria and is recognized as a serious medical condition by the medical and scientific communities. If untreated or inadequately treated, gender dysphoria can lead to severe mental anguish, self-harm or suicide. Treatment for gender dysphoria can include social transition (living, dressing, and presenting oneself in a manner consistent with a person’s gender), hormone therapy, and surgery, among other forms of treatment.
Q: What is wrong with the medical care IDOC provides to transgender people?
A: There are three types of problems that transgender prisoners face, all of which cause can result in extreme distress and which place these individuals at risk of serious harm, including death:
- Transgender prisoners face exceedingly long delays in getting care and these delays are based on administrative barriers and other non-medical reasons. For example, Sasha Reed was forced to wait sixteen months from when she told a mental health professional at Menard that she is transgender and needed hormone therapy until IDOC finally began providing her with the treatment. Janiah Monroe was denied hormone therapy for close to three years despite being repeatedly diagnosed with gender dysphoria by prison medical staff. And even though both Sasha and Janiah are finally receiving hormone therapy, their treatment for gender dysphoria continues to be seriously deficient.
- When transgender prisoners received medical treatment at all, it is woefully inadequate and inconsistent with the standards of care for treating transgender persons. Transgender prisoners are routinely provided the wrong kinds of hormone therapy or inadequate dosages, and are not receiving hormone level monitoring. In addition, transgender prisoners are uniformly denied surgical treatment and clothing and grooming items consistent with the prisoner’s gender, which are necessary for social transition. These treatments, which are medically necessary treatments for many transgender people, are withheld for non-medical reasons.
- Prison medical staff are inadequately trained in how to treat transgender prisoners’ medical needs. IDOC staff are not qualified to treat gender dysphoria, have demonstrated a complete lack of understanding of the condition, consistently misgender transgender prisoners, and misdiagnose the condition and order treatment that is inappropriate for it.
Q: Who decides what kind of medical care a prisoner gets?
A: Prison medical staff decide what kind of care prisoners are provided in the first instance. In Illinois, the vast majority of the medical and mental health staff who initially make these decisions work for a private for-profit company hired by IDOC to provide health care to prisoners. However, when a prison has violated prisoners’ right to adequate medical care, a court may intervene.
Q: You have complained about the GID treatment committee that oversees medical care for transgender prisoners. What is wrong with having such a committee?
A: This committee has not facilitated or improved the care transgender prisoners receive, but often stands in the way of prisoners receiving even the minimal care being ordered by the prisoners’ actual treatment providers. Like the treatment providers, the committee is made up of people who are not qualified to diagnose and treat gender dysphoria. As a result, the committee sometimes overrides the recommendations of the treatment providers and regularly causes additional delay in transgender prisoners receiving any care at all, causing additional suffering for these prisoners.
Q: What about medical care for people who are not transgender? Do they get good medical care?
A: No. Unfortunately, many non-transgender prisoners are denied the medical care they need. That is why the ACLU has another lawsuit Lippert v. Baldwin challenging the widespread, systematic deficiencies in the provision of medical and dental care that can affect everyone in the system. But Lippert focuses on the larger systemic problems in IDOC’s delivery of medical care, in general, rather than the specific inadequacies in the medical and mental health care provided to transgender prisoners with gender dysphoria.
Q: Why should people in prison get good medical care when so many people outside of prison don’t get good care?
A: Everyone should be provided decent health care. The U.S. Constitution requires that the government provide medical care for the people it puts in prison since by virtue of incarceration, we take away the ability for people to seek care for themselves. If we did not provide prisoners with basic health care, they would suffer and die, and this is simply not compatible with our constitutional norms. Treatment for gender dysphoria is essential medical care comparable to treatment provided for other serious medical conditions, not cosmetic or elective.
There is no universal constitutional right to medical care for people who are not in state custody, no matter how serious the need.
As a policy matter, it is beneficial to society as a whole to treat prisoners with health care and other basic survival needs. Studies also make clear that providing quality health care in prison can reduce recidivism and improve public health – since prisoners will eventually leave prison and re-enter our communities. This is an investment in our communities.
Q: You say that this is a class action lawsuit: what does that mean?
A: The people the ACLU represents in this case are seeking relief not only for themselves, but for other transgender prisoners who need medical care to treat their gender dysphoria.
Q: How many transgender people are there in Illinois prisons who need medical treatment for gender dysphoria?
A: In the preparation of this lawsuit, we have spoken to and met with dozens of transgender prisoners with gender dysphoria in state custody who are not receiving constitutionally adequate health care. At any given time, we estimate that there are at least 50 prisoners in Department of Corrections’ custody who have been diagnosed with gender dysphoria and probably many more who have sought treatment for the condition but not received it.
Q: Why are there transgender people in prison?
A: Our country incarcerates more people than any other nation in the world, particularly people of color and people living in poverty. Illinois is no different, housing 43,000 prisoners in a system built to house 32,000 because of a criminal justice system that can only be described as broken. There can be many reasons why transgender people end up in prison. Unfortunately, the discrimination transgender people experience leads to disproportionate poverty. People living in poverty are more likely to face criminalization and to rely on criminalized economies to survive. Our clients, like many other people, have made decisions that they later regret and in some cases, those decisions resulted in their arrest and incarceration. When we punish people through incarceration, we do not as a society take away people’s basic humanity and constitutional protections. All people in prison are entitled to receive the medical care they need.
Q: What is the legal basis for this lawsuit?
A: This case is brought because Illinois is violating the Eighth Amendment to the U.S. Constitution, which prohibits Cruel and Unusual Punishment. Courts have held that this prohibition requires the state to provide adequate medical care to prisoners.
Q: What do these prisoners and the ACLU hope to get out of this lawsuit?
A: This case seeks an order from the judge declaring that the Illinois prisons are violating the Constitutional rights of the plaintiffs and others like them and order those prisons to remedy the inadequacies in the medical care they are currently providing.
Q: Are there other states that provide the kind of medical care you are seeking here?
A: Yes, prison systems in other states, such as California and New York, as well as the federal bureau of prisons and many local jails, provide more appropriate and comprehensive medical care than what Illinois currently provides.. Many states have serious problems with the quality of care they are providing, including Illinois, which has a long way to go to address the suffering it is causing prisoners who are transgender.