Case: 4:16-cv-1357 As of: 05/20/2018 03:15 PM CDT 1 of 20
ADR,ADRC,FULLCON
U.S. District Court Eastern District of Missouri (St. Louis) CIVIL DOCKET FOR CASE #: 4:16−cv−01357−NCC

Hicklin v. Lombardi et al Assigned to: Magistrate Judge Noelle C. Collins Cause: 42:1983 Prisoner Civil Rights
Plaintiff

Date Filed: 08/22/2016 Jury Demand: Defendant Nature of Suit: 550 Prisoner: Civil Rights Jurisdiction: Federal Question

Jessica Hicklin

represented by Demoya Renee Gordon LAMBDA LEGAL DEFENSE 120 Wall St. 19th Fl. New York, NY 10005−3919 212−809−8585 Fax: 212−809−0055 Email: dgordon@lambdalegal.org LEAD ATTORNEY ATTORNEY TO BE NOTICED

Kevin L. Schriener LAW AND SCHRIENER, LLC 141 N. Meramec Avenue Suite 314 St. Louis, MO 63105 314−721−7095 Fax: 314−863−7096 Email: kschriener@schrienerlaw.com LEAD ATTORNEY ATTORNEY TO BE NOTICED

Carl Solomon Charles LAMBDA LEGAL DEFENSE 120 Wall St. 19th Fl. New York, NY 10005−3919 212−809−8585 Email: ccharles@lambdalegal.org TERMINATED: 10/23/2017 PRO HAC VICE ATTORNEY TO BE NOTICED

Frederick Andrew braunstein ROBINS KAPLAN LLP 399 Park Ave. Suite 3600 New York, ny 10022 212−980−7400 Email: FBraunstein@robinskaplan.com ATTORNEY TO BE NOTICED

Kyle Anthony Palazzolo SALVATORE AND PRESCOTT PLLC 1010 Davis St. Evanston, IL 60201 312−283−5711 Fax: 312−724−8353 Email: palazzolo@spplawyers.com TERMINATED: 07/07/2017 ATTORNEY TO BE NOTICED

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Marla R. Butler ROBINS KAPLAN LLP 800 LaSalle Avenue S. 2800 LaSalle Plaza Minneapolis, MN 55402−2015 612−349−8500 Fax: 612−339−4181 Email: mbutler@robinskaplan.com ATTORNEY TO BE NOTICED
Rajin Singh Olson ROBINS KAPLAN LLP 800 LaSalle Avenue S. 2800 LaSalle Plaza Minneapolis, MN 55402−2015 612−349−8500 Fax: 612−339−4181 Email: Rolson@robinskaplan.com ATTORNEY TO BE NOTICED
Richard Saenz LAMBDA LEGAL DEFENSE 120 Wall St. 19th Fl. New York, NY 10005−3919 212−809−8585 Fax: 212−809−0055 Email: rsaenz@lambdalegal.org PRO HAC VICE ATTORNEY TO BE NOTICED
Sharon Elizabeth Roberg−Perez ROBINS KAPLAN LLP 800 LaSalle Avenue S. 2800 LaSalle Plaza Minneapolis, MN 55402−2015 612−349−8500 Fax: 612−339−4181 Email: SRoberg−Perez@Robinskaplan.com ATTORNEY TO BE NOTICED

V.
Defendant
George Lombardi in his official capacity as Director of the Missouri Department of Corrections (MDOC) TERMINATED: 01/30/2018

represented by David D. Dean ATTORNEY GENERAL OF MISSOURI Old Post Office Building P.O. Box 861 St. Louis, MO 63188 314−340−7950 Email: david.dean@ago.mo.gov LEAD ATTORNEY ATTORNEY TO BE NOTICED
Dean John Sauer ATTORNEY GENERAL OF MISSOURI 1530 Rax Court P.O. Box 899 Jefferson City, MO 65109 573−751−8807 Email: john.sauer@ago.mo.gov LEAD ATTORNEY ATTORNEY TO BE NOTICED

Case: 4:16-cv-1357 As of: 05/20/2018 03:15 PM CDT 3 of 20

Henry F. Luepke , III ATTORNEY GENERAL OF MISSOURI 815 Olive Street Suite 200 St. Louis, MO 63101 (314) 340−7652 Email: Bud.Luepke@ago.mo.gov TERMINATED: 02/06/2018 LEAD ATTORNEY ATTORNEY TO BE NOTICED

Defendant
Dwayne Kempker in his official capacity as former Deputy Director, Division of Adult Institutions, MDOC TERMINATED: 05/22/2017

represented by Henry F. Luepke , III (See above for address) TERMINATED: 02/06/2018 LEAD ATTORNEY ATTORNEY TO BE NOTICED

Defendant
Ian Wallace in his official capacity as current Deputy Director, Division of Adult Institutions, MDOC TERMINATED: 02/26/2018

represented by David D. Dean (See above for address) LEAD ATTORNEY ATTORNEY TO BE NOTICED
Dean John Sauer (See above for address) LEAD ATTORNEY ATTORNEY TO BE NOTICED

Henry F. Luepke , III (See above for address) TERMINATED: 02/06/2018 LEAD ATTORNEY ATTORNEY TO BE NOTICED

Defendant
Cindy Griffith in her offical capacity as Warden of Potosi Correctional Center ("PCC") and in her official capacity as Deputy Director, Division of Adult Institutions, MDOC.

represented by David D. Dean (See above for address) LEAD ATTORNEY ATTORNEY TO BE NOTICED
Dean John Sauer (See above for address) LEAD ATTORNEY ATTORNEY TO BE NOTICED

Henry F. Luepke , III (See above for address) TERMINATED: 02/06/2018 LEAD ATTORNEY ATTORNEY TO BE NOTICED

Defendant
Stan Payne in his official capacity as former Acting Warden, and current Deputy Warden of Offender Management, PCC

represented by David D. Dean (See above for address) LEAD ATTORNEY ATTORNEY TO BE NOTICED

Dean John Sauer (See above for address) LEAD ATTORNEY ATTORNEY TO BE NOTICED

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Defendant Scott O'Kelly L.P.C. in his official capacity as Assistant Division Director, Mental Helath Services, Departmnet of Offender Rehabilitative Services, MDOC
Defendant Deloise Williams R.N., B.S.N., in her official capacity as Assistant Director, Department of Offender Rehabilitative Services, MDOC TERMINATED: 02/26/2018
Defendant Corizon Health, Inc.
Defendant William McKinney M.D., in his official capacity as Medical Director of Corizon TERMINATED: 04/19/2018

Henry F. Luepke , III (See above for address) TERMINATED: 02/06/2018 LEAD ATTORNEY ATTORNEY TO BE NOTICED
represented by David D. Dean (See above for address) LEAD ATTORNEY ATTORNEY TO BE NOTICED
Dean John Sauer (See above for address) LEAD ATTORNEY ATTORNEY TO BE NOTICED
Henry F. Luepke , III (See above for address) TERMINATED: 02/06/2018 LEAD ATTORNEY ATTORNEY TO BE NOTICED
represented by David D. Dean (See above for address) LEAD ATTORNEY ATTORNEY TO BE NOTICED
Dean John Sauer (See above for address) LEAD ATTORNEY ATTORNEY TO BE NOTICED
Henry F. Luepke , III (See above for address) TERMINATED: 02/06/2018 LEAD ATTORNEY ATTORNEY TO BE NOTICED
represented by J. Thaddeus Eckenrode ECKENRODE−MAUPIN 11477 Olde Cabin Rd. Suite 110 St. Louis, MO 63141 314−726−6670 Fax: 314−726−2106 Email: jte@eckenrode−law.com LEAD ATTORNEY ATTORNEY TO BE NOTICED
represented by J. Thaddeus Eckenrode (See above for address) LEAD ATTORNEY ATTORNEY TO BE NOTICED
Kevin K. Peek SANDBERG PHOENIX, P.C. 600 Washington Ave.

Case: 4:16-cv-1357 As of: 05/20/2018 03:15 PM CDT 5 of 20

15th Floor St. Louis, MO 63101−1313 314−426−4209 Fax: 314−241−7604 Email: kevinkpeek@outlook.com TERMINATED: 03/19/2018

Defendant
Glen Babich M.D., in his official capacity as former Associate Regional Medical Director, and current Regional Medical Director, Corizon TERMINATED: 02/26/2018

represented by J. Thaddeus Eckenrode (See above for address) LEAD ATTORNEY ATTORNEY TO BE NOTICED
Kevin K. Peek (See above for address) TERMINATED: 03/19/2018

Defendant
T.K. Bredeman D.O., in his official capacity as Associate Regional Medical Director, Corizon TERMINATED: 04/19/2018

represented by J. Thaddeus Eckenrode (See above for address) LEAD ATTORNEY ATTORNEY TO BE NOTICED

Kevin K. Peek (See above for address) TERMINATED: 03/19/2018

Defendant
Diana Larkin R.N., in her offical capacity as former Director of Nursing and current Health Services Administrator, Corizon TERMINATED: 04/19/2018

represented by J. Thaddeus Eckenrode (See above for address) LEAD ATTORNEY ATTORNEY TO BE NOTICED
Kevin K. Peek (See above for address) TERMINATED: 03/19/2018

Defendant
Kimberley S. Randolph R.N., B.S.N., C.C.H.P., in her official capacity as Director of Operations, Corizon TERMINATED: 04/19/2018

represented by J. Thaddeus Eckenrode (See above for address) LEAD ATTORNEY ATTORNEY TO BE NOTICED
Kevin K. Peek (See above for address) TERMINATED: 03/19/2018

Defendant
Dawn Wade R.N., in her offical capacity as Director of Nursing, Corizon TERMINATED: 02/26/2018

represented by J. Thaddeus Eckenrode (See above for address) LEAD ATTORNEY ATTORNEY TO BE NOTICED

Kevin K. Peek (See above for address) TERMINATED: 03/19/2018

Defendant
Stormi Moeller R.N., in her official capacity as an employee of Corizon

represented by J. Thaddeus Eckenrode (See above for address) LEAD ATTORNEY

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TERMINATED: 04/19/2018

ATTORNEY TO BE NOTICED

Kevin K. Peek (See above for address) TERMINATED: 03/19/2018

Defendant
Shirley Eyman M.D., in her official capacity as Regional Psychiatric Director, Corizon TERMINATED: 02/26/2018

represented by J. Thaddeus Eckenrode (See above for address) LEAD ATTORNEY ATTORNEY TO BE NOTICED

Kevin K. Peek (See above for address) TERMINATED: 03/19/2018

Defendant
Elizabeth Atterberry M.D., L.P., in her official capacity as Clinical Director, Corizon TERMINATED: 04/19/2018

represented by J. Thaddeus Eckenrode (See above for address) LEAD ATTORNEY ATTORNEY TO BE NOTICED

Kevin K. Peek (See above for address) TERMINATED: 03/19/2018

Defendant
Kim Foster L.P.C., in her official capacity as Regional Administrator, Corizon TERMINATED: 04/19/2018

represented by J. Thaddeus Eckenrode (See above for address) LEAD ATTORNEY ATTORNEY TO BE NOTICED

Kevin K. Peek (See above for address) TERMINATED: 03/19/2018

Defendant
Anne Precythe in her official capacity as Director of the Missouri Department of Corrections (MDOC)

represented by David D. Dean (See above for address) LEAD ATTORNEY ATTORNEY TO BE NOTICED

Defendant
Joan Reinkemeyer in her official capacity as Director, Division of Offender Rehabilitative Services, MDOC

represented by David D. Dean (See above for address) LEAD ATTORNEY ATTORNEY TO BE NOTICED

Defendant
Latoya Duckworth in her official capacity as Assistant Division Director, Medical Services, Department of Offender Rehabilitative Services, MDOC

represented by David D. Dean (See above for address) LEAD ATTORNEY ATTORNEY TO BE NOTICED

Defendant
John Deghetto, M.D. in his official capacity as Associate Regional Medical Director, Corizon TERMINATED: 04/19/2018

represented by J. Thaddeus Eckenrode (See above for address) LEAD ATTORNEY ATTORNEY TO BE NOTICED

Case: 4:16-cv-1357 As of: 05/20/2018 03:15 PM CDT 7 of 20

Defendant
Daly Smith in her official capacity as Director of Nursing, Corizon TERMINATED: 04/19/2018
Defendant
Ernest Graypel, M.D. in his official capacity as Regional Psychiatric Director, Corizon TERMINATED: 04/19/2018

represented by J. Thaddeus Eckenrode (See above for address) LEAD ATTORNEY ATTORNEY TO BE NOTICED
represented by J. Thaddeus Eckenrode (See above for address) LEAD ATTORNEY ATTORNEY TO BE NOTICED

Date Filed 08/22/2016 08/22/2016 08/22/2016 08/22/2016 08/22/2016 08/22/2016 08/22/2016 08/22/2016 08/22/2016 08/22/2016 08/22/2016 08/22/2016 08/22/2016 08/22/2016 08/22/2016 08/22/2016 08/22/2016 08/22/2016

# Docket Text
1 NOTICE OF PROCESS SERVER by Plaintiff Jessica Hicklin Process Server: Scott Fitzgerald (Schriener, Kevin) (Entered: 08/22/2016)
2 NOTICE OF PROCESS SERVER by Plaintiff Jessica Hicklin Process Server: Scott Fitzgerald (Schriener, Kevin) (Entered: 08/22/2016)
3 NOTICE OF PROCESS SERVER by Plaintiff Jessica Hicklin Process Server: Scott Fitzgerald (Schriener, Kevin) (Entered: 08/22/2016)
4 NOTICE OF PROCESS SERVER by Plaintiff Jessica Hicklin Process Server: Scott Fitzgerald (Schriener, Kevin) (Entered: 08/22/2016)
5 NOTICE OF PROCESS SERVER by Plaintiff Jessica Hicklin Process Server: Scott Fitzgerald (Schriener, Kevin) (Entered: 08/22/2016)
6 NOTICE OF PROCESS SERVER by Plaintiff Jessica Hicklin Process Server: Scott Fitzgerald (Schriener, Kevin) (Entered: 08/22/2016)
7 NOTICE OF PROCESS SERVER by Plaintiff Jessica Hicklin Process Server: Scott Fitzgerald (Schriener, Kevin) (Entered: 08/22/2016)
8 NOTICE OF PROCESS SERVER by Plaintiff Jessica Hicklin Process Server: Scott Fitzgerald (Schriener, Kevin) (Entered: 08/22/2016)
9 NOTICE OF PROCESS SERVER by Plaintiff Jessica Hicklin Process Server: Scott Fitzgerald (Schriener, Kevin) (Entered: 08/22/2016)
10 NOTICE OF PROCESS SERVER by Defendant George Lombardi Process Server: Scott Fitzgerald (Schriener, Kevin) (Entered: 08/22/2016)
11 NOTICE OF PROCESS SERVER by Plaintiff Jessica Hicklin Process Server: Scott Fitzgerald (Schriener, Kevin) (Entered: 08/22/2016)
12 NOTICE OF PROCESS SERVER by Plaintiff Jessica Hicklin Process Server: Scott Fitzgerald (Schriener, Kevin) (Entered: 08/22/2016)
13 NOTICE OF PROCESS SERVER by Plaintiff Jessica Hicklin Process Server: Scott Fitzgerald (Schriener, Kevin) (Entered: 08/22/2016)
14 NOTICE OF PROCESS SERVER by Plaintiff Jessica Hicklin Process Server: Scott Fitzgerald (Schriener, Kevin) (Entered: 08/22/2016)
15 NOTICE OF PROCESS SERVER by Plaintiff Jessica Hicklin Process Server: Scott Fitzgerald (Schriener, Kevin) (Entered: 08/22/2016)
16 NOTICE OF PROCESS SERVER by Plaintiff Jessica Hicklin Process Server: Scott Fitzgerald (Schriener, Kevin) (Entered: 08/22/2016)
17 NOTICE OF PROCESS SERVER by Defendant Ian Wallace Process Server: Scott Fitzgerald (Schriener, Kevin) (Entered: 08/22/2016)
18 NOTICE OF PROCESS SERVER by Plaintiff Jessica Hicklin Process Server: Scott Fitzgerald (Schriener, Kevin) (Entered: 08/22/2016)

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08/22/2016
08/22/2016 08/23/2016
08/23/2016 08/23/2016
08/23/2016 08/24/2016
09/08/2016 09/16/2016 09/16/2016 09/26/2016 09/26/2016 09/26/2016 09/29/2016

19 COMPLAINT against defendants All Defendants with receipt number 0865−5550597, in the amount of $400 Non−Jury Demand,, filed by Jessica Hicklin. (Attachments: # 1 Civil Cover Sheet, # 2 Original Filing Form, # 3 Summons, # 4 Summons, # 5 Summons, # 6 Summons, # 7 Summons, # 8 Summons, # 9 Summons, # 10 Summons, # 11 Summons, # 12 Summons, # 13 Summons, # 14 Summons, # 15 Summons, # 16 Summons, # 17 Summons, # 18 Summons, # 19 Summons, # 20 Summons)(Schriener, Kevin) Modified on 8/22/2016 (JWD). (Entered: 08/22/2016)
20 MOTION for Leave to Appear Pro Hac Vice Demoya R. Gordon. The Certificate of Good Standing was attached.(Filing fee $100 receipt number 0865−5551098) by Plaintiff Jessica Hicklin. (Attachments: # 1 Certificate of Good Standing)(Gordon, Demoya) (Entered: 08/22/2016)
Case Opening Notification: 18 Summons(es) issued. The summons were emailed to attorney Kevin L. Schriener. All parties must file the Notice Regarding Magistrate Judge Jurisdiction Form (moed−0041.pdf) consenting to or opting out of the Magistrate Judge jurisdiction. Judge Assigned: U.S. Magistrate Judge Noelle C. Collins. (BAK) (Entered: 08/23/2016)
21 First MOTION for Leave to Appear Pro Hac Vice Richard Saenz. The Certificate of Good Standing was attached.(Filing fee $100 receipt number 0865−5552113) by Plaintiff Jessica Hicklin. (Attachments: # 1 Certificate of Good Standing)(Saenz, Richard) (Entered: 08/23/2016)
22 MOTION for Leave to Appear Pro Hac Vice Kyle A. Palazzolo. The Certificate of Good Standing was attached.(Filing fee $100 receipt number 0865−5552616) by Plaintiff Jessica Hicklin. (Attachments: # 1 Attachment Full list of bars, State and Federal, that Kyle Palazzolo is a member, # 2 Certificate of Good Standing Certificate of Admission/Good standing)(Palazzolo, Kyle) (Entered: 08/23/2016)
23 Pursuant to Local Rule 2.08, the assigned/referred magistrate judge is designated and authorized by the court to exercise full authority in this assigned/referred action or matter under 28 U.S.C. Sec. 636 and 18 U.S.C Sec. 3401. (CSAW) (Entered: 08/23/2016)
24 Docket Text ORDER: IT IS HEREBY ORDERED that the Verified Motions for Admission Pro Hac Vice (Docs. 20 , 21 , 22 ) filed by Demoya R. Gordon, Richard Saenz, and Kyle A. Palazzolo, counsel for Plaintiff Jessica Hicklin, are GRANTED. IT IS FURTHER ORDERED that Demoya R. Gordon, Richard Saenz, and Kyle A. Palazzolo are hereby admitted for the purpose of representing Jessica Hicklin in this matter. Signed by Magistrate Judge Noelle C. Collins on 08/24/2016. (KBL) (Entered: 08/24/2016)
25 ENTRY of Appearance by Henry F. Luepke, III for Defendants Cindy Griffith, Dwayne Kempker, George Lombardi, Scott O'Kelly, Stan Payne, Ian Wallace, Deloise Williams. (Luepke, Henry) (Entered: 09/08/2016)
26 ENTRY of Appearance by J. Thaddeus Eckenrode for Defendant Corizon Health, Inc.. (Eckenrode, J.) (Entered: 09/16/2016)
27 ANSWER to 19 Complaint,, by Corizon Health, Inc..(Eckenrode, J.) (Entered: 09/16/2016)
28 SUMMONS Returned Executed filed by Jessica Hicklin. Corizon Health, Inc. served on 8/26/2016, answer due 9/16/2016. (Gordon, Demoya) (Additional attachment(s) added on 9/29/2016: # 1 Summons Original Issued) (NEB). (Entered: 09/26/2016)
29 SUMMONS Returned Executed filed by Jessica Hicklin. Cindy Griffith served on 8/26/2016, answer due 9/16/2016. (Gordon, Demoya) (Additional attachment(s) added on 9/29/2016: # 1 Summons Original/Issued) (NEB). (Entered: 09/26/2016)
30 SUMMONS Returned Executed filed by Jessica Hicklin. Dawn Wade served on 9/8/2016, answer due 9/29/2016. (Gordon, Demoya) (Additional attachment(s) added on 9/29/2016: # 1 Summons Original/Issued) (NEB). (Entered: 09/26/2016)
31 ENTRY of Appearance by J. Thaddeus Eckenrode for Defendants Elizabeth Atterberry, Glen Babich, T.K. Bredeman, Shirley Eyman, Kim Foster, Diana Larkin, William McKinney, Stormi Moeller, Kimberley S. Randolph, Dawn Wade.

Case: 4:16-cv-1357 As of: 05/20/2018 03:15 PM CDT 9 of 20

09/29/2016 09/29/2016 09/29/2016 09/29/2016 09/29/2016 09/29/2016 09/29/2016 09/29/2016 09/29/2016 09/29/2016 09/30/2016
10/03/2016 10/03/2016 10/03/2016
10/03/2016 10/03/2016 10/03/2016 10/03/2016 10/03/2016 10/03/2016 10/03/2016 10/03/2016 10/03/2016 10/03/2016 10/03/2016

(Eckenrode, J.) (Entered: 09/29/2016)
32 ANSWER to 19 Complaint,, by William McKinney.(Eckenrode, J.) (Entered: 09/29/2016)
33 ANSWER to 19 Complaint,, by Glen Babich.(Eckenrode, J.) (Entered: 09/29/2016)
34 ANSWER to 19 Complaint,, by T.K. Bredeman.(Eckenrode, J.) (Entered: 09/29/2016)
35 ANSWER to 19 Complaint,, by Diana Larkin.(Eckenrode, J.) (Entered: 09/29/2016)
36 ANSWER to 19 Complaint,, by Kimberley S. Randolph.(Eckenrode, J.) (Entered: 09/29/2016)
37 ANSWER to 19 Complaint,, by Dawn Wade.(Eckenrode, J.) (Entered: 09/29/2016)
38 ANSWER to 19 Complaint,, by Stormi Moeller.(Eckenrode, J.) (Entered: 09/29/2016)
39 ANSWER to 19 Complaint,, by Shirley Eyman.(Eckenrode, J.) (Entered: 09/29/2016)
40 ANSWER to 19 Complaint,, by Elizabeth Atterberry.(Eckenrode, J.) (Entered: 09/29/2016)
41 ANSWER to 19 Complaint,, by Kim Foster.(Eckenrode, J.) (Entered: 09/29/2016)
42 ANSWER to 19 Complaint,, by Cindy Griffith, Dwayne Kempker, George Lombardi, Scott O'Kelly, Stan Payne, Ian Wallace, Deloise Williams.(Luepke, Henry) (Entered: 09/30/2016)
43 SUMMONS Returned Executed filed by Jessica Hicklin. Deloise Williams served on 8/25/2016, answer due 9/15/2016. (Gordon, Demoya) (Entered: 10/03/2016)
44 SUMMONS Returned Executed filed by Jessica Hicklin. Diana Larkin served on 9/8/2016, answer due 9/29/2016. (Gordon, Demoya) (Entered: 10/03/2016)
45 SUMMONS Returned Executed filed by Jessica Hicklin. defendantElizabeth Atterberry served on 9/8/2016, answer due 11/7/2016. (Gordon, Demoya) (Entered: 10/03/2016)
46 SUMMONS Returned Executed filed by Jessica Hicklin. George Lombardi served on 8/25/2016, answer due 9/15/2016. (Gordon, Demoya) (Entered: 10/03/2016)
47 SUMMONS Returned Executed filed by Jessica Hicklin. Glen Babich served on 9/8/2016, answer due 9/29/2016. (Gordon, Demoya) (Entered: 10/03/2016)
48 SUMMONS Returned Executed filed by Jessica Hicklin. Ian Wallace served on 8/25/2016, answer due 9/15/2016. (Gordon, Demoya) (Entered: 10/03/2016)
49 SUMMONS Returned Executed filed by Jessica Hicklin. Kim Foster served on 9/8/2016, answer due 9/29/2016. (Gordon, Demoya) (Entered: 10/03/2016)
50 SUMMONS Returned Executed filed by Jessica Hicklin. Kimberley S. Randolph served on 9/8/2016, answer due 9/29/2016. (Gordon, Demoya) (Entered: 10/03/2016)
51 SUMMONS Returned Executed filed by Jessica Hicklin. Scott O'Kelly served on 8/25/2016, answer due 9/15/2016. (Gordon, Demoya) (Entered: 10/03/2016)
52 SUMMONS Returned Executed filed by Jessica Hicklin. Shirley Eyman served on 9/8/2016, answer due 9/29/2016. (Gordon, Demoya) (Entered: 10/03/2016)
53 SUMMONS Returned Executed filed by Jessica Hicklin. Stan Payne served on 8/26/2016, answer due 9/16/2016. (Gordon, Demoya) (Entered: 10/03/2016)
54 SUMMONS Returned Executed filed by Jessica Hicklin. Stormi Moeller served on 9/8/2016, answer due 9/29/2016. (Gordon, Demoya) (Entered: 10/03/2016)
55 SUMMONS Returned Executed filed by Jessica Hicklin. T.K. Bredeman served on 9/8/2016, answer due 9/29/2016. (Gordon, Demoya) (Entered: 10/03/2016)
56 SUMMONS Returned Executed filed by Jessica Hicklin. William McKinney served on 9/8/2016, answer due 9/29/2016. (Gordon, Demoya) (Entered: 10/03/2016)

Case: 4:16-cv-1357 As of: 05/20/2018 03:15 PM CDT 10 of 20

10/06/2016
10/12/2016 10/13/2016 11/09/2016 11/14/2016 11/16/2016 11/16/2016
04/04/2017 04/04/2017
04/07/2017
04/12/2017 04/13/2017

Notice from Clerk instructing Defendants Elizabeth Atterberry, Glen Babich, T.K. Bredeman, Corizon Health, Inc., Shirley Eyman, Kim Foster, Cindy Griffith, Dwayne Kempker, Diana Larkin, George Lombardi, William McKinney, Stormi Moeller, Scott O'Kelly, Stan Payne, Kimberley S. Randolph, Dawn Wade, Ian Wallace, Deloise Williams to submit Notice regarding Magistrate Judge Jurisdiction. Click here for the instructions. (NEB) (Entered: 10/06/2016)
57 FULL CONSENT has been received by Defendants Elizabeth Atterberry, Glen Babich, T.K. Bredeman, Corizon Health, Inc., Shirley Eyman, Kim Foster, Cindy Griffith, Dwayne Kempker, Diana Larkin, George Lombardi, William McKinney, Stormi Moeller, Scott O'Kelly, Stan Payne, Kimberley S. Randolph, Dawn Wade, Ian Wallace, Deloise Williams, Plaintiff Jessica Hicklin. (KCB) (Entered: 10/12/2016)
58 RULE 16 ORDER This case is assigned to Track: two Joint Scheduling Plan due by 11/9/2016. Rule 16 Conference set for 11/16/2016 01:30 PM in Chambers before Magistrate Judge Noelle C. Collins. (SEE ORDER FOR COMPLETE DETAILS.) Signed by Magistrate Judge Noelle C. Collins on 10/13/2016. (KCB) (Entered: 10/13/2016)
59 JOINT SCHEDULING PLAN by Plaintiff Jessica Hicklin. . (Gordon, Demoya) (Entered: 11/09/2016)
60 ENTRY of Appearance by Kevin K. Peek for Defendants Elizabeth Atterberry, Glen Babich, T.K. Bredeman, Shirley Eyman, Kim Foster, Diana Larkin, William McKinney, Stormi Moeller, Kimberley S. Randolph, Dawn Wade. (Peek, Kevin) (Entered: 11/14/2016)
61 Minute Entry for proceedings held before Magistrate Judge Noelle C. Collins: Rule 16 Conference held on 11/16/2016. Conference held in person. CMO to issue. (FTR Gold: No) (KCB) (Entered: 11/16/2016)
62 CASE MANAGEMENT ORDER This case is assigned to Track: three Motion to Join Parties due by 12/16/2016. Discovery Completion due by 9/30/2017. Non−Dispositive Motions due by 10/11/2017. ADR Future Reference 9/11/2017. Dispositive Motions due by 10/31/2017. Jury Trial set for 5/7/2018 09:30 AM in Courtroom 15N before Magistrate Judge Noelle C. Collins. Pretrial Conference set for 4/30/2018 10:00 AM in Courtroom 15N before Magistrate Judge Noelle C. Collins. (SEE ORDER FOR COMPLETE DETAILS.) Signed by Magistrate Judge Noelle C. Collins on 11/16/216. (KCB) (Entered: 11/16/2016)
63 MOTION for Preliminary Injunction by Plaintiff Jessica Hicklin. (Schriener, Kevin) (Entered: 04/04/2017)
64 MEMORANDUM in Support of Motion re 63 MOTION for Preliminary Injunction filed by Plaintiff Jessica Hicklin. (Attachments: # 1 Affidavit Dr. Ettner Declaration, # 2 Affidavit Dr. Throop Delcaration, # 3 Exhibit Dr. Throop Exhibit A, # 4 Exhibit Dr. Throop Exhibit B, # 5 Affidavit Demoya Gordon Declaration, # 6 Exhibit Demoya Gordon Exhibit A, # 7 Text of Proposed Order Proposed Order Granting Preliminary Injunction)(Schriener, Kevin) (Entered: 04/04/2017)
65 ORDER: IT IS HEREBY ORDERED that this matter is set for a telephone conference with counsel on Wednesday, April 12, 2017 at 3:30 p.m. Counsel participating in the telephone conference are directed to call the conference toll free at: 1−888−363−4735. The access code to enter the telephone conference for all participants is: 3329658. (Telephone Conference set for 4/12/2017 03:30 PM in Telephone before Magistrate Judge Noelle C. Collins.) Signed by Magistrate Judge Noelle C. Collins on April 7, 2017. (BRP) (Entered: 04/07/2017)
66 Minute Entry for proceedings held before Magistrate Judge Noelle C. Collins: Telephone Conference held on 4/12/2017. Parties present for a telephone conference. The court hears argument from counsel. Order to Issue. (Court Reporter:FTR GOLD)(FTR Gold Operator initials:KCB) (FTR Gold: Yes) (KCB) (Entered: 04/12/2017)
67 ORDER: IT IS HEREBY ORDERED that Defendants oral motion for extension of time is GRANTED. By agreement of counsel, any response to Plaintiffs Motion for Preliminary Injunction shall be filed no later than April 19, 2017, and any reply shall be filed no later than April 27, 2017. IT IS FURTHER ORDERED that this matter is

Case: 4:16-cv-1357 As of: 05/20/2018 03:15 PM CDT 11 of 20

04/17/2017 04/19/2017 04/27/2017
05/01/2017 05/08/2017 05/16/2017 05/22/2017
05/23/2017
05/23/2017 05/23/2017 05/24/2017

set for a Preliminary Injunction Hearing on Tuesday, May 23, 2017, at 10:00 A.M. The Court will hear oral argument on Plaintiffs Motion for Preliminary Injunction. Each side shall have fifteen (15) minutes for argument. IT IS FURTHER ORDERED that no later than May 1, 2017 Plaintiff shall file a status report with the Court regarding the potential dismissal of Defendant Dwayne Kempker. IT IS FINALLY ORDERED that the parties shall file with the Court, under seal, a status report concerning their progress, if any, towards reaching a settlement and if they intend to move forward with the Preliminary Injunction Hearing no later than May 16, 2017. ( In Court Hearing set for 5/23/2017 10:00 AM in Courtroom 15N before Magistrate Judge Noelle C. Collins. Status Report due by 5/16/2017.) Signed by Magistrate Judge Noelle C. Collins on 04/13/2017. (KCB) (Entered: 04/13/2017)
68 MEMORANDUM in Opposition re 63 MOTION for Preliminary Injunction filed by Defendants Cindy Griffith, Dwayne Kempker, George Lombardi, Scott O'Kelly, Stan Payne, Ian Wallace, Deloise Williams. (Attachments: # 1 Exhibit A, # 2 Exhibit B, # 3 Exhibit C, # 4 Exhibit D, # 5 Exhibit E, # 6 Exhibit F, # 7 Exhibit G, # 8 Exhibit H, # 9 Exhibit I, # 10 Exhibit J, # 11 Exhibit K)(Luepke, Henry) (Entered: 04/17/2017)
69 MEMORANDUM in Opposition re 63 MOTION for Preliminary Injunction filed by Defendants Elizabeth Atterberry, Glen Babich, T.K. Bredeman, Corizon Health, Inc., Shirley Eyman, Kim Foster, Diana Larkin, William McKinney, Stormi Moeller, Kimberley S. Randolph, Dawn Wade. (Eckenrode, J.) (Entered: 04/19/2017)
70 REPLY to Response to Motion re 63 MOTION for Preliminary Injunction filed by Plaintiff Jessica Hicklin. (Attachments: # 1 Affidavit Second Declaration of Demoya R. Gordon, # 2 Exhibit Ex. A to Second Declaration of Demoya R. Gordon, # 3 Exhibit Ex. B to Second Declaration of Demoya R. Gordon, # 4 Exhibit Ex. C to Second Declaration of Demoya R. Gordon, # 5 Exhibit Ex. D to Second Declaration of Demoya R. Gordon, # 6 Exhibit Ex. E to Second Declaration of Demoya R. Gordon, # 7 Exhibit Ex. F to Second Declaration of Demoya R. Gordon, # 8 Exhibit Ex. G to Second Declaration of Demoya R. Gordon, # 9 Exhibit Ex. H to Second Declaration of Demoya R. Gordon, # 10 Exhibit Ex. I to Second Declaration of Demoya R. Gordon, # 11 Exhibit Ex. J to Second Declaration of Demoya R. Gordon)(Gordon, Demoya) (Entered: 04/27/2017)
71 STATUS REPORT by Jessica Hicklin. (Gordon, Demoya) (Entered: 05/01/2017)
72 STIPULATION for Dismissal Without Prejudice of Defendant Dwayne Kempker by Plaintiff Jessica Hicklin. (Gordon, Demoya) (Entered: 05/08/2017)
73 SEALED DOCUMENT by Plaintiff Jessica Hicklin. (Gordon, Demoya) (Entered: 05/16/2017)
74 ORDER...IT IS HEREBY ORDERED that Defendant Dwayne Kempker is DISMISSED from this action without prejudice, with Plaintiff Jessica Hicklin and Defendant Dwayne Kempker to bear their respective costs and attorneys fees as to the claims between them. (Dwayne Kempker (in his official capacity as former Deputy Director, Division of Adult Institutions, MDOC) terminated.). Signed by Magistrate Judge Noelle C. Collins on 5/22/2017. (NEB) (Entered: 05/22/2017)
75 Minute Entry for proceedings held before Magistrate Judge Noelle C. Collins: Parties present for Preliminary Injunction Hearing. Arguments heard on behalf of Plaintiff and Defendants. Exhibit received from Defendant MODC. (See exhibit list) Plaintiff has until May 30, 2017 to notify the Court if they will be filing any post hearing briefs and shall have until June 14, 2017 to file any such briefs. Defendants shall file their responses on or before June 19, 2017. Order to issue. (FTR Gold Operator initials:NEB) (FTR Gold: Yes) (NEB) Transcript request of this proceeding assigned to Court Reporter: S. Moran on 5/25/2017 (BABS). (Entered: 05/23/2017)
76 CLERKS Exhibit List as to Preliminary Injunction Hearing. (NEB) (Entered: 05/23/2017)
77 EXHIBITS Received from MODC: Exhibit L. (NEB) (Entered: 05/23/2017)
78 ORDER...IT IS HEREBY ORDERED that Plaintiff has until May 30, 2017 to notify the Court if she will be filing a post−hearing brief and shall have until June 14, 2017 to file any such brief. IT IS FURTHER ORDERED that Defendants shall file any

Case: 4:16-cv-1357 As of: 05/20/2018 03:15 PM CDT 12 of 20

05/24/2017 05/30/2017 05/30/2017 05/31/2017
06/13/2017
06/15/2017 06/16/2017
06/23/2017
06/26/2017 06/28/2017 07/05/2017

responses to Plaintiff's post−hearing brief, if one is filed, on or before June 19, 2017. (Response to Court due by 5/30/2017.). Signed by Magistrate Judge Noelle C. Collins on 5/24/2017. (NEB) (Entered: 05/24/2017)
79 ORDER... IT IS HEREBY ORDERED that the Clerk of Court shall cause an expedited written transcript to be prepared and filed with the Court of the Preliminary Injunction Hearing held on May 23, 2017. Signed by Magistrate Judge Noelle C. Collins on 5/24/2017. (cc: Court Reports Box.) (NEB) (Entered: 05/24/2017)
80 NOTICE by Plaintiff Jessica Hicklin regarding Post−hearing Brief (Gordon, Demoya) (Entered: 05/30/2017)
81 TRANSCRIPT ORDER REQUEST for 75 (PRETRIAL CONFERENCE) by Jessica Hicklin for proceedings held on 5/23/2017 court reporter FTR Gold before Judge Collins. (Emailed to S. Moran) (BRP) (Entered: 05/31/2017)
82 TRANSCRIPT of 75 (MOTION HEARING) held on May 23, 2017 before Judge NOELLE C. COLLINS. Court Reporter/Transcriber SUSAN R. MORAN, Telephone number (314) 244−7983. Transcript may be viewed at the court public terminal or purchased through the Court Reporter/Transcriber before the deadline for Release of Transcript Restriction. After that date it may be obtained through PACER. Redaction Request due 6/21/2017. Redacted Transcript Deadline set for 7/3/2017. Release of Transcript Restriction set for 8/29/2017. (BRP) (Entered: 05/31/2017)
83 TRANSCRIPT of 75 (REVISED VERSION) (MOTION HEARING) held on 5/23/2017 before Judge Noelle C. Collins. Court Reporter/Transcriber Susan Moran, Telephone number 314−244−7983. Transcript may be viewed at the court public terminal or purchased through the Court Reporter/Transcriber before the deadline for Release of Transcript Restriction. After that date it may be obtained through PACER. Redaction Request due 7/5/2017. Redacted Transcript Deadline set for 7/14/2017. Release of Transcript Restriction set for 9/11/2017. (NEB) (Entered: 06/13/2017)
84 MOTION to Amend/Correct the Case Management Order by Defendants Elizabeth Atterberry, Glen Babich, T.K. Bredeman, Corizon Health, Inc., Shirley Eyman, Kim Foster, Diana Larkin, William McKinney, Stormi Moeller, Kimberley S. Randolph, Dawn Wade. (Eckenrode, J.) (Entered: 06/15/2017)
85 ORDER... IT IS HEREBY ORDERED that this matter is set for a telephone conference with counsel on Thursday, June 22, 2017 at 11:00 a.m. Counsel participating in the telephone conference are directed to call the conference toll free at: 1−888−363−4735. The access code to enter the telephone conference for all participants is: 3329658. (Telephone Conference set for 6/22/2017 11:00 AM in Telephone before Magistrate Judge Noelle C. Collins.). Signed by Magistrate Judge Noelle C. Collins on 6/16/2017. (NEB) (Entered: 06/16/2017)
86 Minute Entry for proceedings held before Magistrate Judge Noelle C. Collins: Telephone Conference held on 6/23/2017. Ms. Gordon, Mr. Luepke, and Mr. Peek appear by phone for the telephone conference. Judge addresses Plaintiffs requested transcript revisions. Ms. Gordon states that Plaintiff has no further issues with revised transcript as filed (Doc. 83). Judge takes up Defendants Motion to Amend Case Management Order (Doc. 84). Plaintiff shall file a response to the Motion on or before Monday, June 26, 2017. Any reply brief shall be filed five (5) days thereafter. Plaintiff requests leave to supplement the Preliminary Injunction record. Plaintiff shall file a motion for leave to supplement the record no later than Wednesday, June 28, 2017. Defendants are granted seven (7) days from the date of Plaintiffs motion to respond. Any reply brief shall be filed five (5) days thereafter. (FTR Gold: No) (KCB) (Entered: 06/23/2017)
87 RESPONSE to Motion re 84 MOTION to Amend/Correct the Case Management Order filed by Plaintiff Jessica Hicklin. (Gordon, Demoya) (Entered: 06/26/2017)
88 MOTION for Leave to Supplement the Preliminary Injunction Record by Plaintiff Jessica Hicklin. (Attachments: # 1 Affidavit Declaration of Demoya R. Gordon, # 2 Exhibit A)(Gordon, Demoya) (Entered: 06/28/2017)
89 RESPONSE in Opposition re 88 MOTION for Leave to Supplement the Preliminary Injunction Record filed by Defendants Elizabeth Atterberry, Glen Babich, T.K.

