Monroe et al v. Rauner et al

Filing 370

ORDER: Pursuant to Rule 53(b)(1), this Order serves as notice to the parties that a Monitor will be appointed. On or before 14 days from the date of this Order, each party shall submit to the Court and each other the names of up to 5 candidates for a ppointment as Monitor. On or before 21 days from the date of this Order, the parties shall submit any proposed modifications to the above summary of the Monitor's duties. See Order for additional details. Signed by Chief Judge Nancy J. Rosenstengel on 12/13/2021. (beb)

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IN THE UNITED STATES DISTRICT COURT
FOR THE SOUTHERN DISTRICT OF ILLINOIS
JANIAH MONROE, 1
MARILYN MELENDEZ,
LYDIA HELÉNA VISION,
SORA KUYKENDALL, and
SASHA REED, individually and on
behalf of a class of similarly situated
individuals,
Plaintiffs,
v.

Case No. 3:18-CV-00156-NJR

STEVE MEEKS,
MELVIN HINTON, and
ROB JEFFREYS,
Defendants.

MEMORANDUM AND ORDER
ROSENSTENGEL, Chief Judge:
Pursuant to Federal Rule of Civil Procedure 53 and 18 U.S.C. § 3626, the Court
gives notice to the parties of its intent to appoint a Special Master/Monitor (hereinafter
“Monitor”) 2 to oversee Defendants’ compliance with the Court’s Preliminary Injunctions
(Docs. 212, 332, 336), implementation of the Illinois Department of Corrections’ April 2021
revised Administrative Directives regarding transgender prisoners, and to assess and
advise the Court and the parties whether further revisions of Illinois Department of
Corrections (“IDOC”) policies and Administrative Directives are necessary in order to

The named Plaintiffs, and many members of the Plaintiff class, use chosen names reflecting their
gender identity rather than their given names at birth. Throughout this Order, the Court refers to
each Plaintiff by their chosen name, which may not match the name in IDOC records.
2
See 18 U.S.C. § 3626(g)(8).
1

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remedy the unconstitutional treatment of transgender prisoners in IDOC facilities. See
FED. R. CIV. P. 53(b)(1).
The Plaintiff class consists of all prisoners in the custody of IDOC who have
requested evaluation or treatment for gender dysphoria. (Doc. 213). Approximately 130
individuals have been identified as belonging to the class.
The Court’s initial preliminary injunction of December 19, 2019 (Docs. 186, 187,
amended on March 4, 2020 at Doc. 212) ordered Defendants to make and implement
several policy changes and conduct staff training to provide constitutionally adequate
evaluation and medical treatment of class members by qualified professionals, and
medically necessary social transitioning for inmates with gender dysphoria. (Doc. 212).
After a bench trial in August 2021, the Court found that Defendants had not
accomplished what the preliminary injunction ordered them to do over 19 months earlier,
and IDOC’s new Administrative Directives adopted in April 2021 in response to the
December 2019 injunction had not been fully implemented and had not resulted in
improved treatment and care of class members. (Doc. 331, p. 6). In sum, the Court
concluded that despite some progress, serious violations of the Eighth Amendment are
ongoing. The Court continued the first preliminary injunction (Doc. 212) and ordered
additional injunctive relief. (Docs. 331, 332, corrected at Doc. 336).
The August 9, 2021 preliminary injunction, among other requirements, set
timelines for Defendants to complete blood tests for class members on hormone therapy,
to adjust their medication where indicated and conduct regular testing, and to monitor
blood levels of potassium, creatinine, prolactin, and hemoglobin/hematocrit and give
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treatment as medically indicated. Class members who have requested gender affirming
surgery and who have appropriate hormone levels were to be evaluated for surgery
within 120 days, in chronological order according to the date the inmate originally
requested surgery. Transfer requests were likewise to be evaluated in chronological order
by that 120-day deadline, which fell on December 7, 2021. Defendants were ordered to
file under seal—within 60 days—a report on each class member’s hormone levels, status
of any transfer request, and status of any request for surgery. (Doc. 331, p. 13).
Gender affirming commissary items were to be made immediately available and
transgender inmates must immediately have access to a private shower. 3 Medical and
mental health treating professionals must have completed WPATH 4 training in order to
treat class members. Within 120 days of the order, Defendants were to finalize contracts
for outside surgical and hair removal services, as well as finalize and implement training
and certain policies/programs relating to transgender inmates. (Doc. 331, pp. 12-13;
Doc. 332, pp. 3-4).
The parties have now submitted post-trial briefing (Docs. 335, 346), Defendants
have filed their 60-Day Status Report (Sealed Doc. 357), and Plaintiffs have responded to
the Status Report (Sealed Doc. 359). On December 8, 2021, Defendants filed a 120-Day
Status Report outlining progress toward completion of the action items due by that
deadline. (Doc. 369).

