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Trans inmate sues Va. corrections department over denial of surgery

Lawsuit says refusal of medical care is ‘cruel and unusual punishment’

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The LGBTQ litigation group Lambda Legal on Aug. 26 filed a lawsuit in federal court against the Virginia Department of Corrections on behalf of a transgender man incarcerated at a state prison on grounds that he was illegally denied “medically necessary” care, including breast removal surgery.

The lawsuit charges that the denial of surgery for Jason Yoakam, 42, who has been assigned to the Fluvanna Correctional Center for Women in Troy, Va., since 2004, violates the Eighth Amendment of the U.S. Constitution, which prohibits “cruel and unusual punishment.”

According to the lawsuit, prison officials also denied Yoakam treatment from qualified mental healthcare providers for gender dysphoria, a medical condition experienced by transgender people widely recognized by professional associations representing the medical and mental health professions, including the American Psychiatric Association.

A statement released by Lambda Legal points out that gender dysphoria is listed as a medical condition that some transgender people experience as significant distress when their gender identity is not congruent with their sex assigned at birth.  

“Mr. Yoakam is not seeking special treatment, just access to medically necessary health care and reasonable accommodations,” said Richard Saenz, a senior attorney for Lambda Legal and one of a team of attorneys representing Yoakam in the lawsuit. “Every incarcerated person has a right to basic health care based on their medical needs and should not face discrimination because of their sex,” Saenz said in the Lambda Legal statement.

“The only thing I am asking is to be treated fairly and have access to the same standard of healthcare that other incarcerated people receive,” Yoakam said in the statement. “It has been traumatizing, isolating, and stigmatizing to be denied health care services to treat the gender dysphoria that VDOC’s own providers have diagnosed,” he said.

The lawsuit says that from an early age Yoakam has believed his female body was a “mistake” and he finds his breasts an image of “shame and disgust.” It says prison officials did provide him with a “chest binder” that compresses his breasts, but which also causes pain and skin irritation and cannot provide the necessary treatment and remedy that only surgery can bring about.

By denying him surgery and other needed medical or mental health care, the lawsuit charges, prison authorities have also violated the Equal Protection Clause of the Constitution’s 14th Amendment as well as nondiscrimination provisions under the Americans with Disability Act and the Affordable Care Act.

A spokesperson for the Department of Corrections and the facility where Yoakam is being held could not immediately be reached for comment on the lawsuit

Lambda Legal says in its statement that prison officials told Yoakam he could not be approved for the bilateral mastectomy or chest surgery he requested because it considered the surgery an “elective” procedure that was not medically necessary for treatment of gender dysphoria.

The Washington Post reports that a Department of Corrections official told the Post in an email message that its internal guidelines for medical care for inmates calls for deciding on treatment and care requests on a case-by-case basis.

“All medically necessary treatment is available,” the spokesperson told the Post. “We follow the community standard of care.”

Court records show that Yoakam pleaded guilty in 2004 to a charge of first-degree murder and was sentenced by a Virginia judge to 30 years in prison, with nine years suspended for a total of 21 years of incarceration. An inmate information page on the Fluvanna Correctional Center’s website shows that Yoakam is scheduled to complete his sentence and to be released on May 23, 2022, after serving just over 18 years.

A corrections department spokesperson couldn’t immediately be reached about Yoakam’s release schedule, but correctional systems often reduce the time served for inmates based on a number of factors, including good behavior.

Court records and all official references to Yoakam at the Fluvanna Correctional Center for Women refer to him by his legal female birth name. Saenz of Lambda Legal said Yoakam is in the process of legally changing his name to Jason Yoakam.

The court records and news media reports show that Yoakam, at age 24, was arrested on a first-degree murder charge and other related charges, including illegal firearms possession, on March 3, 2004, just over four months after he allegedly shot and killed James “Jamie” Lane, 39, on Oct. 15, 2003.

The incident occurred in Lee County, Va., located in the southwestern corner of the state near the Kentucky and Tennessee borders. The Kingsport, Tenn., Times-News reported in a Dec. 3, 2003, story that Yoakam was identified at that time as a lesbian woman who became enraged when his girlfriend left him to begin a relationship with Lane.

“Testimony from a number of witnesses indicated that the shooting may have stemmed from a love triangle with a twist,” the Times-News reported.

The newspaper reported that Lane’s ex-wife, Tonya Garrett Lane, 30, who is Yoakam’s half-sister, was charged with allegedly conspiring to murder the ex-girlfriend of Yoakam who reportedly left Yoakam to begin a relationship with her ex-husband.

“The ex-Mrs. Lane was apparently involved because she didn’t want her children ‘being raised by a (expletives deleted) lesbian,’” the Times-News reported based on testimony in court.