Case: 4:16-cv-1357 As of: 05/20/2018 03:15 PM CDT 13 of 20

07/06/2017 07/07/2017 07/10/2017 07/14/2017 07/24/2017 07/25/2017
08/07/2017 08/25/2017 09/28/2017 10/04/2017 10/06/2017 10/10/2017 10/10/2017

Bredeman, Corizon Health, Inc., Shirley Eyman, Kim Foster, Diana Larkin, William McKinney, Stormi Moeller, Kimberley S. Randolph, Dawn Wade. (Eckenrode, J.) (Entered: 07/05/2017)
90 MOTION to Withdraw as Attorney ;attorney/firm Kyle A. Palazzolo by Plaintiff Jessica Hicklin. (Palazzolo, Kyle) (Entered: 07/06/2017)
91 Docket Text ORDER: IT IS HEREBY ORDERED that Attorney Kyle Anthony Palazzolo's Motion to Withdraw as Counsel for Plaintiff Jessica Hicklin (Doc. 90 ) is GRANTED. Attorney Kyle Anthony Palazzolo terminated. Signed by Magistrate Judge Noelle C. Collins on 7/7/2017. (KBL) (Entered: 07/07/2017)
92 REPLY to Response to Motion re 88 MOTION for Leave to Supplement the Preliminary Injunction Record filed by Plaintiff Jessica Hicklin. (Gordon, Demoya) (Entered: 07/10/2017)
93 First MOTION for Leave to Appear Pro Hac Vice Carl Charles. The Certificate of Good Standing was attached.(Filing fee $100 receipt number 0865−6050245) by Plaintiff Jessica Hicklin. (Attachments: # 1 Certificate of Good Standing)(Charles, Carl) (Entered: 07/14/2017)
94 Docket Text ORDER: IT IS HEREBY ORDERED that the Verified Motion for Admission Pro Hac Vice (Doc. 93 ) filed by Carl Charles, counsel for Jessica Hicklin, is GRANTED. IT IS FURTHER ORDERED that Carl Charles is hereby admitted for the purpose of representing Jessica Hicklin in this matter. Signed by Magistrate Judge Noelle C. Collins on 07/24/2017. (KBL) (Entered: 07/24/2017)
95 AMENDED CASE MANAGEMENT ORDER: [SEE ORDER FOR COMPLETE DETAILS] ( Discovery Completion due by 12/29/2017., Non−Dispositive Motions due by 1/9/2018., ADR Future Reference 8/7/2017., Dispositive Motions due by 1/31/2018., Pretrial Compliance due by 4/7/2018., Motion in Limine due by 4/17/2018.) Signed by Magistrate Judge Noelle C. Collins on 07/25/2017. (KCB) (Entered: 07/25/2017)
96 ORDER REFERRING CASE to Alternative Dispute Resolution. This case is referred to: Mediation Designation of Lead Counsel: Demoya Renee Gordon ADR Completion Deadline due by 9/29/2017. ADR Compliance Report Deadline due by 10/13/2017. Designation of Neutral/Conference Report due by 8/28/2017. Signed by Magistrate Judge Noelle C. Collins on August 7, 2017. (BRP) (Entered: 08/08/2017)
97 Designation of Neutral by parties and ADR Conference Report by Plaintiff Jessica Hicklin Neutral: Tokarz, Karen L. Date of Conference: September 20, 2017 time: 9:30am Location: United States Courthouse, 111 South Tenth Street, St. Louis, MO 63102(Gordon, Demoya) (Entered: 08/25/2017)
98 Second MOTION to Supplement the Preliminary Injunction Record by Plaintiff Jessica Hicklin. (Attachments: # 1 Affidavit Declaration of Demoya R. Gordon, # 2 Exhibit A)(Gordon, Demoya) (Entered: 09/28/2017)
99 RESPONSE to Motion re 98 Second MOTION to Supplement the Preliminary Injunction Record filed by Defendants Cindy Griffith, Dwayne Kempker, George Lombardi, Scott O'Kelly, Stan Payne, Ian Wallace, Deloise Williams. (Luepke, Henry) (Entered: 10/04/2017)
100 RESPONSE to Motion re 98 Second MOTION to Supplement the Preliminary Injunction Record filed by Defendants Elizabeth Atterberry, Glen Babich, T.K. Bredeman, Corizon Health, Inc., Shirley Eyman, Kim Foster, Diana Larkin, William McKinney, Stormi Moeller, Kimberley S. Randolph, Dawn Wade. (Eckenrode, J.) (Entered: 10/06/2017)
101 First MOTION for Leave to Appear Pro Hac Vice Marla R. Butler. The Certificate of Good Standing was attached.(Filing fee $100 receipt number 0865−6183218) by Plaintiff Jessica Hicklin. (Attachments: # 1 Certificate of Good Standing Certificate of Good Standing)(Butler, Marla) (Entered: 10/10/2017)
102 Docket Text ORDER: IT IS HEREBY ORDERED that the Verified Motion for Admission Pro Hac Vice (Doc. 101 ) filed by Marla R. Butler, counsel for Jessica Hicklin, is GRANTED. IT IS FURTHER ORDERED that Marla R. Butler is hereby

Case: 4:16-cv-1357 As of: 05/20/2018 03:15 PM CDT 14 of 20

10/10/2017 10/10/2017 10/10/2017 10/10/2017 10/11/2017
10/20/2017 10/23/2017 10/23/2017 10/26/2017 10/27/2017 10/30/2017 10/30/2017

admitted for the purpose of representing Jessica Hicklin in this matter. Signed by Magistrate Judge Noelle C. Collins on 10/10/2017. (KBL) (Entered: 10/10/2017)
103 First MOTION for Leave to Appear Pro Hac Vice Sharon Roberg−Perez. The Certificate of Good Standing was attached.(Filing fee $100 receipt number 0865−6183545) by Plaintiff Jessica Hicklin. (Attachments: # 1 Certificate of Good Standing Certificate of Good Standing)(Roberg−Perez, Sharon) (Entered: 10/10/2017)
104 First MOTION for Leave to Appear Pro Hac Vice Rajin S. Olson. The Certificate of Good Standing was attached.(Filing fee $100 receipt number 0865−6183633) by Plaintiff Jessica Hicklin. (Attachments: # 1 Certificate of Good Standing Certificate of Good Standing)(Olson, Rajin) (Entered: 10/10/2017)
105 First MOTION for Leave to Appear Pro Hac Vice Frederick A. Braunstein. The Certificate of Good Standing was attached.(Filing fee $100 receipt number 0865−6185158) by Plaintiff Jessica Hicklin. (Attachments: # 1 Certificate of Good Standing Certificate of Good Standing)(braunstein, Fredreick) (Entered: 10/10/2017)
106 REPLY to Response to Motion re 98 Second MOTION to Supplement the Preliminary Injunction Record filed by Plaintiff Jessica Hicklin. (Gordon, Demoya) (Entered: 10/10/2017)
107 Docket Text ORDER: IT IS HEREBY ORDERED that the Verified Motions for Admission Pro Hac Vice (Docs. 103 , 104 , 105 ) filed by Sharon Roberg−Perez, Rajin S. Olson, and Frederick A. Braunstein, counsel for Jessica Hicklin, are GRANTED. IT IS FURTHER ORDERED that Sharon Roberg−Perez, Rajin S. Olson, and Frederick A. Braunstein are hereby admitted for the purpose of representing Jessica Hicklin in this matter. Signed by Magistrate Judge Noelle C. Collins on 10/11/2017. (KBL) (Entered: 10/11/2017)
108 First MOTION to Withdraw as Attorney ;attorney/firm Carl S. Charles by Plaintiff Jessica Hicklin. (Charles, Carl) (Entered: 10/20/2017)
109 Docket Text ORDER: IT IS HEREBY ORDERED that the Motion to Withdraw as Counsel (Doc. 108 ) filed by Attorney Carl S. Charles is GRANTED. Attorney Carl S. Charles terminated. Signed by Magistrate Judge Noelle C. Collins on 10/23/2017. (KBL) (Entered: 10/23/2017)
110 NOTICE of Appointment of Neutral. Neutral name: Tokarz, Karen L. Neutral selected by Parties. (cc: Neutral) (BRP) (Entered: 10/24/2017)
111 ADR COMPLIANCE REPORT by Neutral: Tokarz, Karen L.. The parties have elected to extend the completion deadline 28 days and will continue efforts to assist the parties in reaching a settlement. ADR Completion Deadline due by 11/1/2017. ADR Compliance Report Deadline due by 11/15/2017.(BRP) (Entered: 10/27/2017)
112 ORDER...IT IS HEREBY ORDERED that the deadline for completing ADR in this matter is extended until November 1, 2017. (ADR Completion Deadline due by 11/1/2017. ADR Compliance Report Deadline due by 11/15/2017.). Signed by Magistrate Judge Noelle C. Collins on 10/27/2017. (NEB) (Entered: 10/27/2017)
113 First MOTION to Compel Discovery and Impose Sancations by Plaintiff Jessica Hicklin. (Roberg−Perez, Sharon) (Entered: 10/30/2017)
114 MEMORANDUM in Support of Motion re 113 First MOTION to Compel Discovery and Impose Sancations on Defendants filed by Plaintiff Jessica Hicklin. (Attachments: # 1 Affidavit Declaration of Demoya R. Gordon ISO Motion to Compel, # 2 Exhibit Ex. A Plaintiffs First RFPs to Defendants, # 3 Exhibit Ex. B. Corizon Defendants Response to Plaintiffs First RFPs, # 4 Exhibit Ex. C MDOC Defendants Response to Plaintiffs First RFPs, # 5 Exhibit Ex. D June 16, 2017 Letter from D. Gordon, # 6 Exhibit Ex. E Email Chain between D. Gordon and K. Peek, # 7 Exhibit Ex. F Email Chain between D. Gordon and B. Luepke, # 8 Exhibit Ex. G Plaintiffs First Interrogatories to Defendants, # 9 Exhibit Ex. H Plaintiffs First RFAs to Defendants, # 10 Exhibit Ex. I Email Chain between D. Gordon, K. Peek and B. Luepke, # 11 Exhibit Ex. J − Email Chain between D. Gordon, K. Peek and B. Luepke, # 12 Exhibit Ex. K MDOC Defendants Answers to Plaintiffs First RFAs, # 13 Exhibit Ex. L MDOC Defendants Answers to Plaintiffs First Interrogatories, # 14 Exhibit Ex. M − Email Chain between D. Gordon and K. Peek, # 15 Exhibit Ex. N Defendant McKinneys

Case: 4:16-cv-1357 As of: 05/20/2018 03:15 PM CDT 15 of 20

11/06/2017 11/07/2017
11/20/2017 11/21/2017 11/22/2017 11/22/2017
11/22/2017 11/28/2017

Answers to Plaintiffs First Interrogatories, # 16 Exhibit Ex. O Defendant McKinneys Responses to Plaintiffs First RFAs, # 17 Exhibit Ex. P Defendant Babichs Answers to Plaintiffs First Interrogatories, # 18 Exhibit Ex. Q − Defendant Babichs Responses to Plaintiffs First RFAs, # 19 Exhibit Ex. R − Email Chain between D. Gordon and B. Luepke, # 20 Exhibit Ex. S Defendant Eymans Responses to Plaintiffs First RFAs, # 21 Exhibit Ex. T Defendant Larkins Responses to Plaintiffs First RFAs, # 22 Exhibit Ex. U Defendant Bredemans Responses to Plaintiffs First RFAs, # 23 Exhibit Ex. V Defendant Atterberrys Responses to Plaintiffs First RFAs, # 24 Exhibit Ex. W Defendant Eymans Answers to Plaintiffs First Interrogatories, # 25 Exhibit Ex. X Defendant Larkins Answers to Plaintiffs First Interrogatories, # 26 Exhibit Ex. Y Defendant Bredemans Answers to Plaintiffs First Interrogatories, # 27 Exhibit Ex. Z Defendant Atterberys Answers to Plaintiffs First Interrogatories, # 28 Exhibit Ex. AA Defendant Bredemans Verification, # 29 Exhibit Ex. BB Defendant Larkins Verification, # 30 Exhibit Ex. CC Defendant Moellers Responses to Plaintiffs First RFAs, # 31 Exhibit Ex. DD − Email Chain between D. Gordon and K. Peek, # 32 Exhibit Ex. EE − Email Chain between D. Gordon and K. Peek, # 33 Exhibit Ex. FF Email Transmission of Corizons Third Supplemental Initial Disclosures, # 34 Exhibit Ex. GG Corizon Defendants December 16, 2016 Initial Disclosures, # 35 Attachment Certification of Complaince, # 36 Text of Proposed Order Proposed Order)(Roberg−Perez, Sharon) (Entered: 10/30/2017)
115 MOTION for Extension of Time to File Response/Reply as to 113 First MOTION to Compel Discovery and Impose Sancations by Defendants Elizabeth Atterberry, Glen Babich, T.K. Bredeman, Corizon Health, Inc., Shirley Eyman, Kim Foster, Diana Larkin, William McKinney, Stormi Moeller, Kimberley S. Randolph, Dawn Wade. (Eckenrode, J.) (Entered: 11/06/2017)
116 Docket Text ORDER: IT IS HEREBY ORDERED that Defendants Elizabeth Atterberry, Glen Babich, T.K. Bredeman, Corizon Health, Inc., Shirley Eyman, Kim Foster, Diana Larkin, William McKinney, Stormi Moeller, Kimberley S. Randolph, Dawn Wade's ("the Corizon Defendants") Motion for Extension of Time (Doc. 115 ) is GRANTED. The Corizon Defendants shall file their response to Plaintiff's Motion to Compel on or before November 21, 2017. Signed by Magistrate Judge Noelle C. Collins on 11/7/2017. (KBL) (Entered: 11/07/2017)
117 ADR COMPLIANCE REPORT by Neutral: Tokarz, Karen L. Date of Conference: 9/20/2017. The parties participated in good faith. The parties did not achieve a settlement.(BRP) (Entered: 11/20/2017)
118 STIPULATION re 62 Case Management Order,, Second Amended by Plaintiff Jessica Hicklin. (Olson, Rajin) (Entered: 11/21/2017)
119 First MOTION for Extension of Time to File ;Extension to file the following: Reply to Defendant's Opposition to Plaintiff's Motion to Compel Discovery and Impose Sanctions ;Proposed extension date 12/1/2017 by Plaintiff Jessica Hicklin. (Olson, Rajin) (Entered: 11/22/2017)
120 MOTION for Leave to File out of Time Defendants' Suggestions in Opposition to Plaintiff's Motion to Compel by Defendants Elizabeth Atterberry, Glen Babich, T.K. Bredeman, Corizon Health, Inc., Shirley Eyman, Kim Foster, Diana Larkin, William McKinney, Stormi Moeller, Kimberley S. Randolph, Dawn Wade. (Attachments: # 1 Exhibit Exhibit A − Email to Plaintiff's Attorney with Suggestions in Opposition to Plaintiffs Motion to Compel and Impose Sanctions, # 2 Exhibit Exhibit B − Defendant's Suggestions in Opposition to Plaintiffs Motion to Compel and Impose Sanctions)(Eckenrode, J.) (Entered: 11/22/2017)
121 MEMORANDUM in Opposition re 113 First MOTION to Compel Discovery and Impose Sancations filed by Defendants Elizabeth Atterberry, Glen Babich, T.K. Bredeman, Corizon Health, Inc., Shirley Eyman, Kim Foster, Diana Larkin, William McKinney, Stormi Moeller, Kimberley S. Randolph, Dawn Wade. (Attachments: # 1 Exhibit Exhibit 1)(Eckenrode, J.) (Entered: 11/22/2017)
122 REPLY to Response to Motion re 113 First MOTION to Compel Discovery and Impose Sancations filed by Plaintiff Jessica Hicklin. (Attachments: # 1 Exhibit Ex. HH)(Gordon, Demoya) (Entered: 11/28/2017)

Case: 4:16-cv-1357 As of: 05/20/2018 03:15 PM CDT 16 of 20

12/05/2017 12/05/2017 12/14/2017
01/19/2018 01/19/2018 01/19/2018
01/19/2018 01/26/2018
01/29/2018 01/29/2018 01/29/2018 01/30/2018
02/01/2018 02/02/2018

123 Docket Text ORDER: IT IS HEREBY ORDERED that Plaintiff's Motion for Extension of Time (Doc. 119 ) is GRANTED. Plaintiff's reply (Doc. 122 ) is deemed timely filed. Signed by Magistrate Judge Noelle C. Collins on 12/5/2017. (KBL) (Entered: 12/05/2017)
124 Docket Text ORDER: IT IS HEREBY ORDERED that the Corizon Defendants' Motion for Leave to File Out of Time (Doc. 120 ) is GRANTED. Signed by Magistrate Judge Noelle C. Collins on 12/5/2017. (KBL) (Entered: 12/05/2017)
125 MEMORANDUM AND ORDER...IT IS HEREBY ORDERED that Plaintiff Jessica Hicklin's Motion to Compel Discovery and Impose Sanctions (Doc. 113 ) is GRANTED, in part and DENIED, in part, without prejudice. IT IS FURTHER ORDERED that the parties' Motion to Amend the First Amended Case Management Order (Doc. 118 ) is GRANTED. Signed by Magistrate Judge Noelle C. Collins on 12/14/2017. (NEP) (Entered: 12/14/2017)
126 Second MOTION to Compel Discovery and Impose Sanctions by Plaintiff Jessica Hicklin. (braunstein, Frederick) (Entered: 01/19/2018)
127 MEMORANDUM in Support of Motion re 126 Second MOTION to Compel Discovery and Impose Sanctions filed by Plaintiff Jessica Hicklin. (braunstein, Frederick) (Entered: 01/19/2018)
128 DECLARATION filed by Plaintiff Jessica Hicklin of Frederick Andrew Braunstein. (Attachments: # 1 Exhibit A − 12/19/17 Letter, # 2 Exhibit B − 11/22/17 Notice of Award, # 3 Exhibit C − Foster's Answers to Interrogatories, # 4 Exhibit D − Randolph's Answers to Interrogatories, # 5 Exhibit E − Wade's Answers to Interrogatories, # 6 Exhibit F − Moeller's Answers to Interrogatories)(braunstein, Frederick) (Entered: 01/19/2018)
129 NOTICE Compliance with Rule 37(d) and Local Rule 3.04(A): by Plaintiff Jessica Hicklin re 126 Second MOTION to Compel Discovery and Impose Sanctions (braunstein, Frederick) (Entered: 01/19/2018)
130 RESPONSE in Opposition re 126 Second MOTION to Compel Discovery and Impose Sanctions filed by Defendants Elizabeth Atterberry, Glen Babich, T.K. Bredeman, Corizon Health, Inc., Shirley Eyman, Kim Foster, Diana Larkin, William McKinney, Stormi Moeller, Kimberley S. Randolph, Dawn Wade. (Eckenrode, J.) (Entered: 01/26/2018)
131 MOTION for Protective Order by Defendants Cindy Griffith, George Lombardi, Scott O'Kelly, Stan Payne, Ian Wallace, Deloise Williams. (Attachments: # 1 Exhibit 1)(Luepke, Henry) (Entered: 01/29/2018)
132 MEMORANDUM in Support of Motion re 131 MOTION for Protective Order filed by Defendants Cindy Griffith, George Lombardi, Scott O'Kelly, Stan Payne, Ian Wallace, Deloise Williams. (Luepke, Henry) (Entered: 01/29/2018)
133 MEMORANDUM re 62 Case Management Order,, Amended Initial Disclosures of MDOC Defendants by Defendants Cindy Griffith, George Lombardi, Scott O'Kelly, Stan Payne, Ian Wallace, Deloise Williams. (Luepke, Henry) (Entered: 01/29/2018)
134 ORDER : IT IS HEREBY ORDERED that Plaintiff shall respond to Defendant Anne Precythes Motion for Protective Order (Doc. 131) on or before February 1, 2018. Any reply brief shall be filed on or before February 2, 2018. IT IS FURTHER ORDERED that the deposition of Defendant Anne Precythe is stayed pending a ruling on her Motion for Protective Order. Signed by Magistrate Judge Noelle C. Collins on 01/30/2018. (KCB) (Entered: 01/30/2018)
135 MEMORANDUM in Opposition re 131 MOTION for Protective Order filed by Plaintiff Jessica Hicklin. (Attachments: # 1 Affidavit Declaration of Frederick Braunstein, # 2 Exhibit Ex. A − Sturm Dep. Excerpts, # 3 Exhibit Ex. B − E−mail Chain)(braunstein, Frederick) (Entered: 02/01/2018)
136 REPLY to Response to Motion re 126 Second MOTION to Compel Discovery and Impose Sanctions filed by Plaintiff Jessica Hicklin. (Saenz, Richard) (Entered: 02/02/2018)

Case: 4:16-cv-1357 As of: 05/20/2018 03:15 PM CDT 17 of 20

02/05/2018 02/05/2018 02/05/2018 02/05/2018 02/05/2018 02/05/2018 02/05/2018 02/06/2018 02/09/2018
02/16/2018 02/20/2018
02/21/2018
02/21/2018

137 ENTRY of Appearance by David D. Dean for Defendants Cindy Griffith, George Lombardi, Scott O'Kelly, Stan Payne, Ian Wallace, Deloise Williams. (Dean, David) (Entered: 02/05/2018)
138 ENTRY of Appearance by Dean John Sauer for Defendants Cindy Griffith, George Lombardi, Scott O'Kelly, Stan Payne, Ian Wallace, Deloise Williams. (Sauer, Dean) (Entered: 02/05/2018)
139 MOTION to Withdraw by Defendants Cindy Griffith, George Lombardi, Scott O'Kelly, Stan Payne, Ian Wallace, Deloise Williams. (Luepke, Henry) (Entered: 02/05/2018)
140 MEMORANDUM in Opposition re 126 Second MOTION to Compel Discovery and Impose Sanctions filed by Defendants Cindy Griffith, George Lombardi, Scott O'Kelly, Stan Payne, Ian Wallace, Deloise Williams. (Sauer, Dean) (Entered: 02/05/2018)
141 MOTION for Extension of Time to File Response/Reply as to 126 Second MOTION to Compel Discovery and Impose Sanctions by Defendants Cindy Griffith, George Lombardi, Scott O'Kelly, Stan Payne, Ian Wallace, Deloise Williams. (Sauer, Dean) (Entered: 02/05/2018)
142 MOTION for Extension of Time to File Response/Reply as to 131 MOTION for Protective Order by Defendants Cindy Griffith, George Lombardi, Scott O'Kelly, Stan Payne, Ian Wallace, Deloise Williams. (Sauer, Dean) (Entered: 02/05/2018)
143 MEMORANDUM in Support of Motion re 131 MOTION for Protective Order filed by Defendants Cindy Griffith, George Lombardi, Scott O'Kelly, Stan Payne, Ian Wallace, Deloise Williams. (Sauer, Dean) (Entered: 02/05/2018)
144 Docket Text ORDER: IT IS HEREBY ORDERED that the Motion to Withdraw (Doc. 139 ) filed by Attorney Henry F. Luepke, III is GRANTED. Signed by Magistrate Judge Noelle C. Collins on 2/6/2018. (KBL) (Entered: 02/06/2018)
145 MEMORANDUM AND ORDER : IT IS HEREBY ORDERED that Plaintiff First Motion to Supplement (Doc. 88 ) is GRANTED and Plaintiffs Second Motion to Supplement (Doc. 98 ) is DENIED. IT IS FURTHER ORDERED that Plaintiff Jessica Hicklins Motion for Preliminary Injunction (Doc. 63) is GRANTED, in part and DENIED, in part. The Court has carefully considered Plaintiffs specific requests for relief and finds the following injunctive relief to be appropriate: [SEE ORDER FOR COMPLETE DETAILS]. Signed by Magistrate Judge Noelle C. Collins on 02/09/2018. (KCB) (Entered: 02/09/2018)
146 STIPULATION re 62 Case Management Order,, Third Amended by Plaintiff Jessica Hicklin. (Gordon, Demoya) (Entered: 02/16/2018)
147 Docket Text ORDER: IT IS HEREBY ORDERED that, at the request of the parties, this matter is set for a Status Conference on Wednesday, February 21, 2018 at 2:00 PM in Courtroom 15N before Magistrate Judge Noelle C. Collins. Counsel may appear in person or by phone. Counsel participating in the conference by phone are directed to call the conference toll free at: 1−888−398−2342. The access code to enter the conference for all participants is: 2359637. Signed by Magistrate Judge Noelle C. Collins on 2/20/2018. (KBL) (Entered: 02/20/2018)
148 Minute Entry for proceedings held before Magistrate Judge Noelle C. Collins: Status Conference held on 2/21/2018. The parties provide the court with an update on the current status of the case. The Court will issue a Second Amended Case Management Order. Order to issue. (Court Reporter:Susan Moran, Susan_Moran@moed.uscourts.gov, 314−244−7983) (FTR Gold: No) (NEP) (Entered: 02/21/2018)
149 SECOND AMENDED CASE MANAGEMENT ORDER...IT IS HEREBY ORDERED that the Parties' request is GRANTED, in part. IT IS FURTHER ORDERED that the Amended Case Management Order issued on July 25, 2017 (Doc. 95 ) is further amended as follows: [SEE ORDER FOR COMPLETE DETAILS.] Motion to Join Parties due by 2/23/2018. Dispositive Motions due by 3/30/2018. Jury Trial set for 8/13/2018 09:30 AM in Courtroom 15N before Magistrate Judge Noelle C. Collins. Pretrial Conference set for 8/6/2018 10:00 AM in Courtroom 15N before

Case: 4:16-cv-1357 As of: 05/20/2018 03:15 PM CDT 18 of 20

02/23/2018 02/26/2018 02/26/2018
03/02/2018
03/14/2018 03/14/2018 03/15/2018 03/16/2018 03/16/2018 03/19/2018

Magistrate Judge Noelle C. Collins. Pretrial Compliance due by 7/14/2018. Motion in Limine due by 7/24/2018.. Signed by Magistrate Judge Noelle C. Collins on 2/21/2018. (NEP) (Entered: 02/21/2018)
150 First MOTION for Leave to File First Amended Complaint by Plaintiff Jessica Hicklin. (Attachments: # 1 Attachment First Amended Complaint)(Saenz, Richard) (Entered: 02/23/2018)
151 Docket Text ORDER: IT IS HEREBY ORDERED that Plaintiff's Motion for Leave to File Her First Amended Complaint (Doc. 150 ) is GRANTED. The Clerk of Court is directed to detach and docket Plaintiff's First Amended Complaint, filed as an attachment to the current motion (Doc. 150−1). Signed by Magistrate Judge Noelle C. Collins on 02/26/2018. (KBL) (Entered: 02/26/2018)
152 FIRST AMENDED COMPLAINT FOR DECLARATORY AND INJUNCTIVE RELIEF against defendant Elizabeth Atterberry, T.K. Bredeman, Corizon Health, Inc., Kim Foster, Cindy Griffith, Diana Larkin, William McKinney, Stormi Moeller, Scott O'Kelly, Stan Payne, Kimberley S. Randolph, Anne Precythe, Joan Reinkemeyer, Latoya Duckworth, John Deghetto, M.D., Daly Smith, Ernest Graypel, M.D.,Terminating Dawn Wade (R.N., in her offical capacity as Director of Nursing, Corizon), Ian Wallace (in his official capacity as current Deputy Director, Division of Adult Institutions, MDOC), Deloise Williams (R.N., B.S.N., in her official capacity as Assistant Director, Department of Offender Rehabilitative Services, MDOC), Glen Babich (M.D., in his official capacity as former Associate Regional Medical Director, and current Regional Medical Director, Corizon) and Shirley Eyman (M.D., in her official capacity as Regional Psychiatric Director, Corizon) Amendment to 19 Complaint,, no Summons(es) issued, Waivers issued none, Consents issued none, non−jury demand,, filed by Jessica Hicklin. Related document: 19 Complaint,, filed by Jessica Hicklin.(NEP) (Entered: 02/27/2018)
153 TRANSCRIPT of 148 (STATUS CONFERENCE) held on February 21, 2018 before Judge NOELLE C. COLLINS. Court Reporter/Transcriber Susan Moran, Susan_Moran@moed.uscourts.gov, 314−244−7983. Transcript may be viewed at the court public terminal or purchased through the Court Reporter/Transcriber before the deadline for Release of Transcript Restriction. After that date it may be obtained through PACER. Redaction Request due 3/23/2018. Redacted Transcript Deadline set for 4/2/2018. Release of Transcript Restriction set for 5/31/2018. (BRP) (Entered: 03/02/2018)
154 ANSWER to 152 Amended Complaint,,,, by Elizabeth Atterberry, T.K. Bredeman, Corizon Health, Inc., John Deghetto, M.D., Kim Foster, Ernest Graypel, M.D., Diana Larkin, William McKinney, Stormi Moeller, Kimberley S. Randolph, Daly Smith.(Eckenrode, J.) (Entered: 03/14/2018)
155 Consent MOTION for Extension of Time to File Answer to Plainitff's First Amended Complaint by Defendants Latoya Duckworth, Cindy Griffith, Scott O'Kelly, Stan Payne, Anne Precythe, Joan Reinkemeyer. (Attachments: # 1 Answer to Plaintiff's First Amended Complaint)(Dean, David) (Entered: 03/14/2018)
156 Docket Text ORDER: IT IS HEREBY ORDERED that the MDOC Defendants' Motion for Extension of Time (Doc. 155 ) is GRANTED. The Clerk of Court shall detach and docket the MDOC Defendants' Answer to Plaintiff's First Amended Complaint, attached as an exhibit to the current motion (Doc. 155−1). Signed by Magistrate Judge Noelle C. Collins on 3/15/2018. (KBL) (Entered: 03/15/2018)
157 MOTION to Withdraw as Attorney ;attorney/firm Kevin K. Peek by Defendants Elizabeth Atterberry, T.K. Bredeman, Corizon Health, Inc., John Deghetto, M.D., Kim Foster, Ernest Graypel, M.D., Diana Larkin, William McKinney, Stormi Moeller, Kimberley S. Randolph, Daly Smith. (Peek, Kevin) (Entered: 03/16/2018)
158 ANSWER to 152 Amended Complaint, by Latoya Duckworth, Cindy Griffith, Scott O'Kelly, Stan Payne, Anne Precythe, Joan Reinkemeyer.(NEP) (Entered: 03/16/2018)
159 Docket Text ORDER: IT IS HEREBY ORDERED that the Motion to Withdraw (Doc. 157 ) filed by Attorney Kevin K. Peek is GRANTED. Attorney Kevin K. Peek terminated. Signed by Magistrate Judge Noelle C. Collins on 03/19/2018. (KBL) (Entered: 03/19/2018)

Case: 4:16-cv-1357 As of: 05/20/2018 03:15 PM CDT 19 of 20

03/30/2018 03/30/2018 03/30/2018 03/30/2018 03/30/2018
04/04/2018 04/05/2018
04/06/2018 04/06/2018 04/12/2018 04/12/2018

160 MOTION for Extension of: Time to File Dispositive Motions by Defendants Latoya Duckworth, Cindy Griffith, Scott O'Kelly, Stan Payne, Anne Precythe, Joan Reinkemeyer. (Dean, David) (Entered: 03/30/2018)
161 MOTION for Extension of Time to File Dispositive Motions ;Extension to file the following: dispositive motions ;Proposed extension date April 6, 2018 by Defendants Elizabeth Atterberry, T.K. Bredeman, Corizon Health, Inc., John Deghetto, M.D., Kim Foster, Ernest Graypel, M.D., Diana Larkin, William McKinney, Stormi Moeller, Kimberley S. Randolph, Daly Smith. (Eckenrode, J.) (Entered: 03/30/2018)
162 MEMORANDUM in Opposition re 161 MOTION for Extension of Time to File Dispositive Motions ;Extension to file the following: dispositive motions ;Proposed extension date April 6, 2018, 160 MOTION for Extension of: Time to File Dispositive Motions filed by Plaintiff Jessica Hicklin. (Saenz, Richard) (Entered: 03/30/2018)
163 MOTION for Declaratory Judgment and Permanent Injunction by Plaintiff Jessica Hicklin. (Gordon, Demoya) (Entered: 03/30/2018)
164 MEMORANDUM in Support of Motion re 163 MOTION for Declaratory Judgment and Permanent Injunction filed by Plaintiff Jessica Hicklin. (Attachments: # 1 Affidavit Declaration of Demoya R. Gordon, # 2 Exhibit A − Corizon 30b6 Depo. Excerpts, # 3 Exhibit B − Atterberry Depo. Excerpts, # 4 Exhibit C − WPATH SOC Excerpts, # 5 Exhibit D − M. Sturm Depo. Excerpts, # 6 Exhibit E − MDOC Resp. to 2d RFAs, # 7 Exhibit F − MDOC 2d Supp. Resp. to Pl.'s Interrogatories, # 8 Exhibit G − Grievance File Excerpts, # 9 Exhibit H − MDOC File Excerpts, # 10 Exhibit I − Randolph Resp. to 1st RFAs, # 11 Exhibit J − Foster Resp. to 1st RFAs, # 12 Exhibit K − Wade Resp. to 1st RFAs, # 13 Exhibit L − Med and MH File Excerpts, # 14 Exhibit M − Hicklin Depo. Excerpts, # 15 Exhibit N − V. Sturm Depo. Excerpts, # 16 Text of Proposed Order Proposed Order Granting Declaratory Judgment and Permanent Injunction)(Gordon, Demoya) (Entered: 03/30/2018)
165 RESPONSE to Motion re 163 MOTION for Declaratory Judgment and Permanent Injunction filed by Defendants Latoya Duckworth, Cindy Griffith, Scott O'Kelly, Stan Payne, Anne Precythe, Joan Reinkemeyer. (Dean, David) (Entered: 04/04/2018)
166 ORDER: IT IS HEREBY ORDERED that the MDOC Defendants Motion for Extension of Time (Doc. 160 ) is DENIED, without prejudice, as moot. IT IS FURTHER ORDERED that the Corizon Defendants Motion for Extension of Time (Doc. 161 ) is GRANTED, in part. The Corizon Defendants shall file any dispositive motions on or before April 6, 2018. The Court will thereafter set a responsive briefing schedule, if necessary. IT IS FURTHER ORDERED that the Corizon Defendants shall file a response to Plaintiffs Motion for Declaratory Relief and a Permanent Injunction (Doc. 164 ) on or before April 10, 2018. Plaintiffs reply brief, if she chooses to file one, shall be filed no later than April 13, 2018. ( Dispositive Motions due by 4/6/2018.) Signed by Magistrate Judge Noelle C. Collins on 04/05/2018. (KCB) (Entered: 04/05/2018)
167 RESPONSE to Motion re 163 MOTION for Declaratory Judgment and Permanent Injunction filed by Defendant Corizon Health, Inc. (Eckenrode, J.) (Entered: 04/06/2018)
168 MEMORANDUM re 164 Memorandum in Support of Motion,,, Defendant Corizon, LLC's Response to Plaintiff's Memorandum of Law [Doc 164] by Defendant Corizon Health, Inc.. (Attachments: # 1 Exhibit A, # 2 Exhibit B, # 3 Exhibit C, # 4 Exhibit D)(Eckenrode, J.) (Entered: 04/06/2018)
169 STIPULATION for Dismissal of Defendants William McKinney, John Deghetto, Thomas Kevin Bredeman, Diana Larkin, Kimberley S. Randolph, Daly Smith, Stormi Moeller, Ernest Graypel, Elizabeth Atterberry, and Kim Foster by Plaintiff Jessica Hicklin. (Gordon, Demoya) (Entered: 04/12/2018)
170 REPLY to Response to Motion re 163 MOTION for Declaratory Judgment and Permanent Injunction filed by Plaintiff Jessica Hicklin. (Attachments: # 1 Affidavit Second Declaration of Demoya R. Gordon, # 2 Exhibit Ex. O − 2009 Brown Article, # 3 Exhibit Ex. P − 2010 Brown Article, # 4 Exhibit Ex. Q − Excerpted Brown Depo., # 5 Exhibit Ex. R − Excerpted 2006 Brown Trial Testimony, # 6 Exhibit Ex. S − Excerpted Atterberry Depo., # 7 Exhibit Ex. T. − Excerpted Corizon 30(b)(6) Depo., # 8 Exhibit Ex. U − Excerpted Bredeman Depo., # 9 Exhibit Ex. V − Excerpted Babich

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04/13/2018 04/13/2018 04/13/2018
04/19/2018 04/19/2018

Depo.)(Gordon, Demoya) (Entered: 04/12/2018)
171 NOTICE by Plaintiff Jessica Hicklin re 170 Reply to Response to Motion,, Notice of Errata (Attachments: # 1 Errata Corrected page 5 of Pl.'s Reply in Supp. of Mot. for Decl. Relief and Perm. Inj.)(Gordon, Demoya) (Entered: 04/13/2018)
172 MOTION for Leave to File Sealed Document by Plaintiff Jessica Hicklin. (Gordon, Demoya) (Entered: 04/13/2018)
173 SEALED DOCUMENT re 172 MOTION for Leave to File Sealed Document − Unredacted copy of Ex. P to Reply Memorandum of Law in Support of Plaintiff's Motion for Declaratory Relief and a Permanent Injunction by Plaintiff Jessica Hicklin. (Gordon, Demoya) (Entered: 04/13/2018)
174 Docket Text ORDER: IT IS HEREBY ORDERED that Plaintiff's Motion for Leave to File Sealed Document (Doc. 172 ) is GRANTED. Signed by Magistrate Judge Noelle C. Collins on 04/19/2018. (KBL) (Entered: 04/19/2018)
175 ORDER OF PARTIAL DISMISSAL IT IS HEREBY ORDERED that Defendants William McKinney, M.D., John Deghetto, M.D., Thomas Kevin Bredeman, D.O., Diana Larkin, R.N., Kimberley S. Randolph, R.N., B.S.N., C.C.H.P., Daly Smith, Stormi Moeller, R.N., Ernest Graypel, M.D., Elizabeth Atterberry, and Kim Foster, L.P.C. are DISMISSED, without prejudice. Signed by Magistrate Judge Noelle C. Collins on 4/19/18. (KXS) (Entered: 04/19/2018)

 
 Case: 4:16-cv-01357-NCC Doc. #: 19 Filed: 08/22/16 Page: 1 of 32 PageID #: 19

IN THE UNITED STATES DISTRICT COURT FOR THE EASTERN DISTRICT OF MISSOURI
EASTERN DIVISION

JESSICA HICKLIN, v.

