Lynch v. LEWIS et al
ORDER granting in part and denying in part 34 Motion to Dismiss for Failure to State a Claim; granting in part and denying in part 53 Motion to Dismiss for Failure to State a Claim; adopting 66 Report and Recommendations. Ordered by U.S. District Judge HUGH LAWSON on 3/23/2015 (aks)
IN THE UNITED STATES DISTRICT COURT
FOR THE MIDDLE DISTRICT OF GEORGIA
CHRISTOPHER A. LYNCH,
Civil Action No. 7:14-CV-24 (HL)
SHARON LEWIS, M.D. and
BILLY NICHOLS, M.D.,
This case is before the Court on a Recommendation from United States
Magistrate Judge Thomas Q. Langstaff. (Doc. 66). Judge Langstaff recommends
granting Plaintiff’s Motion for Reconsideration (Doc. 42); granting Plaintiff’s
motion to clarify the allegations set forth in his Complaint but denying his Motion
to Amend (Doc. 47); denying Plaintiff’s Motion for Appointment of Counsel (Doc.
62); and granting in part and denying in part Defendants’ motions to dismiss
(Docs. 34, 53). Specifically, Judge Langstaff recommends that Defendants’
motions to dismiss Plaintiff’s official capacity money damages claims and
conspiracy claims be granted. However, Judge Langstaff opines that Plaintiff has
met the pleading requirements for his Eighth Amendment claims of deliberate
indifference by Defendants in their refusal to provide Plaintiff with necessary
treatment for his gender identity disorder (“GID”) and that Defendants’ motions to
dismiss these claims should be denied.
Defendants filed timely objections to the recommendation. Defendants
object only to those portions of the recommendation denying their motions to
dismiss and take no issue with the dismissal of Plaintiff’s official capacity and
Plaintiff Christopher, a/k/a “Christina”, Lynch identifies himself in his
Complaint as a 22-year old transsexual female with a gender identity disorder
(“GID”). Plaintiff states that since the age of 9 he has dressed and presented
himself to the world as a female. He has also been employed as a female.
Beginning at age 15, Plaintiff began self-prescribing female hormones that he
admittedly acquired illicitly. At age 16, he was hospitalized following a suicide
attempt after a teacher told him that he would never be a girl. (Doc. 1-2, p. 4).
Plaintiff has been incarcerated since age 19. Upon entering the prison
system, Plaintiff no longer had access to the female hormones he had been
taking prior to commencing his prison term in 2012, though he states that he
attempted to continue self-medicating through the purchase of “hormones from
inmates whom [sic] had prescriptions from non-prison physicians.” (Doc. 1-2, p.
2). He began seeking treatment for her transsexualism while confined at Johnson
State Prison, where he received an unofficial diagnosis of GID from psychiatrist
Dr. McKinnon. Plaintiff alleges that when he arrived at Valdosta State Prison on
July 23, 2013, he again notified prison officials of his GID and began seeking an
official diagnosis and treatment for the condition, including hormone therapy.
Plaintiff spoke both with counselors and facility physician Dr. Raymond Moody
about the physical and mental symptoms she was experiencing as a result of the
discontinuation of his self-prescribed hormone therapy. He described feelings of
nausea, dizziness, acid reflux, headaches, and vomiting. Plaintiff further reported
his depression, anxiety, lethargy, and preoccupation with genital mutilation and
self-castration. He also revealed that he cut his wrist and his arm.
On August 5, 2013, Plaintiff filed a grievance alleging denial of treatment
for his GID. On August 9, 2013, Dr. Moody informed him that Defendants Sharon
Lewis, Medical Director for the Georgia Department of Corrections, and Billy
Nichols, State Medical Director for Georgia Correctional Health Care, determined
that Plaintiff did not meet the requirements to be treated for his GID based on
S.O.P. VH47-0006, a policy Plaintiff states “makes arbitrary distinctions between
transsexuals that have been treated prior to incarceration and transsexuals that
have not.” (Doc. 1, p. 6). Dr. Moody confirmed again on August 15, 2013 the
decision of Defendants not to provide Plaintiff treatment. Plaintiff maintains that
“Mental Health Counselor DeWese and psychologist Dr. Harrison attempted to
argue on my behalf . . . but to no avail.” (Doc. 1, p. 7).