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National

United Methodist Church removes 40-year ban on gay clergy

Delegates also voted for other LGBTQ-inclusive measures

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Underground Railroad, Black History Month, gay news, Washington Blade
Mount Zion United Methodist Church is the oldest African-American church in Washington. (Washington Blade photo by Michael Key)

The United Methodist Church on Wednesday removed a ban on gay clergy that was in place for more than 40 years, voting to also allow LGBTQ weddings and end prohibitions on the use of United Methodist funds to “promote acceptance of homosexuality.” 

Overturning the policy forbidding the church from ordaining “self-avowed practicing homosexuals” effectively formalized a practice that had caused an estimated quarter of U.S. congregations to leave the church.

The New York Times notes additional votes “affirming L.G.B.T.Q. inclusion in the church are expected before the meeting adjourns on Friday.” Wednesday’s measures were passed overwhelmingly and without debate. Delegates met in Charlotte, N.C.

According to the church’s General Council on Finance and Administration, there were 5,424,175 members in the U.S. in 2022 with an estimated global membership approaching 10 million.

The Times notes that other matters of business last week included a “regionalization” plan, which gave autonomy to different regions such that they can establish their own rules on matters including issues of sexuality — about which international factions are likelier to have more conservative views.

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Federal Government

Republican state AGs challenge Biden administration’s revised Title IX policies

New rules protect LGBTQ students from discrimination

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U.S. Secretary of Education Miguel Cardona (Screen capture: AP/YouTube)

Four Republicans state attorneys general have sued the Biden-Harris administration over the U.S. Department of Education’s new Title IX policies that were finalized April 19 and carry anti-discrimination protections for LGBTQ students in public schools.

The lawsuit filed on Tuesday, which is led by the attorneys general of Kentucky and Tennessee, follows a pair of legal challenges from nine Republican states on Monday — all contesting the administration’s interpretation that sex-based discrimination under the statute also covers that which is based on the victim’s sexual orientation or gender identity.

The administration also rolled back Trump-era rules governing how schools must respond to allegations of sexual harassment and sexual assault, which were widely perceived as biased in favor of the interests of those who are accused.

“The U.S. Department of Education has no authority to let boys into girls’ locker rooms,” Tennessee Attorney General Jonathan Skrmetti said in a statement. “In the decades since its adoption, Title IX has been universally understood to protect the privacy and safety of women in private spaces like locker rooms and bathrooms.”

“Florida is suing the Biden administration over its unlawful Title IX changes,” Florida Gov. Ron DeSantis wrote on social media. “Biden is abusing his constitutional authority to push an ideological agenda that harms women and girls and conflicts with the truth.”

After announcing the finalization of the department’s new rules, Education Secretary Miguel Cardona told reporters, “These regulations make it crystal clear that everyone can access schools that are safe, welcoming and that respect their rights.”

The new rule does not provide guidance on whether schools must allow transgender students to play on sports teams corresponding with their gender identity to comply with Title IX, a question that is addressed in a separate rule proposed by the agency in April.

LGBTQ and civil rights advocacy groups praised the changes. Lambda Legal issued a statement arguing the new rule “protects LGBTQ+ students from discrimination and other abuse,” adding that it “appropriately underscores that Title IX’s civil rights protections clearly cover LGBTQ+ students, as well as survivors and pregnant and parenting students across race and gender identity.”

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Federal Government

4th Circuit rules gender identity is a protected characteristic

Ruling a response to N.C., W.Va. legal challenges

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Lewis F. Powell Jr. Courthouse in Richmond, Va. (Photo courtesy of the U.S. Courts/GSA)

BY ERIN REED | The 4th U.S. Circuit Court of Appeals ruled Monday that transgender people are a protected class and that Medicaid bans on trans care are unconstitutional.

Furthermore, the court ruled that discriminating based on a diagnosis of gender dysphoria is discrimination based on gender identity and sex. The ruling is in response to lower court challenges against state laws and policies in North Carolina and West Virginia that prevent trans people on state plans or Medicaid from obtaining coverage for gender-affirming care; those lower courts found such exclusions unconstitutional.

In issuing the final ruling, the 4th Circuit declared that trans exclusions were “obviously discriminatory” and were “in violation of the equal protection clause” of the Constitution, upholding lower court rulings that barred the discriminatory exclusions.

The 4th Circuit ruling focused on two cases in states within its jurisdiction: North Carolina and West Virginia. In North Carolina, trans state employees who rely on the State Health Plan were unable to use it to obtain gender-affirming care for gender dysphoria diagnoses.

In West Virginia, a similar exclusion applied to those on the state’s Medicaid plan for surgeries related to a diagnosis of gender dysphoria. Both exclusions were overturned by lower courts, and both states appealed to the 4th Circuit.