Plaintiff,

GEORGE LOMBARDI, in his official capacity as Director of the Missouri Department of Corrections (“MDOC”);
DWAYNE KEMPKER, in his official capacity as former Deputy Director, Division of Adult Institutions, MDOC;
IAN WALLACE, in his official capacity as current Deputy Director, Division of Adult Institutions, MDOC;
CINDY GRIFFITH, in her official capacity as Warden of Potosi Correctional Center (“PCC”);
STAN PAYNE, in his official capacity as former Acting Warden, and current Deputy Warden of Offender Management, PCC;
SCOTT O’KELLY, L.P.C., in his official capacity as Assistant Division Director, Mental Health Services, Department of Offender Rehabilitative Services, MDOC;
DELOISE WILLIAMS, R.N., B.S.N., in her official capacity as Assistant Director, Department of Offender Rehabilitative Services, MDOC;
CORIZON HEALTH, INC. (“Corizon”); WILLIAM MCKINNEY, M.D., in his official
capacity as Medical Director of Corizon; GLEN BABICH, M.D., in his official capacity as
former Associate Regional Medical Director, and current Regional Medical Director, Corizon; T.K. BREDEMAN, D.O., in his official capacity as Associate Regional Medical Director, Corizon; DIANA LARKIN, R.N., in her official capacity as former Director of Nursing and current Health Services Administrator, Corizon;

Case No. _______________
COMPLAINT FOR DECLARATORY AND INJUNCTIVE RELIEF

Case: 4:16-cv-01357-NCC Doc. #: 19 Filed: 08/22/16 Page: 2 of 32 PageID #: 20
KIMBERLEY S. RANDOLPH, R.N., B.S.N., C.C.H.P., in her official capacity as Director of Operations, Corizon;
DAWN WADE, R.N., in her official capacity as Director of Nursing, Corizon;
STORMI MOELLER, R.N., in her official capacity as an employee of Corizon;
SHIRLEY EYMAN, M.D., in her official capacity as Regional Psychiatric Director, Corizon;
ELIZABETH ATTERBERRY, M.D., L.P., in her official capacity as Clinical Director, Corizon;
KIM FOSTER, L.P.C., in her official capacity as Regional Administrator, Corizon.
Defendants.
PRELIMINARY STATEMENT
1. Plaintiff Jessica Hicklin (“Plaintiff” or “Ms. Hicklin”) is a thirty-seven year old
transgender woman1 in the custody of the Missouri Department of Corrections (“MDOC”) and
housed at Potosi Correctional Center (“PCC”), a facility for male inmates, in Mineral Point,
Missouri. Defendants are individuals and institutions who, for the duration of Ms. Hicklin’s
incarceration, have had authority and responsibility for her medical treatment.
2. Despite knowing that Ms. Hicklin has gender dysphoria, a serious medical
condition that causes severe psychological suffering and can lead to physical injury when not
properly treated, Defendants have refused to provide Ms. Hicklin with medically necessary care.
3. On March 27, 2015, Ms. Hicklin filed a Petition for Change of Name in the
Washington County Circuit Court, seeking to change her name from the traditionally male name
given to her at birth to her current legal name, Jessica Hicklin.2
1 In keeping with Ms. Hicklin’s gender identity, modern judicial practice, and accepted medical protocol, this Complaint uses female pronouns to refer to her. 2 On July 24, 2015, Ms. Hicklin received an order from the Washington County Circuit Court granting her name change petition. Pursuant to this Order, Ms. Hicklin’s social security card, the
2

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4. Although Defendants’ own mental health personnel have evaluated Ms. Hicklin, have diagnosed her with gender dysphoria, and have recommended that she receive hormone therapy to treat her gender dysphoria, Defendants refuse to provide Ms. Hicklin with this therapy, citing a policy or custom of providing hormone therapy only to those transgender inmates who were receiving it prior to incarceration.
5. This type of “freeze-frame” policy violates the medically accepted standard of care for treating gender dysphoria; similar state and federal policies have been held unconstitutional by federal courts as a violation of the Eighth Amendment of the United States Constitution.
6. Upon information and belief, Defendants are providing and have provided hormone therapy to other transgender inmates in MDOC, recognizing that it can be medically necessary treatment for gender dysphoria, but unreasonably refuse to provide this medically necessary treatment to Ms. Hicklin due to MDOC’s unconstitutional “freeze-frame” policy.
7. Defendants have also deprived Ms. Hicklin of other interventions that are also part of the medically necessary treatment Ms. Hicklin requires for her gender dysphoria and have also been recommended by Defendants’ mental health personnel, including permanent hair removal and access to gender-affirming canteen items.
8. Defendants do not deny that Ms. Hicklin has gender dysphoria requiring treatment. Rather, they have been deliberately indifferent to Ms. Hicklin’s serious medical needs and have denied her care pursuant to an unconstitutional policy or custom that ignores the recommendations of the MDOC mental health professionals.
labels on her PCC-issued clothing, and her offender identification card have been updated to reflect her legal name.
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9. MDOC mental health professionals employed by Defendants have recommended that Ms. Hicklin receive treatment in accordance with the World Professional Association for Transgender Health (“WPATH”) Standards of Care for the Health of Transsexual, Transgender, and Gender-Nonconforming People (“Standards of Care”), which are internationally recognized as the authoritative articulation of professional consensus on the treatment of gender dysphoria.
10. Through their deliberate indifference, Defendants have caused and continue to cause Ms. Hicklin profound pain and suffering, for which she seeks preliminary and permanent injunctive relief and declaratory relief.
11. Ms. Hicklin has fully exhausted her administrative remedies to no avail. 12. Ms. Hicklin brings this action pursuant to 42 U.S.C. § 1983, to seek redress for Defendants’ deliberate indifference to her serious medical needs, which constitutes cruel and unusual punishment under the Eighth Amendment to the United States Constitution, made applicable to the State through the Fourteenth Amendment.
JURISDICTION AND VENUE 13. Plaintiff brings this action seeking preliminary and permanent injunctive relief and declaratory relief pursuant to 42 U.S.C. §§ 1983 and 1988 to redress the deprivation under color of state law of rights secured by the United States Constitution. 14. This Court has jurisdiction pursuant to 28 U.S.C. §§ 1331 and 1343 and jurisdiction to grant declaratory relief pursuant to 28 U.S.C. § 2201. 15. Venue is proper in this district pursuant to 28 U.S.C. § 1391(b)(2) because a substantial part of the relevant events occurred within the district. 16. This Court has personal jurisdiction over each and every defendant because, upon information and belief, all Defendants were either residents of Missouri, were employed in
4

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Missouri, or conducted business in Missouri, and all were acting under color of state law during all relevant times.
PARTIES 17. PLAINTIFF JESSICA HICKLIN is a thirty-seven year old white transgender woman, diagnosed with gender dysphoria, who is in the custody of the Missouri Department of Corrections (“MDOC”). At all relevant times, Ms. Hicklin was incarcerated at the Potosi Correctional Center (“PCC”), a facility for male inmates, where she remains at the time of this filing. 18. DEFENDANT GEORGE LOMBARDI (“Lombardi”) is, and has been at all relevant times, the Director of MDOC. In that role, he exercises ultimate policy and decisionmaking authority over MDOC and control over all MDOC employees and contractors, and is responsible for their training, supervision, and conduct. He has ultimate responsibility within MDOC for overseeing day-to-day operation of state prison facilities, including PCC, and is responsible for ensuring the provision of adequate medical care to inmates, including through the implementation of policies and the training and supervision of MDOC staff. Defendant Lombardi has implemented, condoned, and ratified the custom and practice within MDOC of denying medically necessary treatment for gender dysphoria, including hormone therapy to certain inmates, including Ms. Hicklin, pursuant to MDOC’s freeze-frame policy. Defendant Lombardi has also implemented, condoned, and ratified the custom and practice of denying inmates like Ms. Hicklin other forms of medically necessary treatment for gender dysphoria, including permanent hair removal and access to gender-affirming canteen items. Defendant Lombardi has furthermore failed to train and supervise MDOC employees and agents with respect to the proper provision of medically necessary treatment for gender dysphoria, despite
5

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knowing that gender dysphoria is a serious medical need and that failing to train and supervise staff with respect to the provision of medically necessary treatment for this serious medical need places inmates like Ms. Hicklin at substantial risk of mental and physical harm. Defendant Lombardi is among those responsible for denying Ms. Hicklin medically necessary care and is sued in his official capacity.
19. DEFENDANT DWAYNE KEMPKER (“Kempker”) was at relevant times Deputy Director, Division of Adult Institutions of MDOC. On information and belief, Defendant Kempker retired from this position in or around June 2016. Prior to his retirement, he exercised authority, direction, and control over MDOC’s adult institutions and their employees and contractors. He was responsible for ensuring the provision of adequate medical care to adult inmates in MDOC’s custody, including through the implementation of policies and the training and supervision of MDOC staff. Defendant Kempker was among those responsible for denying Ms. Hicklin medically necessary care and is sued in his official capacity.
20. DEFENDANT IAN WALLACE (“Wallace”) is the current Deputy Director, Division of Adult Institutions of MDOC and, on information and belief, has held that position since approximately June 2016, when he succeeded Defendant Kempker. In this role, Defendant Wallace exercises authority, direction, and control over MDOC’s adult institutions and their employees and contractors. He is responsible for ensuring the provision of adequate medical care to adult inmates in MDOC’s custody, including through the implementation of policies and the training and supervision of MDOC staff. Defendant Wallace is among those responsible for denying Ms. Hicklin medically necessary care and is sued in his official capacity.
21. DEFENDANT CINDY GRIFFITH (“Griffith”) is, and has been at all relevant times, Warden of PCC. In that role, she exercises authority, direction, and control over PCC and
6

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its employees and contractors. She is responsible for ensuring the provision of adequate medical care to inmates in PCC, including through the implementation of policies and the training and supervision of PCC staff. Defendant Griffith is among those responsible for denying Ms. Hicklin medically necessary care and is sued in her official capacity.
22. DEFENDANT STAN PAYNE (“Payne”) was at relevant times, Acting Warden of PCC and is now Deputy Warden of Offender Management. In these roles, he has exercised authority, direction, and control over PCC and its employees and contractors. He was and is responsible for ensuring the provision of adequate medical care to inmates in PCC and is among those responsible for denying Ms. Hicklin medically necessary care. He is sued in his official capacity.
23. On information and belief, DEFENDANT SCOTT O’KELLY, L.P.C. (“O’Kelly”) is, and has been at all relevant times, Assistant Division Director, Mental Health Services, Department of Offender Rehabilitative Services at MDOC. In that role, he exercises policy and decision-making authority regarding the care and treatment of MDOC inmates, control of health care personnel, and has the authority to grant or deny medical care to inmates. He is responsible for ensuring the provision of adequate medical care to inmates, including through the implementation of policies and the training and supervision of staff. He is among those responsible for denying Ms. Hicklin medically necessary care and is sued in his official capacity.
24. On information and belief, DEFENDANT DELOISE WILLIAMS, R.N., B.S.N. (“Williams”) is, and has been at all relevant times, Assistant Director, Department of Offender Rehabilitative Services at MDOC. In that role, she exercises policy and decisionmaking authority regarding the care and treatment of MDOC inmates, control of health care
7

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personnel, and has the authority to grant or deny medical care to inmates. She is responsible for ensuring the provision of adequate medical care to inmates, including through the implementation of policies and the training and supervision of staff. She is among those responsible for denying Ms. Hicklin medically necessary care and is sued in her official capacity.
25. DEFENDANT CORIZON HEALTH, INC. (“Corizon”) is and was at all relevant times the contracted medical provider for MDOC. Through its employees and agents, Corizon exercises policy and decision-making authority regarding the care and treatment of MDOC inmates, control of health care personnel, and has the authority to grant or deny medical care to inmates. Corizon is responsible for ensuring the provision of adequate medical care to inmates, including through the implementation of policies and the training and supervision of staff. Corizon is among those responsible for denying Ms. Hicklin medically necessary care.
26. DEFENDANT WILLIAM MCKINNEY, M.D. (“McKinney”) is, and has been at all relevant times, Medical Director of Corizon. In that role, he exercises policy and decisionmaking authority regarding the care and treatment of MDOC inmates, control of health care personnel, and has the authority to grant or deny medical care to inmates. He is responsible for ensuring the provision of adequate medical care to inmates, including through the implementation of policies and the training and supervision of staff. In making decisions related to Ms. Hicklin’s medical care, Defendant McKinney failed to follow WPATH Standards of Care, which are internationally recognized as the authoritative articulation of professional consensus on the treatment of gender dysphoria. Defendant McKinney is among those responsible for denying Ms. Hicklin medically necessary care and is sued in his official capacity.
27. On information and belief, DEFENDANT GLEN BABICH, M.D. (“Babich”) was at relevant times Associate Regional Medical Director of Corizon and is currently Regional
8

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Medical Director. In these roles, he exercises policy and decision-making authority regarding the care and treatment of MDOC inmates, control of health care personnel, and the authority to grant or deny medical care to inmates. He is responsible for ensuring the provision of adequate medical care to inmates, including through the implementation of policies and the training and supervision of staff. In making decisions related to Ms. Hicklin’s medical care, Defendant Babich failed to follow the WPATH Standards of Care, which are internationally recognized as the authoritative articulation of professional consensus on the treatment of gender dysphoria. Defendant Babich is among those responsible for denying Ms. Hicklin medically necessary care and is sued in his official capacity.
28. On information and belief, DEFENDANT T.K. BREDEMAN, D.O. (“Bredeman”) is, and was at all relevant times, Associate Regional Medical Director of Corizon. In this role, he exercises policy and decision-making authority regarding the care and treatment of MDOC inmates, control of health care personnel, and has the authority to grant or deny medical care to inmates. He is responsible for ensuring the provision of adequate medical care to inmates, including through the implementation of policies and the training and supervision of staff. In making decisions related to Ms. Hicklin’s medical care, Defendant Bredeman failed to follow the WPATH Standards of Care, which are internationally recognized as the authoritative articulation of professional consensus on the treatment of gender dysphoria. Defendant Bredeman is among those responsible for denying Ms. Hicklin medically necessary care and is sued in his official capacity.
29. On information and belief, DEFENDANT DIANA LARKIN, R.N. (“Larkin”) was at relevant times Director of Nursing and is currently Health Services Administrator for Corizon. In these roles, she has exercised policy and decision-making authority regarding the
9

Case: 4:16-cv-01357-NCC Doc. #: 19 Filed: 08/22/16 Page: 10 of 32 PageID #: 28
care and treatment of MDOC inmates, control of health care personnel, and has the authority to grant or deny medical care to inmates. She is responsible for ensuring the provision of adequate medical care to inmates, including through the implementation of policies and the training and supervision of staff. In making decisions related to Ms. Hicklin’s medical care, Defendant Larkin failed to follow the WPATH Standards of Care, which are internationally recognized as the authoritative articulation of professional consensus on the treatment of gender dysphoria. Defendant Larkin is among those responsible for denying Ms. Hicklin medically necessary care and is sued in her official capacity.
30. On information and belief, DEFENDANT KIMBERLEY S. RANDOLPH, R.N., B.S.N., C.C.H.P (“Randolph”) is and was at all relevant times Director of Operations for Corizon. In this role, she exercises policy and decision-making authority regarding the care and treatment of MDOC inmates, control of health care personnel, and the authority to grant or deny medical care to inmates. She is responsible for ensuring the provision of adequate medical care to inmates, including through the implementation of policies and the training and supervision of staff. In making decisions related to Ms. Hicklin’s medical care, Defendant Randolph failed to follow the WPATH Standards of Care, which are internationally recognized as the authoritative articulation of professional consensus on the treatment of gender dysphoria. Defendant Randolph is among those responsible for denying Ms. Hicklin medically necessary care and is sued in her official capacity.
31. On information and belief, DEFENDANT DAWN WADE, R.N. (“Wade”) is and was at relevant times Director of Nursing for Corizon. In this role, she exercises policy and decision-making authority regarding the care and treatment of MDOC inmates, control of health care personnel, and the authority to grant or deny medical care to inmates. She is responsible for
10

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ensuring the provision of adequate medical care to inmates, including through the implementation of policies and the training and supervision of staff. In making decisions related to Ms. Hicklin’s medical care, Defendant Wade failed to follow the WPATH Standards of Care, which are internationally recognized as the authoritative articulation of professional consensus on the treatment of gender dysphoria. Defendant Wade is among those responsible for denying Ms. Hicklin medically necessary care and is sued in her official capacity.
32. On information and belief, STORMI MOELLER, R.N. (“Moeller”) is and was at relevant times employed by Corizon in a capacity requiring the exercise of policy and decision-making authority regarding the care and treatment of MDOC inmates, control of health care personnel, and the authority to grant or deny medical care to inmates. On information and belief, Defendant Moeller is responsible for ensuring the provision of adequate medical care to inmates, including through the implementation of policies and the training and supervision of staff. In making decisions related to Ms. Hicklin’s medical care, Defendant Moeller failed to follow the WPATH Standards of Care, which are internationally recognized as the authoritative articulation of professional consensus on the treatment of gender dysphoria. Defendant Moeller is among those responsible for denying Ms. Hicklin medically necessary care and is sued in her official capacity.
33. On information and belief, SHIRLEY EYMAN, M.D. (“Eyman”) is and was at all relevant times Regional Psychiatric Director of Corizon. In this role, she exercises policy and decision-making authority regarding the care and treatment of MDOC inmates, control of health care personnel, and the authority to grant or deny medical care to inmates. She is responsible for ensuring the provision of adequate medical care to inmates, including through the
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implementation of policies and the training and supervision of staff. She is among those responsible for denying Ms. Hicklin medically necessary care and is sued in her official capacity.
34. On information and belief, ELIZABETH ATTERBERRY, M.D., L.P. (“Atterberry”) is and was at all relevant times Clinical Director of Corizon. In this role, she exercises policy and decision-making authority regarding the care and treatment of MDOC inmates, control of health care personnel, and the authority to grant or deny medical care to inmates. She is responsible for ensuring the provision of adequate medical care to inmates, including through the implementation of policies and the training and supervision of staff. She is among those responsible for denying Ms. Hicklin medically necessary care and is sued in her official capacity.
35. On information and belief, KIM FOSTER, L.P.C. (“Foster”) is and was at all relevant times Regional Administrator of Corizon. On information and belief, in this role, she exercises policy and decision-making authority regarding the care and treatment of MDOC inmates, control of health care personnel, and the authority to grant or deny medical care to inmates. She is responsible for ensuring the provision of adequate medical care to inmates and is among those responsible for denying Ms. Hicklin medically necessary care. She is sued in her official capacity.
FACTS Background on Gender Dysphoria and Its Medical Treatment and Standards of Care
36. A person’s gender identity refers to that person’s internal sense of belonging to a particular gender. It is a deeply felt, core component of a person’s identity and the most important determinant of a person’s sex.
37. Emerging research points to the influence of biological factors, most notably the role of sex differentiation in the brain, in gender identity development.
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38. Everyone has a gender identity. For most people, the sex they were assigned at birth matches their gender identity. For transgender people like Ms. Hicklin, the sex they were assigned at birth does not accurately reflect their gender identity.
39. There is medical consensus that gender identity cannot be changed and attempts to change a person’s gender identity are both futile and unethical.
40. Transgender people may experience discomfort or distress caused by the discrepancy between gender identity and sex assigned at birth. Where this distress reaches a clinical level, it may support a formal diagnosis of gender dysphoria.
41. Gender dysphoria is a condition recognized in the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, Fifth ed. (2013) (“DSMV”), and by the other leading medical and mental health professional groups, including the American Medical Associations and the American Psychological Association.
42. As set forth in the DSM-V, the diagnostic criteria for gender dysphoria are: a. A marked incongruence between one’s experienced/expressed gender and assigned gender, of at least six months’ duration, as manifested by at least two of the following: i. A marked incongruence between one’s experienced/expressed gender and primary and/or secondary sex characteristics (or in young adolescents, the anticipated secondary sex characteristics). ii. A strong desire to be rid of one’s primary and/or secondary sex characteristics because of a marked incongruence with one’s experienced/expressed gender (or in young adolescents, a desire to prevent the development of the anticipated secondary sex characteristics).
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iii. A strong desire for the primary and/or secondary sex characteristics of the other gender.
iv. A strong desire to be of the other gender (or some alternative gender different from one’s assigned gender).
v. A strong desire to be treated as the other gender (or some alternative gender different from one’s assigned gender).
vi. A strong conviction that one has the typical feelings and reactions of the other gender (or some alternative gender different from one’s assigned gender).
b. The condition is associated with clinically significant distress or impairment in social, occupational, or other important areas of functioning.
43. There is medical consensus that gender dysphoria is a serious medical condition that if not properly treated is known to cause clinical distress; debilitating depression, anxiety, mental impairment; the impulse to engage in self-surgery and self-harm; and even suicidal thoughts or acts.
44. Incarcerated transgender women like Ms. Hicklin are at a particularly high risk of engaging in self-harm, including attempts at self-surgery, when treatment is withheld.
45. Gender dysphoria often intensifies with time. The longer an individual goes without treatment, the greater the risk of severe harms to the individual’s physical and psychological health.
46. The medically recognized protocols for the treatment of gender dysphoria are set forth in the World Professional Association for Transgender Health (“WPATH”) Standards of
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Care for the Health of Transsexual, Transgender, and Gender-Nonconforming People (“Standards of Care”).
47. The American Psychological Association, the American Medical Association, and the Endocrine Society have recognized the Standards of Care as the authoritative articulation of professional consensus on the treatment of gender dysphoria. Courts that have considered the issue have also consistently relied on the Standards of Care.
48. The Standards of Care provide for the following treatments, some or all of which will be required, depending on the individual medical needs of the patient:
a. Changes in gender expression and role (which may involve living part time or fulltime in another gender role, consistent with one’s gender identity);
b. Hormone therapy to feminize or masculinize the body in order to reduce the distress caused by the discordance between one’s gender identity and sex assigned at birth;
c. Surgery to change primary and/or secondary sex characteristics; d. Psychotherapy (individual, couple, family, or group) for purposes such as
exploring gender identity, role, and expression; addressing the negative impact of gender dysphoria and stigma on mental health; alleviating internalized transphobia; enhancing social and peer support; improving body image; or promoting resilience. 49. The Standards of Care also specifically provide that, for some people, permanent hair removal is a valid part of the treatment of gender dysphoria. A procedure can be medically necessary for some individuals, even though the same procedure may not be medically necessary for others, depending on whether the procedure is treatment for a medical condition.
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50. A critical component of the treatment for gender dysphoria as prescribed by the Standards of Care is a process often referred to as the “social role transition,” which requires living in accordance’s with one’s gender identity through changes in gender expression and role, including dressing, grooming, and otherwise outwardly expressing oneself consistently with one’s gender.
51. Psychotherapy or counseling can provide support and affirmation to individuals diagnosed with gender dysphoria, but is not a substitute for treatments such as hormone therapy or social role transition where such treatments are medically necessary. Likewise, the use of antidepressants and psychotropic medications are inadequate treatments for gender dysphoria where treatments such as hormone therapy or social role transition are medically necessary.
52. Attempting to treat a person who needs hormone therapy, social role transition, or other forms of medically necessary treatment for gender dysphoria with mental health counseling alone, or in combination with psychotropic drugs, is a dangerous deviation from the Standards of Care that puts the person at risk of physical injury, decompensation, and death.
53. Likewise, attempting to “cure” a person of gender dysphoria by attempting to force them to disregard their gender identity and live as their assigned gender is dangerous and unethical and puts them at substantial risk of serious harm.
54. The Standards of Care apply with equal force to persons who are incarcerated and persons who are not incarcerated, and have been endorsed by the National Commission on Correctional Healthcare and the U.S. Department of Justice National Institute of Corrections as the medically accepted standard for the treatment of inmates with gender dysphoria.
55. The Standards of Care state that a “freeze-frame” approach to the provision of hormone therapy to people who are incarcerated is not considered appropriate care and warn that
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“the consequences of . . . lack of initiation of hormone therapy when medically necessary include a high likelihood of negative outcomes such as surgical self-treatment by autocastration, depressed mood, dysphoria, and/or suicidality.”
56. The National Commission on Correctional Healthcare (“NCCHC”) recommends that the medical management of prisoners with gender dysphoria “should follow accepted standards developed by professionals with expertise in transgender health,” citing the Standards of Care. The NCCHC also explains that “policies that make treatments available only to those who received them prior to incarceration or that limit transition and/or maintenance are inappropriate and out of step with medical standards and should be avoided.”
57. The Federal Bureau of Prisons and many state and local corrections agencies administer hormone therapy to prisoners in their custody with gender dysphoria, including to prisoners who did not receive such therapy at the time of incarceration.
58. The mental health providers who have evaluated and diagnosed Ms. Hicklin with gender dysphoria, including the mental health providers at PCC employed by MDOC and Defendant Corizon, recognize that treatment for gender dysphoria should follow the Standards of Care and have recommended hormone therapy for Ms. Hicklin’s gender dysphoria.
59. The mental health providers who have evaluated and diagnosed Ms. Hicklin with gender dysphoria, including the mental health providers at PCC employed by MDOC and Defendant Corizon, agree that access to permanent hair removal and gender-affirming canteen items are medically necessary parts of Ms. Hicklin’s treatment. Ms. Hicklin’s Gender Dysphoria
60. Ms. Hicklin is a thirty-seven-year-old white woman, who is transgender. 61. Although Ms. Hicklin was assigned male at birth, her identity as a woman is just as valid as that of women assigned female at birth.
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62. From an early age, Ms. Hicklin experienced a marked incongruence between her internal sense of her own gender and the gender to which she was assigned at birth.
63. For as long as she can remember, Ms. Hicklin has felt different and uncomfortable in her skin. She recalls feeling most comfortable when playing dress-up by wearing traditionally female clothing or playing with dolls with her sister and female classmates. She felt uncomfortable with the contact sports she was expected to pursue, including football and basketball. She has always felt that her anatomy was wrong and did not understand why she did not have the same anatomy as other women.
64. Since being incarcerated in MDOC at age 16, Ms. Hicklin has repeatedly sought treatment for the depression and anxiety caused by her gender dysphoria, but did not discover there was a “name” for her experience until recently.
65. Although she has struggled with the effects of her gender dysphoria since childhood, Ms. Hicklin has only recently been able to articulate her core identity as a woman who is transgender.
66. In 2015, mental health providers at PCC employed by MDOC and Defendant Corizon, diagnosed Ms. Hicklin with gender dysphoria. These mental health providers have consistently recognized Ms. Hicklin as a woman.
67. Ms. Hicklin experiences severe distress and serious impairments in her daily life due to gender dysphoria. She has discomfort with her body and has experienced and continues to experience psychological and physical symptoms due to her improperly treated gender dysphoria including panic attacks, anxiety, racing heartbeat, shortness of breath, sleep disturbance, lack of appetite, headaches, and excessive sweating. Defendants’ denial of treatment has caused Ms. Hicklin to experience intrusive thoughts of cutting off her testicles.
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68. Under the Standards of Care, hormone therapy and social role transition, including permanent hair removal and access to gender-affirming canteen items, are medically necessary treatments for Ms. Hicklin. Defendants’ Denial of Medically Necessary Treatment for Ms. Hicklin’s Gender Dysphoria
69. In or around early 2015, after struggling for decades with her gender identity, Ms. Hicklin came to terms with the fact that she is a transgender woman and could not suppress the fact that she is female.
70. Under PCC policy, on March 4, 2015, Ms. Hicklin submitted a Health Services Request seeking an initial evaluation for gender dysphoria. Pursuant to that request, Qualified Mental Health Professional (“QMHP”) Katherine Klein evaluated Ms. Hicklin on March 12, 2015 and March 17, 2015. After evaluation, Klein presented Ms. Hicklin’s case to MDOC’s “Treatment Team,” which referred her to Dr. Meredith Throop, a psychiatrist, for assessment.
71. On March 23, 2015, Dr. Throop conducted an assessment of Ms. Hicklin. In her evaluation notes, Dr. Throop states that Ms. Hicklin has identified as female since she was eight years old and documents Ms. Hicklin’s longstanding discomfort with her body and with traditionally male clothes and activities. Dr. Throop also discusses the many struggles Ms. Hicklin has faced throughout her life as a result of her gender identity. Ms. Hicklin shared that she was raised in a small town with very traditional attitudes about gender roles. She has been violently assaulted both physically and sexually due to her gender identity and lack of societal understanding and acceptance of transgender people. As a teenager, she resorted to drug use to cope with the psychological pain she suffered. At age 16, Ms. Hicklin was convicted of a drug-
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influenced crime and sentenced to life without the possibility of parole.3 Ms. Hicklin also explained to Dr. Throop that she continues to face serious impairments in her daily life due to her distress with her body. She expressed a desire to transition physically, with the help of hormone treatment, and ultimately, gender-affirming surgery.
72. Based on this assessment, Dr. Throop determined that Ms. Hicklin met the diagnostic criteria set forth in the DSM-V for gender dysphoria and planned to refer her to an endocrinologist for evaluation for hormone therapy. Dr. Throop’s notes state that “Currently, hormone therapy (estrogen, testosterone blockers) is the accepted treatment for individuals with Gender Dysphoria diagnoses.”
73. Despite Dr. Throop’s assessment and plan as indicated in her notes, Ms. Hicklin was never referred to an endocrinologist, because, as Dr. Throop later learned, MDOC policy prohibited providing hormone therapy for gender dysphoric inmates who were not already receiving such therapy prior to incarceration, as evidenced by a paragraph at the end of Dr. Throop’s evaluation notes that reads: “Addendum: Please note, that after researching DOC protocols, it was found that endocrinology consult is NOT the appropriate next step for psychiatry in the txt of Gender Dysphoria. Endocrinology consult was not requested.”
74. In addition to seeking an assessment for gender dysphoria, Ms. Hicklin filed a Petition for Change of Name in the Washington County Circuit Court to change her name from the traditionally male name given to her at birth to her current legal name, Jessica Hicklin.
3 On information and belief, pursuant to the recently passed Missouri Senate Bill 590, Ms. Hicklin will be eligible for parole in approximately 4 years, after completing 25 years of her sentence.
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75. On April 5, 2015, Ms. Hicklin submitted a 32-page request to Defendants Griffith and McKinney, laying out the Standards of Care and specifically requesting hormone treatment, gender-affirming canteen items, and body hair removal.
76. On April 22, 2015, Ms. Hicklin had a consultation with Defendant McKinney to discuss her request for hormone therapy. Defendant McKinney’s notes from that consult state that MDOC’s mental health staff had diagnosed Ms. Hicklin with gender dysphoria. Despite this diagnosis, Defendant McKinney’s notes go on to state that he “informed [Ms. Hicklin] that [Defendant] Griffith informed [Defendant McKinney] this AM that she was informed by her superiors that per discussions of [Defendant Corizon] and DOC, no plans to proceed with hormone treatment.”
77. The next day, on April 23, 2015, Ms. Hicklin began MDOC’s three-step grievance process by filing Informal Resolution Request (“IRR”) #PC-15-476, in which she reiterated her request for hormone treatment, gender-affirming canteen items, and permanent hair removal.
78. Ms. Hicklin requested that IRR #PCC-15-476 be designated as an Emergency IRR, per MDOC policy, which provides for expedited processing of IRRs “concerning matters that, under regular time limits would subject the offender to a substantial risk of personal injury, or cause other serious risk or irreparable harm.” Per MDOC policy, this request was referred to Defendant Griffith who denied the request to treat IRR #PCC-15-476 as an Emergency IRR.
79. Per MDOC policy, on April 27, 2015, Ms. Hicklin met with Defendant Larkin to determine whether IRR #PCC-15-476 could be resolved through discussion. During that meeting, Defendant Larkin informed Ms. Hicklin that she had received an email from Defendant Kempker stating that Ms. Hicklin would not receive hormone therapy because MDOC policy
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prohibited an inmate who was not on such therapy upon entering MDOC from receiving it while in MDOC. Defendant Larkin also told Ms. Hicklin that MDOC was responding solely to the request for hormones, not the request for canteen items or hair removal.
80. On April 30, 2015, Ms. Hicklin received a letter from Defendant Griffith erroneously construing Ms. Hicklin’s request for permanent hair removal and gender-affirming canteen items as non-medical and instructing Ms. Hicklin to grieve “other issues besides your medical treatment . . . as a separate complaint (IRR) from your medical concerns.” Defendant Payne was copied on this letter.
81. Based on her understanding that her request for medically necessary treatment (including electrolysis and gender-affirming canteen items) had been misconstrued as a request for hormone therapy only, on May 5, 2015, Ms. Hicklin wrote a letter to Defendant Griffith clarifying that all of the items requested in IRR #PCC-15-476 were part of the medically necessary treatment for her gender dysphoria. Ms. Hicklin also sought clarification of DOC policy as it relates to access to gender-affirming canteen items. In this letter, Ms. Hicklin noted that, pursuant to MDOC’s Offender Property Control Policy, female inmates in MDOC’s custody have access to the requested items. Ms. Hicklin further noted that the approved personal property list for PCC (which is designated as a men’s facility) also indicates that female inmates are allowed access to the requested items. Thus, Ms. Hicklin noted that both MDOC and PCC policy allowed her to purchase and possess the requested gender-affirming canteen items.
82. On May 12, 2015, Defendant Griffith responded to Ms. Hicklin’s letter, stating that statewide policy prevented access to the requested items and arguing that the items were not medical in nature. Yet, at the same time, Defendant Griffith also conceded that “the warden’s office is not in a position to determine what treatment(s) are medically necessary for your
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diagnosis. That is something you would have to discuss with your mental health/medical services professionals.” Defendant Payne was copied on this letter.
83. In addition to writing to Defendant Griffith about access to gender-affirming canteen items, Ms. Hicklin also submitted a Health Services Request specifically for permanent hair removal.
84. On May 19, 2015, Ms. Hicklin received an official denial of IRR #PC-15-476, dated April 27, 2015 and signed by Defendant Larkin, which stated that “per PCC administration, after discussion between DOC and Corizon Health representatives, there are no plans to proceed with hormone treatment.”
85. In response, Ms. Hicklin filed a second-stage grievance on May 21, 2015. In this grievance, Ms. Hicklin again clarified that her request was for medically necessary treatment in accordance with the Standards of Care, and that such treatment included not only hormone therapy, but also permanent hair removal and access to gender-affirming canteen items. She also noted that Defendants’ ongoing denial of medical necessary treatment for her gender dysphoria violated both the Standards of Care and federal constitutional law.
86. On May 27, 2015, Ms. Hicklin wrote to Defendant Larkin seeking an official response to her request for permanent hair removal.
87. Pursuant to Ms. Hicklin’s request, Defendant Larkin’s successor, Defendant Wade, arranged a meeting between Ms. Hicklin and Defendant McKinney on June 19, 2015. Ms. Hicklin had requested that a mental health professional be present at this meeting. Despite this request, neither her therapist, Katherine Klein, nor her psychiatrist, Dr. Meredith Throop, nor any other mental health professional was present. During the meeting, Defendant McKinney
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stated repeatedly that the determination of medical necessity for the hair removal request would be made by Defendant Babich in consultation with Defendant Griffith.
88. On June 22, 2015, a nurse informed Ms. Hicklin that Defendant Babich had denied the request for permanent hair removal as not medically necessary. On information and belief, Defendant Babich did not evaluate Ms. Hicklin before making this determination. Additionally, on information and belief, he spoke neither to her therapist, QMHP Klein, nor her psychiatrist, Dr. Throop -- though he apparently consulted with Defendant Griffith.
89. On June 23, 2015, Ms. Hicklin filed IRR #PC-15-734 related specifically to the permanent hair removal denial. She again requested that this IRR be treated as an Emergency IRR, as provided for under MDOC policy. This request was again denied by Defendant Griffith.
90. Ms. Hicklin also stated in IRR #PC-15-734 that Defendants’ continued denial of medically necessary treatment for her gender dysphoria, including their denial of permanent hair removal specifically, has severely impaired her ability to function, leading to negative outcomes including lack of sleep, depression, lack of motivation, and inability to focus. She also stated that the continued denial of permanent hair removal causes her severe mental anguish and noted that her attempts to self-treat via shaving does not address this anguish and has instead resulted in physical injury in the form of cuts, scarring, and rashes on her body, as she has to shave a large part of her body regularly and with dull and ineffective razors.
91. On July 10, 2015, having not received a response within the allotted time to her second-level grievance on IRR # PC-15-476 related to her initial request for hormones, permanent hair removal, and access to gender-affirming canteen items, Ms. Hicklin filed a Grievance Appeal, the final step in the grievance process for IRR # PC-15-476. In this appeal, Ms. Hicklin again discussed Defendants’ ongoing denial of medically necessary treatment for
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her gender dysphoria and the serious psychological distress this denial causes her. She noted that therapy sessions and psychotropic medications (the only treatment Defendants have provided her) are not adequate treatment for gender dysphoria. Ms. Hicklin also reiterated that Defendants’ continued denial of medically necessary treatment for her gender dysphoria violates the Standards of Care and applicable law.
92. On July 14, 2015, Ms. Hicklin received the late response to her second-step grievance for IRR # PC-15-476, dated June 7, 2015 and signed by Defendants Randolph, McKinney, and Griffith. The response reiterated that “hormone therapy will not be ordered to treat your Gender Dysphoria.” The response also instructed Ms. Hicklin to “continue to attend Mental Health appointments or seek the counseling of Mental Health staff as needed.”
93. On July 22, 2015, Ms. Hicklin received a denial of IRR #PC-15-734, the IRR she had filed regarding Defendant Babich’s denial of her permanent hair removal request. The denial was dated July 20, 2015, and signed by Defendant Wade. The denial reiterated that after meeting with Ms. Hicklin on June 19, 2015, “[Defendant] McKinney discussed your request with PCC Warden [Defendant Griffith] and [Defendant] Babich” and that Defendant Babich “confirmed” that permanent hair removal was not medically necessary.
94. In response, on July 28, 2015, Ms. Hicklin filed a second-stage grievance on IRR #PC-15-734. Again, Ms. Hicklin noted that the requested permanent hair removal was part of the medically necessary treatment for her gender dysphoria as set forth in the Standards of Care.
95. On or about August 26, 2015, Ms. Hicklin had her regularly scheduled meeting with her psychiatrist, Dr. Throop. During that meeting, Ms. Hicklin discussed with Dr. Throop Defendants’ failure to provide treatment for her gender dysphoria in accordance with the Standards of Care, despite Ms. Hicklin’s repeated requests for such treatment. Ms. Hicklin also
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discussed her continued symptoms of gender dysphoria. The allotted time for the meeting expired before Dr. Throop had completed her examination of Ms. Hicklin, so she provided Ms. Hicklin written questions, to which Ms. Hicklin provided written answers.
96. On information and belief, around the time of this meeting, Defendants chastised Dr. Throop for following the Standards of Care by properly using female pronouns to refer to Ms. Hicklin.
97. On August 26, 2015 Ms. Hicklin received the denial of her second-step grievance on IRR #PC-15-734, related to her request for permanent hair removal. The denial was dated August 12, 2015 and was signed by Defendants Larkin, McKinney, and Payne. In response, on August 27, 2015, Ms. Hicklin filed the final grievance appeal required for this request.
98. On September 2, 2015, Ms. Hicklin wrote letters to Defendants Foster, Atterberry, Eyman, Williams, and O’Kelly, and to Mental Health Contract Monitor Page Nichols, informing them of the ongoing denial of medically necessary treatment for her gender dysphoria despite her attempts to obtain such treatment.
99. On September 8, 2015, Defendant O’Kelley responded to Ms. Hicklin informing her that “this issue and all correspondence has been forwarded to Department of Corrections Legal Department to address same.”
100. On September 24, 2015, Ms. Hicklin received a response from Defendant Williams informing her that her letter had been received and that, since she had a grievance appeal pending, she should be patient.
101. On October 30, 2015, almost two weeks beyond the allotted time, Ms. Hicklin received the final denial of IRR #PC-15-476. The response was dated October 21, 2015, and signed by Defendants Moeller and Bredeman.
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102. On November 6, 2016, Ms. Hicklin wrote to Defendant Larkin, attaching the NCCHC Position Statement regarding transgender health care in correctional settings and noting where Defendants had deviated from the Position Statement in addressing Ms. Hicklin’s gender dysphoria. The Position Statement is part of a larger body of standards put forth by the NCCHC, which, on information and belief, is quoted as an authority in MDOC’s Quality Improvement Policy among others.
103. Despite knowing that Ms. Hicklin has been diagnosed with gender dysphoria by their own mental health personnel, and despite receiving multiple requests from Ms. Hicklin for medical necessary treatment of this serious medical condition, Defendants have continually withheld such treatment, exhibiting deliberate indifference to the excessive risk this denial poses to her health and safety.
104. On information and belief, Defendants have prohibited Ms. Hicklin’s mental health providers from creating a treatment plan outlining interventions sufficient to treat her gender dysphoria and have instead limited her care to psychotherapy and anti-anxiety medication.
105. Despite the fact that this approach violates the WPATH Standards of Care and the NCCHC Position Statement guidelines, Defendants have steadfastly maintained that Ms. Hicklin will receive no other intervention for her gender dysphoria, except psychotherapy and antianxiety medication.
106. As previously noted, psychotherapy and psychotropic medications are not substitutes for treatments such as hormone therapy or social role transition where such treatments are medically necessary to treat gender dysphoria.
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107. On or around December 16, 2015, Ms. Hicklin began treatment with a new psychiatrist, Dr. Evelynn Stephens for continued care, after Dr. Throop left MDOC.
108. Ms. Hicklin’s medical records from her visits with Dr. Stephens and other mental health staff show that she continues to experience serious psychological and physical symptoms due to her improperly treated gender dysphoria, including panic attacks, anxiety, racing heartbeat, shortness of breath, sleep disturbance, lack of appetite, headaches, and excessive sweating. She also experiences intrusive thoughts of cutting off her testicles as she worries that continued testosterone exposure will cause permanent male pattern baldness. Ms. Hicklin wears her hair in a traditionally feminine style. Currently, her hair is the only part of her body that does not contribute to her dysphoria and the thought of losing her hair is extremely distressing.
109. Like QMHP Klein and Ms. Hicklin’s previous psychiatrist, Dr. Throop, on December 16, 2015, Dr. Stephens diagnosed Ms. Hicklin with gender dysphoria “with associated panic secondary to current body characteristics.” Dr. Stephens recommended that Ms. Hicklin be allowed “hair removal and hormone therapy as these are likely to greatly decrease patient’s current level of discomfort and intrusive thoughts.” Dr. Stephens has also recommended that Ms. Hicklin have access to the same self-care products as other female inmates.
110. On or around January 13, 2016, Dr. Stephens noted that “[Ms. Hicklin’s] symptoms are escalating with age given risk of male pattern baldness more likely at this time if hormone therapy not initiated. This should be taken into account when considering the time table for starting treatment. The patient does meet the requirements for diagnosis of gender dysphoria and has now been diagnosed by two psychiatrists.” On March 16, 2016, Dr. Stephens again noted that Ms. Hicklin was at risk for “male pattern baldness” and recommended that finasteride or dutasteride be considered to halt any noted hair loss.
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111. As the foregoing paragraphs illustrate, although Defendants’ own mental health personnel have diagnosed Ms. Hicklin with gender dysphoria and have recommended that she receive medically necessary treatment for this serious medical condition, Defendants continue to refuse to provide Ms. Hicklin with such treatment.
112. Ms. Hicklin’s gender dysphoria can be effectively treated only by providing her the medically necessary treatments she requires as prescribed by the Standards of Care, namely: hormone therapy and female gender expression, including permanent hair removal and access to gender-affirming canteen items. Defendant’s continued denial of these medically necessary treatments have caused and will continue to cause her severe psychological pain and physical discomfort and puts her at continued risk of depression, anxiety, mental impairment, self-surgery and self-harm, and suicidal thoughts or acts.
CLAIM FOR RELIEF COUNT I
Refusal to Provide Medically Necessary Care In Violation of the Eighth Amendment to the U.S. Constitution
(against all Defendants) 113. Ms. Hicklin incorporates paragraphs 1 through 112 as though fully set forth herein. 114. At all relevant times, Defendants knew that Ms. Hicklin has gender dysphoria, a serious medical need that jeopardizes an individual’s physical health and mental well-being when not properly treated. 115. Defendants knew that the medically accepted standards for the treatment of gender dysphoria are the Standards of Care, and that hormone therapy and social role transition, not merely psychotherapy and psychotropic drugs, are the medically necessary treatment for Ms. Hicklin’s gender dysphoria. Defendants knew that denying Ms. Hicklin hormone therapy and
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social role transition placed her at a substantial risk of serious harm, including depression, anxiety, mental impairment, physical self-harm, and suicide.
116. Despite this knowledge and despite Ms. Hicklin’s repeated requests for care, Defendants, while acting under color of state law, have refused to provide Ms. Hicklin with the medically necessary treatment for her gender dysphoria, in deliberate indifference to her serious medical needs, and in violation of the Eighth Amendment’s prohibition on cruel and unusual punishment.
117. Each of the Defendants has also implemented, condoned, ratified, followed, and/or enforced, and continues to implement, condone, ratify, follow, and/or enforce a policy or custom, having the force of law, of refusing requests to initiate appropriate and effective gender dysphoria treatment, irrespective of an inmate’s medical need, and providing counseling and psychotropic drugs alone, when each knew that this was inadequate care that placed Ms. Hicklin at substantial risk of further mental and physical distress.
118. Each of the Defendants has also failed and continues to fail to train and supervise MDOC and/or Corizon staff with respect to the proper provision of medically necessary treatment for gender dysphoria, despite knowing that gender dysphoria is a serious medical need and that failing to train and supervise staff with respect to the provision of medically necessary treatment for this serious medical need places inmates like Ms. Hicklin at substantial risk of serious mental and physical harm.
119. Defendants’ continuous denial of medically necessary care is causing and will continue to cause irreparable harm to Ms. Hicklin, including severe anxiety and distress. It also puts her at serious risk of continued irreparable harm including permanent male pattern baldness, physical self-harm, and suicidal thoughts or acts.
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120. Each of the Defendants disregarded, and continues to disregard the known or obvious consequences of their actions and inactions, as set forth herein, resulting in a substantial risk of serious harm to Ms. Hicklin.
121. By failing to provide Ms. Hicklin with effective treatment for gender dysphoria while incarcerated, Defendants have deprived Ms. Hicklin of her right to medically necessary treatment guaranteed by the Eighth Amendment of the United States Constitution.
PRAYER FOR RELIEF WHEREFORE, Ms. Hicklin respectfully requests that this Court enter judgment: A. Declaring that Defendants’ refusal to provide Ms. Hicklin medically necessary care related to her gender dysphoria violates the Eighth Amendment to the Unites States Constitution; B. Entering preliminary and permanent injunctive relief requiring Defendants to provide Ms. Hicklin with medically necessary treatment for her gender dysphoria under the Standards of Care, including but not limited to hormone therapy, permanent hair removal, and access to gender-affirming canteen items; C. Awarding Ms. Hicklin costs, expenses, and reasonable attorneys’ fees pursuant to 42 U.S.C. § 1988 and other applicable laws; and D. Granting such other and further relief as the Court deems just and proper.
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Date: August 22, 2016.
Demoya Gordon* Richard Saenz* LAMBDA LEGAL DEFENSE AND EDUCATION FUND, INC. 120 Wall Street, 19th Floor New York, NY 10005-3919 Phone: (212) 809-8585 Fax: (212) 809-0055 dgordon@lambdalegal.org rsaenz@lambdalegal.org
*Motion for admission pro hac vice pending

