Lamb v. Norwood

FILED
United States Court of Appeals
PUBLISH Tenth Circuit
UNITED STATES COURT OF APPEALS July 9, 2018
Elisabeth A. Shumaker
FOR THE TENTH CIRCUIT Clerk of Court
_________________________________
MICHELLE RENEE LAMB, a/k/a
Thomas Lamb,
Plaintiff - Appellant,
No. 17-3171
v.
JOE NORWOOD; JOHNNIE
GODDARD; PAUL CORBIER;
KANSAS DEPARTMENT OF
CORRECTIONS; CORIZON
HEALTH SERVICES,
Defendants - Appellees.
_________________________________
Appeal from the United States District Court
for the District of Kansas
(D.C. No. 5:16-CV-03077-EFM-DJW)
_________________________________
Submitted on the briefs * :
Michelle Renee Lamb a/k/a Thomas Lamb, pro se.
Dwight R. Carswell, Assistant Solicitor General, Bryan C. Clark, Assistant
Solicitor General, and Rachael D. Longhofer, Assistant Attorney General,
Office of Attorney General for the State of Kansas, Topeka, Kansas, for
Defendants–Appellees Joe Norwood, Johnnie Goddard, and the Kansas
Department of Corrections; Casey L. Walker and Trevin Erik Wray,
*
The parties have not requested oral argument, and it would not
materially aid our consideration of the appeal. See Fed. R. App. P.
34(a)(2)(C); 10th Cir. R. 34.1(G). Thus, we have decided the appeal based
on the briefs.
Simpson, Logback, Lynch, Norris, P.A., Overland Park, Kansas, for
Defendant–Appellee Paul Corbier; and Jeffrey T. Donoho and Roger W.
Slead, Horn Aylward & Bandy, LLC, Kansas City, Missouri, for
Defendant–Appellee Corizon Health Services.
_________________________________
Before BACHARACH, McKAY, and BALDOCK, Circuit Judges.
_________________________________
BACHARACH, Circuit Judge.
_________________________________
Michelle Renee Lamb was born a male. From a young age, however,
Michelle displayed feminine characteristics and identified as a female.
Michelle is now in state prison and is experiencing gender dysphoria. For
this condition, she is receiving medical treatment, though she claims that
the treatment is so poor that it violates the Eighth Amendment. For this
claim, Michelle must show that prison officials have acted with deliberate
indifference to her gender dysphoria. 1
The undisputed evidence shows that Michelle is receiving hormone
treatment, testosterone-blocking medication, and weekly counseling
sessions. A 1986 precedent, Supre v. Ricketts, 752 F.2d 958
(10th Cir. 1986), suggests that these forms of treatment would preclude
liability for an Eighth Amendment violation. Based partly on this
precedent, the district court granted summary judgment to the prison
1
See Perkins v. Kan. Dep’t of Corrs., 165 F.3d 803, 811 (10th Cir.
1999).
2
officials. Michelle challenges the grant of summary judgment, and we
affirm.
1. What is gender dysphoria and how is it treated?
To address Michelle’s appeal, we must consider what gender
dysphoria is and consider the available forms of treatment. The term
“[g]ender dysphoria describes the psychological distress caused by
identifying with the sex opposite to the one assigned at birth.” 2 Treatment
forms currently include
 [c]hanges in gender expression and role (which may
involve living part time or full time in another
gender role, consistent with one’s gender identity);
 [h]ormone therapy to feminize or masculinize the
body;
 [s]urgery to change primary and/or secondary sex
characteristics (e.g., breasts/chest, external and/or
internal genitalia, facial features, body contouring);
 [p]sychotherapy (individual, family, or group) for
purposes such as exploring gender identity, role,
and expression; addressing the negative impact of
gender dysphoria and stigma on mental health;
alleviating internalized transphobia; enhancing
social and peer support; improving body image; and
promoting resilience. 3
2
Sven C. Mueller, et al., Transgender Research in the 21st Century: A
Selective Critical Review from a Neurocognitive Perspective, 174 Am. J.
Psychiatry 1155, 1155 (2017).
3
E. Coleman et al., Standards of Care for the Health of Transsexual,
Transgender, & Gender-Nonconforming People, Version 7, 13 Int’l J.
(continued)
3
2. What are the applicable legal tests?
To determine whether the prison’s treatment for Michelle’s gender
dysphoria was constitutionally adequate, we consider the constitutional
test, the standard for summary judgment, and our standard of review.
The Eighth Amendment prohibits officials from acting with
deliberate indifference to a prisoner’s serious medical need. 4 The
seriousness of Michelle’s medical need is uncontested for purposes of
summary judgment. Thus, the only substantive issue is whether the existing
treatment constituted deliberate indifference to Michelle’s gender
dysphoria.
