a highly treatable condition and there is an emerging medical consensus on its treatment that includes hormones and feminizing accommodations there are three issues its amendment claim the equal protect claim and a request to remand to allow an end of the complaint my adversary places much emphasis on the reid vs griffin case i would say the chord it is not controlling treatment she was getting was appropriate and it did not include hormones the court did not order a trial here we have someone who has a gender dysphoria diagnosis from a psychiatrist but was put up against a committed as gate keeper on a treatment plan the committee said she could not have hormones they gave her no reasons she asked for the reasons the absolute was because we  sense then she asked who said so and the committee said we introduced you in our meeting so we're not even sure of who on the committee made this decision but a committee made it there are no medical records affidavits statements records or anything of that nature in the record in this case this court is never that i could find affirmed or summary dismissal with no medical evidence at  i expect my adversary to stand up here today and tell you that the state is giving stansell prost hormones because that's what she said to me yesterday at four o'clock  they are that would be pulling back the blanket a bit but it's not in the record and it's not before the court and the way to treat that kind of evidence is to send it back to the district judge diagnosed her with gender dysphoria but that the transgender community were not let her have hormones and would not make a medical decision on that point the way the other thing that has to be read with the complaint is the arkansas directive which is in the record in the a dent into the brief a just not into eleven that sets up this committee and its powers it has the power to do a treatment plan not the licensed doctor so she had to go to the committee the st time she went to the committee they said you don't have a diagnosis go away then she went back and to the doctor and say will you give me a diagnosis so i can see the commit it he gave her a diagnosis she went to the committee in the committee said you don't mean norma that if they could show that was some professional judgement within the range of professionally acceptable care decisions we might not win summary judgment but that's not the standard here and the committee has gatekeeper is the actor that committed the deliberate indifference under the the nd arm of the te says that there are four or five members of the committee some are drawn from concert for cation some are drawn from mental health and one from the medical department but it doesn't say that those are the people will sit because it says those folks or their designees so we don't know who they designate and whether they had a new training in transgender care the one thing the committee directed does say is that they're supposed to approve a treatment plan individually tailored to each patient that's not in the record there's no record that they have a treatment plan for the plaintiff and that's to liberty and difference on these  diagnosis that sent to the committee and i think that given the favorable inferences from the record about as far as i can go jim strauss in trying to explain why i believe there is to liberty and from it's the same defendant in both cases the person in charge of mental health and i don't know if she sat on the committee or she was named because that all i just don't know which it was because our client wasn't granted a list of who the committee people were but but assume that it was this person she could still be outvoted we don't know whether the physician and could actually prescribe medicine so what we're asking for is some evidence that there was an effort by the state of arkansas to professional judgment to this plaintiff the one thing that links all of this court's decisions on transgender inmates going all the way back to white is an that there needs to be a professional judgment in these cases why it was actually a an appeal where the inmate won and the court said no there was not enough deference to the prefer small judgment of the d rs and prison long actually went to trial and in that case the court observed that i would done a great deal including taking the extraordinary step of sending the inmate out of state trying to the d s m had been upgraded to say that the condition should be analyzed as gender dysphoria not gender identity disorder so they got the rd opinion it was the same as the other two so there were three opinions and the question really there which is to describe it is to show how different it is was that this court was not going to make the district judges try that kind of case where the state has three separate opinions that agree with each other in the end has only her argument that she disagrees with the diagnosis that's not this case in fact this case begins with the diagnosis from the spike higher trust who is a physician and the interruption of that diagnosis by a committee our client should be given the the chance to show that that was a blanket denial that was in fact the policy not the policy but the practice of the state regardless of their written policy  i'd like to also mention the equal protection argument here because the district judges i think that's construed the argument in both of these cases but i'm just go have to go to a good keeping committee to get their treatment chance gender inmates to wear the look at it is the treatment they're seeking or the status they hold there's an equal protection issue  there's also an equal protection issue on stereotyping and i'd like to to just quote you briefly from the the plaintiffs pleading she wants to be allowed to groom her south to dress herself and to present herself according to her gender identity and allow her to heal from the damage of this being