Monroe et al v. Rauner et al

Filing 384

PRELIMINARY INJUNCTION. Signed by Chief Judge Nancy J. Rosenstengel on 2/7/2022. (beb)

Case 3:18-cv-00156-NJR Document 384 Filed 02/07/22 Page 1 of 13 Page ID #11600

IN THE UNITED STATES DISTRICT COURT
FOR THE SOUTHERN DISTRICT OF ILLINOIS
JANIAH MONROE,
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.

PRELIMINARY INJUNCTION
ROSENSTENGEL, Chief Judge:
Pursuant to Rule 65(d)(1)(C) of the Federal Rules of Civil Procedure and
MillerCoors LLC v. Anheuser-Busch Companies, LLC, 940 F.3d 922 (7th Cir. 2019), the Court
issues the following preliminary injunctive relief. This Order incorporates the
preliminary injunctive relief ordered on December 19, 2019 (Docs. 186, 212), on August 9,
2021 (Doc. 332, corrected at Doc. 336), and the additional relief ordered this date in
February 2022 (Doc. 383). Each of these preliminary injunctions CONTINUES in force.
I. FIRST PRELIMINARY INJUNCTION
On December 19, 2019, Defendants were ORDERED to immediately:
1. cease the policy and practice of allowing the Transgender Committee to
make the medical decisions regarding gender dysphoria and develop a
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policy to ensure that decisions about treatment for gender dysphoria are
made by medical professionals who are qualified to treat gender dysphoria;
2. ensure that timely hormone therapy is provided when medically necessary,
including the administration of hormone dosage adjustments, and to
perform routine monitoring of hormone levels; and
3. cease the policy and practice of depriving gender dysphoric prisoners of
medically necessary social transition, including by mechanically assigning
housing based on genitalia and/or physical size or appearance.
And FURTHER ORDERED to:
1. develop policies and procedures which allow transgender inmates access
to clinicians who meet the competency requirements stated in the WPATH
Standards of Care to treat gender dysphoria;
2. allow inmates to obtain evaluations for gender dysphoria upon request or
clinical indications of the condition;
3. develop a policy to allow transgender inmates medically necessary social
transition, including individualized placement determinations, avoidance
of cross-gender strip searches, and access to gender-affirming clothing and
grooming items; and
4. advise the Court what steps, if any, IDOC has taken to train all correctional
staff on transgender issues, including the harms caused by misgendering
and harassment—by both IDOC staff and other inmates.
(Docs. 186, 212).
II. SECOND PRELIMINARY INJUNCTION
On August 9, 2021, the Court ORDERED the following additional relief:
1. Plaintiffs Sora Kuykendall and Sasha Reed shall, within 7 days of the date
of this Order, be given lab tests to check their prolactin levels. If those levels
are still elevated, they shall be given an MRI test within 5 days of receipt of
the prolactin results.
2. Each member of the Plaintiff class who is currently receiving hormone
therapy shall, within 14 days of the date of this Order, be given blood tests
to assess hormone levels, as well as potassium, creatinine, and prolactin
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levels (for transgender females) and hemoglobin/hematocrit levels (for
transgender males). Thereafter, if the hormone levels are not within the
appropriate range set forth by the Endocrine Society Hormone Guidelines
(for transgender females, testosterone of less than 50 nanograms/deciliter
[as corrected on August 18, 2021, at Doc. 336] and estradiol between 100200 picograms/milliliter; for transgender males, testosterone levels
between 400-600 nanograms/deciliter), Defendants shall ensure that the
individual’s hormone medication is titrated following receipt of the blood
work results and blood work repeated at least every 3 months until the
levels are within an appropriate range.
3. Any Plaintiff class member who has requested hormone therapy to date
shall, within 21 days of the date of this Order, get baseline blood work done
and hormone therapy started within 14 days thereafter, with follow-up
blood work at least every 3 months until the levels are within an
appropriate range.
4. Each Plaintiff class member receiving hormone therapy shall get blood
work done at least once a year to assess hormone levels, as well as
potassium, creatinine, and prolactin levels (for transgender females) and
hemoglobin/hematocrit levels (for transgender males) and shall be treated
as medically indicated by the results. No Plaintiff class member shall be
prescribed conjugated estrogen.
5. Any Plaintiff class member whose hormone levels are within the
appropriate range, and who has requested evaluation for gender-affirming
surgery, shall be evaluated for such surgery within 120 days of the date of
this Order with inmates being evaluated in chronological order of the date of
the inmate’s original request for surgery. Each class member so evaluated
shall be provided a prompt written notification of the decision and, if
surgery is denied, the written notification shall include an explanation of
the reasons for denial and a timeframe to request another evaluation
thereafter.
6.