Respectfully submitted,
/s/ Kevin L. Schriener Kevin L. Schriener Law & Schriener, LLC 141 N. Meramac Avenue, Suite 314 St. Louis, MO 63105 Phone: (314) 721-7095 Fax: (314) 863-7096 kschriener@schrienerlaw.com
Kyle A. Palazzolo* LAMBDA LEGAL DEFENSE AND EDUCATION FUND, INC. 105 W. Adams, Suite 2600 Chicago, IL 60603 Phone: (312) 663-4413 Fax: (312) 663-4307 kpalazzolo@lambdalegal.org

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 Case: 4:16-cv-01357-NCC Doc. #: 63 Filed: 04/04/17 Page: 1 of 3 PageID #: 424

IN THE UNITED STATES DISTRICT COURT FOR THE EASTERN DISTRICT OF MISSOURI
EASTERN DIVISION

JESSICA HICKLIN, v.

Plaintiff,

GEORGE LOMBARDI, et al.,
Defendants.

Case No. 4:16-CV-01357-NCC

PLAINTIFF’S MOTION FOR PRELIMINARY INJUNCTION Pursuant to Rule 65 of the Federal Rules of Civil Procedure, Plaintiff Jessica Hicklin, by and through her attorneys, moves this Court for the issuance of a preliminary injunction that: (1) directs Defendants to provide Ms. Hicklin with medically necessary treatment for gender dysphoria, including but not limited to providing her hormone therapy, access to permanent body hair removal, and access to gender-affirming canteen items, and (2) enjoining Defendants from enforcing the policies, customs, or practices that have served as a moving force behind their constitutional violations by denying inmates with gender dysphoria individualized medically necessary treatment and care, contrary to widely accepted standards of care and the recommendations of Ms. Hicklin’s treating mental health professionals. The grounds for this Motion are set forth in the accompanying Memorandum of Law. Plaintiff also respectfully refers the Court to her Complaint for Declaratory and Injunctive Relief, the Declaration of Dr. Randi C. Ettner, the Declaration of Dr. Meredith L. Throop, and the Declaration of Demoya R. Gordon.

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Ms. Hicklin respectfully requests oral argument on this Motion, which will assist the

Court in resolving the issues presented.

Date: April 4, 2017.

Respectfully submitted,

Demoya Gordon* Richard Saenz* LAMBDA LEGAL DEFENSE AND EDUCATION FUND, INC. 120 Wall Street, 19th Floor New York, NY 10005-3919 Phone: (212) 809-8585 Fax: (212) 809-0055 dgordon@lambdalegal.org rsaenz@lambdalegal.org
*Admitted pro hac vice

/s/ Kevin L. Schriener Kevin L. Schriener Law & Schriener, LLC 141 N. Meramac Avenue, Suite 314 St. Louis, MO 63105 Phone: (314) 721-7095 Fax: (314) 863-7096 kschriener@schrienerlaw.com
Kyle A. Palazzolo* LAMBDA LEGAL DEFENSE AND EDUCATION FUND, INC. 105 W. Adams, Suite 2600 Chicago, IL 60603 Phone: (312) 663-4413 Fax: (312) 663-4307 kpalazzolo@lambdalegal.org

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CERTIFICATE OF SERVICE
IT IS HEREBY CERTIFIED that service of the foregoing Motion for Preliminary Injunction was made on April 4, 2017 via the Court’s CM/ECF system to:
Henry F. Luepke, #38782MO Assistant Attorney General Missouri Attorney General’s Office P.O. Box 861 St. Louis, MO 63188 Tel: 314-340-7652 bud.luepke@ago.mo.gov Attorney for Defendants George Lombardi, Dwayne Kempker, Ian Wallace, Cindy Griffith, Stan Payne, Scott O’Kelly, and Deloise Williams J. Thaddeus Eckenrode, MoBar #31080 Kevin K. Peek, MoBar # 67440 Eckenrode-Maupin 11477 Olde Cabin Rd Suite 110 St. Louis, MO 63141 Tel: 314-726-6670 Fax: 314-726-2106 jte@eckenrode-law.com kkp@eckenrode-law.com Attorneys for Defendants Corizon LLC, William McKinney, Glen Babich, T.K. Bredeman, Diana Larkin, Kimberley S. Randolph, Dawn Wade, Stormi Moeller, Shirley Eyman, Elizabeth Atterberry, and Kim Foster
__s/Kevin L. Schriener
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 Case: 4:16-cv-01357-NCC Doc. #: 64 Filed: 04/04/17 Page: 1 of 21 PageID #: 427

IN THE UNITED STATES DISTRICT COURT FOR THE EASTERN DISTRICT OF MISSOURI
EASTERN DIVISION

JESSICA HICKLIN, v.

Plaintiff,

GEORGE LOMBARDI, et al.,
Defendants.

Case No. 4:16-CV-01357-NCC

MEMORANDUM OF LAW IN SUPPORT OF PLAINTIFF’S MOTION FOR PRELIMINARY INJUNCTION

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TABLE OF CONTENTS TABLE OF CONTENTS................................................................................................................. i TABLE OF AUTHORITIES .......................................................................................................... ii INTRODUCTION .......................................................................................................................... 1 FACTS ............................................................................................................................................ 2 Background on Gender Dysphoria and Standards of Care............................................................ 2 Ms. Hicklin’s Gender Dysphoria .................................................................................................... 3 ARGUMENT .................................................................................................................................. 6 I. Ms. Hicklin Is Suffering Irreparable Harm That Will Continue In The Absence Of A
Preliminary Injunction............................................................................................................. 7 II. Ms. Hicklin Is Substantially Likely To Succeed On The Merits............................................. 9
A. Ms. Hicklin’s Gender Dysphoria and Risk of Self-Harm Are Objectively Serious Medical Needs.................................................................................................................................. 10
B. Defendants Have Acted With Deliberate Indifference to Ms. Hicklin’s Serious Medical Needs.................................................................................................................................. 11
III. The Balance of Harms Strongly Favors Ms. Hicklin. ........................................................... 13 IV. An Injunction Is In The Public Interest. ................................................................................ 14 CONCLUSION............................................................................................................................. 15
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Federal Cases

TABLE OF AUTHORITIES

Battista v. Clarke, 645 F.3d 449 (1st Cir. 2011)........................................................................... 10

Brown v. Plata, 563 U.S. 493 (2011).............................................................................................. 9

Coleman v. Rahija, 114 F.3d 778 (8th Cir. 1997)........................................................................... 9

De’lonta v. Angelone (De’lonta I), 330 F.3d 630 (4th Cir. 2003) ................................................ 11

De’lonta v. Johnson (De’lonta II), 708 F.3d 520 (4th Cir. 2013)................................................. 13

Elrod v. Burns, 427 U.S. 347 (1976) .............................................................................................. 8

Estelle v. Gamble, 429 U.S. 97 (1976) ............................................................................... 9, 10, 12

Farmer v. Brennan, 511 U.S. 825 (1994) ..................................................................................... 11

Fields v. Smith, 712 F. Supp. 2d 830 (E.D. Wis. 2010), aff’d, 653 F.3d 550 (7th Cir. 2011) 10, 13

Gammett v. Idaho State Bd. of Corr., No. CV05-257-S-MHW, 2007 WL 2186896 (D. Idaho July

27, 2007).................................................................................................................................... 14

Helling v. McKinney, 509 U.S. 25 (1993)........................................................................... 9, 10, 11

Henderson v. Bodine Aluminum, Inc., 70 F.3d 958 (8th Cir. 1995) ............................................... 7

Johnson v. Bd. of Police Comm’rs, 351 F. Supp. 2d 929 (E.D. Mo. 2004).................................. 15

Jones v. Muskegon Ctny., 625 F.3d 935 (6th Cir. 2010); ............................................................. 12

Kirkeby v. Furness, 52 F.3d 772 (8th Cir. 1995) ............................................................................ 6 Kothmann v. Rosario, 558 F. App’x 907 (11th Cir. 2014) ........................................................... 12 Langford v. Norris, 614 F.3d 445 (8th Cir. 2010) ........................................................................ 12 Lee v. Downs, 641 F.2d 1117 (4th Cir. 1981)............................................................................... 11 Nelson v. Corr. Med. Servs., 583 F.3d 522 (8th Cir. 2009) ............................................................ 9 Norsworthy v. Beard, 87 F. Supp. 3d 1164 (N.D. Cal. 2015)......................................................... 8 Phelps-Roper v. City of Manchester, Mo., 697 F.3d 678 (2012) (en banc) .................................. 14

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Phelps-Roper v. Nixon, 545 F.3d 685 (8th Cir. 2008) ............................................................ 14, 15 Phillips v. Mich. Dep't of Corr., 731 F. Supp. 792 (W.D. Mich. 1990), aff’d, 932 F.2d 969 (6th
Cir. 1991) ............................................................................................................................ 10, 14 Richland/Wilkin Joint Powers Auth. v. U.S. Army Corps of Eng’rs, 826 F.3d. 1030 (8th Cir.
2016).......................................................................................................................................... 15 Roe v. Crawford, 396 F. Supp. 2d 1041 (W.D. Mo. 2005)............................................................. 9 Roe v. Elyea, 631 F.3d 843 (7th Cir. 2011) .................................................................................. 11 Soneeya v. Spencer, 851 F. Supp. 2d 228 (D. Mass. 2012) .................................................... 11, 13 White v. Farrier, 849 F.2d 322 (8th Cir. 1988) ............................................................................ 10 Winter v. Nat’l Res. Def. Council, 555 U.S. 7 (2008)..................................................................... 7 Federal Rules Fed. R. Civ. P. 65(c) ..................................................................................................................... 15 Other Authorities George R. Brown, Autocastration and Autopenectomy as Surgical Self-Treatment in
Incarcerated Persons with Gender Identity Disorder, 12 Int’l J. of Transgenderism 31 (2010) ................................................................................................................................................... 11
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INTRODUCTION Jessica Hicklin, a thirty-eight-year-old woman who is transgender, has been incarcerated since age sixteen in the Missouri Department of Corrections (“MDOC”) system. Ms. Hicklin1 lives every day with intense psychological and physical suffering due to the refusal of MDOC and its contracted medical provider, Corizon LLC (“Corizon”), (collectively, “Defendants”), to provide her with urgently needed medical care that Defendants’ own mental health providers have deemed medically necessary to treat her gender dysphoria. Ms. Hicklin has not suffered in silence; she has exhausted Defendants’ grievance process. But, despite being aware of Ms. Hicklin’s gender dysphoria diagnosis and her ongoing need for care, Defendants have refused to provide her with medically necessary treatment due, in part, to an unconstitutional “freeze-frame policy” that categorically prohibits the initiation of gender dysphoria treatment to inmates in need. Because Ms. Hicklin remains at a substantial risk of irreparable harm, including ongoing mental and bodily anguish, she now moves for a preliminary injunction that: (1) directs Defendants to provide Ms. Hicklin with care that her doctors deem to be medically necessary treatment for gender dysphoria, including but not limited to providing her hormone therapy, access to permanent body hair removal, and access to gender-affirming canteen items; and (2) enjoining Defendants from enforcing the policies, customs, or practices that have served as a moving force behind their constitutional violations by denying inmates with gender dysphoria individualized medically necessary treatment and care, contrary to widely accepted standards of care and the recommendations of Ms. Hicklin’s treating mental health professionals.
1In keeping with modern judicial practice (including this Court’s instructions to the parties on November 16, 2016) and accepted medical protocol, this Memorandum refers to Ms. Hicklin using female pronouns and honorifics.
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FACTS Background on Gender Dysphoria and Standards of Care
Gender dysphoria refers to the clinical distress caused by the incongruence between a person’s gender identity—their innate sense of their own gender—and the sex they were assigned at birth. See Declaration of Dr. Randi C. Ettner (“Ettner Decl.”) ¶¶ 12-13. Gender dysphoria appears in the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (“DSM-V”). Id. Individuals with untreated gender dysphoria experience clinically significant depression, anxiety, and mental impairment, and, when left untreated, additional serious medical problems including suicidality and the compulsion to engage in self-castration and self-harm. Id. at ¶¶ 15-16. The World Professional Association for Transgender Health’s Standards of Care for the Health of Transsexual, Transgender, and GenderNonconforming People (the “Standards of Care”) provide the authoritative treatment protocol for gender dysphoria and apply in incarcerated and non-incarcerated settings. Id. at ¶¶ 18-19; 23-24.
Under the Standards of Care, persons with gender dysphoria should be individually assessed by qualified health care providers and referred for treatment, which can include: (1) living in another gender role that is consistent with one’s gender identity; (2) hormone therapy to feminize or masculinize the body; and/or (3) surgery to change primary and/or secondary sex characteristics. Id. at ¶¶ 20-21. Counseling can also provide support for some individuals, but it is not a substitute for medical intervention, and exclusive reliance on it constitutes a gross departure from medically accepted practice. Id. at ¶¶ 35-36.
The Standards of Care also recognize that hormone therapy, in particular, is fundamental to the treatment of gender dysphoria, and that the denial of hormone treatment leads to significant deterioration and impairment in patients, including a high likelihood of depression,
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suicidal ideation, and surgical self-treatment by auto-castration (removal of the testicles) or autopenectomy (removal of the penis). Id. at ¶¶ 28-33. Ms. Hicklin’s Gender Dysphoria
Throughout her life, Ms. Hicklin has experienced a marked incongruence between her internal sense of her own gender and the gender she was assigned at birth. Ms. Hicklin has always felt that her anatomy was wrong and she has struggled to understand why her anatomy was different from other women. See Complaint, D.E. 19 at ¶ 63 (“Complaint”); Ettner Decl. ¶¶ 44, 46. Growing up, Ms. Hicklin recalls feeling most comfortable when she played dress-up by wearing traditionally female clothing or playing with dolls with her sister and female classmates. See Complaint at ¶ 63; Ettner Decl. ¶ 43. For most of her life, Ms. Hicklin has felt different and uncomfortable in her own skin. See Complaint at ¶ 63.
While she has always felt different, only recently has Ms. Hicklin been able to articulate her core identity as a woman who is transgender. See Complaint at ¶¶ 64-65. Pursuant to Potosi Correctional Center (“PCC”) policy, on or around March 4, 2015, Ms. Hicklin requested an initial evaluation for gender dysphoria. Id. at ¶ 70. As a result, Dr. Meredith Throop, a psychiatrist, evaluated Ms. Hicklin on March, 23, 2015. Id. at ¶ 71. Dr. Throop’s notes detail how Ms. Hicklin has identified as female since she was eight years old. See Declaration of Dr. Meredith L. Throop (“Throop Decl.”) Ex. B at EM 0111-12. Dr. Throop also documents Ms. Hicklin’s longstanding discomfort with her body and with wearing traditionally male clothes and engaging in traditionally male activities. Id. at EM 0112. Ms. Hicklin explained to Dr. Throop that she continues to face serious impairments in her daily life because of distress around her body. Id. Based on this assessment, Dr. Throop determined that Ms. Hicklin met the diagnostic criteria for gender dysphoria outlined in the DSM-V. Id. at EM 0114.
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Dr. Throop referred Ms. Hicklin to an endocrinologist, noting that “Currently, hormone therapy (estrogen, testosterone blockers) is the accepted treatment for individuals with Gender Dysphoria diagnoses.” Id.; see also Complaint at ¶ 72. But Ms. Hicklin has never been treated by an endocrinologist because MDOC policy arbitrarily prohibits providing hormone therapy for inmates with gender dysphoria who were not receiving such therapy before incarceration. See Throop Decl. Ex. B at EM 0114 (an “addendum” to Dr. Throop’s evaluation notes states that “after researching DOC protocols, it was found that endocrinology consult is NOT the appropriate next step for psychiatry in the txt of Gender Dysphoria. Endocrinology consult was not requested”); see also Complaint at ¶ 73; D.E. 42, MDOC Answer at ¶ 79 (admitting that Defendant Kempker emailed Defendant Larkin citing this policy as the reason for denying Ms. Hicklin hormone treatment).
Despite MDOC policy, Dr. Throop continued to recommend proper gender dysphoria treatment for Ms. Hicklin, noting that “neglecting to treat [Ms. Hicklin] with the currently accepted standards of care for gender dysphoria, as per APA and WPATH SOC is detrimental currently to [her] mental/emotional/psychiatric well-being.” Throop. Decl. Ex. B at EM 0134 (emphasis added).
After receiving the diagnosis from Dr. Throop, Ms. Hicklin took steps to live her life in line with her gender identity. She legally changed her name to Jessica Hicklin in July of 2015 and has updated her Social Security card, PCC-issued clothing, and offender identification card. See Complaint at ¶ 3, n 2.
Around mid-December of 2015, Dr. Throop left MDOC for another position. Ms. Hicklin then began treatment with her new psychiatrist, Dr. Evelynn Stephens. See Declaration of Demoya R. Gordon (“Gordon Decl.”) Ex. A at EM 0145-47, 0152; Complaint at ¶¶ 107-08. The
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medical records from her visits with Dr. Stephens and other mental health staff show that Ms. Hicklin continues to experience serious psychological and physical symptoms due to improperly treated gender dysphoria, including panic attacks, anxiety, tachycardia (racing heartbeat), shortness of breath, sleep disturbance, loss of appetite, headaches, and excessive sweating. See, e.g., Gordon Decl. Ex. A at EM 0138-39, 0145-47, 0161, 0822-27, 0832-33; Complaint at ¶ 67. She also still experiences intrusive thoughts of cutting off her testicles. See, e.g., Gordon Decl. Ex. A at EM 0146, 0162, 0822-27; Complaint at ¶ 108.
Ms. Hicklin’s hair, in sharp contrast to the rest of her body hair, is the only physical part of her that does not contribute to her dysphoria. See Gordon Decl. Ex. A at EM 0146; Complaint at ¶ 108. However, she now worries that her continued testosterone exposure will cause permanent male pattern baldness. Id. The thought of losing her hair because of delayed hormone treatment is extremely distressing. Id. Consistent with Dr. Throop, Dr. Stephens also diagnosed Ms. Hicklin with gender dysphoria “with associated panic secondary to current body characteristics” on December 16, 2015. See Gordon Decl. Ex. A at EM 0147; Complaint at ¶ 109.
In agreement with Dr. Throop, Dr. Stephens recommended that Ms. Hicklin be treated with “hair removal device and hormone therapy as these are likely to greatly decrease patient’s current level of discomfort and intrusive thoughts.” See Gordon Decl. Ex. A at EM 0147. Dr. Stephens also recommended that Ms. Hicklin have access to the same self-care products as other female inmates. See id; Complaint at ¶ 109. On or around, January 13, 2016, Dr. Stephens noted in Ms. Hicklin’s records that:
[Ms. Hicklin’s] symptoms are escalating with age given risk of male pattern baldness more likely at this time if hormone therapy not initiated. This should be taken into account when considering the time table for starting treatment. The patient does meet the
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requirements for diagnosis of gender dysphoria and has now been diagnosed by two psychiatrists. See Gordon Decl. Ex. A at EM 0152 (emphasis added). On March 16, 2016, Dr. Stephens again noted that Ms. Hicklin was at risk for “male pattern baldness” and recommended that finasteride or dutasteride be considered to stop hair loss. Id. at EM 0158, 0161; see also Complaint at ¶ 110. Defendants admit that Ms. Hicklin has gender dysphoria. See D.E. 27, Corizon Answer at ¶ 8; D.E. 42, MDOC Answer at ¶ 8. Yet, they continue to withhold treatment as prescribed by the Standards of Care, namely: hormone therapy and access to gender-affirming care, including permanent body hair removal and canteen items such as clothing, hair accessories, and personal hygiene items available to other female prisoners. This denial of medically necessary care continues to cause severe psychological pain and physical discomfort and puts Ms. Hicklin at continued risk of depression, anxiety, mental impairment, self-harm, and suicidal thoughts or acts. See Ettner Decl. at ¶¶ 52-56, 61, 74-75; Throop Decl. Ex. B at EM 0134; Gordon Decl. Ex. A at EM 0822-27, 0832-33 (noting exacerbation of Ms. Hicklin’s gender dysphoria symptoms, including her “overwhelming sense of dread” and worsening intrusive thoughts of engaging in self-harm by removing her testicles).
ARGUMENT Ms. Hicklin’s motion for preliminary injunction meets all four factors considered in the Eighth Circuit: (1) the threat of irreparable harm to the movant; (2) the probability that the movant will succeed on the merits; (3) the balance between the harm to the movant and the injury that granting the injunction will inflict on other litigants; and (4) the public interest. See Kirkeby v. Furness, 52 F.3d 772, 774 (8th Cir. 1995) (citation omitted).
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I. Ms. Hicklin Is Suffering Irreparable Harm That Will Continue In The Absence Of A Preliminary Injunction. To obtain a preliminary injunction, Ms. Hicklin need not demonstrate that irreparable
injury is inevitable, but only that it “is likely in the absence of an injunction.” Winter v. Nat’l Res. Def. Council, 555 U.S. 7, 22 (2008) (emphasis in original). Defendants’ own doctors have documented the serious harms that Ms. Hicklin has suffered and will continue to suffer without medical treatment in accordance with the prevailing Standards of Care. Ms. Hicklin already suffers from depression, anxiety, and intrusive thoughts of self-castration as a result of Defendants’ conduct and it will only worsen with time. See Ettner Decl. at ¶¶ 52-56, 59, 61, 7475; Throop Decl. Ex. B at EM 112; Gordon Decl. Ex. A at EM 0138-39, 0145-47, 0161-62, 0822-27, 0832-33. Indeed, “gender dysphoria intensifies with age” and the longer an individual goes without treatment, the higher their levels of depression, anxiety, and social distress. See Ettner Decl. at ¶¶ 17, 32. Absent an injunction, Defendants’ actions in withholding medically necessary care are likely to result in serious and irreparable physical and psychological harm to Ms. Hicklin, including the possibility of permanent injury or death. Id. at ¶¶ 56, 66-67, 74-75. As Dr. Ettner notes, “Without proper treatment, Jessica Hicklin is at imminent risk for serious psychological harm. She is presently overloaded by symptoms that signal a highly disruptive state. Elevations of autonomic hyperarousal, and dysregulation of mood, left untreated in a severely gender dysphoric individual become chronic aversive experiences that devolve into an ingravescent course.” Id. at ¶ 74.
Denying access to medical treatment, as Defendants have done in this case, creates the threat of an irreparable injury. See Henderson v. Bodine Aluminum, Inc., 70 F.3d 958, 961, 962 (8th Cir. 1995) (“It is hard to imagine a greater harm than losing a chance for potentially lifesaving medical treatment” and “[u]rgent medical treatment is the kind of equitable relief that
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cannot abide trial.”); see also Norsworthy v. Beard, 87 F. Supp. 3d 1164, 1192 (N.D. Cal. 2015) (“Emotional distress, anxiety, depression, and other psychological problems can constitute irreparable injury.”). Defendants’ continuous denial of hormone therapy, gender-affirming canteen items, and permanent body hair removal causes Ms. Hicklin to experience both physical and psychological symptoms, including depression, panic attacks, anxiety, racing heartbeat, shortness of breath, sleep disturbance, loss of appetite, headaches, and excessive sweating. See Ettner Decl. ¶ 54; Complaint at ¶ 67; Gordon Decl. Ex. A at EM 0138-39, 0145-47, 0161, 082227, 0832-33.
Ms. Hicklin has tried her best to express her gender identity without relying on Defendants for proper treatment. She styles her hair in a traditionally female manner, but she is worried that if she does not begin treatment soon she will experience male pattern baldness, the thought of which causes her further distress. Complaint at ¶ 108; see also Ettner Decl. at ¶ 31. Ms. Hicklin has tried to remove her other body hair with MDOC-issued razors, which has led to cuts, scarring, rashes, and other skin problems. See Gordon Decl. Ex. A at EM 0822, 825; see also Complaint at ¶ 90. Defendants’ withholding of medically necessary gender dysphoria care has also caused Ms. Hicklin to experience thoughts of removing her testicles and she has attempted on one occasion to amputate them with a tourniquet. See Ettner Decl. at ¶¶ 46, 59; Gordon Decl. Ex. A at 0146, 0162, 0822-27.
In addition to the emotional and physical harm Ms. Hicklin experiences as a result of being denied gender dysphoria treatment, the deprivation of her Eighth Amendment right to medically necessary care independently establishes an irreparable harm. See generally Elrod v. Burns, 427 U.S. 347, 373 (1976) (loss of a constitutional right “for even minimal periods of time, unquestionably constitutes irreparable injury”); Roe v. Crawford, 396 F. Supp. 2d 1041, 1044
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(W.D. Mo. 2005) (finding irreparable injury because “further delay by Defendants may cause Plaintiff substantial injury, exposing her to increased medical, financial, and psychological risks”). Defendants’ deliberate indifference in denying medically necessary treatment continuously violates Ms. Hicklin’s Eighth Amendment rights, and as such, she has demonstrated the threat of irreparable harm. II. Ms. Hicklin Is Substantially Likely To Succeed On The Merits.
“A prison that deprives prisoners of basic sustenance, including adequate medical care, is incompatible with the concept of human dignity and has no place in civilized society.” Brown v. Plata, 563 U.S. 493, 511 (2011). Corrections officials inflict cruel and unusual treatment on an incarcerated individual, in violation of the Eighth Amendment, when they are deliberately indifferent to their serious medical needs. See Estelle v. Gamble, 429 U.S. 97, 104 (1976). “[D]eliberate indifference to serious medical needs of prisoners violates the [Eighth] Amendment because it constitutes the unnecessary and wanton infliction of pain contrary to contemporary standards of decency.” Helling v. McKinney, 509 U.S. 25, 32 (1993) (citing Estelle, 429 U.S. at 104 (internal quotation marks omitted)). To establish an Eighth Amendment violation, an incarcerated individual must show that “she had an objectively serious medical need and that the defendant knew of and disregarded that need.” Coleman v. Rahija, 114 F.3d 778, 784 (8th Cir. 1997) (citations omitted); see also Nelson v. Corr. Med. Servs., 583 F.3d 522, 529 (8th Cir. 2009). Ms. Hicklin suffers from an objectively serious medical condition that Defendants, acting with deliberate indifference, have failed to treat in violation of the Eighth Amendment.
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Case: 4:16-cv-01357-NCC Doc. #: 64 Filed: 04/04/17 Page: 14 of 21 PageID #: 440
A. Ms. Hicklin’s Gender Dysphoria and Risk of Self-Harm Are Objectively Serious Medical Needs.
To meet the objective requirement of the deliberate indifference standard, an incarcerated individual must demonstrate the existence of a serious medical need, Estelle, 429 U.S. at 104, or demonstrate a substantial risk of future serious harm resulting from the action or inaction of prison officials, Helling, 509 U.S. at 35. Here, Ms. Hicklin has established both a serious medical need—serious psychological and physical symptoms of distress from untreated gender dysphoria—and a substantial risk of future serious harm—continued anguish, auto-castration, and possibly suicide—if her medically necessary treatment continues to be withheld.
Courts, including the Eighth Circuit, have routinely held that gender dysphoria (previously referred to as gender identity disorder or transsexualism) is a serious medical need. See White v. Farrier, 849 F.2d 322, 325 (8th Cir. 1988) (“We therefore conclude that transsexualism is a serious medical need.”); see also Battista v. Clarke, 645 F.3d 449 (1st Cir. 2011) (upholding district court decision recognizing gender identity disorder as a serious medical need); Fields v. Smith, 712 F. Supp. 2d 830, 862 (E.D. Wis. 2010) (gender identity disorder is a serious medical need for purposes of the Eighth Amendment), aff’d, 653 F.3d 550 (7th Cir. 2011); Phillips v. Mich. Dep't of Corr., 731 F. Supp. 792, 800 (W.D. Mich. 1990), aff’d, 932 F.2d 969 (6th Cir. 1991) (same). There is no question that Ms. Hicklin has persistent and welldocumented gender dysphoria that requires treatment, and therefore, meets the requirement that her medical need is objectively serious. See, e.g., Ettner Decl. at ¶¶ 52-56, 61, 66-67, 74-75; Throop Decl. Ex. B at EM 0111-12, 0114, 0134; Gordon Decl. Ex. A at EM 0138-39, 0145-47, 0161-62, 0822-27, 0832-33.
In addition, if access to hormone therapy, permanent body hair removal, and genderaffirming canteen items continues to be withheld, Ms. Hicklin is at very high risk of resorting to
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self-harm. See Ettner Decl. at ¶¶ 56, 66-67, 74-75; Gordon Decl. Ex. A at EM 0822-27. In De’lonta v. Angelone (De’lonta I), 330 F.3d 630, 634 (4th Cir. 2003), the Fourth Circuit held that an incarcerated individual with diagnosed gender dysphoria’s “need for protection against continued self-mutilation constitutes a serious medical need to which prison officials may not be deliberately indifferent.” See also Lee v. Downs, 641 F.2d 1117, 1121 (4th Cir. 1981) (“[P]rison officials have a duty to protect prisoners from self-destruction or self-injury.”); Soneeya v. Spencer, 851 F. Supp. 2d 228, 244-52 (D. Mass. 2012) (incarcerated individual with gender identity disorder and history of suicide attempts and self-mutilation has serious medical condition for which surgery must be considered); see generally George R. Brown, Autocastration and Autopenectomy as Surgical Self-Treatment in Incarcerated Persons with Gender Identity Disorder, 12 Int’l J. of Transgenderism 31 (2010). The law is clear that “a remedy for unsafe conditions need not await a tragic event.” Helling, 509 U.S. at 33; see also Roe v. Elyea, 631 F.3d 843, 858 (7th Cir. 2011) (“the Eighth Amendment ‘protects [an inmate] not only from deliberate indifference to his or her current serious health problems, but also from deliberate indifference to conditions posing an unreasonable risk of serious damage to future health”) (citation omitted) (emphases in original).
B. Defendants Have Acted With Deliberate Indifference to Ms. Hicklin’s Serious Medical Needs.
The deliberate indifference prong is subjective and “entails something more than mere negligence . . . [but] is satisfied by something less than acts or omissions for the very purpose of causing harm or with knowledge that harm will result.” Farmer v. Brennan, 511 U.S. 825, 835 (1994). If Defendants knew that the risk existed and either intentionally or recklessly ignored it, and will continue to do so in the future, then the subjective test has been met. Id. at 837-47. This indifference is impermissible “whether . . . manifested by prison doctors in their response to the
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prisoner’s needs or by prison guards in intentionally denying or delaying access to medical care or intentionally interfering with the treatment once prescribed.” Estelle, 429 U.S. at 104-05. Here, Defendants are aware of and do not contest Ms. Hicklin’s gender dysphoria diagnosis and they have direct knowledge of her escalating distress, anxiety, and thoughts of self-harm as a result of their failure to provide her care. Despite all of this, Defendants have continued to deny treatment that is medically necessary for Ms. Hicklin in accordance with the prevailing Standards of Care, even as their own mental health professionals have repeatedly warned them of the serious risks posed to Ms. Hicklin by this continued denial.
This Court should reject any contentions by Defendants that psychotherapy or antianxiety medications prescribed to Ms. Hicklin are sufficient to treat her gender dysphoria. The relevant inquiry is not whether any care has been provided but whether “constitutionally adequate” care has been provided. See Estelle, 429 U.S. at 103-06 (prison officials may not adopt an “easier and less efficacious treatment” that does not adequately address an incarcerated individual’s serious medical needs). It is well established that, while incarcerated individuals may not be entitled to any particular treatment of their choosing, prison officials may not avoid liability “simply by providing some measure of treatment.” Jones v. Muskegon Ctny., 625 F.3d 935, 944 (6th Cir. 2010); see also Langford v. Norris, 614 F.3d 445, 460 (8th Cir. 2010) (“a total deprivation of care is not a necessary condition for finding a constitutional violation”).
There is no gender dysphoria exception to these well-established principles. Courts have repeatedly held that limiting treatment for gender dysphoria to psychotherapy where hormone therapy is medically indicated violates the Eighth Amendment. See, e.g., Kothmann v. Rosario, 558 F. App’x 907, 910 (11th Cir. 2014) (denying qualified immunity to prison official who denied transgender prisoner hormone therapy while providing “anti-anxiety and anti-depression
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medications, mental health counseling, and psychotherapy treatments”); Fields, 653 F.3d at 556 (“Although DOC can provide psychotherapy as well as antipsychotics and antidepressants, defendants failed to present evidence rebutting the testimony that these treatments do nothing to treat the underlying [gender dysphoria].”); Soneeya, 851 F. Supp. 2d at 246-50 (blanket ban on laser hair removal and surgery was deliberately indifferent even though transgender plaintiff was receiving some treatment, including psychotherapy and hormones). In De’lonta v. Johnson (De’lonta II), 708 F.3d 520, 526 (4th Cir. 2013), the court held that “just because Appellees have provided De’lonta with some treatment consistent with the GID Standards of Care, it does not follow that they have necessarily provided her with constitutionally adequate treatment” (emphasis in original).
The same is true here, where Defendants have taken “a gross departure from the evidence-based Standards of Care” by treating Ms. Hicklin’s gender dysphoria solely with psychotherapy and psychotropic drugs. See Ettner Decl. at ¶ 73; see also id. at ¶¶ 35-37. Thus, Defendants have denied Ms. Hicklin constitutionally adequate treatment by withholding the medical care that she needs, despite having knowledge of the risk of harm caused by withholding such treatment. As a result, Ms. Hicklin is likely to succeed on the merits of her claim under the Eighth Amendment. III. The Balance of Harms Strongly Favors Ms. Hicklin.
The balance of harms substantially weighs in favor of granting injunctive relief. Defendants’ refusal to provide Ms. Hicklin with medically necessary care has placed her mental and physical health in extreme peril. In contrast, Defendants will not suffer any harm—much less irreparable harm—from providing medically necessary care to Ms. Hicklin consistent with their constitutional obligations. See, e.g., Gammett v. Idaho State Bd. of Corr., No. CV05-257-S-
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MHW, 2007 WL 2186896, at *15-16 (D. Idaho July 27, 2007) (finding balance of harms “sharply” favored plaintiff, who would experience suicidality and mental harm without gender dysphoria treatment).
Any allegations of harm to the Defendants are undermined by Defendants’ own admission that they are already providing at least hormone therapy to other transgender individuals incarcerated in MDOC facilities. See D.E. 27, Corizon Answer at ¶ 6; D.E. 42, MDOC Answer at ¶ 6. Accordingly, the balance of harms weighs in favor of Ms. Hicklin. IV. An Injunction Is In The Public Interest.
The public interest also favors injunctive relief because Ms. Hicklin seeks to vindicate her right to medically adequate treatment under the Eighth Amendment. See Phelps-Roper v. Nixon, 545 F.3d 685, 690 (8th Cir. 2008) (“[I]t is always in the public interest to protect constitutional rights.”), overturned on other grounds by Phelps-Roper v. City of Manchester, Mo., 697 F.3d 678 (2012) (en banc); accord Phillips, 731 F. Supp. at 801 (finding “the public interest will be served by safeguarding Eighth Amendment rights” of prisoners with gender dysphoria).
In addition to ensuring her own constitutionally protected rights, Ms. Hicklin’s motion should also be granted because the public interest is served by enjoining enforcement of Defendants’ policies, customs, or practices that hamper the provision of constitutionally adequate care to all inmates diagnosed with gender dysphoria. Thus, an injunction at this time will broadly serve to protect the rights of incarcerated transgender individuals throughout the State of Missouri.
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CONCLUSION For the foregoing reasons, Ms. Hicklin respectfully requests that this Court issue a preliminary injunction: (1) directing Defendants to provide Ms. Hicklin with medically necessary treatment for gender dysphoria, including but not limited to providing her hormone therapy, access to permanent body hair removal, and access to gender-affirming canteen items, and (2) enjoining Defendants from enforcing the policies, customs, or practices that have served as a moving force behind their constitutional violations by denying inmates with gender dysphoria individualized medically necessary treatment and care, contrary to widely accepted standards of care and the recommendations of Ms. Hicklin’s treating mental health professionals. The Court should require no bond or at most a nominal bond under Fed. R. Civ. P. 65(c). It is within the Court’s discretion to waive bond based on the enforcement of constitutional rights, which is always in the public interest. See Richland/Wilkin Joint Powers Auth. v. U.S. Army Corps of Eng’rs, 826 F.3d. 1030, 1043 (8th Cir. 2016); Phelps-Roper, 545 F.3d at 690. Additionally, Ms. Hicklin is unable to pay a bond under her current circumstances, which should not be a bar to the relief requested. See Johnson v. Bd. of Police Comm’rs, 351 F. Supp. 2d 929, 952 (E.D. Mo. 2004)(“[A] district court has discretion to grant injunctive relief without requiring bond or other security, especially when doing so would function to bar poor people from obtaining judicial redress.”). Ms. Hicklin respectfully requests oral argument on this Motion, which will assist the Court in resolving the issues presented.
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Date: April 4, 2017.
Demoya Gordon* Richard Saenz* LAMBDA LEGAL DEFENSE AND EDUCATION FUND, INC. 120 Wall Street, 19th Floor New York, NY 10005-3919 Phone: (212) 809-8585 Fax: (212) 809-0055 dgordon@lambdalegal.org rsaenz@lambdalegal.org
*Admitted pro hac vice