suppressed up some tahj ninety three of the appendix that is very much like a gender stereotyping claim in the style of the young college case and whether you look at it as a discrete class presenting equal protection issues or you look at it just a gender stereotyping case because she also says in the complaint she's being forced to present as a man up as an equal protection claim and i think the supreme court's decision in bostic just last summer underscores that transgender people have equal were on the panel up you sent it back to the district judge to review again in light of the pasta and i think that in underscores the need for the district judge to do that here to should there need to be some for the claim to succeed somehow allegation that i'm entitle to this because some doctors and i did we do have some of that evidence and butterfield because we  don't have any of this year we don't have it in a complaint going to surgeon or anything of the kind isn't that necessary well i would back up just a bit on in my response here on there because your st premise was that was a characterization of what the committee did actually it was a quote the committee said that hormones are not clinically indicated or recommended and it's an odd way for a committee to say something record it would be interesting whether he just sent it to the committee or in your narrative some discovery should be better to you up on here to flesh out what the decision and how that was and how it was made up and she says that she thinks she should have been given a professional judgment well i think she should have to and i think that's the point once you've got the professional based on the allegations is this just a simple disagreement or is the allegation here that there is no magical judgment all and if so where is that in the complaint when the allegation is that there's a blanket practice of denying it even if it's allowed in theory under the policy where is that in the complaint i think the word blanket is used repeatedly and her opposition to dismiss all i'm not sure she uses the word blanket in the complaint itself i would urge the court also consider the opposition to the dismissal motion because it's much more length thing is from a pro se plaintiff but she makes her point quite clear that she thinks the status applying a blanket policy and until yesterday so did our op i don't know what it is going on in practice  believe anything like that that would suggest that's the case well i think if you look at the way they respond to the grievances it's their own they sat was a clinical decision but they wouldn't say who made the decision  i think you have to look at this in part as how d extraordinary this cake keeping function really is if we had a sister a new woman in her middle ages who wanted estrogen because her body wasn't making it anymore she wouldn't be sent to a committee but it turns gender push it would be and i know  that's equal protection but it's also a way to amendment they overlap here they have created a barrier to the command of this group of people and i think it would be fair to argue that that affects the deliberate indifference standard and should be figured into the analysis of the court on the nd arm of the th amendment test there's no question they knew that she felt she should have hormones if they had presented anything from a doctor but they didn't there's just nothing in the record we don't  tell our children you can't because i said so after a certain age but that's what they did here and i think there is a right and under this court been going all the way back to a still to have a professional medical judgment made and that's not here i have very little time left so maybe i could save it for rebuttal if i could grieving we don't have anything in the rocker and so obviously we get you know we need something to substantiate that how would you recommend that we proceed from here if in fact that kate is moot because i mean and i wonder whether there is damage i think there's some damages  it seems like that puts us in a sort of an interesting position maybe it gets reminded i don't know what would happen there but it almost seems like you would have to agree but i kind of thinking it through was a sense here that having realized that this may be an issue step of whether or not she had then recommended for for treatment so i struggle with it being sort dispositive of this one because it seems that what we have here is a plane to complaint as i've been diagnosed with this specific disorder and the prison is not treating me at all that seems to at least make the allegation that it is just being ignored and that's viewing it in any other kind of treatment for the gender dysphoria is it does that speak to another certainly whether hormone treatment is appropriate for this plaintiff both both counsels and what are the documents that were limited to it the motion to dismiss kate's state in this case because it seems to me that once you start getting into these other documents we really have got a conversation going about really what's going on but what do you think we should be looking at to decide this at a motion to dismiss you should be looking at the complaint and i think you would be appropriate to look at her check since the motion but i don't believe it's definitive i would like you to focus on page fifty seven dollars now the appendix the part of the complaint where she's those i have the diagnosis it's like having the car without the key i have the would like you to address that extends you feel you can't well i would just call the court's attention to the supreme court's ruling in the new york rifle case where the concealed written by the chief justice that they would send that back down to determine minuteness because there may be other applications and there may be other issues and there would still be a damages claim that would be alive even if it were