United States District Court, M.D. Louisiana
RULING AND ORDER
A. JACKSON, JUDGE UNITED STATES DISTRICT COURT.
the Court is Plaintiffs Request for Emergency
Temporary Restraining Order (Doc. 10). Plaintiff was
born a male, but as Plaintiffs Request (Doc. 10) and other
pleadings filed in this matter explain, Plaintiff has been
diagnosed with a medical condition known today as
"gender dysphoria." The State of Louisiana
Department of Public Safety and Corrections recognizes
"gender dysphoria disorder," and provides that a
confirmed diagnosis shall result in an individualized
treatment plan that will meet the acceptable standard of
care. (Doc. 3-3 at p. 3-4). Treatment requests beyond those
specified in the policy, such as Plaintiffs request to
maintain long hair, are to be forwarded to a Gender Dysphoria
Clinical Management Team (GDCMT) for review. Based on the
record, the Court cannot determine whether Defendants
complied with this policy.
American Psychiatric Association ("APA") defines
"gender dysphoria" as a marked incongruence between
one's experienced/expressed gender and assigned gender,
of at least 6 months duration, as manifested by at least two
of six factors: (1) a marked incongruence between one's
experienced/expressed gender and primary and/or secondary sex
characteristics... (2) a strong desire to be rid of one's
primary and/or secondary sex characteristics because of a
marked incongruence with one's experienced/expressed
gender... (3) a strong desire for the primary and/or
secondary sex characteristics of the other gender; (4) a
strong desire to be of the other gender (or some alternative
gender different from one's assigned gender); (5) a
strong desire to be treated as the other gender (or some
alternative gender different from one's assigned gender);
and (6) a strong conviction that one has the typical feelings
and reactions of the other gender (or some alternative gender
different from one's assigned gender). See Diagnostic
and Statistical Manual of Mental Disorders
("DSM-5"). The APA further notes that the condition
is associated with clinically significant distress or
impairment in social, occupational, or other important areas
review of the records provided by Plaintiff reveals that, as
early as June 8, 2016, Plaintiff was noted by Dr. Gamble to
be complaining of stressors "largely in the context of
gender dysphoria..." See (Doc. 3-4 at p. 41).
That same month, Plaintiff requested to be placed on hormones
and to be allowed to shower alone. Plaintiffs requests were
forwarded to Dr. Lavespere, whose response was,
"Hormones denied. Shower as per security."
See (Doc. 3-4 at p. 42). Plaintiff again requested
hormone therapy, and to be allowed to alter Plaintiffs
appearance to appear more effeminate on June 28, 2016 and
again on July 22, 2016. See (Doc. 3-4 at p. 43-44).
On August 4, 2016, Plaintiff was informed by a social worker
that there were no specific policies in place for those with
October 18, 2016, Plaintiffs diagnosis of gender dysphoria
was documented by Dr. Gamble, and Dr. Gamble again referred
the plaintiff to Dr. Lavespere for treatment. See
(Doc. 3-4 at p. 45-46). Dr. Lavespere responded that
Plaintiffs case was being discussed with the "HQ
office." (Doc. 3-4 at p. 47). In November, Dr. Gamble
again consulted with Dr. Lavespere, who responded that a
policy was being discussed at the "HQ office."
(Doc. 3-4 at p. 52). Plaintiff continued to request treatment
for gender dysphoria and no treatment other than counseling
was provided. On January 26, 2017, Plaintiff was placed on
suicide watch. (Doc. 3-4 at p. 56). On March 27, 2017,
Plaintiff was again placed on suicide watch. (Doc. 3-4 at p.
65). On November 13, 2018, Plaintiff was again told that
counseling through the psychiatry department would be the
only treatment offered for Plaintiffs diagnosis. (Doc. 3-4 at
p. 76). Plaintiff alleges that as a result of medical
attention being denied, Plaintiff suffers from insomnia,
clinical depression, and dysphoria, and has attempted auto
castration resulting in stitches, and another suicide attempt
resulting in staples being placed to close the wound. (Doc.