Respectfully submitted,
/s/ Kevin L. Schriener Kevin L. Schriener Law & Schriener, LLC 141 N. Meramac Avenue, Suite 314 St. Louis, MO 63105 Phone: (314) 721-7095 Fax: (314) 863-7096 kschriener@schrienerlaw.com
Kyle A. Palazzolo* LAMBDA LEGAL DEFENSE AND EDUCATION FUND, INC. 105 W. Adams, Suite 2600 Chicago, IL 60603 Phone: (312) 663-4413 Fax: (312) 663-4307 kpalazzolo@lambdalegal.org

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Case: 4:16-cv-01357-NCC Doc. #: 64 Filed: 04/04/17 Page: 21 of 21 PageID #: 447
CERTIFICATE OF SERVICE
IT IS HEREBY CERTIFIED that service of the foregoing Memorandum in Support of Plaintiff’s Motion for Preliminary Injunction was made on April 4, 2017 via the Court’s CM/ECF system to:
Henry F. Luepke, #38782MO Assistant Attorney General Missouri Attorney General’s Office P.O. Box 861 St. Louis, MO 63188 Tel: 314-340-7652 bud.luepke@ago.mo.gov Attorney for Defendants George Lombardi, Dwayne Kempker, Ian Wallace, Cindy Griffith, Stan Payne, Scott O’Kelly, and Deloise Williams J. Thaddeus Eckenrode, MoBar #31080 Kevin K. Peek, MoBar # 67440 Eckenrode-Maupin 11477 Olde Cabin Rd Suite 110 St. Louis, MO 63141 Tel: 314-726-6670 Fax: 314-726-2106 jte@eckenrode-law.com kkp@eckenrode-law.com Attorneys for Defendants Corizon LLC, William McKinney, Glen Babich, T.K. Bredeman, Diana Larkin, Kimberley S. Randolph, Dawn Wade, Stormi Moeller, Shirley Eyman, Elizabeth Atterberry, and Kim Foster
__s/Kevin L. Schriener
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UNITED STATES DISTRICT COURT EASTERN DISTRICT OF MISSOURI
EASTERN DIVISION

)

JESSICA HICKLIN,

)

)

Plaintiff,

)

)

v.

)

)

ANNE PRECYNTHE1,

)

IAN WALLACE,

)

CINDY GRIFFITH, STAN PAYNE,

)

SCOTT O'KELLY, DELOISE WILLIAMS, )

CORIZON HEALTH, INC.,

)

WILLIAM MCKINNEY, GLEN BABICH, )

T.K. BREDEMAN, DIANA LARKIN,

)

KIMBERLEY S. RANDOLPH,

)

DAWN WADE, STORMI MOELLER,

)

SHIRLEY EYMAN,

)

ELIZABETH ATTERBERRY, and

)

KIM FOSTER,

)

)

Defendants.

)

Case No. 4:16-cv-01357-NCC

MEMORANDUM AND ORDER This matter is before the Court on Plaintiff Jessica Hicklin’s Motion for Preliminary Injunction (Doc. 63). The Motion is fully briefed and ready for disposition. The parties have consented to the jurisdiction of the undersigned United States Magistrate Judge pursuant to 28 U.S.C. § 636(c) (Doc. 57). For the following reasons, Plaintiff’s Motion will be GRANTED, in part and DENIED, in part.

1 Anne Precynthe is the current Missouri Department of Corrections (MDOC) Director and is therefore substituted for the former director of the MDOC George Lombardi. Fed. R. Civ. P. 25(d).

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I. FACTS AND BACKGROUND2 On August 22, 2016, Plaintiff Jessica Hicklin (“Ms. Hicklin”)3 filed this action for injunctive and declaratory relief pursuant to 42 U.S.C. § 1983 against Defendant Corizon, LLC4 (“Corizon”), the Individual Corizon Defendants,5,6 and the MDOC Defendants7 (collectively “Defendants”) for their alleged deliberate indifference to Ms. Hicklin’s serious medical needs (Doc. 19). Ms. Hicklin specifically alleges that despite knowing that she has gender dysphoria, a serious medical condition, Defendants have refused to provide Ms. Hicklin with medically necessary care including hormone therapy, permanent hair removal, and access to “genderaffirming” canteen items (Id. at 2-3). Ms. Hicklin asserts that Defendants refuse to provide her with this hormone therapy, citing a policy or custom of providing hormone therapy only to those transgender inmates who were receiving it prior to incarceration (the so-called “freeze-frame” policy) (Id.).
2 Facts and conclusions determined by a court in granting or denying a preliminary injunction are provisional and nonbinding. See Henderson v. Bodine Aluminum, Inc., 70 F.3d 958, 962 (8th Cir. 1995).
3 In July 2015, Ms. Hicklin changed her name and has since updated her social security card and offender identification card as well as her prison-issued clothing. The parties have agreed to use female pronouns when addressing Plaintiff Jessica Hicklin.
4 Defendant is improperly named as Corizon Health, Inc. 5 Defendants William McKinney, Glen Babich, T.K. Bredeman, Diana Larkin, Kimberley S. Randolph, Dawn Wade, Stormi Moeller, Shirley Eyman, Elizabeth Atterberry, and Kim Foster. 6 Corizon and the Individual Corizon Defendants will be collectively referred to as the “Corizon Defendants.” 7 Defendants George Lombardi, Dwayne Kempker, Ian Wallace, Cindy Griffith, Stan Payne, Scott O'Kelly, and Deloise Williams.
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On April 4, 2017, Ms. Hicklin filed a Motion for Preliminary Injunction (Doc. 63) requesting a preliminary injunction order that (1) directs Defendants to provide Ms. Hicklin with care that her doctors deem to be medically necessary treatment for gender dysphoria, including but not limited to providing her hormone therapy, access to permanent body hair removal, and access to “gender-affirming” canteen items; and (2) enjoins Defendants from enforcing the unconstitutional policies, customs, or practices that deny inmates with gender dysphoria individualized medically necessary treatment and care, which are contrary to widely accepted standards of care and the recommendations of Ms. Hicklin’s treating mental health professionals (Doc. 64 at 5). As to gender-affirming canteen items, Ms. Hicklin seeks to have access to, and purchase herself, the same items available to women in the MDOC (Doc. 83 at 9).
The Court held a hearing on the Motion on May 23, 2017 during which the Parties presented oral argument (Doc. 75). The Court subsequently granted Plaintiff leave to supplement the record no later than June 28, 2017 (Doc. 85). Plaintiff filed two Motions to Supplement the Preliminary Injunction Record (Docs. 88, 98). In the first of these Motions, filed on June 28, 2017, Plaintiff seeks leave to supplement the record with two letters written by Ms. Hicklin to her treating psychiatrist (Doc. 88-2). While the Court will allow Plaintiff to supplement the preliminary injunction record with these two letters, it will take into consideration the Corizon Defendants’ arguments in their opposition to the Motion to Supplement (Doc. 89). The Second Motion to Supplement the Preliminary Injunction Record (Doc. 98), however, is untimely and will be denied. Accordingly, the facts before the Court are as follows.
Ms. Hicklin is a thirty-eight year old pre-operative transgender woman in the custody of the Missouri Department of Corrections (“MDOC”) and housed at Potosi Correctional Center (“PCC”), a facility for male inmates, in Mineral Point, Missouri (Doc. 19 at 5). Ms. Hicklin has
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been in the custody of the Missouri Department of Corrections (“MDOC”) since the age of 16,
serving a sentence of life without the possibility of parole and 100 years, to be served
concurrently (See Doc. 16 at ¶64; Doc. 64-1 at 12; Doc. 68-1 at 3). Ms. Hicklin suffers from
gender dysphoria (also known as gender identity disorder or transsexualism), a medical condition
caused by the incongruence between a person’s gender identify and the sex they were assigned at
birth (Doc. 64-1 at 3).
Gender Dysphoria Background
Gender dysphoria is listed in the American Psychiatric Association’s Diagnostic and
Statistical Manual of Mental Disorders, Fifth Edition (“DSM-V”) (Doc. 64-1 at 3). The
diagnostic criteria for gender dysphoria in adolescents and adults are as follows:
A. A marked incongruence between one’s experienced/expressed gender and assigned gender, of at least six months’ duration, as manifested by at least two of the following:
1. A marked incongruence between one’s experienced/expressed gender and primary and/or secondary sex characteristics (or in young adolescents, the anticipated secondary sex characteristics).
2. A strong desire to be rid of one’s primary and/or secondary sex characteristics because of a marked incongruence with one's experienced/expressed gender (or in young adolescents, a desire to prevent the development of the anticipated sex characteristics).
3. A strong desire for the primary and/or secondary sex characteristics of the other gender.
4. A strong desire to be of the other gender (or some alternative gender different from one’s assigned gender).
5. A strong desire to be treated as the other gender (or some alternative gender different from one’s assigned gender).
6. A strong conviction that one has the typical feelings and reactions of the other gender (or some alternative gender different from one’s assigned gender).
B. The condition is associated with clinically significant distress or impairment in social, occupational or other important areas of functioning.
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(Id. at 3-4 (citing DSM-V)). According to the Declaration of Dr. Randi C. Ettner (“Dr. Ettner”), a clinical and forensic psychologist retained by Ms. Hicklin as an expert, individuals with untreated gender dysphoria experience clinically significant depression, anxiety, and mental impairment, and, when left untreated, additional serious medical problems including suicidality and the compulsion to engage in self-castration and self-harm (Doc. 64-1 at 4-5).8 Ms. Hicklin asserts that she should be provided treatment consistent with the World Professional Association for Transgender Health’s (“WPATH”) Standards of Care for the Health of Transsexual, Transgender, and Gender-Nonconforming People (the “Standards of Care”) (Doc. 19 at 2-4). Dr. Ettner notes that these Standards of Care are “the internationally recognized guidelines for the treatment of persons with gender dysphoria” and have been endorsed by numerous professional medical organizations including the American Medical Association, the American Psychological Association, the American Psychiatric Association, the World Health Organization, and the National Commission of Correctional Health Care (Doc. 64-1 at 5, 8). The Standards of Care explicitly state that they are equally applicable to patients in prison (Id. at 7). The Standards of Care The following provisions of the Standards of Care are pertinent to this case. Once a diagnosis of gender dysphoria is established, individualized treatment should be initiated (Id. at 6). Such treatment may include (1) living in the gender role that is consistent with one’s gender identity, (2) hormone therapy to feminize or masculinize the body, (3) surgery to change primary and/or secondary sex characteristics and/or (4) psychotherapy (Id.). Changes in gender expression including clothing and grooming that affirm one’s gender identity as well as permanent body hair removal are significant in alleviating gender dysphoria (Id. at 8). “For
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individuals with persistent, well-documented gender dysphoria, hormone therapy is an effective, essential, medically indicated treatment to alleviate the distress of the condition” (Id.). Dr. Ettner indicates that the therapeutic effects of hormone therapy are twofold: (1) the patient acquires congruent secondary sex characteristics (i.e., breast development, retribution of body fat, cessation of male pattern baldness, and reduction of body hair) and (2) the hormones act directly on the brain lessening the gender dysphoria and associated psychiatric symptoms (Id. at 9). In regards to psychotherapy:
Merely providing counseling and/or psychotropic medication to a severely gender dysphoric patient is a gross departure from medically accepted practice. Inadequate treatment of this disorder puts an individual at serious risk of psychological and physical harm. (Id. at 11 (quoting WPATH Medical Necessity Statement, 2016)). As Dr. Ettner explains, Psychotherapy can provide support for the many issues that arise in tandem with gender dysphoria. However, psychotherapy alone is not a substitute for medical intervention when medical intervention is required, nor is it a precondition for medically indicated treatment. By analogy, counseling can be useful for patients with diabetes by providing psychoeducation about living with chronic illness and nutritional information, but counseling doesn't obviate the need for insulin. (Id. at 10). The Medical Record Pursuant to PCC policy, on March 4, 2015, Ms. Hicklin requested an initial evaluation for gender dysphoria (Doc. 19 at ¶70). As a result, Dr. Meredith Throop (“Dr. Throop”), a psychiatrist, evaluated Ms. Hicklin on March 23, 2015 (Doc. 64-4 at 2-4). Based on this assessment, Dr. Throop determined that Ms. Hicklin met the diagnostic criteria for gender dysphoria outlined in the DSM-V (Id. at 4). Dr. Throop referred Ms. Hicklin to an endocrinologist “for evaluation of cross-sex hormone [treatment]. Currently, hormone therapy
8 The Defendants did not object to Dr. Ettner’s declaration. 6

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(estrogen, testosterone blockers) is the accepted treatment for individuals with [a] Gender Dysphoria diagnoses” (Id.). In an addendum to Dr. Throop’s notes from the evaluation, Dr. Throop notes, “after researching DOC protocols, it was found that endocrinology consult is NOT the appropriate next step for psychiatry in the [treatment] of Gender Dysphoria. Endocrinology consult was not requested” (Id.). Ms. Hicklin was thereafter referred to the Chronic Care Clinic for mental health symptoms, PTSD and anxiety, related to her diagnosis of gender dysphoria and she continued to see Dr. Throop (Doc. 64-4 at 4-6). During her treatment with Dr. Throop, Ms. Hicklin reported that she “continues to experience much discomfort and anxiety surrounding [her] assigned gender [(male).]” (Id. at 7). Ms. Hicklin also reported “occasional feelings of hopelessness” and “distress pertaining to male attributes (body hair, lack of gender affirming canteen items, male attire)” (Id. at 10). Dr. Throop continued to recommend hormone therapy, noting, “It is the opinion of this provider that neglecting to treat this [patient] with the currently accepted standards of care for gender dysphoria as per the APA and WPATH [Standards of Care] is detrimental to [her] mental/emotional/psychiatric well-being” (Id. at 9, 11). Dr. Throop left MDOC for another position in December 2015 (Doc. 64-3 at 2). Dr. Throop indicates, in a declaration provided by Ms. Hicklin, that “[i]f called to testify in this matter, I would do so consistent with my notes and evaluation of Ms. Hicklin, including testimony to confirm her diagnosis of gender dysphoria, and my recommended course of treatment in accordance with the medically accepted Standards of Care” (Doc. 64-2 at 1).
During the same time period, on June 19, 2015, Ms. Hicklin was evaluated for a TRIA hair removal device9 she requested or formal electrolysis (Doc. 64-6 at 31). Defendant Associate
9 A laser hair-removal device for personal use at home. See Tria Beauty, Inc. v. Nat'l Fire Ins. Co. of Hartford, No. C 12-05465 WHA, 2013 WL 2181649, at *1 (N.D. Cal. May 20, 2013).
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Regional Medical Director Dr. Glen Babich determined that neither treatment option was medically necessary (Id. at 32; Doc. 68-4; Doc. 68-5; Doc. 68-7).
Ms. Hicklin continued her treatment with a new psychiatrist, Dr. Evelynn Stephens (“Dr. Stephens”) (Doc. 64-6 at 4). Dr. Stephens diagnosed Ms. Hicklin with “gender dysphoria with associated panic secondary to current body characteristics” on December 16, 2015 (Id. at 6). Dr. Stephens prescribed medication for panic and body anxiety symptoms (Id.). Dr. Stephens also recommended that Ms. Hicklin be treated with “hair removal device and hormone therapy as these are likely to greatly decrease patient’s current level of discomfort and intrusive thoughts” (Id.). After this initial evaluation, Dr. Stephens met with the gender dysphoria committee on January 13, 2016 to discuss next steps (Id.). Dr. Stephens noted that her “overall suggestion is to utilize the standard of care discussed by the 2012 APA task force on treatment of gender identity disorder (now gender dysphoria)” and specifies “the patient initially requires psychotherapy during a period that patient is presenting as desired gender, then I would suggest referral to medicine to initiate hormone therapy” (Id.). Dr. Stephens added:
[Ms. Hicklin’s] symptoms are escalating with age given risk of male pattern baldness more likely at this time if hormone therapy not initiated. This should be taken into account when considering the time table for starting treatment. The patient does meet the requirements for diagnosis of gender dysphoria and has now been diagnosed by two psychiatrists. (Id. at 10). During this time, Ms. Hicklin discontinued anxiety medication shortly after its prescription (Id. at 14). At her next visit with Dr. Stephens on or about February 3, 2016, Dr. Stephens recommended “psychotherapy ongoing, 3-6 months living as a female with access to products that females in DOC have access to for self care [sic], then referral to medicine for hormone therapy. Suggest weekly psychotherapy if possible given the severity of illness” (Id. at 15). However, on March 14, 2016, Dr. Stephens suggests the use of medication to prevent hair
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loss as “this could be used while pending decision on DOC policy of use of hormone treatment of gender dysphoria diagnosed while incarcerated. Defer to medical” (Id. at 17). Then again, Dr. Stephens in a plan note dated April 22, 2016, states:
Per discussion from Gender Dysphoria council at PCC, still pending decision from recent request on policy surrounding treatment of gender dysphoria with hormonal treatment if diagnosed in prison. Suggest consideration of addition of hormone treatment as patient showing improved sense of self during therapy sessions and addition of this treatment likely to aid in partial decrease of anxiety symptoms. Defer final decision to medical and pending decision as noted above. Gender dysphoria committee continues to follow. (Id. at 21). On June 6, 2016, while Dr. Stephens notes that she will defer the final decision regarding whether Ms. Hicklin can begin hormone therapy to the medical team, she states, “[f]ormal request for hormone therapy consideration was submitted again today as the patient has successfully lived as a female with ongoing therapy for over 6 months” (Id. at 24). See also id. at 35 (formal referral to medical to consider hormone replacement, noting “[t]his is the next step in accordance with APA guidelines”). On September 20, 2016, Dr. Stephens notes, “[g]iven this increased agitation, self harm [sic] thoughts and reported active symptoms of male pattern baldness will refer to gender dysphoria committee to consider dermatology referral and treatment for hair loss (head) and removal (body) as at this time symptoms [constitute] medical necessity” (Id. at 35). On August 31, 2016, Ms. Hicklin’s case was discussed during a conference call of the Gender Dysphoria Clinical Supervision Group (“GDCSG”) members (Doc. 64-6 at 28). During the call, the members concurred with Dr. Stephens’ diagnosis of gender dysphoria, and “[a] referral to the Gender Dysphoria Committee was agreed upon” and “[a]ppropriate hormone therapy was agreed upon” (Id.). While it is unclear to the Court which group determined a referral to the Gender Dysphoria Committee was warranted, in a note dated September 20, 2016,
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Dr. Stephens indicates, “[r]eferral for hormone therapy treatment placed previously, gender dysphoria committee in Jefferson City in agreement with referral - - Defer further steps to medical” (Id. at 34).
On September 29, 2016, Dr. Stephens added an addendum to these notes indicating that she has received a letter from Ms. Hicklin regarding Ms. Hicklin’s hair removal difficulties (Id. at 34). Dr. Stephens notes that Ms. Hicklin’s agitation is at “higher levels than previously reported” as Ms. Hicklin describes an “‘overwhelming feeling of dread,” in the context of thinning hair on head” and “increasing intrusive self harm [sic] thoughts to remove own testicles in order to remove offensive testosterone” (Id. at 34-35). While Dr. Stephens references just one letter, the record reflects that Dr. Stephens received two letters from Ms. Hicklin and Dr. Stephen’s notes clearly refer to both letters. See Doc. 88-2 (the referenced letters sent to Dr. Stephens from Ms. Hicklin). Upon receiving these letters, Dr. Stephens set a follow-up visit within a week of her prior visit with Ms. Hicklin (Doc. 64-6 at 35). In her notes, Dr. Stephens indicates that Ms. Hicklin suffered from “some increased dysphoria symptoms with body/facial hair growth . . . and increase in intrusive thoughts to remove testicles with fear of active male pattern baldness symptoms” (Id. at 36).
On November 10, 2016, Dr. Stephens again notes that she plans to “[c]ontinue to follow [up] with gender dysphoria committee which has already suggested hormone treatment” (Doc. 68-8 at 9). On January 25, 2017, the GDCSG again convened to discuss Ms. Hicklin’s case (Doc. 68-8 at 16). The group determined that Ms. Hicklin’s diagnosis was confirmed and approved her treatment plan (Id.). The treatment plan appears to address Ms. Hicklin’s “gender integration” and does not include any reference to hormone therapy, “gender affirming” canteen items, or hair removal (See id. at 17-18).
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During her treatment with Dr. Stephens, Ms. Hicklin reported “panic symptoms” with “active body anxiety, tachycardia,[10] sob, diaphoresis[11]noted almost daily” (Doc. 64-6 at 5). Notably, Ms. Hicklin frequently discussed, and Dr. Stephens noted, Ms. Hicklin’s anxiety as it relates to her gender dysphoria. See also id. at 14 (“Body anxiety and obsessive body hair removal directly related to gender dysphoria.”); id. at 34 (“increased body anxiety noted”); id. at 36 (“notable body anxiety”); Doc. 68-8 at 12 (“Anxiety related to gender issues and personal necessities are on going [sic] issues for [her]. Offender reports anxiety is higher than usual this month.”). Ms. Hicklin also described “disgust surrounding [her] testicles for multiple reasons [including. . .] the fact that they produce testosterone which is causing [her] body to not look like [her] own” (Doc. 64-6 at 23). Indeed, Dr. Stephens diagnosed Ms. Hicklin with Anxiety NOS12 occasionally as “acute exacerbation secondary to hair removal difficulty” (see Doc. 68-8 at 5) and otherwise listed as “Anxiety NOS (2/2 gender dysphoria vs co-occurring personality disorder with chronic fixed false beliefs-likely combination with improving insight)” (see Doc. 68-8 at 12). Ms. Hicklin also reported experiencing intrusive thoughts of cutting off her testicles (Doc. 64-6 at 5, 18, 35) and counsel stated on the record that Ms. Hicklin has attempted to remove her testicles and has a past history of suicidal attempts (Doc. 83 at 6). See also Doc. 64-1 at 12-13 (“Ms. Hicklin avoids contact with her genitals, and, typical of incarcerated gender dysphoric individuals without access to care, she has thoughts of removing them. On one occasion, Ms. Hicklin tried to amputate her testicles with a tourniquet, but was stopped by the awareness of the consequences . . . and a lack of necessary tissue for future surgical treatment.”).
10 Tachycardia is defined as “rabid beating of the heart, conventionally applied to rates over 90 beats per minute.” Stedman’s Medical Dictionary 895100 (2014).
11 Diaphoresis is a synonym for perspiration. Stedman’s Medical Dictionary 244680 (2014).
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As of today’s date, Ms. Hicklin is not receiving hormone therapy and does not have access to “gender-affirming” canteen items or the means for permanent hair removal. The MDOC Defendants indicate that medical staff continues to provide Plaintiff with psychiatric care and counseling (Id. at 26; Doc. 83 at 18).
Expert Testimony—Dr. Ettner’s Evaluation of Ms. Hicklin On January 27, 2017, Plaintiff’s expert, Dr. Ettner, met with and evaluated Ms. Hicklin. Dr. Ettner diagnosed Ms. Hicklin with “intractable, untreated gender dysphoria” (Doc. 64-1 at 15). Upon review of Ms. Hicklin’s medical records, Dr. Ettner found that: [The] lack of appropriate treatment for gender dysphoria is causing Ms. Hicklin to experience serious psychological and physical symptoms including panic attacks, anxiety, racing heartbeat (tachycardia), shortness of breath, sleep disturbance, lack of appetite, headaches, and excessive sweating. She also experiences intrusive thoughts of cutting off her testicles, and has attempted to amputate them with a tourniquet[.] (Doc. 64-1 at 16). Dr. Ettner further indicated that, “Ms. Hicklin has a history of suicide ideation and two suicide attempts” (Id. at 12). At the evaluation conducted by Dr. Ettner, Dr. Ettner administered four standardized psychometric indices and, from their outcomes, concluded that “Ms. Hicklin experiences moderately severe depressive symptoms. These include changes in appetite and sleep irritability, loss of energy, suicidal thoughts, fatigue, and agitation” (Doc. 64-1 at 14). Dr. Ettner recommended the immediate initiation of feminizing hormone therapy (Doc. 64-1 at 20). She further stated that, “[i]ntegral to successful treatment of gender dysphoria is the ability to present as a female” and,”[t]herefore, Ms. Hicklin should also be allowed access to items and clothing available to female inmates, and effective, permanent means of body hair removal” (Doc. 64-1 at 20).
12 NOS stands for not otherwise specified. 12