Plaintiff class members shall be allowed to choose the gender of the
correctional officer who will conduct a search of their person, and the search
SHALL BE conducted by a correctional officer of the gender requested.

7. Each Plaintiff class member who has requested transfer to a facility
matching his or her expressed gender (female facility for transgender
women, male facility for transgender men) shall be evaluated for transfer
within 120 days of the date of this Order, with inmates being evaluated in
chronological order of the date of the inmate’s original request for transfer.
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Each class member so evaluated and denied transfer shall be promptly
provided with a written explanation of each reason for the denial and
allowed to request another evaluation for transfer within 180 days
thereafter.
8. Each Plaintiff class member shall immediately be provided with access to
gender-affirming items in the commissary and shall immediately be
provided with a list of available gender-affirming items. Defendants shall
immediately ensure all approved gender-affirming items are available at
the commissary at each class member’s institution. Defendants shall, within
30 days of the date of this Order, provide the Court with a list of all
commissary items available at each facility.
9. Defendants shall immediately ensure that medical care and mental health
treatment of Plaintiff class members shall be conducted only by medical
staff and mental health professionals who have taken WPATH training and
are committed to continuing education on issues of transgender health.
Similarly, medical providers and mental health professionals who hold
personal or religious beliefs that prohibit their treatment of inmates with
gender dysphoria shall have no contact with any member of the class from
this date forward.
10. Defendants shall immediately ensure that transgender inmates are allowed
access to a private shower.
(Doc. 332, corrected at Doc. 336).
Also on August 9, 2021, the Court ordered the following additional injunctive
relief, to be completed within 120 days (on or before December 7, 2021), with respect to
projects that were “in progress” as of the time of trial:
1. Finalize the contract with Wexford to provide hair removal services to
Plaintiff class members;
2. Finalize the contract with Dr. Schechter to provide gender-affirming
surgery to Plaintiff class members who are approved to receive such
surgery;
3. Finalize and implement the CQI (Continuing Quality Improvement)
program for transgender care;

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4. Finalize IDOC’s written surgical standards for transgender care;
5. Finalize and implement the PRISM project (the special population
program) (discussed in Doc. 326, pp. 640, 648-49, 651)
6. Finalize and implement additional and ongoing training for all correctional
staff on transgender issues and awareness, including the harm caused by
misgendering and harassment;
7. Finalize and implement training for inmates and staff at Logan Correctional
Center regarding incoming/transferred transgender inmates;
8. Finalize and implement IDOC’s transgender identification policy.
(Doc. 332).
III. NEW INJUNCTIVE RELIEF
1.

In addition to the relief ordered on August 9, 2021 in paragraph 2 regarding blood

work to assess hormone levels and titration of hormone medication (see pp. 2-3 above),
the Court FURTHER ORDERS that:
Defendants shall ensure that any necessary follow-up medical
tests/treatment to address the results of potassium, creatinine, and
prolactin level testing for transgender females and hemoglobin/hematocrit
for transgender males takes place on a timely basis (for example, MRI tests
for transgender females with elevated prolactin levels).
2.

In addition to the injunctive relief ordered on August 9, 2021 in paragraph 1

concerning “in progress” projects (specifically, hair removal services, see Doc. 332, p. 3,
para. 1), the Court FURTHER ORDERS that:
Defendants shall ensure the availability to class members of all medically
necessary hair removal services, in addition to and including hair removal
to prepare for gender-affirming surgery, within 30 days of the date of this
Order.

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IV. FOLLOW UP TO INJUNCTIVE RELIEF ORDERED ON AUGUST 9, 2021
1.

Follow Up Injunctive Relief – Blood Work for Class Members Receiving Hormone
Therapy
Defendants were ordered to ensure that each member of the Plaintiff class who

was receiving hormone therapy shall have blood work done to assess hormone levels and
safety levels, and that each individual’s hormone medication is titrated following receipt
of the blood work results and blood work repeated at least every 3 months until the levels are
within an appropriate range (emphasis added) (para. 2, pp. 2-3 above; and Doc. 332, pp. 12, para. 2). 1
Defendants shall provide an update to the Court on this issue (whether blood
work was done in November 2021 and is scheduled for February 2022, whether any doses
have been titrated or follow up tests or treatment ordered, what has been done to address
elevated prolactin levels, and whether class members with hormone levels outside of the
recommended ranges have been brought within range) within 14 days of the date of this
Order.
2.