The 30-day and 60-day status reports indicate Defendants have not fully complied with the
commissary and private shower directives. (Doc. 351; Doc. 359, p. 8).
4
World Professional Association for Transgender Health.
3

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Plaintiffs’ Post-Trial Brief (Doc. 355) presents cogent arguments for the
appointment of a Monitor, noting that IDOC had not adequately responded to the Court’s
December 2019 injunction, the revised Administrative Directive had not been
implemented and is not being fully followed by staff, and Defendants’ witnesses
admitted that they need but had not drafted—let alone implemented—a quality
assurance program to ensure that medical and mental health practitioners are providing
adequate care to class members and are following IDOC’s written policies. (Doc. 355,
pp. 20-28). Defendants oppose the appointment of a Monitor but are willing to consider
some of Plaintiffs’ proposals on policy changes. (Doc. 346).
In January 2021, when the Court denied Plaintiffs’ Renewed Request for
Appointment of an Independent Monitor, the Court accepted Defendants’ assurances of
their progress toward meeting the requirements of the initial December 2019 preliminary
injunction, despite some reservations about their compliance. (Doc. 246). The August
2021 trial testimony demonstrated, however, that Defendants had not made or
implemented the changes necessary to comply with the December 2019 injunction,
despite having an additional eight months to do so. This record underscores the need for
a Monitor to provide more intensive and regular oversight of Defendants’ actions to
comply with the Court’s Orders of December 2019 and August 2021.
The 120-Day Status Report demonstrates progress, but also reveals that
Defendants have not fully implemented the requirements of the August 2021 order. For
example, IDOC will deploy five body scanners “to ensure no cross-gender searches
occur.” (Doc. 369; Doc. 369-1). While these units should reduce the incidence of crossPage 4 of 16

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gender body searches, the scanners will be placed in only five prisons (Stateville, Logan,
Pontiac, Lawrence, and Menard), which together house approximately 60 transgender
prisoners, according to Defendants’ report filed in October 2021.5 (Sealed Doc. 357).
Approximately 90 members of the Plaintiff class are housed in 15 other prisons which
will not receive the scanners. Id. Defendants’ 120-day report does not address what steps
will be taken to ensure that class members’ choice of gender of the officer conducting a
body search will be honored in prisons that do not have a body scanner, in the event of a
breakdown of the scanner, or when officials determine that a physical strip search or body
cavity search is necessary. 6 And it is unclear when the units will be installed and
operational.
Based on the briefing and in particular the voluminous material in Defendants’ 60Day Status Report (Sealed Doc. 357), the Court concludes that the post-trial remedial
phase of this matter is sufficiently complex to exceed the Court’s ability to effectively and
timely evaluate the records to determine whether Defendants are making adequate
progress toward compliance with the Court’s orders. Defendants’ 60-day report includes
approximately 1,700 pages of documents regarding individual inmates’ hormone
treatment, laboratory test results and other medical/mental health records, and