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Relevant Policy and Procedures The MDOC Defendants have provided the Court with limited written policies and procedures relating to the care of transgender individuals within MDOC custody. First, the MDOC Defendants provide the Court with the Missouri Department of Corrections Institutional Services Procedure Manual Procedure IS5-3.1 titled “Offender Housing Assignments” (Doc. 689). The following are the relevant portions of this policy. The MDOC defines a transgender individual as “[a] person shows a gender identity (i.e., internal sense of feeling male or female) is different from the person’s assigned gender at birth” (Id. at 1). Each MDOC institution has a transgender committee comprised of the health service administrator, medical director, institutional chief of mental health services and the deputy warden or Prison Rape Elimination Act (PREA) site coordinator (Id.). “The transgender committee is responsible for determining a permanent housing assignment for each transgender . . . offender, and prior to this assignment shall meet with each offender to determine his vulnerability within the general population and length of time living as the acquired gender” (Id. at 3). Of note, the housing policy does not address any medical issues. Second, during the Preliminary Injunction Hearing, the MDOC Defendants provided the Court and opposing counsel with a single paragraph on a sheet of paper without any identifying information and stated that it was the freeze-frame policy at issue (hereinafter “the Policy”) (Doc. 77). The Policy of unknown origin reads in its entirety as follows: [The Prison Rape Elimination Act (PREA)] is designed to keep all offenders safe from sexual assault and harassment, particularly those at greater risk of sexual victimization. The Department has adopted and is committed to enforce [sic] PREA zero tolerance of sexual abuse and harassment by complying with all PREA standards and making every effort to keep our offenders safe. The Department believes the initiation of Hormone Replacement Therapy (HRT) is not appropriate in a prison environment. An attempt at such transition in the prison venue severely compromises the safety of the offender and places them at substantial risk of sexual abuse and harassment. Therefore, after carefully balancing the potential benefit of HRT therapy [sic] to an offender, the increased risk to
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their personal safety as well as impact on the safety and security of other offenders and staff, we conclude such therapy is not appropriate in a prison setting and is not approved. Although HRT therapy [sic] is not approved, Mental Health is directed to and shall continue to provide all counseling and support deemed necessary.
(Doc. 77).
Third, the MDOC Defendants also indicate that they, in conjunction with Corizon have
developed explicit procedures to respond to inmates with gender dysphoria (Doc. 68 at 6). In
support of this assertion, the MDOC Defendants provide an August 2016 Corizon Memo
regarding “Gender Dysphoria Patients”(Doc. 68-10). In the memo, Corizon outlines its “initial
guidance into the treatment or continuation of treatment for patients with Gender Dysphoria”
(Doc. 68-10). Corizon defines gender dysphoria using the DSM-V definition as provided in full
above (Id. at 2). Relevant to the current case, the memo indicates that the following steps should
be taken when a new diagnosis of Gender Dysphoria is under consideration or suspected, to be
“ruled in or ruled out:”
a. The patient will be scheduled with a Psychiatrist for an evaluation to include a thorough history and for a consideration of a provisional diagnosis of Gender Dysphoria.
b. Before a diagnosis of Gender Dysphoria can be ruled in, the Gender Dysphoria Clinical Supervision Group must convene to review the case.
c. During this meeting a review of all medical records, medication records, and independent reports detailing their findings, and evaluations by site staff must occur, and a diagnosis of Gender Dysphoria will be ruled in or ruled out.
d. Once the final diagnosis of Gender Dysphoria is ruled in, the individualized medical and mental health treatment plans will be developed by site health care staff and will then be forwarded to the Gender Dysphoria Clinical Supervision Group for their review and approval.
e. Once the treatment plans are approved by the Gender Dysphoria Clinical Supervision Group, they will forward such plans to the DOC Transgender Committee for their review and subsequent referral to the DOC Central Office.
f. At this time, the patient’s diagnosis should be noted on the problem list and treatment documented and when implemented with the involvement of the offender within the electronic medical record.
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g. On a case-by-case base, hormonal replacement therapy (HRT) may need to be considered. In such a situation, the Gender Dysphoria Clinical Supervision Group will be forward [sic] such decision on to the DOC Transgender Committee for their review and subsequent referral to DOC Central Office. h. Upon review, DOC Central Office will provide direction to the DOC Transgender Committee, and copy the appropriate facility [Health Services Administrator (HSA)], facility medical director, and the [Intuitional Chief of Mental Health Services (ICMHS)]. i. With the approval of the DOC Central Office, the offender will be scheduled for a medical evaluation to include a thorough history, complete physical examination, and baseline laboratory studies and initiate HRT as clinically indicated. j. Also, if the patient is transferred to another facility, it is expected the sending site HSA and ICMHS will notify the receiving site’s HSA and ICMHS of this patient, treatment plan and expectations for fulfilling the requirements of this plan.
(Id. at 4-5). The Gender Dysphoria Clinical Supervision Group is comprised of the healthcare professionals who are assigned to work with a patient diagnosed with Gender Dysphoria, the contractual Regional Director of Psychiatry, the appropriate contractual Mental Health Director, the contractual Regional Medical Director, and a contractual Specialty Physician Consultant based upon identified need (Id. at 1). This Group meets as needed to conduct an ongoing review of the management of patients diagnosed with Gender Dysphoria (Id.). Each Department of Corrections (DOC) institution will have a transgender committee comprised of the health services administrator (HSA), the medical director, institutional chief of mental health services (ICMHS) and the deputy warden or prison rape elimination act (PREA) site coordinator (Id. at 2). Defendants also provided a copy of the Corizon Transgender MTF (Male to Female) Hormone Protocol and Patient Consent form (Id. at 6-7).
Plaintiff’s counsel also indicated during oral argument that it was her understanding that other individuals were being treated for gender dysphoria, including being given hormone therapy (Doc. 83 at 9). Although MDOC counsel indicated otherwise, stating at the hearing that
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he was not aware, “at this stage of the litigation,” of any other inmates in male facilities receiving hormone treatment (Id. at 22), the MDOC Defendants admitted in their answer that “hormone therapy has been provided to transgender inmates in the MDOC” (Doc. 42 at 2).
Internal Grievance Procedure The parties do not dispute that Ms. Hicklin has exhausted the MDOC’s internal grievance process (See Doc. 68-2 (Informal Resolution Request Response dated April 27, 2015); Doc. 68-3 (Grievance Response dated June 7, 2015); Doc. 68-4 (Informal Resolution Request Response dated July 20, 2015); Doc. 68-5 (Grievance Response dated August 12, 2015); Doc. 68-6 (Grievance Response dated August 12, 2015); Doc. 68-7 (Offender Grievance Appeal Response dated October 21, 2015)). One such grievance response, dated April 27, 2015, although partially cut off, appears to read, “On that [date,] physician [sic] recorded that per PCC administration, after discussions between DOC and [Corizon] Health representatives, there are no plans to proceed with hormone treatment” (Doc. 68-2 at 2). The MDOC Defendants admit that when Ms. Hicklin met with Defendant Nurse Diana Larkin to discuss whether this grievance could be resolved through discussion, Defendant Larkin informed Ms. Hicklin that she had received an email from Dwayne Kempker, previously named in this action as a defendant and the former Deputy Director, Division of Adult Institutions, MDOC, stating that Ms. Hicklin would not receive hormone therapy because MDOC policy prohibited an inmate who was not on such therapy upon entering MDOC from receiving it while in MDOC (Doc. 19 at 21-22; Doc. 42 at 14). Another grievance response, dated August 12, 2015 and signed by Dr. Throop, appears to read, “The treatment team agre[es] the Standards of Care, in regard to Mental health professionals helping clients become psych[ologically] prepared in every way as they consider hormone therapy. This preparation would also include[e] recently being told that you would not receive hormone therapy treatment, and being able to p[rocess] this news” (Doc. 68-6).
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II. DISCUSSION Federal Rule of Civil Procedure 65 gives courts the authority to grant preliminary injunctions. “A preliminary injunction is an extraordinary remedy never awarded as of right.” Winter v. Nat. Res. Def. Council, Inc., 555 U.S. 7, 24 (2008) (quoting Munaf v. Green, 553 U.S. 674, 689-90 (2008)). “Whether a preliminary injunction should issue involves consideration of (1) the threat of irreparable harm to the movant, (2) the state of the balance between this harm and the injury that granting the injunction will inflict on other parties litigant, (3) the probability that movant will succeed on the merits, and (4) the public interest.” Dataphase Sys., Inc. v. C.L. Sys., Inc., 640 F.2d 109, 113 (8th Cir. 1981). Although “‘no single factor is determinative,’ the probability of success factor is the most significant.” Home Instead, Inc. v. Florance, 721 F.3d 494, 497 (8th Cir. 2013) (quoting Barrett v. Claycomb, 705 F.3d 315, 320 (8th Cir. 2013)) (internal citations omitted). “The burden of demonstrating that a preliminary injunction is warranted is a heavy one where, as here, granting the preliminary injunction will give plaintiff substantially the relief [she] would obtain after a trial on the merits.” Dakota Indus., Inc. v. Ever Best Ltd., 944 F.2d 438, 440 (8th Cir. 1991). See also Blankenship v. Chamberlain, 2008 WL 4862717, at *2 (E.D. Mo. Nov. 7, 2008) (quoting Kikumura v. Hurley, 242 F.3d 950, 955 (10th Cir. 2001)) (In seeking a mandatory injunction that disrupts the status quo, the plaintiff “must demonstrate not only that the four requirements for a preliminary injunction are met but also that they weigh heavily and compellingly in [her] favor.”). A. Threat of Irreparable Harm “The threshold inquiry is whether the movant has shown the threat of irreparable injury.” Modern Computer Sys., Inc. v. Modern Banking Sys., Inc., 871 F.2d 734, 738 (8th Cir. 1989) (en banc). “The failure to show irreparable harm is, by itself, a sufficient ground upon which to deny a preliminary injunction.” Id. Irreparable harm must be certain and imminent such that there is a
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clear and present need for equitable relief. Iowa Utils. Bd. v. F.C.C., 109 F.3d 418, 425 (8th Cir. 1996). Possible or speculative harm is not sufficient. Local Union No. 884, United Rubber, Cork, Linoleum, & Plastic Workers of Am. v. Bridgestone/Firestone, Inc., 61 F.3d 1347, 1355 (8th Cir. 1995). When there is an adequate remedy at law, a preliminary injunction is not appropriate. Modern Computer Sys., 871 F.2d at 738.
The Court finds that Plaintiff has met her burden to show the threat of irreparable injury. Plaintiff asserts that she has and will continue to suffer irreparable harm in the absence of a preliminary injunction because she suffers from depression, anxiety, and intrusive thoughts of self-castration as a result of Defendants’ conduct (Doc. 64 at 7-9). Defendants’ assertion that Ms. Hicklin cannot establish irreparable injury because any injury is merely speculative is inaccurate (Doc. 69 at 4). The medical records establish that Ms. Hicklin suffers and will continue to suffer from “panic symptoms” with “active body anxiety, tachycardia, sob, [with] diaphoresis noted almost daily” (Doc. 64-6 at 5). The record also reflects that these symptoms are as a result of Ms. Hicklin’s gender dysphoria. Indeed, Plaintiff’s expert, Dr. Ettner indicates, that:
[The] lack of appropriate treatment for gender dysphoria is causing Ms. Hicklin to experience serious psychological and physical symptoms including panic attacks, anxiety, racing heartbeat (tachycardia), shortness of breath, sleep disturbance, lack of appetite, headaches, and excessive sweating. (Doc. 64-1 at 16). The records further indicate that Ms. Hicklin’s symptoms have been worsening and would continue to do so absent treatment for her gender dysphoria. For example, Dr. Stephens, upon receiving several letters from Ms. Hicklin and after an urgent follow-up appointment with her, found that Ms. Hicklin suffered from “some increased dysphoria symptoms with body/facial hair growth . . . and increase in intrusive thoughts to remove testicles with fear of active male pattern baldness symptoms” (Doc. 64-6 at 36).
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The records also establish that Ms. Hicklin is at severe risk of self-harm. While Ms. Hicklin has consistently indicated that she does not have suicidal ideations or that she will commit self-harm, she has a history of suicide ideation and has indicated on more than one occasion the inclination to remove her own testicles. Specifically, “Ms. Hicklin has a history of suicide ideation and two suicide attempts” (Doc. 64-1 at 13). Ms. Hicklin has also attempted to remove her testicles with a tourniquet (Doc. 64-1 at 12-13, 16; Doc. 83 at 6). Dr. Ettner notes that “Ms. Hicklin avoids contact with her genitals, and, typical of incarcerated gender dysphoric individuals without access to care, she has thoughts of removing them. On one occasion, Ms. Hicklin tried to amputate her testicles with a tourniquet . . .” (Doc. 64-1 at 16). “Emotional distress, anxiety, depression and other psychological problems can constitute irreparable injury.” Norsworthy v. Beard, 87 F. Supp. 3d 1164, 1192 (N.D. Cal.), appeal dismissed and remanded, 802 F.3d 1090 (9th Cir. 2015) (citing Chalk v. U.S. Dist. Ct. Cent. Dist. of California, 840 F.2d 701, 709 (9th Cir. 1988); Stanley v. University of Southern California, 13 F.3d 1313, 1324 n.5 (9th Cir.1994)). See also cf. Reid v. Kelly, No. 5:13CV00249 JLH-JTK, 2013 WL 6231149, at *2 (E.D. Ark. Dec. 2, 2013) (suggesting self-harm may be sufficient to establish a threat of irreparable harm).
Finally, as addressed in more detail below, the deprivation of Ms. Hicklin’s constitutional rights under the Eighth Amendment is alone sufficient to establish irreparable harm. See Elrod v. Burns, 427 U.S. 347, 373 (1976) (plurality opinion) (“The loss of First Amendment freedoms, for even minimal periods of time, unquestionably constitutes irreparable injury.”); Michigan State A. Philip Randolph Inst. v. Johnson, 833 F.3d 656, 669 (6th Cir. 2016) (internal quotation marks omitted) (“When constitutional rights are threatened or impaired, irreparable injury is presumed.”); Jolly v. Coughlin, 76 F.3d 468, 482 (2d Cir. 1996) (“The district court properly relied on the presumption of irreparable injury that flows from a violation of constitutional
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rights.”); Mitchell v. Cuomo, 748 F.2d 804, 806 (2d Cir. 1984) (“When an alleged deprivation of a constitutional right is involved, most courts hold that no further showing of irreparable injury is necessary.”).
Therefore, because Ms. Hicklin has established that she suffers from and will continue to suffer from severe emotional distress as well as a substantial risk of self-harm and that she has been deprived of her constitutional rights, Ms. Hicklin has met her burden to show the threat of irreparable harm. B. Likelihood of Success
The Court will next consider the likelihood that Plaintiff will succeed on the merits as the Eighth Circuit has long held this factor to be the most significant. Dataphase, 640 F.2d at 113. In considering this factor, the Court need not decide whether Ms. Hicklin, as the moving party, will ultimately succeed on her claims but, rather, whether Ms. Hicklin has a “fair chance of success on the merits.” Planned Parenthood Minn., N.D., S.D. v. Rounds, 530 F.3d 724, 732 (8th Cir. 2008). Here, Ms. Hicklin asserts that she suffers from an objectively serious medical condition that Defendants, acting with deliberate indifference, have failed to treat in violation of the Eighth Amendment (Doc. 64 at 13).
“The Eighth Amendment forbids prison officials from ‘unnecessarily and wantonly inflicting pain’ on an inmate by acting with ‘deliberate indifference’ toward the inmate’s serious medical needs.” Blackmore v. Kalamazoo Cnty., 390 F.3d 890, 895 (6th Cir. 2004). The “deliberate indifference” standard applies to a prisoner's challenge to medical treatment. Wilson v. Seiter, 501 U.S. 294, 303 (1991). Deliberate indifference has both subjective and objective components. A plaintiff must show (1) that she suffered from an objectively serious medical need and (2) that the prison officials actually knew of, but deliberately disregarded, that need. Jolly v. Knudsen, 205 F.3d 1094, 1096 (8th Cir. 2000).
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1. Serious Medical Need First, Ms. Hicklin must demonstrate that she suffers from an objectively serious medical need. To be objectively serious, the medical need must be “one that has been diagnosed by a physician as requiring treatment, or one that is so obvious that even a layperson would easily recognize the necessity for a doctor's attention.” Johnson v. Busby, 953 F.2d 349, 351 (8th Cir. 1991). In this case, Ms. Hicklin asserts that both her diagnosis for gender dysphoria disorder and her risk of self-harm constitute serious medical needs. Defendants do not contest that Ms. Hicklin’s gender dysphoria is a serious medical need (Doc. 83 at 24). Regardless, the Court will engage in the analysis. The Court finds that Ms. Hicklin suffers from an objectively serious medical need. A diagnosis of gender dysphoria disorder alone may constitute a serious medical need. See White v. Farrier, 849 F.2d 322, 325 (8th Cir. 1988) (“We therefore conclude that transsexualism is a serious medical need.”). See also Battista v. Clarke, 645 F.3d 449 (1st Cir. 2011) (upholding district court decision recognizing gender identity disorder as a serious medical need); Fields v. Smith, 712 F. Supp. 2d 830, 862 (E.D. Wis. 2010) (gender identity disorder is a serious medical need for purposes of the Eighth Amendment), aff’d, 653 F.3d 550 (7th Cir. 2011); Phillips v. Mich. Dep't of Corr., 731 F. Supp. 792, 800 (W.D. Mich. 1990), aff’d, 932 F.2d 969 (6th Cir. 1991) (same). Two separate psychiatrists diagnosed Ms. Hicklin with gender dysphoria and noted that she required specific treatment in order to treat her disorder. See Kosilek v. Maloney, 221 F. Supp. 2d 156, 184 (D. Mass. 2002) (finding a gender identity disorder diagnosis by two doctors to be significant in establishing a serious medical need). Further, upon review of Ms. Hicklin’s medical records, the Court finds that her gender dysphoria disorder is especially severe. Id. (D. Mass. 2002) (citing Farmer v. Moritsugu, 163 F.3d 610, 615 (D.C. Cir.1998)). As addressed in more detail above, as a result of her gender dysphoria, Ms. Hicklin suffers from
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the severe symptoms of anxiety, panic attacks, shortness of breath, sleep disturbance, lack of appetite, headaches, and excessive sweating (See, e.g., Doc. 64-1 at 16). The evidence also indicates that Ms. Hicklin is at significant risk of self-harm and has attempted on one occasion to remove her own testicles with a tourniquet (Doc. 64-1 at 12-13, 16; Doc. 83 at 6). De’lonta v. Angelone (“De’lonta I”), 330 F.3d 630, 634 (4th Cir. 2003) (citing Lee v. Downs, 641 F.2d 1117, 1121 (4th Cir. 1981) (“[P]rison officials have a duty to protect prisoners from selfdestruction or self-injury.”)). See also Soneeya v. Spencer, 851 F. Supp. 2d 228, 244-52 (D. Mass. 2012) (incarcerated individual with gender identity disorder and history of suicide attempts and self-mutilation has a serious medical condition).
2. Deliberate Indifference “In order to demonstrate that a defendant actually knew of, but deliberately disregarded, a serious medical need, the plaintiff must establish a mental state akin to criminal recklessness: disregarding a known risk to the inmate’s health.” Allard v. Baldwin, No. 14-1087, 2015 WL 921006, at *3 (8th Cir. Mar. 5, 2015) (internal quotation omitted) (quoting Vaughn v. Gray, 557 F.3d 904, 908 (8th Cir. 2009)). Negligence or medical malpractice does not constitute a constitutional violation. Estelle, 429 U.S. at 106. The Court finds that Ms. Hicklin is likely to succeed in establishing that Defendants were deliberately indifferent to her serious medical need. Ms. Hicklin has presented compelling evidence that Defendants’ refusal to provide her with hormone therapy after her diagnosis is based on the Policy rather than on a medical judgment concerning Ms. Hicklin’s specific circumstances. Medical professionals, including members of several reviewing committees, are generally in consensus that Ms. Hicklin requires hormone therapy to treat her gender dysphoria in accordance with the Standards of Care. Both of Ms. Hicklin’s physiatrists, Dr. Throop and Dr.
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Stephens, recommended hormone therapy in accordance with the Standards of Care (See, e.g., Doc. 64-6 at 35; Doc. 64-4 at 9, 11). Cf. Smith v. Hayman, 489 F. App’x 544, 547 (3d Cir. 2012) (unpublished) (footnote omitted) (“While in certain circumstances the failure to provide hormones and other courses of treatment can be constitutionally impermissible, the allegations of the present case do not show ignorance or an affirmative failure to treat, but rather caution and diagnostic disagreement. Such circumstances, in the absence of aggravating factors such as previous GID treatment or even a definitive GID diagnosis, do not rise to the level of constitutional violation.”). The Gender Dysphoria Clinical Supervision Group also agreed on appropriate hormone therapy to treat Ms. Hicklin’s gender dysphoria (Doc. 64-6 at 28).
Despite these recommendations, the evidence indicates that the decision to refuse Ms. Hicklin the hormone therapy rests solely on the Policy. The Policy is mentioned extensively throughout the medical record as the reason for the refusal to provide Ms. Hicklin with hormone therapy. For example, after her initial review of Ms. Hicklin, Dr. Throop referred Ms. Hicklin to an endocrinologist “for evaluation of cross-sex hormone [treatment]. Currently, hormone therapy (estrogen, testosterone blockers) is the accepted treatment for individuals with [a] Gender Dysphoria diagnoses” (Doc. 64-4 at 4). However, in an addendum to her notes from the evaluation, Dr. Throop indicates, “after researching DOC protocols, it was found that endocrinology consult is NOT the appropriate next step for psychiatry in the [treatment] of Gender Dysphoria” (Id.). Dr. Stephens also references the Policy multiple times. For example, Dr. Stephens states in a plan note dated April 22, 2016, “Per discussion from Gender Dysphoria council at PCC, still pending decision from recent request on policy surrounding treatment of gender dysphoria with hormonal treatment if diagnosed in prison” (Doc. 64-6 at 21). See also Id. at 17 (“pending decision on DOC policy of use of hormone treatment of gender dysphoria diagnosed while incarcerated”). The MDOC Defendants also admit that when Ms. Hicklin met
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with Defendant Nurse Diana Larkin to discuss whether one of her grievances could be resolved through discussion, Defendant Larkin informed Ms. Hicklin that she had received an email from Dwayne Kempker, the former Deputy Director, Division of Adult Institutions, MDOC, stating that Ms. Hicklin would not receive hormone therapy because MDOC policy prohibited an inmate who was not on such therapy upon entering MDOC from receiving it while in MDOC (Doc. 19 at 21-22; Doc. 42 at 14). The denial of hormone therapy based on a blanket rule, rather than an individualized medical determination, constitutes deliberate indifference in violation of the Eighth Amendment. See, e.g., Kosilek v. Spencer, 774 F.3d 63, 91 (1st Cir. 2014) (en banc); Fields v. Smith, 653 F.3d 550, 556-57 (7th Cir. 2011); De’lonta I, 330 F.3d at 635; Allard v. Gomez, 9 Fed.Appx. 793, 794 (9th Cir. 2001) (unpublished).
The MDOC Defendants do not contest that the medical staff at PCC recommends hormone therapy for Ms. Hicklin nor do they appear to dispute that the treatment was denied based on the Policy, instead they argue, “there is an important distinction to be made between what medical professionals recommend and what the federal constitution requires” (Doc. 68 at 12). Citing Smith v. Rasmussen, 249 F.3d 755 (8th Cir. 2001), a case upholding a state Medicaid regulation prohibiting payment for sex reassignment surgery, the MDOC Defendants specifically assert that “[t]here is no constitutional right to sex-reassignment therapy” (Id. at 7). Reliance of Rasmussen is misplaced here and Plaintiff has not asked for surgery (Id.). The MDOC Defendants also argue, citing portions of a report entitled, “Sexuality and Gender: Findings from the Biological, Psychological, and Social Services,” by Dr. Lawrence S. Mayer and Dr. Paul R. McHugh, that “there is a legitimate disagreement in the scientific community about what treatment is or is not appropriate for a patient with gender dysphoria” (Doc. 68 at 13). Similarly, the Corizon Defendants indicate that they have not “refused the particular care that Plaintiff seeks” but that this is, “at best, merely . . . a disagreement regarding treatment decisions that
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have been made” (Doc. 69 at 3). Defendants assert that Plaintiff is receiving extensive and continuing medical and psychological care for her gender dysphoria, “far more than that could possibly be required by the federal Constitution” (Doc. 68 at 1). See also id. at 9-10 (“Plaintiff has not shown that the medical and psychological care and counseling she has received and continues to receive somehow amounts to ‘cruel and unusual punishment.’”).
Defendants’ decision to provide “some treatment” is inadequate and, therefore, not constitutional. De’lonta v. Johnson (De’lonta II), 708 F.3d 520, 526 (4th Cir. 2013) (emphasis in original). See also Langford v. Norris, 614 F.3d 445, 460 (8th Cir. 2010) (internal quotation marks omitted) (“[A] total deprivation of care is not a necessary condition for finding a constitutional violation: Grossly incompetent or inadequate care can also constitute deliberate indifference . . . .”). As aptly put by the District Court of Massachusetts, “if [Ms. Hicklin] had cancer, and was depressed and suicidal because of that disease, the DOC would discharge its duty to [her] under the Eighth Amendment by treating both [her] cancer and [her] depression.” Kosilek v. Maloney, 221 F. Supp. 2d 156, 188 (D. Mass. 2002) (emphasis added). See also e.g., Kothmann v. Rosario, 558 F. App’x 907, 910 (11th Cir. 2014) (unpublished) (denying qualified immunity to prison official who denied transgender prisoner hormone therapy while providing anti-anxiety and anti-depression medications, mental health counseling, and psychotherapy treatments); De’lonta II, 708 F.3d at 526 (finding counseling and anti-depressants insufficient as defendants had not clearly demonstrated that this treatment was provided for the purpose of alleviating plaintiff’s self-harm or that it was deemed to be a reasonable method of preventing further mutilation); Fields, 653 F.3d at 556 (“Although DOC can provide psychotherapy as well as antipsychotics and antidepressants, defendants failed to present evidence rebutting the testimony that these treatments do nothing to treat the underlying [gender dysphoria].”); Soneeya, 851 F. Supp. 2d at 246-50 (blanket ban on laser hair removal and surgery was
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deliberately indifferent even though transgender plaintiff was receiving some treatment, including psychotherapy and hormones). Accordingly, while Defendants are correct in their assertion that Ms. Hicklin is not constitutionally entitled to the treatment of her choice, the treatment must nevertheless be adequate to address the prisoner’s serious medical need. See cf. Reid v. Griffin, 808 F.3d 1191, 1192-93 (8th Cir. 2015) (finding plaintiff unable to establish that the defendants’ conduct amounted to deliberate indifference when plaintiff was not diagnosed with gender identity disorder and the medical records and physician affidavits indicated that the care provided was adequate). In light of treating physicians’ recommendations, psychiatric care and counseling alone are constitutionally inadequate to address Ms. Hicklin’s gender dysphoria.
The Court further finds that Ms. Hicklin is likely to succeed on the merits as to her requests to have access to “gender-affirming” canteen items and permanent hair removal. Pursuant to the Standards of Care, individualized treatment for gender dysphoria may include living in the gender role that is consistent with one’s gender identity (Doc. 64-1 at 6). In line with and specifically noting the Standards of Care, Dr. Stephens suggested that Ms. Hicklin be given the opportunity to live as her desired gender (See 64-6 at 6, 15). In order to accomplish this, Dr. Stephens recommended “psychotherapy ongoing, 3-6 months living as a female with access to products that females in DOC have access to for self care [sic]” (Id. at 5). Dr. Stephens also endorsed the use of medication to prevent hair loss and treatment for hair removal (Id. at 35). Specifically, Dr. Stephens notes, on September 20, 2016, “[g]iven this increased agitation, self harm [sic] thoughts and reported active symptoms of male pattern baldness will refer to gender dysphoria committee to consider dermatology referral and treatment for hair loss (head) and removal (body) as at this time symptoms [constitute] medical necessity” (Doc. 64-6 at 35). The basis of the denial of these items is unclear from the record. At one point, in response to an internal grievance, Nurse Wade indicates Dr. Babich, Associate Regional Medical Director,
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stated that various forms of permanent hair removal were “not medically necessary” (Doc. 68-4 at 2). However, as discussed above, the medical evidence does not support this blanket assertion and the case law is clear—“gender-affirming” canteen items and permanent hair removal are not merely cosmetic treatments but, instead, medically necessary treatments to address a serious medical disease. See Alexander v. Weiner, 841 F. Supp. 2d 486, 493 (D. Mass. 2012) (finding plaintiff sufficiently asserted factual allegations to support a claim of deliberate indifference to survive a motion to dismiss when she alleged that she was prescribed laser hair removal and/or electrolysis on at least three occasions but defendants “repeatedly ignored treatment prescriptions given to [p]laintiff by her doctors”). See also Soneeya, 851 F. Supp. 2d at 247 (finding the department of corrections’ blanket policy prohibiting, among other things, laser hair removal to be unconstitutional and, therefore, entering a permanent injunction enjoining the department of corrections from enforcing it); Konitzer v. Frank, 711 F. Supp. 2d 874, 909 (E.D. Wis. 2010) (finding modest makeup, female undergarments, facial hair remover, and hair growth stimulators to be “part of the real-life experience” required under the applicable standards of care such that sufficient evidence supported the conclusion that these items may be medically necessary to survive summary judgment).
Accordingly, the Court finds that Ms. Hicklin is likely to succeed on the merits as to her Eighth Amendment claim that Defendants were deliberately indifferent by failing to provide her with hormone therapy, “gender-affirming” canteen items, and permanent hair removal to treat her serious medical of gender dysphoria. C. Balance of Harms
In considering the equities of a preliminary injunction, courts “must balance the competing claims of injury and must consider the effect on each party of the granting or withholding of the requested relief.” Winter, 555 U.S. at 24. “In exercising their sound
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discretion, courts of equity should pay particular regard for the public consequences in employing the extraordinary remedy of injunction.” Id.
The balance of harms substantially weighs in favor of granting injunctive relief to Ms. Hicklin. Ms. Hicklin has met her heavy burden to establish that she continues to face irreparable injury absent relief, as addressed in more detail above, including the denial of her constitutional rights. Conversely, the MDOC Defendants contend that they will be harmed, as addressed for the first time during oral argument, by considerations of safety both for Ms. Hicklin as well as other inmates, suggesting that any gender-identity transition places her at substantial risk of sexual abuse and harassment (Doc. 77; Doc. 83 at 17-22). The MDOC Defendants have also tangentially raised the issue of cost (See, e.g., Doc. 68 at 12). The Court is cognizant that Defendants have the difficult task of ensuring staff and inmate safety and security, and appropriate medical care for those incarcerated. However, the challenge of housing thousands of inmates safely cannot impede on the constitutional rights of the individuals in MDOC custody. The Court finds the MDOC Defendants’ assertions particularly unavailing in this case because the limited evidence reflects that other inmates within the MDOC system have received hormone therapy. And MDOC Defendants have accommodated Plaintiff by giving her the option to shower without male inmates present (Doc. 83 at 18). Therefore, the Court cannot determine that the MDOC Defendants’ decision to deny Ms. Hicklin the medical care she seeks is based on substantiated penological concerns. Cf. Kosilek v. Spencer, 774 F.3d 63, 83 (1st Cir. 2014) (internal citations and quotation marks omitted) (“‘Wide-ranging deference’ is accorded to prison administrators in the adoption and execution of policies and practices that in their judgement are needed to maintain institutional security. In consequence, even a denial of care may not amount to an Eighth Amendment violation if that decision is based in legitimate concerns regarding prisoner safety and institutional security.”). Similarly, the MDOC
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Defendants’ assertions regarding cost are unsupported by specifics. MDOC is already providing—or has provided—this treatment to other inmates and did not provide the Court with any information regarding the cost of these treatments for the Court’s consideration.13 Accordingly, the Court finds the balance of harms weighs heavily in favor of Ms. Hicklin. D. The Public Interest
Finally, the public interest weighs strongly in favor of issuing the preliminary injunction. Ms. Hicklin seeks to protect her constitutional rights (Id. at 14). “[I]t is always in the public interest to prevent the violation of a party’s constitutional rights.” Melendres v. Arpaio, 695 F.3d 990, 1002 (9th Cir. 2012). E. The Policy
Additionally, as relief in her Motion for Preliminary Injunction, Ms. Hicklin requests the Court enter an order “enjoining Defendants from enforcing the policies, customs, or practices that have served as a moving force behind their constitutional violations by denying inmates with gender dysphoria individualized medically necessary treatment and care, contrary to widely accepted standards of care and the recommendations of Ms. Hicklin’s treating mental health professionals” (Doc. 64 at 19). Although unclear as to the precise meaning of this request, Ms. Hicklin appears to suggest that the Policy is itself unconstitutional and the MDOC Defendants should be enjoined from enforcing it. The Court notes that the Policy categorically restricts inmates who are diagnosed with gender dysphoria after entering the MDOC from receiving hormone treatment. There does not appear to be any rational relationship between the Policy and a legitimate governmental interest or penological purpose especially in light of the evidence
13 By illustration, as noted by the Seventh Circuit, “[i]n 2004, [the Wisconsin Department of Corrections (DOC)] paid a total of $2,300 for hormones for two inmates. That same year, DOC paid $2.5 million to provide inmates with quetiapine, an antipsychotic drug which costs more than $2,500 per inmate.” Fields, 653 F.3d at 555.
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indicating that other inmates in the MDOC system receive hormone therapy. Turner v. Safley, 482 U.S. 78, 89 (1987). Further, failure to conduct an individualized review of a prisoner’s needs may violate the Eighth Amendment. Kosilek v. Spencer, 774 F.3d 63, 91 (1st Cir. 2014) (citing Roe v. Elyea, 631 F.3d 843, 863 (7th Cir. 2011)) (any blanket policy regarding sex reassignment surgery would conflict with the requirement that medical care be individualized based on a particular prisoner’s serious medical needs and that such a failure may violate the Eighth Amendment). See also Fields, 653 F.3d at 556 (finding blanket law denying access to hormone treatment to be unconstitutional; “Refusing to provide effective treatment for a serious medical condition serves no valid penological purpose and amounts to torture.”). However, Ms. Hicklin does not raise this issue in her Complaint nor did any of the Parties present argument on this claim either in their briefs or before the Court during the hearing.
The Court has considered the entire record and the arguments presented at the hearing on this matter. Based upon the foregoing consideration of all of the Dataphase factors, the Court finds that Ms. Hicklin is entitled to a preliminary injunction that Defendants’ provide Ms. Hicklin with care that her doctors deem to be medically necessary treatment for her gender dysphoria, including hormone therapy, access to permanent body hair removal, and access to “gender-affirming” canteen items. However, Ms. Hicklin’s has failed to meet her burden to warrant a preliminary injunction as to the Policy in general. F. Bond
Federal Rule of Civil Procedure 65(c)’s instruction that “[n]o restraining order or preliminary injunction shall issue except upon the giving of security by the applicant, in such sum as the court deems proper” has long been interpreted to mean that a district court has discretion to grant injunctive relief without requiring bond or other security, especially when doing so would function to bar poor people from obtaining judicial redress. See, e.g., Doctor’s
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Assocs., Inc. v. Stuart, 85 F.3d 975, 985 (2d Cir. 1996); Kaepa, Inc. v. Achilles Corp., 76 F.3d 624, 628 (5th Cir. 1996); Miller v. Carlson, 768 F. Supp. 1331 (N.D. Cal.1991); Brown v. Artery Org., Inc., 691 F. Supp. 1459, 1462 (D.D.C. 1987). In this case, Ms. Hicklin is incarcerated and appears to lack sufficient resources from which to provide security. Requiring a bond in this case would effectively bar Ms. Hicklin from obtaining injunctive relief. Therefore, the Court will grant injunctive relief without requiring bond or other security. See Johnson v. Bd. of Police Comm’rs, 351 F. Supp. 2d 929, 952 (E.D. Mo. 2004)(“[A] district court has discretion to grant injunctive relief without requiring bond or other security, especially when doing so would function to bar poor people from obtaining judicial redress.”).
III. CONCLUSION Accordingly, IT IS HEREBY ORDERED that Plaintiff First Motion to Supplement (Doc. 88) is GRANTED and Plaintiff’s Second Motion to Supplement (Doc. 98) is DENIED. IT IS FURTHER ORDERED that Plaintiff Jessica Hicklin’s Motion for Preliminary Injunction (Doc. 63) is GRANTED, in part and DENIED, in part. The Court has carefully considered Plaintiff’s specific requests for relief and finds the following injunctive relief to be appropriate: (1) Defendants are directed to provide Ms. Hicklin with care that her doctors deem to be medically necessary treatment for her gender dysphoria, including hormone therapy, access to permanent body hair removal, and access to “gender-affirming” canteen items. Dated this 9th day of February, 2018.
/s/ Noelle C. Collins
NOELLE C. COLLINS UNITED STATES MAGISTRATE JUDGE
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 Case: 4:16-cv-01357-NCC Doc. #: 152 Filed: 02/26/18 Page: 1 of 35 PageID #: 1784

IN THE UNITED STATES DISTRICT COURT FOR THE EASTERN DISTRICT
OF MISSOURI EASTERN DIVISION

JESSICA HICKLIN, v.