Plaintiff alleges that on August 20, 2013, he wrote a four-page letter to
both Defendants. (Doc. 1-1, pp. 8-22). In her letters, he “beseeched them to
provide care, to at least make their decision based upon sound medical judgment
rather then [sic] policy.” (Doc. 1, p. 7). He wrote to Defendants again on
September 26, 2013. (Doc. 1-1, pp. 17-18). Defendant Lewis appears to have
authored a response to Plaintiff’s continued grievance on November 20, 2013,
concluding “that medical personnel handled this case appropriately and no
further action is warranted.” (Doc. 1-1, p. 3; Doc. 28-1).
Plaintiff continues to seek medical treatment for his GID. Plaintiff attached
medical records from October 2013 to his Complaint reflecting a diagnosis of
GID. (Doc. 1, pp. 14-16). The records further note that Plaintiff suffers “significant
distress associated with incongruence between natal gender and experienced
gender, persistent desire to be rid of male sexual characteristics and with preincarceration intervention (self-administered hormone therapy and surgical
alteration 2d characteristics).” (Doc. 1, p. 14). He reports a “[d]esire to live as the
other sex, persistent discomfort and sense of inappropriateness in gender role of
male, preoccupation with ridding self of sexual characteristics of male, significant
stress and impairment in multiple areas of functioning.” (Doc.1, p. 15).
Plaintiff avers that the American Medical Association has articulated that
the appropriate standard of care for GID is hormone therapy and surgery. He
notes that while psychotherapy is an acknowledged instrument to monitor the
mental welfare of a transsexual patient, it generally is not considered treatment
for GID. He further articulates that the Harry Benjamin Standards of Care
published by the World Professional Association for Transgender Health
(“WPATH”) should be applied and that Defendants’ failure to abide by the
recognized standard of care “disregarded my needs and disregarded degrees of
contemporary care with callous and deliberate indifference; not even bothering
with the pretense of caring or offering a less effective remedy.” (Doc. 1, p. 8). As
a result, he has resorted to self-mutilation of his wrist, arm, thigh and genitals, is
experiencing severe depression, insomnia, and an immeasurable increase of
manic-anxiety, psychological breakdowns, self-loathing, and a desire to be rid of
his facial hair and other male characteristics . (Doc. 1, p. 8).
STANDARD OF REVIEW
Pursuant to 28 U.S.C. § 636(b)(1),
within fourteen (14) days of the
magistrate judge’s report and recommendation, a party may submit written
objections to the recommendation. The district court then shall conduct a de novo
review of the portions of the recommendation to which the party objects. Id.; see
also LoConte v. Dugger, 847 F.2d 745, 750 (11th Cir. 1988). The court may
accept, reject, or modify the findings or recommendations of the magistrate. Id.
Defendants object to the magistrate’s recommendation on three grounds.
First, Defendants reiterate their contention that Plaintiff has failed to state a claim
for an Eighth Amendment violation for deliberate indifference as he has not
alleged that Defendants had knowledge of a serious risk of harm posed to
Plaintiff in failing to provide him treatment for his GID. Next, Defendants maintain
that the magistrate erred in determining that Defendants are not entitled to
qualified immunity. Finally, Defendants object to the magistrate’s finding that
dismissal of Plaintiff’s claim for injunctive relief would be premature.
Eighth Amendment Claims
Defendants argue that the magistrate erred in determining that Plaintiff
adequately articulated a cognizable Eighth Amendment claim for deliberate
indifference. According to Defendants, Plaintiff has failed to demonstrate
Defendants’ subjective knowledge that he faced a risk of serious harm if not
prescribed treatment, including hormone therapy, and, even assuming that GID
is a serious medical need, his conclusory allegations that Defendants failed to
exercise sound medical judgment in denying his request for hormone therapy do
not meet the requirements for a claim of deliberate indifference.
To avoid dismissal under Federal Rule of Civil Procedure 12(b)(6), “a
complaint must contain sufficient factual matter, accepted as true, to ‘state a
claim for relief that is plausible on its face.’” Ashcroft v. Iqbal, 556 U.S. 662, 678
(2009) (quoting Bell Atl. Corp. v. Twombly, 550 U.S. 544, 570 (2007)). The court
shall accept “all well-pleaded facts . . . as true, and the reasonable inferences
therefrom are construed in the light most favorable to the plaintiff.” Bryant v.