Of these five prisons, Stateville does not house any transgender prisoners, according to
Defendants. (Sealed Doc. 357, p. 73).
6
The Court acknowledges that Defendants report they have finalized and implemented a
transgender identification policy, which will memorialize a prisoner’s gender identification
change and preference for gender of the officer conducting a search in the IDOC prisoner tracker
(Offender360). (Doc. 369-9). The gender identity status may or may not be displayed on the
individual’s ID card. No information has yet been provided regarding how this new system is
operating “on the ground” regarding body searches in the institutions housing transgender
prisoners.
5

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committee records on surgery and transfer requests. Plaintiffs point out that these
documents omit significant information that is necessary to determine, for example,
whether Defendants are taking sufficient steps to ensure that class members’ hormone
treatment is achieving therapeutic levels, or whether endocrinology referrals are
proceeding for the numerous class members who have elevated prolactin levels.
(Doc. 359). IDOC has completed evaluations of Plaintiff class members who have
requested gender-affirming surgery and transfers, but this process will be ongoing for
those whose requests were denied. The new Continuing Quality Improvement tool,
PRISM project, and training programs represent progress (Doc. 369, pp. 3-5), but
Defendants’ past track record on implementation of policy revisions raises concern over
when and how effectively these changes will be fully put into practice to produce tangible
results and improve conditions for the Plaintiff class. And by Defendants’ own
description, these changes are still in the beginning stages and not fully implemented.
The Court does not possess the resources or expertise to effectively and timely
evaluate this complex material or the additional information that will be required to
monitor compliance with the ordered injunctive relief, including implementation of new
policies, procedures, and programs, and concludes the appointment of a Monitor is
warranted. See 18 U.S.C. § 3626(f)(1)(B); FED. R. CIV. P. 53(a)(1)(C).
The parties’ briefs indicate that with continued effort, the parties may be able to
agree on meaningful revisions to policies and procedures that will result in improved
care and conditions for the Plaintiff class while addressing concerns raised by both sides.
In addition to monitoring compliance with the specific directives in the Court’s Orders,
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the Monitor will assist the parties in the development of remedial plans to achieve
compliance with the Court’s Orders, to include modifications of IDOC’s policies and
procedures regarding medical and mental health treatment, social transition, and related
accommodations for the Plaintiff class. See 18 U.S.C. § 3626(f)(6)(C); Docs. 212, 332, 336).
I. Duties of Monitor
A. Treatment for Gender Dysphoria—Hormone Therapy
The Monitor will review IDOC’s records relating to Plaintiff class members’
hormone therapy, including blood tests for hormone levels and levels of other substances
monitored for safety and efficacy of hormone treatment, to assess whether Defendants
are conducting blood tests at the intervals ordered in the Preliminary Injunction (at least
every three months for persons whose hormone levels were not within range or who just
started hormone therapy; and at least yearly for those whose hormone levels were
previously within range) (see Docs. 332, 336) and whether Defendants are responding
promptly and appropriately to those test results by titrating hormone dosages to reach
the appropriate ranges set for the by the Endocrine Society Hormone Guidelines, 7 and by
providing treatment/testing for any class members whose tests show blood levels of
prolactin, potassium, creatinine (for transgender women), or hemoglobin/hematocrit
(for transgender men) that indicate medical intervention is appropriate. 8
The Monitor shall assess whether Defendants are ensuring that all medical and
The Endocrine Society Hormone Guidelines set these blood level ranges for persons on hormone
therapy: for transgender females, testosterone of less than 50 nanograms/deciliter and estradiol
between 100-200 picograms/milliliter; for transgender males, testosterone levels between 400-600
nanograms/deciliter. (Doc. 336).
8
For example, an endocrinology referral and/or MRI test for elevated prolactin levels.
7