This issue arose in summary judgment proceedings. To obtain
summary judgment, the prison officials needed to show the absence of a
genuine dispute of material fact and their entitlement to judgment as a
matter of law. 5 In considering the district court’s application of the
summary judgment test, we engage in de novo review. 6
Transgenderism 165, 171 (2011); see R., Doc. 43-1 (Decl. of Dr. Randi C.
Ettner at 5–6 ¶ 23).
4
Perkins v. Kan. Dep’t of Corrs., 165 F.3d 803, 811 (10th Cir. 1999).
5
Fed. R. Civ. P. 56(a).
6
Rife v. Okla. Dep’t of Pub. Safety, 854 F.3d 637, 643 (10th Cir.),
cert. denied, 138 S. Ct. 364 (2017).
4
3. What does our 1986 precedent say?
As noted above, we addressed a similar issue in 1986, when we
issued Supre v. Ricketts, 792 F.2d 958 (10th Cir. 1986). 7 There an inmate
with gender dysphoria claimed violation of the Eighth Amendment based
on a refusal to provide estrogen therapy. We concluded that the treatment
did not violate the Eighth Amendment, reasoning that the state’s
department of corrections had made an informed judgment about treatment
options in the face of disagreement within the medical community. 8
4. Do subsequent medical advances render Supre obsolete?
Strictly speaking, Supre does not answer our question. There the
claim involved denial of estrogen therapy, and Michelle is not complaining
about a lack of estrogen therapy. She wants other forms of treatment,
including greater doses of hormones and authorization for surgery. But if
the Eighth Amendment was not violated by the denial of estrogen therapy,
it stands to reason that Michelle’s current treatment methods do not
constitute deliberate indifference.
Michelle’s rejoinder is that Supre is too old to provide guidance
because it rested on outdated medical assumptions. As Michelle points out,
7
Less than two months before issuance of the opinion in Supre,
Michelle lost a similar suit on summary judgment. Lamb v. Maschner, 633
F. Supp. 351 (D. Kan. 1986).
8
Supre, 792 F.2d at 963.
5
science has advanced since 1986, resulting in new forms of treatment for
gender dysphoria. 9 With the availability of these new treatment forms, we
must ask: Do scientific advances in treating gender dysphoria render our
1986 precedent obsolete? We think not. Panels in our court are typically
bound by precedents issued by other panels, 10 and we typically do not
reconsider the medical assumptions underlying our precedents. 11
But even if we were to reconsider our earlier medical assumptions,
Supre would continue to provide our analytical framework. As noted
above, Supre addressed an inmate’s unsuccessful effort to obtain estrogen
therapy, with the Court concluding that the inmate had not proven
deliberate indifference through conflicting medical opinions as to the need
for estrogen therapy. 12
9
See Tim C. van de Grift et al., Surgical Satisfaction, Quality of Life,
& Their Association After Gender-Affirming Surgery: A Follow-Up Study,
44 J. of Sex & Marital Therapy 138, 139 (2018) (“In the past decades,
(surgical) care for people diagnosed with gender dysphoria is increasingly
provided in specialized, interdisciplinary health-care facilities following
the Standards of Care.”)
10
See White v. Chafin, 862 F.3d 1065, 1067 (10th Cir. 2017).
11
See Alexander v. Whitman, 114 F.3d 1392, 1401 (3d Cir. 1997)
(“[N]o advance in technology or science can authorize us to depart from
well established legal precedent.”); see also Planned Parenthood of Se.
Penn. v. Casey, 505 U.S. 833, 860 (1992) (plurality opinion) (stating that
advances in maternal and neonatal health care had not affected the validity
of Roe v. Wade’s central holding).
12
Supre v. Ricketts, 792 F.2d 958, 963 (10th Cir. 1986).
6
Michelle does not complain about a lack of estrogen therapy. Instead,
she wants surgery and an increase in her dosage of hormones. But the
summary judgment record does not contain any evidence suggesting that
these are suitable treatment options for Michelle. And there is no
governing medical consensus on the appropriateness of the treatment
options that Michelle is requesting. 13 Thus, even if we were to reconsider
Supre’s assumptions, its analytical framework would govern here.
5. Does the existing treatment of Michelle constitute deliberate
indifference?
Under this analytical framework, we have consistently held that
prison officials do not act with deliberate indifference when they provide
medical treatment even if it is subpar or different from what the inmate
wants. 14 These holdings apply here because Michelle is obtaining
psychological counseling and hormone treatments, including estrogen and
testosterone-blocking medication. Though prison officials have not
13
See Jameson Rammell, Polarizing Procedures: Transsexual Inmates,
Sex Reassignment Surgery, and the Eighth Amendment, 50 J. Marshall L.