Avado Brands, Inc., 187 F.3d 1271, 1273 n. 1 (11th Cir. 1999). The plaintiff is
required to plead “factual content that allows the court to draw the reasonable
inference that the defendant is liable for the misconduct alleged.” Id. While there
is no probability requirement at the pleading stage, “something beyond . . . mere
possibility . . . must be alleged.” Twombly, 550 U.S. at 557 (citing Dura Pharm.,
Inc. v. Broudo, 544 U.S. 336, 347 (2005)). This standard “calls for enough fact to
raise a reasonable expectation that discovery will reveal evidence” of the
defendant’s liability. Id. at 556. Rule 12(b)(6) does not permit dismissal of a
complaint “simply because ‘it strikes a savvy judge that actual proof of those
facts is improbable.’” Watts v. Fla. Int’l Univ., 495 F.3d 1289, 1295 (11th Cir.
2007) (quoting Twombly, 550 U.S. at 556).
While there is no Eighth Amendment guarantee for any particular type of
medical treatment, it is well established that the prison must provide
constitutionally adequate treatment. See Estelle v. Gamble, 429 U.S. 97, 103-06
(1976). A prison official’s “deliberate indifference to a serious medical need” 1
Defendants, without conceding, do not object to the presumption that GID
constitutes a serious medical need for the purposes of the pending motions to
dismiss. (Doc. 34-1, p. 8). However, as noted by the magistrate in his
recommendation, other courts have acknowledged or assumed that GID can be
a serious medical need for purposes of an Eighth Amendment deliberate
indifference claim. See Kothman v. Rosario, 558 F. App’x. 907 (11th Cir. 2014)
(recognizing GID as a serious medical need); White v. Farrier, 849 F.2d 322 (8th
Cir. 1988) (acknowledging that transsexualism is a serious medical condition);
Praylor v. Texas Dep’t. of Criminal Justice, 430 F.3d 1208 (5th Cir. 2005)
(assuming without deciding that transsexualism does present a serious medical
need); Phillips v. Michigan Dep’t. of Corr., 731 F.Supp. 792 (W.D.Mich. 1990),
violates the Eighth Amendment. Id. at 106. To survive a motion to dismiss, a
plaintiff must demonstrate “that a defendant (1) had ‘subjective knowledge of a
risk of serious harm,” (2) disregarded that risk, and (3) did so by conduct that was
more than mere negligence.” Kothman v. Rosario, 558 Fed. App’x 907, 910 (11th
Cir. 2014) (quoting McElligott v. Foley, 182 F.3d 1248, 1255 (11th Cir. 1999));
see also Lancaster v. Monroe Cnty., 116 F.3d 1419, 1425 (11th Cir. 1997) (“[A]n
official acts with deliberate indifference when he knows that an inmate is in
serious need of medical care, but he fails or refuses to obtain medical treatment
for the inmate.”).
Defendants object to the magistrate’s conclusion that Plaintiff pled
sufficient facts to establish Defendants’ subjective knowledge of Plaintiff’s GID
condition and knew that the treatment requested by Plaintiff was medically
necessary. According to Defendants, there is no evidence that Defendants
reviewed or had knowledge of any of the medical records, grievances, or letters
attached to Plaintiff’s Complaint, and, even if Defendants were aware of any of
these documents, the records themselves do not show that hormone therapy is
medically necessary, that Plaintiff faced a risk of serious harm in the absence of
affirmed, 932 F.2d 969 (6th Cir. 1991) (transsexualism is a serious medical need
for purposes of the Eighth Amendment); Fields v. Smith, 653 F.3d 550 (7th Cir.
2011) (plaintiff suffered from a serious medical need in the form of GID;
defendants conceded that GID is a serious medical condition); Meriweather v.
Faulkner, 821 F.2d 408 (7th Cir. 1987) (transsexualism is a serious medical
need); Howard v. Green, 2011 WL 4969599 (M.D.Ga. 2011) (CHW), adopted in
2011 WL 4975852 (court assumes for purposes of a motion to dismiss that GID
is a serious medical need).
hormone therapy, or that any proposed intervention strategy by the prison
physicians is inadequate to avoid substantial risk of harm. Additionally,
Defendants call into question the magistrate’s reliance on the Plaintiff’s reference
to noted standards of treatment for GID issued by WPATH and the American
Medical Association in support of the conclusion that these particular standards
demonstrate Defendants’ subjective knowledge of the standards and the medical
necessity of the particular treatment requested by Plaintiff.