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mental health treatment of Plaintiff class members is rendered only by medical/mental
health professionals who have taken WPATH training and are committed to continuing
education on issues of transgender health, that class members have access to clinicians
who meet the competency requirements stated in the WPATH Standards of Care to treat
gender dysphoria, and that inmates are allowed to obtain evaluations for gender
dysphoria upon request or clinical indications of the condition. The Monitor shall assess
whether Defendants are ensuring that decisions about treatment for gender dysphoria
are made by medical professionals who are qualified to treat gender dysphoria, and that
providers who hold personal or religious beliefs that prohibit their treatment of inmates
with gender dysphoria have no contact with any member of the Plaintiff class. (Docs. 212,
332).
Defendants shall provide the Monitor and Plaintiffs’ counsel with all
medical/mental health records, reports, documents, data, and other information
necessary to conduct this monitoring, beginning with the materials filed under seal at
Doc. 357, to be supplemented at intervals of at least every three months or as determined
by the Monitor. Plaintiffs shall provide the Monitor with their responsive materials filed
under seal at Doc. 359. Medical/mental health information on Plaintiff class members
that is filed with the Court shall be filed under seal. Plaintiffs’ counsel shall keep this
material obtained from Defendants confidential (except that information on a particular
individual may be disclosed to that person only) and use it in this matter only.
The Monitor shall inform the Court and the parties whether Defendants are in
compliance, partial compliance, or not in compliance with the ordered injunctive relief,
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at the intervals set forth below and at such additional times as the Monitor finds
necessary.
B. Treatment for Gender Dysphoria—Gender Affirming Surgery
The Monitor will review IDOC’s records relating to Plaintiff class members’
requests for gender affirming surgery and assess whether Defendants are in compliance
with the ordered injunctive relief. (Doc. 332). Defendants were ordered to evaluate
requests for gender affirming surgery from class members whose hormone levels were
within the appropriate range, by December 7, 2021, in chronological order of the inmate’s
original surgery request; to provide written notification of the decision and explanation
of the reasons for any denial; and where denied, to inform the inmate of a timeframe to
request another evaluation. Defendants shall provide the Monitor and Plaintiffs’ counsel
with all records, reports, documents, data, and other information necessary to conduct
this monitoring. The Monitor shall inform the Court and the parties whether Defendants
are in compliance.
For any class members whose requests for surgery have been denied, Defendants
shall inform the Monitor, the Court, and Plaintiffs’ counsel of the date when each inmate
originally requested surgery, the reasons for the denials, and the timeline when the
inmates may request another evaluation.
The Monitor shall oversee the implementation of Defendants’ contracts,
arrangements, programs, and standards as follows: Contract with Wexford to provide
hair removal services to Plaintiff class members; contract/arrangement with Dr.

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Schechter 9 to provide gender affirming surgery to Plaintiff class members whose surgery
requests are approved; implementation of the CQI (Continuing Quality Improvement)
program for transgender care; and implementation of IDOC’s written surgical standards
for transgender care. (Doc. 332, pp. 3-4). The Monitor shall assess and report to the Court
and the parties whether surgery and related treatment is being provided to class
members in a timely manner relative to inmates’ requests.
C. Transfers and PRISM Project
The Monitor will review IDOC’s records relating to Plaintiff class members’
requests for transfer to a facility matching his or her expressed gender (female facility for
transgender women, male facility for transgender men) and assess whether Defendants
have complied with the ordered injunctive relief. (Doc. 332). Defendants were ordered to
evaluate class members’ transfer requests by December 7, 2021, in chronological order of
the inmate’s original transfer request, to provide the inmate with written explanation of
each reason for any denial, and to allow the inmate to request another evaluation for
transfer within 180 days after a denial. Defendants were also ordered to immediately
ensure that transgender inmates who remain in institutions not matching their expressed
gender are allowed access to a private shower. (Doc. 332). Defendants shall provide the
Monitor and Plaintiffs’ counsel with all records, reports, documents, data, and other
information necessary to conduct this monitoring. The Monitor shall inform the Court
The Court accepts Defendants’ clarification that no contract is necessary for Dr. Schechter to
provide gender affirming surgery to class members; he will perform such surgery as individual
patients are referred, at IDOC expense. IDOC did contract with Dr. Schechter to provide expert
surgical consulting to IDOC providers and education to class members regarding gender
affirming surgery. (Doc. 369, p. 3).
9