Attorneys for the states had argued that the policies were not discriminatory because the exclusions for gender affirming care “apply to everyone, not just transgender people.” The majority of the court, however, struck down such a claim, pointing to several other cases where such arguments break down, such as same-sex marriage bans “applying to straight, gay, lesbian, and bisexual people equally,” even though straight people would be entirely unaffected by such bans.

Other cases cited included literacy tests, a tax on wearing kippot for Jewish people, and interracial marriage in Loving v. Virginia.

See this portion of the court analysis here:

4th Circuit rules against legal argument that trans treatment bans do not discriminate against trans people because ‘they apply to everyone.’

Of particular note in the majority opinion was a section on Geduldig v. Aiello that seemed laser-targeted toward an eventual U.S. Supreme Court decision on discriminatory policies targeting trans people. Geduldig v. Aiello, a 1974 ruling, determined that pregnancy discrimination is not inherently sex discrimination because it does not “classify on sex,” but rather, on pregnancy status.

Using similar arguments, the states claimed that gender affirming care exclusions did not classify or discriminate based on trans status or sex, but rather, on a diagnosis of gender dysphoria and treatments to alleviate that dysphoria.

The majority was unconvinced, ruling, “gender dysphoria is so intimately related to transgender status as to be virtually indistinguishable from it. The excluded treatments aim at addressing incongruity between sex assigned at birth and gender identity, the very heart of transgender status.” In doing so, the majority cited several cases, many from after Geduldig was decided.

Notably, Geduldig was cited in both the 6th and 11th Circuit decisions upholding gender affirming care bans in a handful of states.

The court also pointed to the potentially ridiculous conclusions that strict readings of what counts as proxy discrimination could lead to, such as if legislators attempted to use “XX chromosomes” and “XY chromosomes” to get around sex discrimination policies:

The 4th Circuit majority rebuts the state’s proxy discrimination argument.

Importantly, the court also rebutted recent arguments that Bostock applies only to “limited Title VII claims involving employers who fired” LGBTQ employees, and not to Title IX, which the Affordable Care Act’s anti-discrimination mandate references. The majority stated that this is not the case, and that there is “nothing in Bostock to suggest the holding was that narrow.”

Ultimately, the court ruled that the exclusions on trans care violate the Equal Protection Clause of the Constitution. The court also ruled that the West Virginia Medicaid Program violates the Medicaid Act and the anti-discrimination provisions of the Affordable Care Act.

Additionally, the court upheld the dismissal of anti-trans expert testimony for lacking relevant expertise. West Virginia and North Carolina must end trans care exclusions in line with earlier district court decisions.

The decision will likely have nationwide impacts on court cases in other districts. The case had become a major battleground for trans rights, with dozens of states filing amicus briefs in favor or against the protection of the equal process rights of trans people. Twenty-one Republican states filed an amicus brief in favor of denying trans people anti-discrimination protections in healthcare, and 17 Democratic states joined an amicus brief in support of the healthcare rights of trans individuals.

Many Republican states are defending anti-trans laws that discriminate against trans people by banning or limiting gender-affirming care. These laws could come under threat if the legal rationale used in this decision is adopted by other circuits. In the 4th Circuit’s jurisdiction, West Virginia and North Carolina already have gender-affirming care bans for trans youth in place, and South Carolina may consider a similar bill this week.

The decision could potentially be used as precedent to challenge all of those laws in the near future and to deter South Carolina’s bill from passing into law.

The decision is the latest in a web of legal battles concerning trans people. Earlier this month, the 4th Circuit also reversed a sports ban in West Virginia, ruling that Title IX protects trans student athletes. However, the Supreme Court recently narrowed a victory for trans healthcare from the 9th U.S. Circuit Court of Appeals and allowed Idaho to continue enforcing its ban on gender-affirming care for everyone except the two plaintiffs in the case.

Importantly, that decision was not about the constitutionality of gender-affirming care, but the limits of temporary injunctions in the early stages of a constitutional challenge to discriminatory state laws. It is likely that the Supreme Court will ultimately hear cases on this topic in the near future.

Celebrating the victory, Lambda Legal Counsel and Health Care Strategist Omar Gonzalez-Pagan said in a posted statement, “The court’s decision sends a clear message that gender-affirming care is critical medical care for transgender people and that denying it is harmful and unlawful … We hope this decision makes it clear to policy makers across the country that health care decisions belong to patients, their families, and their doctors, not to politicians.” 

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Erin Reed is a transgender woman (she/her pronouns) and researcher who tracks anti-LGBTQ+ legislation around the world and helps people become better advocates for their queer family, friends, colleagues, and community. Reed also is a social media consultant and public speaker.

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The preceding article was first published at Erin In The Morning and is republished with permission.

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