The Court’s review of the case is restricted to the facts as alleged in
Plaintiff’s Complaint. See Erickson v. Pardus, 551 U.S. 89 (2007). Here, Plaintiff
alleges that (1) he has a GID; (2) Defendants were aware of Plaintiff’s GID
diagnosis, past use of hormones, and his medical need to continue hormone
treatments; (3) Plaintiff has attempted to harm himself as a result of the denial of
treatment and is at risk of serious future harm without treatment; (4) the medical
community recognizes hormone therapy as an appropriate treatment for GID;
and (5) Defendants knowingly refused to provide Plaintiff with the medically
necessary hormone treatment. At this stage, the Court is not called upon to
determine whether hormone therapy is, indeed, medically necessary to treat
Plaintiff’s condition or whether Plaintiff even has a constitutional right to request
this specific type of treatment for his GID, nor is the Court in a position to
determine whether Defendants actually knew that hormone therapy is medically
necessary for this particular Plaintiff. Rather, the Court must only determine
whether based on the four corners of the Complaint Plaintiff alleged sufficient
facts that, taken as true, set the groundwork for a plausible claim of deliberate
indifference for failure to treat Plaintiff for GID. The Court agrees with the
magistrate judge that Plaintiff has satisfied that requirement and overrules
Defendants next object to the magistrate’s finding that Defendants are not
entitled to qualified immunity and assert that the magistrate applied too general a
standard. “[Q]ualified immunity protects government officials from liability for civil
damages insofar as their conduct does not violate clearly established statutory or
constitutional rights of which a reasonable person would have known.” Pearson
v. Callahan, 555 U.S. 223, 231 (2009). The Supreme Court has established a
two-part inquiry for qualified immunity. “The threshold inquiry a court must
undertake in a qualified immunity analysis is whether plaintiff’s allegations, if true,
establish a constitutional violation.” Hope v. Pelzer, 536 U.S. 730 (2002). “If a
constitutional right would have been violated under the plaintiff’s version of the
facts, ‘the next, sequential step is to ask whether the right was clearly
established.’” Vinyard v. Wilson, 311 F.3d 1340, 1346 (11th Cir. 2002) (quoting
Saucier v. Katz, 533 U.S. 194, 201 (2001)).
Accepting the allegations set forth in Plaintiff’s Complaint as true, Plaintiff
has established an Eighth Amendment claim for deliberate indifference. Plaintiff
alleges that he has been denied hormone therapy, which he claims is medically
necessary to treat his GID and which he alleges Defendants knew was the
appropriate treatment for his condition. The question now before the Court is
whether there is a clearly established constitutional right to receive medically
necessary treatment and whether denial of that right amounts to deliberate
Defendants urge the Court to narrow the focus of the qualified immunity
analysis to address specifically whether there is a clearly established right to
receive hormone therapy. As discussed above, at the motion to dismiss stage,
the Court is not deciding whether the particular treatment requested by Plaintiff
legitimately is medically necessary to treat his disorder or whether he has a right
to demand a specific course of treatment. Rather, the Court shall only address
whether the law of this circuit recognizes that refusal to provide medically
necessary treatment constitutes deliberate indifference and violates the Eighth
Amendment. The Court finds that principle to be well established in the Eleventh
Circuit. See H.C. v. Jarrard, 786 F.2d 1080, 1086 (11th Cir. 1986); Ancata v.
Prison Health Servs., Inc., 769 F.2d 700, 704 (11th Cir. 1985) (“The knowledge
of the need for medical care has consistently been held to surpass negligence
and constitute deliberate indifference.”). Accordingly, the Court affirms the
magistrate’s recommendation and overrules Defendants objection.
In their motions to dismiss Defendants assert that Plaintiff’s claim for
injunctive relief is overly broad and that Plaintiff cannot recover monetary or
nominal damages under § 1983 without allegations of more than a de minimis
physical injury. The magistrate denied Defendants’ motion on this basis, finding
that “any restriction or elimination of the injunctive relief sought by Plaintiff would
be premature at this point.” (Doc. 66, p. 13). The Court agrees and rejects
Defendants’ generalized objection.
Accordingly, after conducting a de novo review, the Court overrules
Plaintiff’s objections. The Court accepts and adopts the Recommendation and
grants in part and denies in part Defendants’ motions to dismiss.
SO ORDERED, this 23rd day of March, 2015.
s/ Hugh Lawson______________
HUGH LAWSON, SENIOR JUDGE
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