Plaintiff,

ANNE PRECYTHE, in her official capacity as Director of the Missouri Department of Corrections (“MDOC”);
JOAN REINKEMEYER, in her official capacity as Director, Division of Offender Rehabilitative Services, MDOC;
CINDY GRIFFITH, in her official capacity as Deputy Director, Division of Adult Institutions, MDOC;
CINDY GRIFFITH, in her official capacity as Warden of Potosi Correctional Center (“PCC”);
STAN PAYNE, in his official capacity as Deputy Warden of PCC;
SCOTT O’KELLY, L.P.C., in his official capacity as Assistant Division Director, Mental Health Services, Department of Offender Rehabilitative Services, MDOC;
LATOYA DUCKWORTH, in her official capacity as Assistant Division Director, Medical Services, Department of Offender Rehabilitative Services, MDOC;
CORIZON, LLC. (“Corizon”); WILLIAM MCKINNEY, M.D., in his official
capacity as Medical Director of PCC, Corizon; JOHN DEGHETTO, M.D., in his official capacity as Associate Regional Medical Director, Corizon; THOMAS KEVIN BREDEMAN, D.O., in his official capacity as Associate Regional Medical Director, Corizon; DIANA LARKIN, R.N., in her official capacity as Health Services Administrator, Corizon;

Case No. 4:16-CV-01357-NCC
FIRST AMENDED COMPLAINT FOR DECLARATORY AND INJUNCTIVE RELIEF

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KIMBERLEY S. RANDOLPH, R.N., B.S.N., C.C.H.P., in her official capacity as Director of Operations, Corizon;
DALY SMITH, in her official capacity as Director of Nursing, Corizon;
STORMI MOELLER, R.N., in her official capacity as an employee of Corizon;
ERNEST GRAYPEL, M.D., in his official capacity as Regional Psychiatric Director, Corizon;
ELIZABETH ATTERBERRY, Psy. D., in her official capacity as Regional Mental Health
Director, Corizon; KIM FOSTER, L.P.C., in her official capacity as
Mental Health Director for PCC, Corizon.
Defendants.
PRELIMINARY STATEMENT
1. Plaintiff Jessica Hicklin (“Plaintiff” or “Ms. Hicklin”) is a thirty-eight year old
transgender woman1 in the custody of the Missouri Department of Corrections (“MDOC”)
and housed at Potosi Correctional Center (“PCC”), a facility for male inmates, in Mineral
Point, Missouri. Defendants are individuals and institutions who, for the duration of Ms.
Hicklin’s incarceration, have had authority and responsibility for her medical treatment.
2. Despite knowing that Ms. Hicklin has gender dysphoria, a serious medical
condition that causes severe psychological suffering and can lead to physical injury when not
properly treated, Defendants have refused to provide Ms. Hicklin with medically necessary
care.
3. On March 27, 2015, Ms. Hicklin filed a Petition for Change of Name in the
Washington County Circuit Court, seeking to change her name from the traditionally male
1 In keeping with Ms. Hicklin’s gender identity, modern judicial practice, and accepted medical protocol, this Complaint uses female pronouns to refer to her.
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name given to her at birth to her current legal name, Jessica Hicklin.2 4. Although Defendants’ own mental health personnel have evaluated Ms. Hicklin,
have diagnosed her with gender dysphoria, and have recommended that she receive hormone therapy to treat her gender dysphoria, Defendants have failed to provide Ms. Hicklin with this therapy pursuant to MDOC’s policy or custom of providing hormone therapy only to those transgender inmates who were receiving it prior to incarceration (“the freeze-frame policy”).
5. This type of freeze-frame policy violates the medically accepted standard of care for treating gender dysphoria; similar state and federal policies have been held unconstitutional by federal courts as a violation of the Eighth Amendment of the United States Constitution.
6. Upon information and belief, Defendants are providing and have provided hormone therapy to other transgender inmates in MDOC, recognizing that it can be medically necessary treatment for gender dysphoria, but unreasonably refuse to provide this medically necessary treatment to Ms. Hicklin due to MDOC’s unconstitutional freeze-frame policy.
7. Defendants have also deprived Ms. Hicklin of other interventions that are also part of the medically necessary treatment Ms. Hicklin requires for her gender dysphoria and have also been recommended by Defendants’ mental health personnel, including permanent hair removal and access to gender-affirming canteen items.
8. Defendants do not deny that Ms. Hicklin has gender dysphoria requiring
2 On July 24, 2015, Ms. Hicklin received an order from the Washington County Circuit Court granting her name change petition. Pursuant to this Order, Ms. Hicklin’s social security card, the labels on her PCC-issued clothing, and her offender identification card have been updated to reflect her legal name.
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treatment. Rather, they have been deliberately indifferent to Ms. Hicklin’s serious medical needs and have denied her care pursuant to an unconstitutional policy or custom that ignores the recommendations of the MDOC mental health professionals.
9. MDOC mental health professionals employed by Defendants have recommended that Ms. Hicklin receive treatment in accordance with the World Professional Association for Transgender Health (“WPATH”) Standards of Care for the Health of Transsexual, Transgender, and Gender-Nonconforming People (“Standards of Care”), which are internationally recognized as the authoritative articulation of professional consensus on the treatment of gender dysphoria.
10. Through their deliberate indifference, Defendants have caused and continue to cause Ms. Hicklin profound pain and suffering, for which she seeks preliminary and permanent injunctive relief and declaratory relief.
11. Ms. Hicklin has fully exhausted her administrative remedies to no avail. 12. Ms. Hicklin brings this action pursuant to 42 U.S.C. § 1983, to seek redress for Defendants’ deliberate indifference to her serious medical needs, which constitutes cruel and unusual punishment under the Eighth Amendment to the United States Constitution, made applicable to the State through the Fourteenth Amendment.
JURISDICTION AND VENUE 13. Plaintiff brings this action seeking preliminary and permanent injunctive relief and declaratory relief pursuant to 42 U.S.C. §§ 1983 and 1988 to redress the deprivation under color of state law of rights secured by the United States Constitution. 14. This Court has jurisdiction pursuant to 28 U.S.C. §§ 1331 and 1343 and jurisdiction to grant declaratory relief pursuant to 28 U.S.C. § 2201. 15. Venue is proper in this district pursuant to 28 U.S.C. § 1391(b)(2) because a substantial part of the relevant events occurred within the district.
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16. This Court has personal jurisdiction over each and every defendant because,

upon information and belief, all Defendants were either residents of Missouri, were

employed in Missouri, or conducted business in Missouri, and all were acting under color

of state law during all relevant times.

PARTIES

17. PLAINTIFF JESSICA HICKLIN is a thirty-eight year old white transgender

woman, diagnosed with gender dysphoria, who is in the custody of the Missouri Department

of Corrections (“MDOC”). At all relevant times, Ms. Hicklin was incarcerated at the Potosi

Correctional Center (“PCC”), a facility for male inmates, where she remains at the time of this

filing. 18.

DEFENDANT ANNE PRECYTHE (“Precythe”)3 is the Director of MDOC,

a position formerly held by GEORGE LOMBARDI (“Lombardi”). At all relevant times, the

Director of MDOC (“the Director”) has exercised, and continues to exercise, ultimate policy

and decision-making authority over MDOC and control over all MDOC employees and

contractors, and is responsible for their training, supervision, and conduct. The Director has

ultimate responsibility within MDOC for overseeing day-to-day operation of state prison

facilities, including PCC, and is responsible for ensuring the provision of adequate medical

care to inmates, including through the implementation of policies and the training and

supervision of MDOC staff. The Director has implemented, condoned, and ratified the custom

and practice within MDOC of denying medically necessary treatment for gender dysphoria,

3 Pursuant to Fed. R. Civ. P. 25(d), and to the best of Plaintiff Jessica Hicklin’s knowledge and information, this First Amended Complaint substitutes former MDOC Director George Lombardi—and all other former MDOC and Corizon officials who have left their official positions since this lawsuit was originally filed on August 22, 2016—with current MDOC Director Anne Precythe and the other persons currently holding these positions.
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including hormone therapy to certain inmates, including Ms. Hicklin, pursuant to MDOC’s freeze-frame policy. The Director has also implemented, condoned, and ratified the custom and practice of denying inmates like Ms. Hicklin other forms of medically necessary treatment for gender dysphoria, including permanent hair removal and access to gender-affirming canteen items. The Director has furthermore failed to train and supervise MDOC employees and agents with respect to the proper provision of medically necessary treatment for gender dysphoria, despite knowing that gender dysphoria is a serious medical need and that failing to train and supervise staff with respect to the provision of medically necessary treatment for this serious medical need places inmates like Ms. Hicklin at substantial risk of mental and physical harm. The Director is among those responsible for denying Ms. Hicklin medically necessary care and is sued in her official capacity.
19. DEFENDANT JOAN REINKEMEYER (“Reinkemeyer”) is Director, Division of Offender Rehabilitative Services of MDOC (“DORS Director”), a position formerly held by MATT STURM. At all relevant times, the DORS Director has exercised, and continues to exercise, authority, direction, and control over MDOC’s Division of Offender Rehabilitative Services, including its employees and contractors. The DORS Director is responsible for ensuring the provision of adequate medical care to adult inmates in MDOC’s custody, including through the implementation of policies and the training and supervision of MDOC staff. The DORS Director is among those responsible for denying Ms. Hicklin medically necessary care and is sued in her official capacity.
20. DEFENDANT CINDY GRIFFITH is the current Deputy Director, Division of Adult Institutions of MDOC (“Deputy DAI Director”), a position formerly held by DWAYNE KEMPKER (“Kempker”) and IAN WALLACE. At all relevant times, the Deputy DAI Director has exercised, and continues to exercise, authority, direction, and control over
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MDOC’s adult institutions and their employees and contractors. The Deputy Director DAI is responsible for ensuring the provision of adequate medical care to adult inmates in MDOC’s custody, including through the implementation of policies and the training and supervision of MDOC staff. The Deputy Director DAI is among those responsible for denying Ms. Hicklin medically necessary care and is sued in her official capacity.
21. DEFENDANT CINDY GRIFFITH4 was, at relevant times, Warden of PCC (“Warden”). At all relevant times, the Warden has exercised, and continues to exercise, authority, direction, and control over PCC and its employees and contractors. The Warden is responsible for ensuring the provision of adequate medical care to inmates in PCC, including through the implementation of policies and the training and supervision of PCC staff. The Warden is among those responsible for denying Ms. Hicklin medically necessary care and is sued in her official capacity.
22. DEFENDANT STAN PAYNE (“Payne”) is Deputy Warden of PCC. At all relevant times, the Deputy Warden of PCC has exercised, and continues to exercise, authority, direction, and control over PCC and its employees and contractors. The Deputy Warden of PCC is responsible for ensuring the provision of adequate medical care to inmates in PCC and is among those responsible for denying Ms. Hicklin medically necessary care. He is sued in his official capacity.
23. On information and belief, DEFENDANT SCOTT O’KELLY, L.P.C. (“O’Kelly”) is, and has been at all relevant times, the Assistant Division Director, Mental Health Services, Department of Offender Rehabilitative Services at MDOC (“Asst. DORS
4To the best of Plaintiff Jessica Hicklin’s knowledge and information, Cindy Griffith is no longer Warden at PCC. As of the time of filing of this First Amended Complaint, to the best of Ms. Hicklin’s knowledge and information, there has been no official replacement.
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Director-Mental Health”). At all relevant times, the Asst. DORS Director-Mental Health has exercised, and continues to exercise, policy and decision-making authority regarding the care and treatment of MDOC inmates, control of health care personnel, and has the authority to grant or deny medical care to inmates. The Asst. DORS Director-Mental Health is responsible for ensuring the provision of adequate medical care to inmates, including through the implementation of policies and the training and supervision of staff. The Asst. DORS DirectorMental Health is among those responsible for denying Ms. Hicklin medically necessary care and is sued in his official capacity.
24. On information and belief, DEFENDANT LATOYA DUCKWORTH is the Assistant Division Director, Medical Services, Department of Offender Rehabilitative Services at MDOC (“Asst. DORS Director-Medical”), a position formerly held by DELOISE WILLIAMS, R.N., B.S.N. (“Williams”). At all relevant times, the Asst. DORS DirectorMedical has exercised, and continues to exercise, policy and decision-making authority regarding the care and treatment of MDOC inmates, control of health care personnel, and has the authority to grant or deny medical care to inmates. The Asst. DORS Director-Medical is responsible for ensuring the provision of adequate medical care to inmates, including through the implementation of policies and the training and supervision of staff. The Asst. DORS Director-Medical is among those responsible for denying Ms. Hicklin medically necessary care and is sued in her official capacity.
25. DEFENDANT CORIZON, LLC (“Corizon”) is and was at all relevant times the contracted medical provider for MDOC. Through its employees and agents, Corizon exercises policy and decision-making authority regarding the care and treatment of MDOC inmates, control of health care personnel, and has the authority to grant or deny medical care to inmates. Corizon is responsible for ensuring the provision of adequate medical care to inmates,
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including through the implementation of policies and the training and supervision of staff. Corizon is among those responsible for denying Ms. Hicklin medically necessary care.
26. DEFENDANT WILLIAM MCKINNEY, M.D. (“McKinney”) is, and has been at all relevant times, Medical Director of PCC. At all relevant times, the Medical Director of PCC has exercised, and continues to exercise, policy and decision-making authority regarding the care and treatment of MDOC inmates, control of health care personnel, and has the authority to grant or deny medical care to inmates. The Medical Director of PCC is responsible for ensuring the provision of adequate medical care to inmates, including through the implementation of policies and the training and supervision of staff. In making decisions related to Ms. Hicklin’s medical care, the Medical Director of PCC failed to follow WPATH Standards of Care, which are internationally recognized as the authoritative articulation of professional consensus on the treatment of gender dysphoria. The Medical Director of PCC is among those responsible for denying Ms. Hicklin medically necessary care and is sued in his official capacity.
27. On information and belief, DEFENDANT JOHN DEGHETTO, M.D. (“DeGhetto”) and DEFENDANT THOMAS KEVIN BREDEMAN, D.O. (“Bredeman”) are Associate Regional Medical Directors of Corizon, a position formerly held by GLEN BABICH, M.D. (“Babich”). At all relevant times, the Associate Regional Medical Directors have exercised, and continue to exercise, policy and decision-making authority regarding the care and treatment of MDOC inmates, control of health care personnel, and have the authority to grant or deny medical care to inmates. The Associate Regional Medical Directors are responsible for ensuring the provision of adequate medical care to inmates, including through the implementation of policies and the training and supervision of staff. In making decisions related to Ms. Hicklin’s medical care, the Associate Regional Medical Directors failed to follow the
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WPATH Standards of Care, which are internationally recognized as the authoritative articulation of professional consensus on the treatment of gender dysphoria. The Associate Regional Medical Directors are among those responsible for denying Ms. Hicklin medically necessary care and are sued in their official capacities.
28. On information and belief, DEFENDANT DIANA LARKIN, R.N. (“Larkin”) is currently Health Services Administrator for Corizon. At all relevant times, the Health Services Administrator has exercised, and continues to exercise, policy and decision-making authority regarding the care and treatment of MDOC inmates, control of health care personnel, and has the authority to grant or deny medical care to inmates. The Health Services Administrator is responsible for ensuring the provision of adequate medical care to inmates, including through the implementation of policies and the training and supervision of staff. In making decisions related to Ms. Hicklin’s medical care, the Health Services Administrator failed to follow the WPATH Standards of Care, which are internationally recognized as the authoritative articulation of professional consensus on the treatment of gender dysphoria. The Health Services Administrator is among those responsible for denying Ms. Hicklin medically necessary care and is sued in her official capacity.
29. On information and belief, DEFENDANT KIMBERLEY S. RANDOLPH, R.N., B.S.N., C.C.H.P (“Randolph”) is and was at all relevant times Corizon’s Director of Operations. At all relevant times, Corizon’s Director of Operations has exercised, and continues to exercise, policy and decision-making authority regarding the care and treatment of MDOC inmates, control of health care personnel, and the authority to grant or deny medical care to inmates. Corizon’s Director of Operations is responsible for ensuring the provision of adequate medical care to inmates, including through the implementation of policies and the training and supervision of staff. In making decisions related to Ms. Hicklin’s medical care, Corizon’s
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Director of Operations failed to follow the WPATH Standards of Care, which are internationally recognized as the authoritative articulation of professional consensus on the treatment of gender dysphoria. Corizon’s Director of Operations is among those responsible for denying Ms. Hicklin medically necessary care and is sued in her official capacity.
30. On information and belief, DEFENDANT DALY SMITH, R.N. (“Smith”) is the Director of Nursing, a position formerly held by DAWN WADE, R.N. (“Wade”) and Defendant Larkin. At all relevant times, the Director of Nursing has exercised, and continues to exercise, policy and decision-making authority regarding the care and treatment of MDOC inmates, control of health care personnel, and the authority to grant or deny medical care to inmates. The Director of Nursing is responsible for ensuring the provision of adequate medical care to inmates, including through the implementation of policies and the training and supervision of staff. In making decisions related to Ms. Hicklin’s medical care, the Director of Nursing failed to follow the WPATH Standards of Care, which are internationally recognized as the authoritative articulation of professional consensus on the treatment of gender dysphoria. The Director of Nursing is among those responsible for denying Ms. Hicklin medically necessary care and is sued in her official capacity.
31. On information and belief, STORMI MOELLER, R.N. (“Moeller”) is and was at relevant times employed by Corizon in a capacity requiring the exercise of policy and decision-making authority regarding the care and treatment of MDOC inmates, control of health care personnel, and the authority to grant or deny medical care to inmates. On information and belief, Defendant Moeller is responsible for ensuring the provision of adequate medical care to inmates, including through the implementation of policies and the training and supervision of staff. In making decisions related to Ms. Hicklin’s medical care, Defendant Moeller failed to follow the WPATH Standards of Care, which are internationally recognized
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as the authoritative articulation of professional consensus on the treatment of gender dysphoria. Defendant Moeller is among those responsible for denying Ms. Hicklin medically necessary care and is sued in her official capacity.
32. On information and belief, ERNEST GRAYPEL, M.D., is the Regional Psychiatric Director of Corizon (“Regional Psychiatric Director”), a position formerly held by SHIRLEY EYMAN, M.D. (“Eyman”). At all relevant times, the Regional Psychiatric Director has exercised, and continues to exercise, policy and decision-making authority regarding the care and treatment of MDOC inmates, control of health care personnel, and the authority to grant or deny medical care to inmates. The Regional Psychiatric Director is responsible for ensuring the provision of adequate medical care to inmates, including through the implementation of policies and the training and supervision of staff. The Regional Psychiatric Director is among those responsible for denying Ms. Hicklin medically necessary care and is sued in his official capacity.
33. On information and belief, ELIZABETH ATTERBERRY, PSY. D., (“Atterberry”) is and was at all relevant times Regional Mental Health Director of Corizon. At all relevant times, the Regional Mental Health Director has exercised, and continues to exercise, policy and decision-making authority regarding the care and treatment of MDOC inmates, control of health care personnel, and the authority to grant or deny medical care to inmates. The Regional Mental Health Director is responsible for ensuring the provision of adequate medical care to inmates, including through the implementation of policies and the training and supervision of staff. The Regional Mental Health Director is among those responsible for denying Ms. Hicklin medically necessary care and is sued in her official capacity.
34. On information and belief, KIM FOSTER, L.P.C. (“Foster”) is and was at all relevant times the Mental Health Director of PCC. On information and belief, at all relevant
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times, the Mental Health Director of PCC has exercised, and continues to exercise, policy and decision-making authority regarding the care and treatment of MDOC inmates, control of health care personnel, and the authority to grant or deny medical care to inmates. The Mental Health Director of PCC is responsible for ensuring the provision of adequate medical care to inmates and is among those responsible for denying Ms. Hicklin medically necessary care. She is sued in her official capacity.
FACTS Background on Gender Dysphoria and Its Medical Treatment and Standards of Care
35. A person’s gender identity refers to that person’s internal sense of belonging to a particular gender. It is a deeply felt, core component of a person’s identity and the most important determinant of a person’s sex.
36. Emerging research points to the influence of biological factors, most notably the role of sex differentiation in the brain, in gender identity development.
37. Everyone has a gender identity. For most people, the sex they were assigned at birth matches their gender identity. For transgender people like Ms. Hicklin, the sex they were assigned at birth does not accurately reflect their gender identity.
38. There is medical consensus that gender identity cannot be changed and attempts to change a person’s gender identity are both futile and unethical.
39. Transgender people may experience discomfort or distress caused by the discrepancy between gender identity and sex assigned at birth. Where this distress reaches a clinical level, it may support a formal diagnosis of gender dysphoria.
40. Gender dysphoria is a condition recognized in the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, Fifth ed. (2013) (“DSM- V”), and by the other leading medical and mental health professional groups,
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including the American Medical Associations and the American Psychological Association. 41. As set forth in the DSM-V, the diagnostic criteria for gender dysphoria are: a. A marked incongruence between one’s experienced/expressed gender and assigned gender, of at least six months’ duration, as manifested by at least two of the following: i. A marked incongruence between one’s experienced/expressed gender and primary and/or secondary sex characteristics (or in young adolescents, the anticipated secondary sex characteristics). ii. A strong desire to be rid of one’s primary and/or secondary sex characteristics because of a marked incongruence with one’s experienced/expressed gender (or in young adolescents, a desire to prevent the development of the anticipated secondary sex characteristics). iii. A strong desire for the primary and/or secondary sex characteristics of the other gender. iv. A strong desire to be of the other gender (or some alternative gender different from one’s assigned gender). v. A strong desire to be treated as the other gender (or some alternative gender different from one’s assigned gender). vi. A strong conviction that one has the typical feelings and reactions of the other gender (or some alternative gender different from one’s assigned gender). b. The condition is associated with clinically significant distress or impairment in social, occupational, or other important areas of functioning. 42. There is medical consensus that gender dysphoria is a serious medical condition 14

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that if not properly treated is known to cause clinical distress; debilitating depression, anxiety, mental impairment; the impulse to engage in self-surgery and self-harm; and even suicidal thoughts or acts.
43. Incarcerated transgender women like Ms. Hicklin are at a particularly high risk of engaging in self-harm, including attempts at self-surgery, when treatment is withheld.
44. Gender dysphoria often intensifies with time. The longer an individual goes without treatment, the greater the risk of severe harms to the individual’s physical and psychological health.
45. The medically recognized protocols for the treatment of gender dysphoria are set forth in the World Professional Association for Transgender Health (“WPATH”) Standards of Care for the Health of Transsexual, Transgender, and Gender-Nonconforming People (“Standards of Care”).
46. The American Psychological Association, the American Medical Association, and the Endocrine Society have recognized the Standards of Care as the authoritative articulation of professional consensus on the treatment of gender dysphoria. Courts that have considered the issue have also consistently relied on the Standards of Care.
47. The Standards of Care provide for the following treatments, some or all of which will be required, depending on the individual medical needs of the patient:
a. Changes in gender expression and role (which may involve living part time or fulltime in another gender role, consistent with one’s gender identity);
b. Hormone therapy to feminize or masculinize the body in order to reduce the distress caused by the discordance between one’s gender identity and sex assigned at birth;
c. Surgery to change primary and/or secondary sex characteristics; 15

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d. Psychotherapy (individual, couple, family, or group) for purposes such as exploring gender identity, role, and expression; addressing the negative impact of gender dysphoria and stigma on mental health; alleviating internalized transphobia; enhancing social and peer support; improving body image; or promoting resilience.
48. The Standards of Care also specifically provide that, for some people, permanent hair removal is a valid part of the treatment of gender dysphoria. A procedure can be medically necessary for some individuals, even though the same procedure may not be medically necessary for others, depending on whether the procedure is treatment for a medical condition.
49. A critical component of the treatment for gender dysphoria as prescribed by the Standards of Care is a process often referred to as the “social role transition,” which requires living in accordance’s with one’s gender identity through changes in gender expression and role, including dressing, grooming, and otherwise outwardly expressing oneself consistently with one’s gender.
50. Psychotherapy or counseling can provide support and affirmation to individuals diagnosed with gender dysphoria, but is not a substitute for treatments such as hormone therapy or social role transition where such treatments are medically necessary. Likewise, the use of antidepressants and psychotropic medications are inadequate treatments for gender dysphoria where treatments such as hormone therapy or social role transition are medically necessary.
51. Attempting to treat a person who needs hormone therapy, social role transition, or other forms of medically necessary treatment for gender dysphoria with mental health counseling alone, or in combination with psychotropic drugs, is a dangerous deviation from the Standards of
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Care that puts the person at risk of physical injury, decompensation, and death. 52. Likewise, attempting to “cure” a person of gender dysphoria by attempting to
force them to disregard their gender identity and live as their assigned gender is dangerous and unethical and puts them at substantial risk of serious harm.
53. The Standards of Care apply with equal force to persons who are incarcerated and persons who are not incarcerated, and have been endorsed by the National Commission on Correctional Healthcare and the U.S. Department of Justice National Institute of Corrections as the medically accepted standard for the treatment of inmates with gender dysphoria.
54. The Standards of Care state that a freeze-frame approach to the provision of hormone therapy to people who are incarcerated is not considered appropriate care and warn that “the consequences of . . . lack of initiation of hormone therapy when medically necessary include a high likelihood of negative outcomes such as surgical self-treatment by autocastration, depressed mood, dysphoria, and/or suicidality.”
55. The National Commission on Correctional Healthcare (“NCCHC”) recommends that the medical management of prisoners with gender dysphoria “should follow accepted standards developed by professionals with expertise in transgender health,” citing the Standards of Care. The NCCHC also explains that “policies that make treatments available only to those who received them prior to incarceration or that limit transition and/or maintenance are inappropriate and out of step with medical standards and should be avoided.”
56. The Federal Bureau of Prisons and many state and local corrections agencies administer hormone therapy to prisoners in their custody with gender dysphoria, including to prisoners who did not receive such therapy at the time of incarceration.
57. The mental health providers who have evaluated and diagnosed Ms. Hicklin with gender dysphoria, including the mental health providers at PCC employed by MDOC and
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Defendant Corizon, recognize that treatment for gender dysphoria should follow the Standards of Care and have recommended hormone therapy for Ms. Hicklin’s gender dysphoria.
58. The mental health providers who have evaluated and diagnosed Ms. Hicklin with gender dysphoria, including the mental health providers at PCC employed by MDOC and Defendant Corizon, agree that access to permanent hair removal and gender-affirming canteen items are medically necessary parts of Ms. Hicklin’s treatment. Ms. Hicklin’s Gender Dysphoria
59. Ms. Hicklin is a thirty-eight-year-old white woman, who is transgender. 60. Although Ms. Hicklin was assigned male at birth, her identity as a woman is just as valid as that of women assigned female at birth. 61. From an early age, Ms. Hicklin experienced a marked incongruence between her internal sense of her own gender and the gender to which she was assigned at birth. 62. For as long as she can remember, Ms. Hicklin has felt different and uncomfortable in her skin. She recalls feeling most comfortable when playing dress-up by wearing traditionally female clothing or playing with dolls with her sister and female classmates. She felt uncomfortable with the contact sports she was expected to pursue, including football and basketball. She has always felt that her anatomy was wrong and did not understand why she did not have the same anatomy as other women. 63. Since being incarcerated in MDOC at age 16, Ms. Hicklin has repeatedly sought treatment for the depression and anxiety caused by her gender dysphoria, but did not discover there was a “name” for her experience until recently. 64. Although she has struggled with the effects of her gender dysphoria since childhood, Ms. Hicklin has only recently been able to articulate her core identity as a woman who is transgender.
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65. In 2015, mental health providers at PCC employed by MDOC and Defendant Corizon, diagnosed Ms. Hicklin with gender dysphoria. These mental health providers have consistently recognized Ms. Hicklin as a woman.
66. Ms. Hicklin experiences severe distress and serious impairments in her daily life due to gender dysphoria. She has discomfort with her body and has experienced and continues to experience psychological and physical symptoms due to her improperly treated gender dysphoria including panic attacks, anxiety, racing heartbeat, shortness of breath, sleep disturbance, lack of appetite, headaches, and excessive sweating. Defendants’ denial of treatment has caused Ms. Hicklin to experience intrusive thoughts of cutting off her testicles.
67. Under the Standards of Care, hormone therapy and social role transition, including permanent hair removal and access to gender-affirming canteen items, are medically necessary treatments for Ms. Hicklin. Defendants’ Denial of Medically Necessary Treatment for Ms. Hicklin’s Gender Dysphoria
68. In or around early 2015, after struggling for decades with her gender identity, Ms. Hicklin came to terms with the fact that she is a transgender woman and could not suppress the fact that she is female.
69. Under PCC policy, on March 4, 2015, Ms. Hicklin submitted a Health Services Request seeking an initial evaluation for gender dysphoria. Pursuant to that request, Qualified Mental Health Professional (“QMHP”) Katherine Klein evaluated Ms. Hicklin on March 12, 2015 and March 17, 2015. After evaluation, Klein presented Ms. Hicklin’s case to MDOC’s “Treatment Team,” which referred her to Dr. Meredith Throop, a psychiatrist, for assessment.
70. On March 23, 2015, Dr. Throop conducted an assessment of Ms. Hicklin. In
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her evaluation notes, Dr. Throop states that Ms. Hicklin has identified as female since she was eight years old and documents Ms. Hicklin’s longstanding discomfort with her body and with traditionally male clothes and activities. Dr. Throop also discusses the many struggles Ms. Hicklin has faced throughout her life as a result of her gender identity. Ms. Hicklin shared that she was raised in a small town with very traditional attitudes about gender roles. She has been violently assaulted both physically and sexually due to her gender identity and lack of societal understanding and acceptance of transgender people. As a teenager, she resorted to drug use to cope with the psychological pain she suffered. At age 16, Ms. Hicklin was convicted of a drug-influenced crime and sentenced to life without the possibility of
5
parole. Ms. Hicklin also explained to Dr. Throop that she continues to face serious impairments in her daily life due to her distress with her body. She expressed a desire to transition physically, with the help of hormone treatment, and ultimately, gender-affirming surgery.
71. Based on this assessment, Dr. Throop determined that Ms. Hicklin met the diagnostic criteria set forth in the DSM-V for gender dysphoria and planned to refer her to an endocrinologist for evaluation for hormone therapy. Dr. Throop’s notes state that “Currently, hormone therapy (estrogen, testosterone blockers) is the accepted treatment for individuals with Gender Dysphoria diagnoses.”
72. Despite Dr. Throop’s assessment and plan as indicated in her notes, Ms. Hicklin was never referred to an endocrinologist, because, as Dr. Throop later learned, MDOC policy prohibited providing hormone therapy for gender dysphoric inmates who were not already receiving such therapy prior to incarceration, as evidenced by a paragraph at the
5 On information and belief, pursuant to the recently passed Missouri Senate Bill 590, Ms. Hicklin will be eligible for parole in approximately 4 years, after completing 25 years of her sentence.
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end of Dr. Throop’s evaluation notes that reads: “Addendum: Please note, that after researching DOC protocols, it was found that endocrinology consult is NOT the appropriate next step for psychiatry in the txt of Gender Dysphoria. Endocrinology consult was not requested.”
73. In addition to seeking an assessment for gender dysphoria, Ms. Hicklin filed a Petition for Change of Name in the Washington County Circuit Court to change her name from the traditionally male name given to her at birth to her current legal name, Jessica Hicklin.
74. On April 5, 2015, Ms. Hicklin submitted a 32-page request to Defendants Griffith and McKinney, laying out the Standards of Care and specifically requesting hormone treatment, gender-affirming canteen items, and body hair removal.
75. On April 22, 2015, Ms. Hicklin had a consultation with Defendant McKinney to discuss her request for hormone therapy. Defendant McKinney’s notes from that consult state that MDOC’s mental health staff had diagnosed Ms. Hicklin with gender dysphoria. Despite this diagnosis, Defendant McKinney’s notes go on to state that he “informed [Ms. Hicklin] that [Defendant] Griffith informed [Defendant McKinney] this AM that she was informed by her superiors that per discussions of [Defendant Corizon] and DOC, no plans to proceed with hormone treatment.”
76. The next day, on April 23, 2015, Ms. Hicklin began MDOC’s three-step grievance process by filing Informal Resolution Request (“IRR”) #PC-15-476, in which she reiterated her request for hormone treatment, gender-affirming canteen items, and permanent hair removal.
77. Ms. Hicklin requested that IRR #PCC-15-476 be designated as an Emergency IRR, per MDOC policy, which provides for expedited processing of IRRs “concerning matters
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that, under regular time limits would subject the offender to a substantial risk of personal injury, or cause other serious risk or irreparable harm.” Per MDOC policy, this request was referred to Defendant Griffith who denied the request to treat IRR #PCC-15-476 as an Emergency IRR.
78. Per MDOC policy, on April 27, 2015, Ms. Hicklin met with Defendant Larkin to determine whether IRR #PCC-15-476 could be resolved through discussion. During that meeting, Defendant Larkin informed Ms. Hicklin that she had received an email from Defendant Kempker stating that Ms. Hicklin would not receive hormone therapy because MDOC policy prohibited an inmate who was not on such therapy upon entering MDOC from receiving it while in MDOC. Defendant Larkin also told Ms. Hicklin that MDOC was responding solely to the request for hormones, not the request for canteen items or hair removal.
79. On April 30, 2015, Ms. Hicklin received a letter from Defendant Griffith erroneously construing Ms. Hicklin’s request for permanent hair removal and genderaffirming canteen items as non-medical and instructing Ms. Hicklin to grieve “other issues besides your medical treatment . . . as a separate complaint (IRR) from your medical concerns.” Defendant Payne was copied on this letter.
80. Based on her understanding that her request for medically necessary treatment (including electrolysis and gender-affirming canteen items) had been misconstrued as a request for hormone therapy only, on May 5, 2015, Ms. Hicklin wrote a letter to Defendant Griffith clarifying that all of the items requested in IRR #PCC-15-476 were part of the medically necessary treatment for her gender dysphoria. Ms. Hicklin also sought clarification of DOC policy as it relates to access to gender-affirming canteen items. In this letter, Ms. Hicklin noted that, pursuant to MDOC’s Offender Property Control Policy, female inmates in MDOC’s
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custody have access to the requested items. Ms. Hicklin further noted that the approved personal property list for PCC (which is designated as a men’s facility) also indicates that female inmates are allowed access to the requested items. Thus, Ms. Hicklin noted that both MDOC and PCC policy allowed her to purchase and possess the requested gender-affirming canteen items.
81. On May 12, 2015, Defendant Griffith responded to Ms. Hicklin’s letter, stating that statewide policy prevented access to the requested items and arguing that the items were not medical in nature. Yet, at the same time, Defendant Griffith also conceded that “the warden’s office is not in a position to determine what treatment(s) are medically necessary for your diagnosis. That is something you would have to discuss with your mental health/medical services professionals.” Defendant Payne was copied on this letter.
82. In addition to writing to Defendant Griffith about access to gender-affirming canteen items, Ms. Hicklin also submitted a Health Services Request specifically for permanent hair removal.
83. On May 19, 2015, Ms. Hicklin received an official denial of IRR #PC-15-476, dated April 27, 2015 and signed by Defendant Larkin, which stated that “per PCC administration, after discussion between DOC and Corizon Health representatives, there are no plans to proceed with hormone treatment.”
84. In response, Ms. Hicklin filed a second-stage grievance on May 21, 2015. In this grievance, Ms. Hicklin again clarified that her request was for medically necessary treatment in accordance with the Standards of Care, and that such treatment included not only hormone therapy, but also permanent hair removal and access to gender-affirming canteen items. She also noted that Defendants’ ongoing denial of medical necessary treatment for her gender dysphoria violated both the Standards of Care and federal constitutional law.
85. On May 27, 2015, Ms. Hicklin wrote to Defendant Larkin seeking an 23

