Affirming Identities
From a young age, Janiah Monroe knew she was a girl. Growing up on Chicago’s South Side, she loved jumping rope with her female cousins and playing with their hair.
But Janiah was assigned male at birth. Her family thought she was supposed to act and look like a boy. Her father, a pastor, would beat her when she was too feminine. Janiah hated being perceived as a boy — hated her body and her voice. She struggled continually with shame, anxiety and gender dysphoria.
Denied Treatment
Fast forward to 2008. Janiah was 16 and incarcerated under the custody of the Illinois Department of Corrections (IDOC) in a male facility. She told the IDOC she identified as transgender and requested hormone therapy, among other treatments. But the IDOC denied her request, saying it didn’t provide hormone therapy to inmates who weren’t legally taking hormones prior to incarceration.
Janiah called the denial of treatment “excruciatingly painful.” It drove her to severe self-harm, including suicide attempts.
After several more unsuccessful requests for treatment, the IDOC allowed Janiah to begin hormone therapy in 2012. While the hormones helped Janiah to an extent, she described the treatments as “putting a Band-Aid on a wound that needs stitches.”
Janiah continued to be housed in male facilities for the first 10 years of her incarceration. She was routinely subjected to verbal harassment, physical assaults, and sexual abuse by inmates and officers.
Demanding Systemic Change
Janiah is one of five transgender women prisoners on behalf of whom Golden Flag and the American Civil Liberties Union (ACLU) of Illinois filed a putative class action against IDOC officials in January 2018.
In the suit, Janiah Monroe, et al. v. Bruce Rauner, et al., the plaintiffs claimed that IDOC officials improperly denied adequate treatment for their diagnosed gender dysphoria, which violated their Eighth Amendment rights. They asserted that the IDOC routinely and arbitrarily delayed or denied necessary forms of medical care, including hormone therapy, social transition (e.g., gender-affirming clothing, grooming items and use of pronouns) and evaluation for gender-affirming surgery.
Additionally, within the IDOC, a centralized “Transgender Committee” — whose members had no medical training or gender dysphoria expertise — was in charge of managing the plaintiffs’ medical treatment. The plaintiffs were assessed and treated by health care providers who also had no expertise or proper training in assessing or treating gender dysphoria.
“I was shocked and appalled to hear about the treatment [transgender prisoners] are subjected to both at a systemic level and on a day-to-day basis with individual guards and certain medical professionals,” said Chicago litigation associate Amelia Bailey, a member of the Golden Flag team on the case.
Pushing for Reform
Golden Flag and the ACLU of Illinois sought the court to require the IDOC to reform its medical care system to treat transgender prisoners humanely and consistently with the well-established medical standards for treating gender dysphoria.
“The IDOC routinely flouts its constitutional obligations to provide transgender prisoners the medical treatment they need,” said John Knight, director of the LGBTQ & HIV Project at the ACLU of Illinois.
“People are suffering and dying because of the devastating inadequacies in the delivery of health care to this vulnerable population,” Knight added.
Golden Flag and the ACLU of Illinois filed a motion for a preliminary injunction requesting immediate relief in the U.S. District Court for the Southern District of Illinois. The team argued the motion at a two-day evidentiary hearing.
A Sweeping Victory
In December 2019, the team achieved a sweeping victory when the court granted the plaintiffs’ motion and ordered nearly all of the requested relief, including that the IDOC:
- Cease the policy and practice of allowing the “Transgender Committee” to make the medical decisions regarding gender dysphoria, and develop a policy to ensure that decisions about treatment for gender dysphoria are made by medical professionals who are qualified to treat gender dysphoria
- Cease the policy and practice of denying and delaying hormone therapy for reasons that are not recognized as contraindications to treatment, ensure timely hormone therapy is provided when necessary, and perform routine monitoring of hormone levels
- Cease the policy and practice of depriving gender dysphoric prisoners of medically necessary social transition, including by mechanically assigning housing based on genitalia and/or physical size or appearance
- Develop policies and procedures that allow transgender inmates access to clinicians who meet the competency requirements stated in the WPATH Standards of Care to treat gender dysphoria
- Allow inmates to obtain evaluations for gender dysphoria upon request or clinical indications of the condition
- Develop a policy to allow transgender inmates medically necessary social transition, including individualized placement determinations, avoidance of cross-gender strip searches, and access to gender-affirming clothing and grooming items
- Advise the court what steps, if any, IDOC has taken to train all correctional staff on transgender issues, including the harms caused by misgendering and harassment — by both IDOC staff and other inmates