Follow Up Injunctive Relief – Blood Work for Class Members Requesting
Hormone Therapy
The Court also ordered Defendants to conduct baseline blood work and start

hormone therapy for any Plaintiff class member who has requested hormone therapy by
August 30, 2021, and to start hormone therapy within 14 days thereafter, with follow-up
blood work conducted at least every three months thereafter until the hormone levels are

Today the Court also ordered Defendants to ensure necessary follow-up medical tests and
treatment take place on a timely basis.

1

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within an appropriate range (Doc. 332, p. 2, para. 3).
While Defendants reported that baseline blood tests were done for those inmates
who did not refuse blood work (see Doc. 355, p. 2; Doc. 357), the Court has not been
informed whether (or when) hormone therapy started or whether there has been any
follow up blood work or medication titration. Defendants shall provide an update to the
Court on this issue within 14 days of the date of this Order.
3.

Follow Up Injunctive Relief – Annual Blood Work for Class Members
Defendants were ordered to conduct blood work for each Plaintiff class member

receiving hormone therapy at least once a year to assess hormone levels, as well as
potassium,

creatinine,

and

prolactin

levels

(for

transgender

females)

and

hemoglobin/hematocrit levels (for transgender males) and to treat each Plaintiff as
medically indicated (and to not prescribe conjugated estrogen—see summary of
Dr. Tangpricha’s testimony, above). (Doc. 332, p. 2, para. 4). As this was ordered in
August 2021, the timeframe for completion is months away, in August 2022. Nonetheless,
the Court directs Defendants to provide updated information concerning blood work as
set forth above.
4.

Follow Up Injunctive Relief – Surgery
The Court ordered Defendants to have Plaintiff class members whose hormone

levels were within appropriate range and who had requested gender-affirming surgery
to be evaluated for surgery by December 7, 2021, in chronological order of the inmate’s
original surgery request. (Doc. 332, p. 2, para. 5).
Defendants shall provide an update on the status of those approved for surgery,
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including whether any preliminary treatment—such as hair removal—has occurred,
whether any surgeries have occurred, and the plans for post-surgery facility placement
and treatment. Defendants shall also provide a detailed explanation as to why individual
requests for surgery were denied (between August 9, 2021, and today) and report when
those individuals can request re-evaluation. These status updates are due within 30 days
of the date of this Order.
5.

Follow Up Injunctive Relief – Searches
The Court ordered Defendants to allow Plaintiff class members to choose the

gender of the officer who will search their person and to ensure that searches were
conducted by an officer of the requested gender. (Doc. 332, p. 2, para. 6). Defendants
report that body scanners will be deployed in five prisons (Doc. 369), but the Court is
unsure whether this covers all class members. It is likewise not clear whether all crossgender searches have ceased (discussed below).
The Court orders Defendants to clarify these issues and to provide an update on
steps taken to implement, inform, and train staff on policies to avoid cross-gender
searches within 30 days of the date of this Order.
6.

Follow Up Injunctive Relief – Transfers
The Court ordered Defendants to evaluate Plaintiff class members who have

requested transfer to a facility matching the inmate’s expressed gender for transfer by
December 7, 2021, in chronological order of the inmate’s original transfer request.
(Doc. 332, pp. 2-3, para. 7).
Defendants shall provide an update on the status of evaluations for transfer that
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have occurred since October 8, 2021 (as previously ordered), including detailed reasons
for any denials, within 30 days of the date of this Order. Defendants also shall address
the numerous inconsistencies identified by Plaintiffs in October 2021. (Doc. 359).
7.

Follow Up Injunctive Relief – Commissary Items
Defendants were ordered to make gender-affirming commissary items available

to the Plaintiff class and to provide class members with a list of available items. The Court
further ordered Defendants to provide a list of all items available at each facility by
September 9, 2021. (Doc. 332, p. 3, para. 8). In that September 2021 report (Doc. 351),
Defendants reported that not all items were available.
Defendants shall provide the Court with an updated list of all commissary items
available at each facility and an explanation of when any unavailable items will be
stocked within 14 days from the date of this Order.
8.