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and the parties whether Defendants are in compliance with the ordered relief.
For any class members whose transfer requests have been denied, Defendants
shall inform the Monitor, the Court, and Plaintiffs’ counsel of the date when each inmate
originally requested transfer, the date of denial and reasons for the denial, and whether
the inmate has been informed of the timeline when he or she may renew the transfer
request.
Defendants report they finalized the PRISM project (the special population
program) at Centralia Correctional Center by the deadline of December 7, 2021, but its
implementation is ongoing. The Monitor shall assess and report to the Court and the
parties regarding Defendants’ continued implementation of the PRISM program, which
involves additional inmate transfers, staff training, and may include up to 100 inmate
participants. (Doc. 332; Doc. 326, pp. 640, 648-49, 651; Doc. 369, pp. 3-4; Doc. 369-6).
D. Gender Affirming Commissary Items
On August 9, 2021, Defendants were ordered to immediately provide class
members with access to all approved gender affirming items (clothing and personal
care/hygiene items) in the commissary at each class member’s institution, and to
immediately provide class members with a list of available gender affirming items.
Defendants’ 30-day report to the Court indicated that not all commissary items were yet
available at each institution. (Doc. 332; Doc. 351). Defendants shall provide to the Monitor
and to Plaintiffs’ counsel the list of gender affirming items available at each institution
housing class members. The Monitor shall assess whether Defendants have complied
with the ordered relief and report any noncompliance to the parties and to the Court.
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E. Cross-Gender Searches and Transgender Identification Policy
Defendants were ordered to allow Plaintiff class members to choose the gender of
the correctional officer who will conduct a search of their person, and the search must be
conducted by an officer of the gender requested. (Doc. 332). Defendants were also
ordered to finalize and implement IDOC’s transgender identification policy by December
7, 2021; they report they have done so. (Doc. 369, p. 5; Doc. 369-9). The Monitor will assess
whether Defendants have developed and implemented policies and staff training to
ensure that class members are not being subjected to cross-gender searches, and whether
Defendants‘ new transgender identification policy ensures that staff can verify an
inmate’s transgender status without endangering the inmate by revealing the
transgender status to others if the inmate does not want such status revealed. Defendants
shall provide the Monitor and Plaintiffs’ counsel with any documents/records/data
necessary for the Monitor to conduct this assessment, and Defendants shall permit the
Monitor to access correctional facilities and speak to staff and inmates as part of this
assessment, upon at least 48 hours’ prior notice to Defendants’ counsel. The Monitor shall
report any noncompliance to the parties and to the Court.
F. Training
Defendants were ordered to finalize and implement additional and ongoing
training for all correctional staff on transgender issues and awareness, including the harm
caused by misgendering and harassment, and to finalize and implement training for
inmates and staff at Logan Correctional Center regarding incoming/transferred
transgender inmates, by December 7, 2021. (Doc. 332). Defendants report they have
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contracted with an outside group (Queer Works) to provide staff training to all IDOC
employees, which must be completed by March 30, 2022, and to conduct training for
prisoners at Logan Correctional Center (the women’s facility where a number of
transgender women are housed). (Doc 369, p. 4; Doc. 369-7). Another contractor (The
Moss Group) will provide future trainings on transgender issues at Logan and in IDOC’s
male prisons. (Doc. 369, p. 4; Doc. 369-8). The Monitor shall review the ongoing
implementation of this training to assess whether Defendants are in compliance and
report any noncompliance to the parties and to the Court. Defendants shall provide the
Monitor and Plaintiffs’ counsel with any documents/records/data necessary for the
Monitor to conduct this assessment, and Defendants shall permit the Monitor to access