3-2 at p. 7).
such, Plaintiff undeniably has experienced a marked
incongruence between Plaintiffs experienced/expressed gender
and assigned gender, of at least 6 months duration, as
manifested by at least two of six factors listed in the
DSM-5. Plaintiff also meets the definition for "gender
dysphoria" as set forth in the Department of Public
Safety and Corrections Health Care Policy No. 47 titled,
"Identification and Management of Intersex Offenders,
Transgender Offenders, and Offenders Diagnosed with Gender
Dysphoria Disorder." (Doc. 3-3 at p. 4). Said policy
also provides that when an offender's diagnosis of gender
dysphoria is confirmed, a GDCMT shall be formed to evaluate
and manage the offender and formulate an individualized
treatment plan which meets the acceptable standard of care.
Per the policy, treatment may consist of mental health care,
hormone therapy, housing and programming, and choice of
showering preference. Other requests pertaining to gender
dysphoria needs are to be forwarded to the GDCMT for review.
See (Doc. 3-3).
instant Request (Doc. 10), Plaintiff alleges that Plaintiffs
request to maintain a long hair length was denied by
"headquarters" and was informed that Plaintiff
could either get a haircut or would be held down while
Plaintiffs hair was cut and receive a disciplinary
infraction. Based on the record before the Court, the Court
cannot ascertain whether Plaintiffs request to maintain long
hair was reviewed by the GDCMT as required by Health Care
Policy No. 47, or whether a GDCMT exists for Plaintiff at
obtain injunctive relief, Plaintiff must establish: (1) a
substantial likelihood of prevailing on the merits; (2) a
substantial threat of irreparable injury if the injunction is
not granted; (3) the threatened injury outweighs any harm
that will result to the non-movant if the injunction is
granted; and (4) the injunction will not disserve the public
interest. See Ridgely v. Fed. Emergency Mgmt.
Agency, 512 F.3d 727, 734 (5th Cir. 2008).
upon the standards of care submitted by Plaintiff, it appears
that Plaintiff is being denied necessary treatment for gender
dysphoria that meets the prevailing standards of care. (Doc.
3-5 at p. 12). As evidenced by Plaintiffs medical records,
Plaintiffs risk of suicide and other self-harm pose a
substantial threat of irreparable harm. Plaintiff has been
offered no viable option to relieve the ongoing gender
dysphoria. As such, Plaintiff has established a substantial
threat of irreparable harm that outweighs any harm the
non-movant would suffer from the injunction being granted
(allowing Plaintiff to maintain long hair).
also has a substantial likelihood of prevailing on the
merits. Based upon the record before the Court, Plaintiffs
prescribed treatment of counseling has not relieved the
ongoing gender dysphoria and Plaintiff has been offered no
additional treatment indicating deliberate indifference to
Plaintiffs medical needs. See Gibson u. Collier, 920
F.3d 212 (5th Cir. 2019) (finding no deliberate indifference
to the plaintiffs medical needs where the plaintiff was
treated with means, accepted within the medical community,
other than sex reassignment surgery, including counseling and
there is no indication that allowing Plaintiff to maintain
long hair will disserve the public interest. The Court does
not contemplate that any monetary costs will be incurred at
this time, and public interest weighs in favor of providing
Plaintiff with treatment within the acceptable standards of
care. As such, these factors weigh in favor of granting
Federal Rule of Civil Procedure 65(c) requires Plaintiff to
provide security, but the rule gives the Court discretion in
determining the sum. Plaintiff herein is indigent, and it
appears that no costs of damages will be incurred during the
pendency of the temporary restraining order. As such, no
security bond is required.
IT IS ORDERED that Plaintiffs
Request for Emergency Temporary Restraining Order
(Doc. 10) is GRANTED, without
notice due to the urgency of this matter and for lack of
service at this time on any defendant named herein, to
prevent Plaintiff from suffering irreparable harm in the form
of suicide or self-harm.
IS FURTHER ORDERED that during the pendency of this
Order, Plaintiffs hair shall not be cut ...