Monroe v. Baldwin

The Illinois Department of Corrections (DOC) used a committee to make decisions regarding transgender prisoners, including their medical care, but the committee lacked medical professionals experienced with gender dysphoria or otherwise qualified to treat the condition or its symptoms. The DOC would not provide transgender prisoners with any gender-confirmation surgery and routinely denied transgender prisoners’ requests for increased hormone doses without even testing their current levels. On the few occasions when the DOC did conduct testing, the prisoners’ hormone levels were below therapeutic range. Further, the DOC automatically housed transgender prisoners according to birth sex, allowed male guards to strip-search transgender females, and permitted guards and other prisoners to intentionally use incorrect gender terms and gender slurs when addressing transgender prisoners. The DOC also generally denied transgender female prisoners access to gender-affirming commissary items such as female undergarments, hairbrushes, and makeup. Janiah Monroe (plaintiff), a transgender female incarcerated in an Illinois prison, requested treatment for gender dysphoria but was not even given a diagnosis for four years. Two other transgender prisoners, Sasha Reed and Sora Kuykendall (plaintiffs), also experienced multiyear delays in receiving a diagnosis. During those delays, Reed attempted suicide, and Kuykendall was so distraught that she attempted to castrate herself. Monroe, Reed, Kuykendall, and three other transgender female prisoners (collectively, the prisoners) (plaintiffs) sued DOC director John Baldwin and others (defendants), alleging that the DOC’s treatment of transgender female prisoners violated the Eighth Amendment. The prisoners also sought a preliminary injunction ordering the DOC to adopt policies providing adequate medical care to transgender prisoners. The district court held a two-day hearing on the injunction request. Among the evidence presented was expert testimony that misgendering individuals with gender dysphoria caused psychological trauma and that social transitions, such as access to gender-affirming items and environments, were a key part of treatment for gender dysphoria. No DOC representative attended the hearing or presented any evidence of a medical or penological justification for the DOC’s transgender policies. The district court then considered the prisoners’ request for a preliminary injunction.