Andrea Fields v. Judy P. Smith

Andrea Fields, Matthew/Jessica Davison, and Vankemah Moaton (collectively, the inmates) (plaintiffs) were male-to-female transgender prisoners who had been diagnosed with gender identity disorder and received hormone therapy while incarcerated within the Wisconsin Department of Corrections. When the state passed the Inmate Sex Change Prevention Act (Act 105), which forbade the department from providing hormonal therapy or sexual-reassignment surgery, the inmates lost access to their hormone treatments. The inmates filed an action in federal district court against Warden Judy P. Smith (the department) (defendant). The inmates argued that Act 105 violated the prohibition on cruel and unusual punishment in the Eighth Amendment to the United States Constitution. The inmates also argued that the department had shown deliberate indifference to their serious medical needs by refusing to provide hormonal therapy and sexual-reassignment surgery. The inmates presented expert witnesses on gender identity disorder, who testified that hormonal therapy and sexual-reassignment surgery are medically necessary for some individuals with the disorder. The inmates also introduced into evidence statistics on the cost of hormone therapy and sexual-reassignment surgery for the purpose of showing that the costs were lower than the costs of other permitted medications and surgeries. The department argued that in 1987 the circuit court held that transsexualism was a serious medical condition requiring treatment but that an inmate does not have a right to a specific course of treatment. The department also argued that in 1997 the circuit court held that the state was not required to provide an inmate with hormone therapy or sexual-reassignment surgery because the Eighth Amendment requires only minimum healthcare treatment. Additionally, the department argued that Act 105 should be upheld because it was similar to an upheld statute banning a particular abortion procedure because of uncertainty about safety concerns. However, the department failed to introduce into evidence any safer alternatives to hormone therapy. The department further defended Act 105 on the ground that inmates receiving hormonal therapy or sexual-reassignment surgery were at risk for sexual assault. The district court returned a verdict for the inmates. The department appealed.