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Morris v. Fletcher

United States District Court, W.D. Virginia, Roanoke Division

May 2, 2018

Terah Morris, Plaintiff,
Stephanie Fletcher, ET AL., Defendants.


          Norman K. Moon, Judge.

         Plaintiff Terah Morris is an incarcerated transgender woman. She sued various prison officials because of their alleged delay in diagnosing and treating her gender identity disorder.[1]The matter is before the Court on cross-motions for summary judgment (dkts. 230, 232, 239, & 241), the Report and Recommendation of Magistrate Judge Pamela Sargent (dkt. 262, “R&R”), and Plaintiff's objections to the R&R (dkt. 264). The Court referred the matter to Judge Sargent for proposed factual findings and a recommended disposition. 28 U.S.C. § 636(b)(1)(B). Judge Sargent recommended that the Court deny Plaintiff's motion and grant Defendants' motions. Plaintiff filed three objections, and so the Court will review the objected portions of the R&R de novo.[2] The Court finds Plaintiffs' objections lack merit and will adopt Judge Sargent's R&R.

         I. Legal Standard

         A court shall grant summary judgment “if the movant shows that there is no genuine dispute as to any material fact.” Fed.R.Civ.P. 56(a). A dispute is “genuine” if “the evidence is such that a reasonable jury could return a verdict for the nonmoving party.” Anderson v. Liberty Lobby, Inc., 477 U.S. 242, 248 (1986). “Only disputes over facts that might affect the outcome of the suit under the governing law will properly preclude the entry of summary judgment.” Id. A court must view the record as a whole and draw all reasonable inferences in the light most favorable to the nonmoving party. Celotex Corp. v. Catrett, 477 U.S. 317, 322-24 (1986). If there are cross-motions for summary judgment, a court must “consider each motion separately on its own merits to determine whether either of the parties deserves judgment as a matter of law.” Defs. of Wildlife v. N. Carolina Dep't of Transp., 762 F.3d 374, 392 (4th Cir. 2014).

         When a court refers a matter to a magistrate judge, any objections to the magistrate judge's R&R must be reviewed de novo. Orpiano v. Johnson, 687 F.2d 44, 47 (4th Cir. 1982); see also 28 U.S.C.A. § 636(b)(1). In addressing the objections, “[t]he district court does not need to provide an elaborate or lengthy explanation, but it must provide a specific rationale that permits meaningful appellate review.” Cruz v. Marshall, 673 Fed.Appx. 296, 299 (4th Cir. 2016).

         II. Analysis

         The Court will incorporate Judge Sargent's statement of the relevant facts, addressing two objections to that statement (and one objection to a conclusion of law) below. By way of summary, Plaintiff lived and presented as a male until 2015. While she had suffered from various mental health maladies (including schizophrenia and psychosis) throughout her incarceration, Plaintiff first began telling prison medical staff that she was suffering from gender identity disorder in 2015. She had never been diagnosed with a gender identity disorder or been prescribed any treatment for such a disorder. Around this time, Plaintiff also began requesting hormone shot treatment from Defendants Smith and Phipps. Medical staff, including Defendants Smith and Phipps, referred her to Defendant McDuffie, a psychiatrist.

         Defendant McDuffie was initially skeptical of Plaintiff's self-diagnosis due to a lack of recorded symptoms and Plaintiff's history of manipulating prison staff. In their first meeting about Plaintiff's alleged gender identity disorder, Plaintiff claims that McDuffie yelled at her and ended the meeting abruptly because he believed she was feigning the disorder. In the following months, however, it is undisputed that McDuffie continued meeting with Plaintiff and Plaintiff was given a thorough psychological evaluation. After these continued meetings, McDuffie equivocally diagnosed Plaintiff with an “unspecified” gender identity disorder in 2016, although he retained some concern that Plaintiff was attempting to manipulate him. McDuffie recommended that Plaintiff be referred to an expert for further diagnosis and treatment.[3]Plaintiff has continued to regularly meet with the medical and mental health staff concerning her gender identity disorder, but she has not received her desired hormone shot treatment. She has, however, received continuing treatment and medication for her other psychological issues.