correctional facilities and speak to staff and inmates as part of this assessment, upon at
least 48 hours’ prior notice to Defendants’ counsel.
G. Reporting and Facilitation
For any component of the ordered injunctive relief detailed above, if the Monitor
concludes that Defendants are not in compliance, the Monitor shall report such finding
to the parties and to the Court, within 14 days of such finding. Either party shall have 14
days in which to respond to a report of the Monitor.
The Monitor shall make an initial report to the Court and the parties indicating
Defendants’ compliance, partial compliance, or noncompliance with each of the
components listed above within 90 days of the Monitor’s appointment. Thereafter, the
Monitor shall submit follow-up reports at intervals to be determined by the Court, which
shall address the identified areas of Defendants’ partial compliance or noncompliance.
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Either party shall have 30 days in which to respond to a report.
The Monitor shall assist and facilitate the parties’ efforts to develop remedial
plans, which may include further revisions/modifications to IDOC’s Administrative
Directives, policies and procedures regarding medical and mental health treatment for
transgender prisoners including hormone therapy, surgery and related treatment; social
transition including placement/transfer considerations; and other policies affecting class
members in order to ensure Defendants’ compliance with the ordered injunctive relief.
(See Post-Trial Briefs, Docs. 335, 346, and attachments). At the Monitor’s discretion, the
Monitor may arrange and facilitate conferences which the parties’ counsel shall attend,
and which Defendants and/or identified IDOC staff members shall attend as directed by
the Monitor, in order to achieve timely compliance with the Court’s Orders and to assist
in developing policies/procedures to ensure ongoing compliance.
II. Selection of Monitor
The Monitor shall be independent, impartial, and knowledgeable about the
management and oversight of correctional medical and mental health programs. Each
party shall submit names of candidates for appointment as Monitor as set forth below;
the Court will then select the Monitor unless the parties jointly agree on an individual to
serve as Monitor.
III. Compensation of Monitor
The Monitor shall be compensated from the Court’s appropriated funds at a rate
not to exceed the hourly rate established under 18 U.S.C. § 3006A for payment of courtappointed counsel (currently $155), plus costs reasonably incurred by the Monitor.
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18 U.S.C. § 3626(f)(4); FED. R. CIV. P. 53(g)(2)(B).
IV. Review of Monitor’s Appointment
The Court shall review the Monitor’s appointment every six months following the
appointment, to determine whether the services of the Monitor continue to be required
during the remedial phase of this matter. 18 U.S.C. § 3626(f)(5).
IT IS THEREFORE ORDERED:
1. Pursuant to Rule 53(b)(1), this Order serves as notice to the parties that a
Monitor will be appointed.
2. On or before 14 days from the date of this Order, each party shall submit to the
Court and each other the names of up to 5 candidates for appointment as Monitor. See 18
U.S.C. § 3626(f)(2). Within 7 days of the submission of both lists, each party may remove
up to 3 persons from the opposing party’s list and shall notify the Court and the other
party of the removed names. The Court will select the Monitor from the persons
remaining on the parties’ lists. Alternatively, if the parties reach agreement on an
individual to serve as Monitor, they shall jointly notify the Court of their selection on or
before 14 days after the submission of both lists. The Court will notify the Monitor of
his/her selection.
3. Within 7 days of such notification, the Monitor shall file an affidavit with the
Court disclosing whether there is any ground for his/her disqualification under 28 U.S.C.
§ 455. If a ground is disclosed, the parties shall inform the Court within 3 business days
whether they waive the disqualification. See FED. R. CIV. P. 53(b)(3).
4. On or before 21 days from the date of this Order, the parties shall submit any
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proposed modifications to the above summary of the Monitor’s duties.
IT IS SO ORDERED.
DATED: December 13, 2021
____________________________
NANCY J. ROSENSTENGEL
Chief U.S. District Judge

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