Rev. 747, 785 (2017) (stating that sex reassignment surgery “is a unique
procedure that has proven difficult to study, and the understanding of its
overall effectiveness and long-term ramifications is limited”); E. Coleman
et al., Standards of Care for the Health of Transsexual, Transgender, &
Gender-Nonconforming People, Version 7, 13 Int’l J. Transgenderism 165,
187 (2011) (“Hormone therapy must be individualized based on a patient’s
goals, the risk/benefit ratio of medications, the presence of other medical
conditions, and consideration of social and economic issues.”).
14
Perkins v. Kan. Dep’t of Corrs., 165 F.3d 803, 811 (10th Cir. 1999).
7
authorized surgery or the hormone dosages that Michelle wants, the
existing treatment precludes a reasonable fact-finder from inferring
deliberate indifference.
Paul Corbier, M.D. stated under oath that Michelle’s existing
treatment has proven beneficial and that surgery is impractical and
unnecessary in light of the availability and effectiveness of more
conservative therapies. Though Michelle disagrees with Dr. Corbier’s
opinion, the disagreement alone cannot create a reasonable inference of
deliberate indifference. And even if Dr. Corbier had been wrong, prison
officials could not have been deliberately indifferent by implementing the
course of treatment recommended by a licensed medical doctor like
Dr. Corbier. 15
Michelle questions Dr. Corbier’s opinion based on a case in Tax
Court, O’Donnabhain v. Commissioner of Internal Revenue, 134 T.C. 34
(T.C. 2010). There the Tax Court held that expenses for hormone therapy
and sex reassignment surgery constituted expenses for medical care,
triggering a deduction under the Tax Code. 16 But Tax Court opinions do not
15
See Kosilek v. Spencer, 774 F.3d 63, 91 (1st Cir. 2014) (stating that
even if sex reassignment surgery were the only medically adequate
treatment for gender identity disorder, an Eighth Amendment violation
would have taken place only if prison officials knew or should have known
this fact and failed to appropriately respond).
16
134 T.C. 77.
8
bind our court. And O’Donnabhain bears little relevance to our issue
because the prison officials have not questioned the medical nature of
hormone therapy or sex reassignment surgery. Instead, the prison officials
contend only that they could not have been deliberately indifferent by
providing hormone therapy and psychological counseling.
In our view, the summary judgment record precludes a reasonable
fact-finder from inferring deliberate indifference.
6. Did the district court erroneously restrict discovery?
Michelle also raises procedural challenges involving discovery.
These challenges stem from the district court’s order for an investigative
report.
Under the Prison Litigation Reform Act, the district court had to
screen the amended complaint to determine whether it was frivolous,
malicious, failed to state a claim on which relief could be granted, or
triggered the defendants’ immunities from monetary relief. 17 To facilitate
this screening process, district courts in our circuit frequently require
investigative reports and stay discovery until the filing of these reports.
The district court followed this process here, requiring an
investigative report and staying discovery until the report was filed. Prison
officials filed the report and sought summary judgment at the same time.
17
28 U.S.C. §§ 1915(e)(2)(B), 1915A(a)–(b); 42 U.S.C. § 1997e(c)(1).
9
With the filing of the report, the stay automatically terminated and
Michelle was free to conduct discovery.
One month later, the defendants moved to stay further discovery until
the district court ruled on the summary judgment motion. The motion for a
stay remained pending for roughly six months. During this period,
Michelle was free to conduct discovery. But she apparently thought that
the defendants’ motion for a stay automatically curtailed discovery. It
didn’t.
Michelle also seems to have misunderstood the impact of the
investigative report. The report concluded that Michelle’s treatment was
acceptable; Michelle disagreed and moved for an order requiring prison
officials to supplement the report with additional documentation. The
district court overruled this motion, and Michelle challenges this ruling.
We have little reason to question the ruling. The investigative
report’s function was to facilitate the district court’s screening process. 18
And on screening, the district court allowed the action to proceed.
When the defendants moved for summary judgment, the investigative
report served as the equivalent of an affidavit supporting the summary
18
See Rachel v. Troutt, 820 F.3d 390, 396 (10th Cir. 2016) (“Courts
order the [investigative] report not to provide discovery, but to aid in
screening the complaint.”).
10
judgment motion. 19 To rebut the investigative report, Michelle was free to
present her own evidence, including her own affidavit and material
obtained through discovery. Michelle did not need supplementation of the
investigative report to obtain such material. As a result, the district court
did not err in overruling Michelle’s motion to require supplementation of
the investigative report.
7. Conclusion
We conclude that no genuine issue of material fact exists. In light of
the prison’s treatment for Michelle’s gender dysphoria, no reasonable fact-
finder could infer deliberate indifference on the part of prison officials.
And the district court did not improperly curtail Michelle’s opportunity to
conduct discovery. Thus, we affirm the award of summary judgment to the
prison officials.
Judge Baldock concurs in the judgment only.
19
See Northington v. Jackson, 973 F.2d 1518, 1521 (10th Cir. 1992)
(stating that investigative reports are treated like affidavits when filed as
evidence supporting summary judgment motions).
11