         Plaintiff alleges that the Defendants' failure to provide her with hormone shot treatment was cruel and unusual punishment that violates the Eighth Amendment. The Court finds no reasonable jury could find that the Defendants' continuing diagnostic treatment constituted deliberate indifference to Plaintiff's medical needs, and so the objections will be overruled.

         A. The Eighth Amendment and gender identity disorder

         “Prisoners alleging that they have been subjected to unconstitutional conditions of confinement must satisfy the Supreme Court's two-pronged test set forth in Farmer v. Brennan.” Scinto v. Stansberry, 841 F.3d 219, 225 (4th Cir. 2016); see Farmer v. Brennan, 511 U.S. 825, 832 (1994). First, “Farmer's objective prong requires plaintiffs to demonstrate that ‘the deprivation alleged [was], objectively, sufficiently serious.'” Scinto, 841 F.3d at 225. In order to be sufficiently serious, the deprivation must pose “a serious or significant physical or emotional injury resulting from the challenged conditions, ” or “a substantial risk of such serious harm resulting from . . . exposure to the challenged conditions.” De'lonta v. Angelone, 330 F.3d 630, 634 (4th Cir. 2003) (internal quotation marks and citation omitted). A medical need is sufficiently serious when it has either “been diagnosed by a physician as mandating treatment or . . . is so obvious that even a lay person would easily recognize the necessity for a doctor's attention.” Iko v. Shreve, 535 F.3d 225, 241 (4th Cir. 2008). “Second, under Farmer's ‘subjective' prong, plaintiffs must show that prison officials acted with a ‘sufficiently culpable state of mind.'” Scinto, 841 F.3d at 225. “[T]he requisite state of mind is deliberate indifference.” Id. This means the officials knew of and disregarded an excessive risk to inmate health or safety. Id. Deliberate indifference requires “more than mere negligence.” Id.

         The Fourth Circuit has published two opinions concerning the interaction of the Eighth Amendment and gender identity disorder. See De'lonta v. Angelone, 330 F.3d 630 (4th Cir. 2003) (“De'lonta I”); De'lonta v. Johnson, 708 F.3d 520 (4th Cir. 2013) (“De'lonta II”). Both cases dealt with the same prisoner. The prisoner had been previously diagnosed with gender identity disorder and was receiving estrogen therapy. However, at some point prior to De'lonta I, the Virginia Department of Corrections ceased providing estrogen therapy to the prisoner. This caused the prisoner to suffer nausea, uncontrollable itching, and depression. Most harmfully, she also “developed an uncontrollable urge to mutilate her genitals.” 330 F.3d at 632. Under Farmer's objective prong, the Fourth Circuit held that the prisoner's “need for protection against continued self-mutilation constitutes a serious medical need to which prison officials may not be deliberately indifferent.” Id. at 634. The court found that the allegations of denial of care based on a uniform policy, “rather than on a medical judgment concerning [the prisoner's] specific circumstances, ” sufficiently made out Farmer's subjective prong. Id. at 635.

         Ten years later, the prisoner returned to the Fourth Circuit in De'lonta II. In the interim, the prisoner had received regular psychological counseling, hormone therapy, and been allowed to dress and live as a woman. 708 F.3d at 522. However, she still suffered the urge to self-mutilate, and requested sex reassignment surgery. Id. at 523. The Fourth Circuit again found that the prisoner's “need for protection against continued self-mutilation” constituted an objectively serious medical need. Id. at 525. The court also found Farmer's subjective prong satisfied because the relevant standards of care indicated “that sex reassignment surgery may be necessary for individuals who continue to present with severe GID after one year of hormone therapy and dressing as a woman.” Id. And so the court found that “just because [the Department of Corrections] ha[s] provided [the prisoner] with some treatment consistent with the GID Standards of Care, it does not follow that they have necessarily provided her with constitutionally adequate treatment.” Id. at 526 (emphasis in the original). Accordingly, the court concluded that the prisoner adequately pled facts that satisfied the subjective prong. Id.

         B. The R&R and ...

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