Follow Up Injunctive Relief – Medical and Mental Health Providers
The Court ordered that Plaintiff class members should be treated only by medical

and mental health providers who have taken WPATH training and are committed to
continuing education on transgender health issues. The Court also ordered that providers
whose beliefs prohibit their treatment of inmates with gender dysphoria shall have no
contact with any Plaintiff class member. (Doc. 332, p. 3, para. 9).
Defendants have not provided an update on compliance with this item. The Court
orders Defendants to report whether changes have been made to ensure compliance with
the relief ordered within 30 days of the date of this Order.

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9.

Follow Up Injunctive Relief – Showers
The Court ordered that transgender inmates should have immediate access to a

private shower. (Doc. 332, p. 3, para. 10). Defendants have not complied with the Court’s
Order.
Defendants shall inform the Court of measures taken at each prison housing
transgender inmates to provide them access to a private shower within 14 days from the
date of this Order.
10.

Follow up Injunctive Relief – Contract for Hair Removal Services
Defendants were ordered to finalize the contract with Wexford to provide hair

removal services to Plaintiff class members by December 7, 2021. (Doc. 332, p. 3, para. 1).
Defendants reported on December 8, 2021 (Doc. 369) that an electrolysis machine was
purchased for Logan for hair removal to be done onsite. However, it is not clear whether
treatment has begun or how treatment will be made available to class members not
housed at Logan.
Defendants shall provide an update on these matters within 30 days of the date of
this Order.
And, as set forth above, today the Court has ordered Defendants to ensure the
availability of all medically necessary hair removal services, in addition to and including
hair removal to prepare for gender-affirming surgery, within 30 days of this Order.
11.

Follow Up Injunctive Relief – Contract with Dr. Schechter
Defendants appears to be full compliance with the order to arrange with Dr.

Schechter to provide gender-affirming surgery to Plaintiff class members who are
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approved for surgery. (Doc. 332, p. 3, para. 2). Unless anything has changed since
Defendant’s status report (Doc. 369, p. 3, para. 2), no update is needed on this item.
12.

Follow Up Injunctive Relief – CQI Program for Transgender Care
Defendants were ordered to finalize and implement the CQI (Continuing Quality

Improvement) program for transgender case by December 7, 2021. (Doc. 332, p. 4,
para. 3). Defendants reported on December 8, 2021 (Doc. 369, p. 3, para. 3) that the CQI
tool is complete, and implementation of the tool is underway.
Defendants shall provide an update on the progress made since December 2021
within 30 days of the date of this Order.
13.

Follow Up Injunctive Relief – PRISM Project
Defendants were ordered to finalize and implement the PRISM project (the special

population program discussed in the summary of Dr. Reister’s testimony above).
(Doc. 332, p. 4, para. 5). Defendants appear to be in full compliance and implementation
is ongoing. (Doc. 369, pp. 3-4, para. 5; Doc. 369-6).
Nonetheless, the Court orders Defendants to provide an additional update on the
PRISM project within 30 days of the date of this Order.
14.

Follow Up Injunctive Relief – Training for Correctional Staff
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 by December 7, 2021. (Doc. 332, p. 4, para. 6).
Defendants shall provide an update to the Court on the status of training actually
completed (and scheduled to be completed this year) within 30 days of the date of this
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Order.
15.

Follow Up Injunctive Relief – Training for Inmates and Staff at Logan
Correctional Center
Defendants were ordered to finalize and implement training for inmates and staff

at Logan regarding incoming/transferred transgender inmates by December 7, 2021
(Doc. 332, p. 4, para. 7).
Defendants shall report on the status of training actually completed (and
scheduled to be completed this year) within 30 days of the date of this Order.
16.

Follow Up Injunctive Relief – Transgender Identification Policy
Defendants were ordered to finalize and implement IDOC’s transgender

identification policy by December 7, 2021 (Doc. 332, p. 4, para. 8).
Defendants shall update the Court within 30 days of the date of this Order on
whether this policy has eliminated cross-gender body searches.
The updated status reports ordered above from Defendants shall be filed under
seal to the extent they contain individuals’ names, private health information, or could
reveal other confidential information about an individual such as the person’s
transgender status.
Finally, the Court invites Defendants to advise the Court whether the contract with
Dr. Anderson was renewed (and whether any other changes have occurred with respect
to transgender issues since trial). The Court FURTHER ORDERS Defendants to work
with the Monitor (once appointed) to develop and implement new Administrative
Directives that cure the deficiencies outlined above and to ensure the comprehensive

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training is provided to all staff tasked with responsibility of implementing those
directives.
IT IS SO ORDERED.
DATED: February 7, 2022
____________________________
NANCY J. ROSENSTENGEL
Chief U.S. District Judge

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