De’Lonta v. Angelone

330 F.3d 630 (2003)
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The Appellant, Ophelia Azriel De’lonta (born Michael A. Stokes), a Virginia inmate suffering from gender identity disorder (GID) (also known as gender dysphoria or transsexualism), brought suit against the Respondents, the Director of and doctors at the Virginia Department of Corrections (VDOC), alleging that they inflicted cruel and unusual punishment on her, in violation of her Eighth Amendment rights, by denying her adequate medical treatment for her GID.

From the beginning of her imprisonment in 1983, De’lonta was consistently diagnosed by VDOC doctors as suffering from GID. She started receiving estrogen therapy for the disorder in 1993, which continued until 1995 when the treatment was terminated pursuant to a then-recently created VDOC policy.

The VDOC policy provided that:

  • Neither medical nor surgical interventions related to gender or sex change would be provided to inmates in the management of GID cases.
  • If an inmate came into prison and/or was currently receiving hormone treatment, he was to be informed of the department’s policy and the medication would be tapered immediately then discontinued.
  • Inmates with GID were to be referred to the institution’s mental health staff for further evaluation.

In contravention of the directive that hormone treatment be tapered off, De’lonta’s hormone treatment was terminated abruptly, causing her to suffer nausea, uncontrollable itching, and depression. She also developed an uncontrollable urge to mutilate her genitals, having stabbed or cut her genitals on more than 20 occasions. De’lonta repeatedly requested resumption of the hormone therapy and treatment by a gender specialist but these requests were denied.

De’lonta sought declaratory and monetary relief and an injunction requiring the Respondents to arrange for her to be treated by a doctor with expertise in transsexualism and to allow her to resume her hormone therapy until the requested treatment commenced. The District Court dismissed the case for failure to state a claim, and this appeal followed.

The court held that the facts of the case were sufficient to establish a claim of cruel and unusual punishment in violation of the Eighth Amendment. It held that it did not appear beyond doubt at the early stage of the litigation that De'lonta could not prove facts sufficient to support her claim that she had not received constitutionally adequate treatment to protect her from her compulsion to mutilate herself. The court stated that the “need for protection against continued self-mutilation constitute[d] a serious medical need to which prison officials may not be deliberately indifferent.” The court explained that De’lonta’s alleged facts were sufficient to establish that the Respondents’ denial of treatment constituted “deliberate indifference” to her medical need.

In particular, De’lonta claimed she could prove that:

  • The Respondents knew that she suffered from GID;
  • She had been receiving treatment until 1995, when it was abruptly terminated for no legitimate reason;
  • The termination of her treatment resulted in compulsive, repeated self-mutilation of her genitals;
  • After the Respondents terminated her hormone treatment, they refused to provide any treatment to prevent her from mutilating herself, leaving her at continued risk for serious, self-inflicted injuries.

The court noted that the claim was not simply a medical malpractice claim because the alleged facts “supported the inference that the Respondents’ refusal to provide hormone treatment to De’lonta was based solely on the Policy rather than on a medical judgment concerning her specific circumstances.”

“De'lonta's need for protection against continued self-mutilation constitutes a serious medical need to which prison officials may not be deliberately indifferent.” 330 F.3d, p. 634.

“[T]he limited record before us [does not] demonstrate any justification (although there may be one not yet disclosed) for either the policy requiring termination of De'lonta's hormone treatment or the alleged denial of any other treatment to prevent her continuing self-inflicted injuries.” 330 F.3d, p. 634.

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