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official response to her request for permanent hair removal. 86. Pursuant to Ms. Hicklin’s request, Defendant Larkin’s successor, Defendant
Wade, arranged a meeting between Ms. Hicklin and Defendant McKinney on June 19, 2015. Ms. Hicklin had requested that a mental health professional be present at this meeting. Despite this request, neither her therapist, Katherine Klein, nor her psychiatrist, Dr. Meredith Throop, nor any other mental health professional was present. During the meeting, Defendant McKinney stated repeatedly that the determination of medical necessity for the hair removal request would be made by Defendant Babich in consultation with Defendant Griffith.
87. On June 22, 2015, a nurse informed Ms. Hicklin that Defendant Babich had denied the request for permanent hair removal as not medically necessary. On information and belief, Defendant Babich did not evaluate Ms. Hicklin before making this determination. Additionally, on information and belief, he spoke neither to her therapist, QMHP Klein, nor her psychiatrist, Dr. Throop -- though he apparently consulted with Defendant Griffith.
88. On June 23, 2015, Ms. Hicklin filed IRR #PC-15-734 related specifically to the permanent hair removal denial. She again requested that this IRR be treated as an Emergency IRR, as provided for under MDOC policy. This request was again denied by Defendant Griffith.
89. Ms. Hicklin also stated in IRR #PC-15-734 that Defendants’ continued denial of medically necessary treatment for her gender dysphoria, including their denial of permanent hair removal specifically, has severely impaired her ability to function, leading to negative outcomes including lack of sleep, depression, lack of motivation, and inability to focus. She also stated that the continued denial of permanent hair removal causes her severe mental anguish and noted that her attempts to self-treat via shaving does not address this anguish and has instead resulted in physical injury in the form of cuts, scarring, and rashes on her body, as
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she has to shave a large part of her body regularly and with dull and ineffective razors. 90. On July 10, 2015, having not received a response within the allotted time to her
second-level grievance on IRR # PC-15-476 related to her initial request for hormones, permanent hair removal, and access to gender-affirming canteen items, Ms. Hicklin filed a Grievance Appeal, the final step in the grievance process for IRR # PC-15-476. In this appeal, Ms. Hicklin again discussed Defendants’ ongoing denial of medically necessary treatment for her gender dysphoria and the serious psychological distress this denial causes her. She noted that therapy sessions and psychotropic medications (the only treatment Defendants have provided her) are not adequate treatment for gender dysphoria. Ms. Hicklin also reiterated that Defendants’ continued denial of medically necessary treatment for her gender dysphoria violates the Standards of Care and applicable law.
91. On July 14, 2015, Ms. Hicklin received the late response to her second-step grievance for IRR # PC-15-476, dated June 7, 2015 and signed by Defendants Randolph, McKinney, and Griffith. The response reiterated that “hormone therapy will not be ordered to treat your Gender Dysphoria.” The response also instructed Ms. Hicklin to “continue to attend Mental Health appointments or seek the counseling of Mental Health staff as needed.”
92. On July 22, 2015, Ms. Hicklin received a denial of IRR #PC-15-734, the IRR she had filed regarding Defendant Babich’s denial of her permanent hair removal request. The denial was dated July 20, 2015, and signed by Defendant Wade. The denial reiterated that after meeting with Ms. Hicklin on June 19, 2015, “[Defendant] McKinney discussed your request with PCC Warden [Defendant Griffith] and [Defendant] Babich” and that Defendant Babich “confirmed” that permanent hair removal was not medically necessary.
93. In response, on July 28, 2015, Ms. Hicklin filed a second-stage grievance on IRR #PC-15-734. Again, Ms. Hicklin noted that the requested permanent hair removal was part of
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the medically necessary treatment for her gender dysphoria as set forth in the Standards of Care. 94. On or about August 26, 2015, Ms. Hicklin had her regularly scheduled meeting
with her psychiatrist, Dr. Throop. During that meeting, Ms. Hicklin discussed with Dr. Throop Defendants’ failure to provide treatment for her gender dysphoria in accordance with the Standards of Care, despite Ms. Hicklin’s repeated requests for such treatment. Ms. Hicklin also discussed her continued symptoms of gender dysphoria. The allotted time for the meeting expired before Dr. Throop had completed her examination of Ms. Hicklin, so she provided Ms. Hicklin written questions, to which Ms. Hicklin provided written answers.
95. On information and belief, around the time of this meeting, Defendants chastised Dr. Throop for following the Standards of Care by properly using female pronouns to refer to Ms. Hicklin.
96. On August 26, 2015, Ms. Hicklin received the denial of her second-step grievance on IRR #PC-15-734, related to her request for permanent hair removal. The denial was dated August 12, 2015 and was signed by Defendants Larkin, McKinney, and Payne. In response, on August 27, 2015, Ms. Hicklin filed the final grievance appeal required for this request.
97. On September 2, 2015, Ms. Hicklin wrote letters to Defendants Foster, Atterberry, Eyman, Williams, and O’Kelly, and to Mental Health Contract Monitor Page Nichols, informing them of the ongoing denial of medically necessary treatment for her gender dysphoria despite her attempts to obtain such treatment.
98. On September 8, 2015, Defendant O’Kelley responded to Ms. Hicklin informing her that “this issue and all correspondence has been forwarded to Department of Corrections Legal Department to address same.”
99. On September 24, 2015, Ms. Hicklin received a response from Defendant 26

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Williams informing her that her letter had been received and that, since she had a grievance appeal pending, she should be patient.
100. On October 30, 2015, almost two weeks beyond the allotted time, Ms. Hicklin received the final denial of IRR #PC-15-476. The response was dated October 21, 2015, and signed by Defendants Moeller and Bredeman.
101. On November 6, 2015, Ms. Hicklin wrote to Defendant Larkin, attaching the NCCHC Position Statement regarding transgender health care in correctional settings and noting where Defendants had deviated from the Position Statement in addressing Ms. Hicklin’s gender dysphoria. The Position Statement is part of a larger body of standards put forth by the NCCHC, which, on information and belief, is quoted as an authority in MDOC’s Quality Improvement Policy among others.
102. Despite knowing that Ms. Hicklin has been diagnosed with gender dysphoria by their own mental health personnel, and despite receiving multiple requests from Ms. Hicklin for medical necessary treatment of this serious medical condition, Defendants have continually withheld such treatment, exhibiting deliberate indifference to the excessive risk this denial poses to her health and safety.
103. On information and belief, Defendants have prohibited Ms. Hicklin’s mental health providers from creating a treatment plan outlining interventions sufficient to treat her gender dysphoria and have instead limited her care to psychotherapy and antianxiety medication.
104. Despite the fact that this approach violates the WPATH Standards of Care and the NCCHC Position Statement guidelines, Defendants have steadfastly maintained that Ms. Hicklin will receive no other intervention for her gender dysphoria, except psychotherapy and anti- anxiety medication.
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105. As previously noted, psychotherapy and psychotropic medications are not substitutes for treatments such as hormone therapy or social role transition where such treatments are medically necessary to treat gender dysphoria.
106. On or around December 16, 2015, Ms. Hicklin began treatment with a new psychiatrist, Dr. Evelynn Stephens, for continued care, after Dr. Throop left MDOC.
107. Ms. Hicklin’s medical records from her visits with Dr. Stephens and other mental health staff show that she continues to experience serious psychological and physical symptoms due to her improperly treated gender dysphoria, including panic attacks, anxiety, racing heartbeat, shortness of breath, sleep disturbance, lack of appetite, headaches, and excessive sweating. She also experiences intrusive thoughts of cutting off her testicles as she worries that continued testosterone exposure will cause permanent male pattern baldness. Ms. Hicklin wears her hair in a traditionally feminine style. Currently, her hair is the only part of her body that does not contribute to her dysphoria and the thought of losing her hair is extremely distressing.
108. Like QMHP Klein and Ms. Hicklin’s previous psychiatrist, Dr. Throop, on December 16, 2015, Dr. Stephens diagnosed Ms. Hicklin with gender dysphoria “with associated panic secondary to current body characteristics.” Dr. Stephens recommended that Ms. Hicklin be allowed “hair removal and hormone therapy as these are likely to greatly decrease patient’s current level of discomfort and intrusive thoughts.” Dr. Stephens has also recommended that Ms. Hicklin have access to the same self-care products as other female inmates.
109. On or around January 13, 2016, Dr. Stephens noted that “[Ms. Hicklin’s] symptoms are escalating with age given risk of male pattern baldness more likely at this time if hormone therapy not initiated. This should be taken into account when considering the time
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table for starting treatment. The patient does meet the requirements for diagnosis of gender dysphoria and has now been diagnosed by two psychiatrists.” On March 16, 2016, Dr. Stephens again noted that Ms. Hicklin was at risk for “male pattern baldness” and recommended that finasteride or dutasteride be considered to halt any noted hair loss.
110. As the foregoing paragraphs illustrate, although Defendants’ own mental health personnel have diagnosed Ms. Hicklin with gender dysphoria and have recommended that she receive medically necessary treatment for this serious medical condition, Defendants continue to refuse to provide Ms. Hicklin with such treatment.
111. Ms. Hicklin’s gender dysphoria can be effectively treated only by providing her the medically necessary treatments she requires as prescribed by the Standards of Care, namely: hormone therapy and female gender expression, including permanent hair removal and access to gender-affirming canteen items. Defendant’s continued denial of these medically necessary treatments have caused and will continue to cause her severe psychological pain and physical discomfort and puts her at continued risk of depression, anxiety, mental impairment, selfsurgery and self-harm, and suicidal thoughts or acts.
112. At all relevant times, the freeze-frame policy has been MDOC Defendants’ official policy regarding medical care for all transgender prisoners. Pursuant to the freezeframe policy, decisions regarding whether to initiate hormone therapy for transgender prisoners like Ms. Hicklin are not based on individualized assessments of each prisoner’s medical needs. Rather, hormone therapy is automatically denied to any transgender prisoner with gender dysphoria who was not receiving such therapy before entering MDOC—despite being provided for those who were.
113. As a proximate cause of the enforcement of the freeze-frame policy, Ms. Hicklin has suffered and continues to suffer irreparable harm and the deprivation of her
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constitutional rights. CLAIM FOR RELIEF COUNT I
Refusal to Provide Medically Necessary Care In Violation of the Eighth Amendment to the U.S.
Constitution (against all Defendants) 114. Ms. Hicklin incorporates paragraphs 1 through 113 as though fully set forth herein. 115. At all relevant times, Defendants knew that Ms. Hicklin has gender dysphoria, a serious medical need that jeopardizes an individual’s physical health and mental well-being when not properly treated. 116. Defendants knew that the medically accepted standards for the treatment of gender dysphoria are the Standards of Care, and that hormone therapy and social role transition, not merely psychotherapy and psychotropic drugs, are the medically necessary treatment for Ms. Hicklin’s gender dysphoria. Defendants knew that denying Ms. Hicklin hormone therapy and social role transition placed her at a substantial risk of serious harm, including depression, anxiety, mental impairment, physical self-harm, and suicide. 117. Despite this knowledge and despite Ms. Hicklin’s repeated requests for care, Defendants, while acting under color of state law, have refused to provide Ms. Hicklin with the medically necessary treatment for her gender dysphoria, in deliberate indifference to her serious medical needs, and in violation of the Eighth Amendment’s prohibition on cruel and unusual punishment. 118. Each of the Defendants has also implemented, condoned, ratified, followed, and/or enforced, and continues to implement, condone, ratify, follow, and/or enforce a policy or custom, having the force of law, of refusing requests to initiate appropriate and effective gender dysphoria treatment, irrespective of an inmate’s medical need, and providing counseling and
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psychotropic drugs alone, when each knew that this was inadequate care that placed Ms. Hicklin at substantial risk of further mental and physical distress.
119. Each of the Defendants has also failed and continues to fail to train and supervise MDOC and/or Corizon staff with respect to the proper provision of medically necessary treatment for gender dysphoria, despite knowing that gender dysphoria is a serious medical need and that failing to train and supervise staff with respect to the provision of medically necessary treatment for this serious medical need places inmates like Ms. Hicklin at substantial risk of serious mental and physical harm.
120. Defendants’ continuous denial of medically necessary care is causing and will continue to cause irreparable harm to Ms. Hicklin, including severe anxiety and distress. It also puts her at serious risk of continued irreparable harm including permanent male pattern baldness, physical self-harm, and suicidal thoughts or acts.
121. Each of the Defendants disregarded, and continues to disregard the known or obvious consequences of their actions and inactions, as set forth herein, resulting in a substantial risk of serious harm to Ms. Hicklin.
122. By failing to provide Ms. Hicklin with effective treatment for gender dysphoria while incarcerated, Defendants have deprived Ms. Hicklin of her right to medically necessary treatment guaranteed by the Eighth Amendment of the United States Constitution.
COUNT II Enforcement of the Freeze-Frame Policy in Violation of the Eighth Amendment to the U.S. Constitution (against all Defendants) 123. Ms. Hicklin incorporates paragraphs 1 through 113 as though fully set forth herein. 124. At all relevant times, decisions regarding whether to provide hormone therapy for MDOC inmates with gender dysphoria were made, and continue to be made, pursuant to
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an unconstitutional freeze-frame policy that categorically bars all transgender inmates who did not receive hormone therapy for gender dysphoria before entering MDOC from receiving such therapy while in MDOC.
125. Pursuant to the freeze-frame policy, decisions regarding whether to initiate hormone therapy for transgender prisoners like Ms. Hicklin are not based on individualized assessments of each prisoner’s medical needs.
126. Rather, hormone therapy is automatically denied to any transgender prisoner with gender dysphoria who was not receiving such therapy before entering MDOC—despite being provided for those who were.
127. The freeze-frame policy serves no legitimate governmental interest or penological purpose.
128. As a proximate cause of the enforcement of the freeze-frame policy, Ms. Hicklin has suffered and continues to suffer irreparable harm and the deprivation of her constitutional rights.
PRAYER FOR RELIEF WHEREFORE, Ms. Hicklin respectfully requests that this Court enter judgment: A. Declaring that Defendants’ refusal to provide Ms. Hicklin medically necessary care related to her gender dysphoria violates the Eighth Amendment to the Unites States Constitution; B. Declaring that the freeze-frame policy, both on its face and as applied to Ms. Hicklin, violates the Eighth Amendment to the United States Constitution; C. Entering preliminary and permanent injunctive relief requiring Defendants to provide Ms. Hicklin with medically necessary treatment for her gender dysphoria under the Standards of Care, including but not limited to hormone therapy, permanent hair removal, and
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access to gender-affirming canteen items;
D. Entering permanent injunctive relief enjoining the enforcement of the freeze-
frame policy by Defendants;
E. Awarding Ms. Hicklin costs, expenses, and reasonable attorneys’ fees pursuant
to 42 U.S.C. § 1988 and other applicable laws; and
F. Granting such other and further relief as the Court deems just and proper.
Respectfully submitted this 23rd day of February 2018.
s/ Demoya Gordon_____ 1 Demoya R. Gordon* Richard Saenz* Lambda Legal Defense & Education Fund, Inc. 120 Wall Street, Floor 19 New York, NY 10005 Tel: 212-809-8585 Fax: 212-809-0055 dgordon@lambdalegal.org rsaenz@lambdalegal.org
Marla R. Butler* Sharon E. Roberg-Perez* Rajin S. Olson* Robins Kaplan LLP 800 LaSalle Avenue 2800 LaSalle Plaza Minneapolis, MN 55402 Tel: 612-349-8500 Fax: 612-339-4181 mbutler@robinskaplan.com sroberg-perez@robinskaplan.com rolson@robinskaplan.com
Frederick A. Braunstein* Robins Kaplan LLP 399 Park Avenue Suite 3600 New York, NY 10022 Tel: 212-980-7400
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Case: 4:16-cv-01357-NCC Doc. #: 152 Filed: 02/26/18 Page: 34 of 35 PageID #: 1817 Fax: 212-980-7499 fbraunstein@robinskaplan.com Kevin L. Schriener, #35490MO Law & Schriener, LLC 141 N. Meramec Avenue Suite 314 St. Louis, MO 63105 Tel: (314) 721-7095 Fax: (314) 863-7096 kschriener@schrienerlaw.com Attorneys for Plaintiff Jessica Hicklin *Admitted pro hac vice
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CERTIFICATE OF SERVICE
On February 23, 2018, pursuant to agreement of the undersigned counsel to accept service
on behalf of their respective clients, I served the foregoing First Amended Complaint on counsel
of record as set forth below via email and the Court’s CM/ECF system. I hereby certify that I
have served the following counsel of record by email and the Court’s CM/ECF system.
D. John Sauer, # 58721MO First Assistant and Solicitor David Dean, # 67190MO Assistant Attorney General Missouri Attorney General’s Office P.O. Box 861 St. Louis, MO 63188 Tel: 314-340-7652 John.Sauer@ago.mo.gov David.Dean@ago.mo.gov
Attorneys for Defendants Anne Precythe, Dwayne Kempker, Joan Reinkmeyer, Cindy Griffith, Stan Payne, Scott O’Kelly, and Latoya Duckworth
J. Thaddeus Eckenrode, MoBar #31080 Kevin K. Peek, MoBar # 67440 Eckenrode-Maupin 11477 Olde Cabin Rd Suite 110 St. Louis, MO 63141 Tel: 314-726-6670 Fax: 314-726-2106 jte@eckenrode-law.com kkp@eckenrode-law.com
Attorneys for Defendants Corizon LLC, William McKinney, John DeGhetto, Thomas Kevin Bredeman, Diana Larkin, Kimberley S. Randolph, Daly Smith, Stormi Moeller, Ernest Graypel, Elizabeth Atterberry, and Kim Foster
s/_Richard Saenz_______
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 Case: 4:16-cv-01357-NCC Doc. #: 163 Filed: 03/30/18 Page: 1 of 4 PageID #: 1928

IN THE UNITED STATES DISTRICT COURT FOR THE EASTERN DISTRICT OF MISSOURI
EASTERN DIVISION

JESSICA HICKLIN, v.

Plaintiff,

ANNE PRECYTHE, et al.,
Defendants.

Case No. 4:16-CV-01357-NCC

PLAINTIFF’S MOTION FOR DECLARATORY RELIEF AND A PERMANENT INJUNCTION1
Pursuant to 42 U.S.C. §§ 1983 and 1988, 28 U.S.C. § 2201, and Federal Rule of Civil Procedure 65, Plaintiff Jessica Hicklin (“Plaintiff” or “Ms. Hicklin”), by and through her attorneys, hereby moves this Court to enter judgment in her favor (1) declaring that Defendants’ refusal to provide Ms. Hicklin medically necessary care related to her gender dysphoria violates the Eighth Amendment to the United States Constitution; (2) declaring that Missouri Department of Corrections’ policy, practice, custom, or usage of banning the provision of hormone therapy to any transgender inmate who was not receiving such therapy before entering MDOC (“the freezeframe policy”) violates the Eighth Amendment to the United States Constitution, both on its face and as applied to Ms. Hicklin; (3) entering permanent injunctive relief requiring all Defendants to provide Ms. Hicklin with care that her doctors deem medically necessary, including hormone therapy, permanent hair removal, and access to gender-affirming canteen items; (4) entering permanent injunctive relief enjoining the enforcement of the freeze-frame policy by all
1 As of the filing of this Motion, Defendants have not confirmed whether this Motion is unopposed.

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Defendants; and (5) awarding Ms. Hicklin costs, expenses, reasonable attorneys’ fees, and any
other relief the Court deems just and proper.
The grounds for this Motion are set forth in the accompanying Memorandum of Law,
declarations, and attached exhibits. Ms. Hicklin also respectfully refers the Court to its February
9, 2018 Memorandum and Order granting her Motion for Preliminary Injunction (Doc. 145) and
Plaintiff’s First Amended Complaint for Declaratory and Injunctive Relief (Doc. 152), filed on
February 26, 2018.
Ms. Hicklin respectfully requests oral argument on this Motion, which will assist the
Court in resolving the issues presented.
Respectfully submitted this 30th day of March 2018.
s/Demoya R. Gordon 1 Demoya R. Gordon* Richard Saenz* Lambda Legal Defense & Education Fund, Inc. 120 Wall Street, Floor 19 New York, NY 10005 Tel: 212-809-8585 Fax: 212-809-0055 dgordon@lambdalegal.org rsaenz@lambdalegal.org
Marla R. Butler* Sharon E. Roberg-Perez* Rajin S. Olson* Robins Kaplan LLP 800 LaSalle Avenue 2800 LaSalle Plaza Minneapolis, MN 55402 Tel: 612-349-8500 Fax: 612-339-4181 mbutler@robinskaplan.com sroberg-perez@robinskaplan.com rolson@robinskaplan.com
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Frederick A. Braunstein* Robins Kaplan LLP 399 Park Avenue Suite 3600 New York, NY 10022 Tel: 212-980-7400 Fax: 212-980-7499 fbraunstein@robinskaplan.com Kevin L. Schriener, #35490MO Law & Schriener, LLC 141 N. Meramec Avenue Suite 314 St. Louis, MO 63105 Tel: (314) 721-7095 Fax: (314) 863-7096 kschriener@schrienerlaw.com Attorneys for Plaintiff Jessica Hicklin *Admitted pro hac vice
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CERTIFICATE OF SERVICE
IT IS HEREBY CERTIFIED that service of the foregoing Plaintiff’s Motion for
Declaratory Relief and a Permanent Injunction was made on March 30, 2018 via the Court’s
CM/ECF system to:
D. John Sauer, # 58721MO First Assistant and Solicitor David Dean, # 67190MO Assistant Attorney General Missouri Attorney General’s Office P.O. Box 861 St. Louis, MO 63188 Telephone: (314) 340-7652 Facsimile: (314) 340-7029 John.Sauer@ago.mo.gov David.Dean@ago.mo.gov
Attorneys for Anne Precythe, Joan Reinkmeyer, Cindy Griffith, Stan Payne, Scott O’Kelly, and Latoya Duckworth
J. Thaddeus Eckenrode, MoBar #31080 Eckenrode-Maupin 11477 Olde Cabin Rd Suite 110 St. Louis, MO 63141 Tel: 314-726-6670 Fax: 314-726-2106 jte@eckenrode-law.com kkp@eckenrode-law.com
Attorneys for Corizon LLC, William McKinney, John Deghetto, Thomas Kevin Bredeman, Diana Larkin, Kimberley S. Randolph, Daly Smith, Stormi Moeller, Ernest Graypel, Elizabeth Atterberry, and Kim Foster
__s/_Demoya R. Gordon_____________________
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 Case: 4:16-cv-01357-NCC Doc. #: 164 Filed: 03/30/18 Page: 1 of 21 PageID #: 1932

IN THE UNITED STATES DISTRICT COURT FOR THE EASTERN DISTRICT OF MISSOURI
EASTERN DIVISION

JESSICA HICKLIN, v.

Plaintiff,

ANNE PRECYTHE, et al.,
Defendants.

Case No. 4:16-CV-01357-NCC

MEMORANDUM OF LAW IN SUPPORT OF PLAINTIFF’S MOTION FOR DECLARATORY RELIEF AND A PERMANENT
INJUNCTION

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TABLE OF CONTENTS
TABLE OF CONTENTS……………………………………………………………………..i TABLE OF AUTHORITIES…………………………………………………………………ii INTRODUCTION…………………………………………………………………………….1 STATEMENT OF UNCONTROVERTED FACTS………………………………………….2 ARGUMENT………………………………………………………………………………….7 I. Defendants Violated the Eighth Amendment by Knowingly Disregarding Ms. Hicklin’s
Serious Medical Needs……………………………………………………………………8 A. Defendants Failed to Provide Ms. Hicklin Medically Necessary Hormone Therapy
Pursuant to the Freeze-Frame Policy, Which is Unconstitutional on Its Face and As Applied to Ms. Hicklin………………………………………………………...……8 1. Ms. Hicklin’s gender dysphoria and risk of self-harm are objectively serious medical needs………………………………………………………………………9 2. Defendants knew of Ms. Hicklin’s serious medical needs but disregarded them by denying her hormone therapy pursuant to the freeze-frame policy……………….10 B. Defendants’ Refusal to Provide Ms. Hicklin Access to Permanent Body Hair Removal and Gender-Affirming Canteen Items Also Violated the Eighth Amendment…………………………………………………………………………12 II. This Court Should Declare Defendants’ Actions Unconstitutional and Permanently Enjoin Them from Withholding Medically Necessary Gender Dysphoria Treatments from Ms. Hicklin and from Enforcing the Freeze-Frame Policy…………………………………………………...………………………………..12 CONCLUSION……………………………………………………………………………...15
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TABLE OF AUTHORITIES
Alexander v. Weiner, 841 F. Supp. 2d 486 (D. Mass. 2012)....................................................................................... 12
Allard v. Gomez, 9 F. App’x 793 (9th Cir. 2001)................................................................................................. 11
Alsager v. Dist. Ct. of Polk Cnty., 518 F.2d 1161 (8th Cir. 1975) .............................................................................................. 7, 13
Amos v. Higgins, 996 F. Supp. 2d 810 (W.D. Mo. 2014)..................................................................................... 14
Bank One, Utah v. Guttau, 190 F.3d 844 (8th Cir. 1999) .......................................................................................... 8, 13, 14
Barrett v. Coplan, 292 F. Supp. 2d 281 (D.N.H. 2003) ................................................................................... 11, 15
Battista v. Clarke, 645 F.3d 449 (1st Cir. 2011) .................................................................................................... 10
Brown v. Plata, 563 U.S. 493 (2011), ................................................................................................................ 13
Coleman v. Rahija, 114 F.3d 778 (8th Cir. 1997) ...................................................................................................... 8
De’lonta v. Angelone (De’lonta I), 330 F.3d 630 (4th Cir. 2003) .............................................................................................. 10, 11
De’lonta v. Johnson (De’lonta II), 708 F.3d 520 (4th Cir. 2013) .................................................................................................... 11
DePaola v. Clarke, No. 16-7360, 2018 WL 1219611 (4th Cir. Mar. 9, 2018) .......................................................... 8
Elrod v. Burns, 427 U.S. 347 (1976)…………………………………………………………………………..14
Estelle v. Gamble, 429 U.S. 97, 104 (1976) ................................................................................................. 9, 10, 11
Fields v. Smith, 712 F. Supp. 2d 830 (E.D. Wis. 2010), aff’d, 653 F.3d 550 (7th Cir. 2011) ................. 9, 11, 13
Friends of the Earth v. Laidlaw Envt’l Servs., Inc., 528 U.S. 167 (2000) ................................................................................................................. 13
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Gammett v. Idaho State Bd. of Corr., No. CV05-257-S-MHW 2007 WL 2186896 (D. Idaho July 27, 2007).................................... 15
Gordon ex rel. Gordon v. Frank, 454 F.3d 858 (8th Cir. 2006) .................................................................................................... 10
Helling v. McKinney, 509 U.S. 25 (1993) ..................................................................................................................... 9
Hicklin v. Precynthe, No. 4:16-CV-01357-NCC, 2018 WL 806764 (E.D. Mo. Feb. 9, 2018) ........................... passim
Houston v. Trella, No. 2:04-cv-1393, 2006 WL 2772748 (D.N.J. Sept. 22, 2006) ............................................... 11
Langford v. Norris, 614 F.3d 445 (8th Cir. 2010) .................................................................................................... 11
Layton v. Elder, 143 F.3d 469 (8th Cir. 1998) .............................................................................................. 14, 15
Konitzer v. Frank, 711 F. Supp. 2d 874 (E.D. Wis. 2010) ..................................................................................... 12
Melendres v. Arpaio, 695 F.3d 990 (9th Cir. 2012) .................................................................................................... 15
Mental Health Ass’n of Minn. v. Heckler, 720 F.2d 965 (8th Cir. 1983) .................................................................................................... 13
Nelson v. Corr. Med. Servs., 583 F.3d 522 (8th Cir. 2009) ...................................................................................................... 8
Norsworthy v. Beard, 87 F. Supp. 3d 1164 (N.D. Cal. 2015)................................................................................ 14, 15
Phelps-Roper v. Nixon, 545 F.3d 685 (8th Cir. 2008) .................................................................................................... 15
Phillips v. Mich. Dep't of Corr., 731 F. Supp. 792 (W.D. Mich. 1990), aff’d, 932 F.2d 969 (6th Cir. 1991) ....................... 10, 15
Soneeya v. Spencer, 851 F. Supp. 2d 228 (D. Mass. 2012)....................................................................... 9, 10, 11, 12
White v. Farrier, 849 F.2d 322 (8th Cir. 1988) ...................................................................................................... 9
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INTRODUCTION In its February 9, 2018 Memorandum and Order (Doc. 145)1, this Court thoroughly analyzed the evidence and the applicable law and concluded that Ms. Hicklin was likely to succeed on the merits, Ms. Hicklin faced irreparable harm due to Defendants’ denial of medically necessary gender dysphoria treatment, and both the balance of harms and the public interest favored Ms. Hicklin. Hicklin v. Precynthe, No. 4:16-CV-01357-NCC, 2018 WL 806764, at *9-14 (E.D. Mo. Feb. 9, 2018). Since filing her preliminary injunction motion, Ms. Hicklin has unearthed additional evidence that decisively moves her success on the merits from likely to actual. This evidence shows that, despite knowing Ms. Hicklin faced a substantial risk of serious harm without adequate treatment, Defendants Missouri Department of Corrections (“MDOC”) and its private medical contractor, Corizon LLC (“Corizon”) (collectively, “Defendants”) repeatedly failed to provide her with medically necessary hormone therapy, permanent body hair removal, and gender-affirming canteen items, contrary to the recommendations of her psychiatrists. The evidence also shows conclusively that Defendants failed to provide Ms. Hicklin with hormone therapy based on MDOC’s unconstitutional blanket administrative policy, practice, custom, or usage of banning the provision of hormone therapy to any transgender inmate who was not receiving such therapy before entering MDOC (“the freeze-frame policy”). The Court’s previous findings, combined with Ms. Hicklin’s Amended Complaint (Doc. 152) and the newly discovered evidence, warrant a declaration that the freeze-frame policy is unconstitutional on its face and as applied to Ms. Hicklin and that Defendants’ failure to provide Ms. Hicklin with medically necessary gender dysphoria treatment violates the Eighth
1 Hereinafter “the 2/9/18 Order.”
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Amendment. The evidence and applicable law also warrant entry of a permanent injunction directing Defendants to provide Ms. Hicklin with care that her doctors deem medically necessary (including hormone therapy, access to permanent body hair removal, and access to genderaffirming canteen items) and enjoining Defendants from enforcing the freeze-frame policy.
STATEMENT OF UNCONTROVERTED FACTS The following uncontroverted facts, and the facts set forth in Plaintiff’s briefing in Support of her Motion for Preliminary Injunction (Docs. 64 and 70) and the 2/9/18 Order,2 illustrate the need for declaratory relief and a permanent injunction in this case. I. PLAINTIFF JESSICA HICKLIN’S GENDER DYSPHORIA DIAGNOSIS 1. Ms. Hicklin is a transgender woman in the custody of the Missouri Department of Corrections (“MDOC”) housed at Potosi Correctional Center, a facility for male inmates. Doc. 152 at ¶ 1. 2. Ms. Hicklin suffers from gender dysphoria (previously known as gender identity disorder or transsexualism), a medical condition characterized by clinically significant distress due to the incongruence between a person’s gender identity—their innate sense of their own gender—and the sex they were assigned at birth. Doc. 64-4 at 2-4 (March 2015 diagnosis by Corizon psychiatrist Dr. Meredith Throop); Doc. 64-6 at 4-6 (Dec. 2015 diagnosis by Corizon psychiatrist Dr. Evelynn Stephens); Doc. 64-1 at ¶¶ 12-13; Doc. 154 at ¶ 8; Doc. 158 at ¶ 8. 3. Ms. Hicklin has exhibited symptoms of severe gender dysphoria, including recurring intrusive thoughts of removing her testicles. Doc. 64-1 at ¶ 60.
2 Ms. Hicklin hereby incorporates by reference all facts set forth in Docs. 64, 70, and 145. 2

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II. GENDER DYSPHORIA AND THE STANDARDS OF CARE 4. Gender dysphoria appears in the American Psychiatric Association’s Diagnostic
and Statistical Manual of Mental Disorders, Fifth Edition. Doc. 64-1 at ¶ 12. 5. Gender dysphoria is an objectively serious medical need. Doc. 83 at 24; Doc. 145
at 21. 6. Individuals with untreated gender dysphoria experience clinically significant
depression, anxiety, and mental impairment, and, when left untreated, additional serious medical problems including suicidality and the compulsion to engage in self-castration and self-harm. Doc. 64-1 at ¶¶ 15-16; Excerpted Transcript of Deposition of Corizon’s 30(b)(6) Representative (“Corizon 30(b)(6) Depo.”) 3 at 6:19-7:1, 95:2-96:4, 99:6-100:12, 102:7-103:12, 103:15-18; Gordon Decl. Ex. B, Excerpted Transcript of Deposition of Elizabeth Atterberry, Corizon’s Regional Mental Health Director (“Atterberry Depo.”) at 11:4-7, 147:19-149:2.
7. The World Professional Association for Transgender Health’s Standards of Care for the Health of Transsexual, Transgender, and Gender-Nonconforming People (the “Standards of Care”) are “the internationally recognized guidelines for the treatment of persons with gender dysphoria.” Doc. 64-1 at ¶ 18. Numerous professional medical organizations, including the American Medical Association, the American Psychological Association, the American Psychiatric Association, and the National Commission on Correctional Health Care, endorse the Standards of Care. Id. at ¶ 19. The Standards of Care explicitly state that they are equally applicable to patients in prison. Id. at ¶¶ 23-24; Gordon Decl. Ex. C, Excerpted Standards of Care, at PL000712-13.
3 Attached as Ex. A to Declaration of Demoya R. Gordon (“Gordon Decl.”). 3

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8. Under the Standards of Care, persons with gender dysphoria should be individually assessed by qualified health care providers and referred for treatment, which can include: (1) living in another gender role that is consistent with one’s gender identity; (2) hormone therapy to feminize or masculinize the body; and/or (3) surgery to change primary and/or secondary sex characteristics. Doc. 64-1 at ¶¶ 20-21.
9. Changes in gender expression, including clothing and grooming that affirm one’s gender identity and permanent body hair removal, are significant in alleviating gender dysphoria. Id. at ¶¶ 26-27; see also Doc. 70-10 (National Commission on Correctional Health Care Position Statement on Transgender Health Care in Correctional Settings (“NCCHC Position Statement”) stating that commissary items consistent with an individual’s gender identity should be made available).
10. Hormone therapy is fundamental to the treatment of gender dysphoria, and the denial of hormone therapy for patients for whom such therapy is medically necessary leads to significant deterioration and impairment in patients, including a high likelihood of depression, suicidal ideation, and surgical self-treatment by auto-castration (removal of the testicles) or autopenectomy (removal of the penis). Doc. 64-1 at ¶¶ 28-33.
11. Counseling can provide support for some individuals with gender dysphoria, but it is not a substitute for medical intervention. Id. at ¶ 35. Merely providing counseling and/or psychotropic medication to a severely gender dysphoric patient is a significant departure from medically accepted practice. Id. at ¶ 36. Inadequate treatment of this condition puts an individual at serious risk of psychological and physical harm. Id.
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III. THE FREEZE-FRAME POLICY 12. At all relevant times prior to the 2/9/18 Order, MDOC maintained and enforced
the freeze-frame policy. Doc. 77 (Hicklin v. Lombardi 00616); Gordon Decl. Ex. D, Excerpted Deposition of Matt Sturm, MDOC’s Deputy Director (“Sturm Depo.”) at 26:24-27:1, 81:13-24, 99:7-21, 132:9-133:6, 145:4-149:1; Corizon 30(b)(6) Depo. at 105:14-106:5, 108:5-23, 113:1114:9, 143:1-11; Gordon Decl. Ex. E, MDOC Defendants’ Responses to Plaintiff’s Second Set of Requests for Admissions (“MDOC 2d RFA Responses”), Nos. 4-6.
13. Pursuant to the freeze-frame policy, decisions regarding whether to initiate hormone therapy for transgender prisoners like Ms. Hicklin are not based on individualized assessments of each prisoner’s medical needs. Doc. 77; Sturm Depo. at 81:13-24, 99:7-21, 132:9-133:6. Instead, hormone therapy is automatically denied to any transgender prisoner with gender dysphoria who was not receiving such therapy before entering MDOC—despite being provided for those who were receiving such therapy prior to entering MDOC. Doc. 152 at ¶¶6, 112; Doc. 77; Sturm Depo. at 81:13-24, 99:7-21, 132:9-133:6, 145:4-149:1; Gordon Decl. Ex. F, MDOC’s Second Supplemental Response to Interrogatory No. 16; Corizon 30(b)(6) Depo. at 108:5-23, 143:1-11; Atterberry Depo. at 32:24-33:7.
14. The Standards of Care state that a freeze-frame approach is not considered appropriate care and warn that “the consequences of . . . lack of initiation of hormone therapy when medically necessary include a high likelihood of negative outcomes such as surgical selftreatment by auto-castration, depressed mood, dysphoria, and/or suicidality.” Doc. 64-1 at ¶ 70; see also Doc. 70-10 (NCCHC Position Statement stating that freeze-frame policies are “out of step with medical standards and should be avoided”).
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IV. DEFENDANTS’ FAILURE TO PROVIDE MEDICALLY NECESSARY GENDER DYSPHORIA TREATMENT FOR MS. HICKLIN
15. Corizon psychiatrists Dr. Meredith Throop and Dr. Evelynn Stephens diagnosed Ms. Hicklin with gender dysphoria and prescribed medically necessary hormone therapy for her in 2015. Doc. 64-4 at 2-4; Doc. 64-6 at 4-6, 21; see also Doc 64-1 at ¶ 75. Yet, for almost three years, Defendants failed to provide hormone therapy for Ms. Hicklin due to the freeze-frame policy. See Doc. 64-6 at 17, 21 (Dr. Stephens’s notes referencing the freeze-frame policy as the basis for the denial of hormone therapy for Ms. Hicklin); Doc 64-6 at 30-31; Gordon Decl. Ex. G at GF 0107, 127; Gordon Decl. Ex. H at Hicklin v. Lombardi 00911-912, 00941-945; Sturm Depo. at 81:13-24, 99:7-21, 132:9-133:6, 145:4-149:1, 154:24-157:3, 160:10-164:25, 172:4-9, 173:15-175:11, 179:2-184:1; MDOC 2d RFA Responses, Nos. 4-6.
16. Without conducting an individualized evaluation of Ms. Hicklin, Defendants also failed to provide her access to medically necessary permanent body hair removal and genderaffirming canteen items (i.e., canteen items made available to other female inmates), contrary to the recommendations of her current treating psychiatrist Dr. Stephens, gender dysphoria expert Dr. Randi Ettner, and the Standards of Care. Doc. 64-6 at 6, 15, 31-32; Doc. 64-1 at ¶ 77; Ex. G at GF 0046, 0151, 0155; Docs. 114-12, 114-16, 114-18, 114-20, 114-21, 114-22, 114-23, 11430; Gordon Decl. Exs. I, J, K.
17. Both Dr. Throop and Dr. Stephens have noted that neglecting to treat Ms. Hicklin in accordance with the Standards of Care put her at risk of serious harm. See, e.g., Doc. 64-4 at 11 (noting denial of treatment in accordance with the Standards of Care as “detrimental currently to [her] mental/emotional/psychiatric well-being”); Doc. 64-6 at 10 (noting escalating symptoms), 34-36 (noting “overwhelming sense of dread” and “increased agitation [and] self
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harm [sic] thoughts”), Doc. 98-2 (noting worsening anxiety, increased gender dysphoria symptoms, and thoughts of self-harm).
18. Medical records show that lack of appropriate treatment for gender dysphoria caused Ms. Hicklin to experience serious psychological and physical symptoms (including panic attacks, anxiety, racing heartbeat, shortness of breath, sleep disturbance, lack of appetite, headaches, and excessive sweating) and put her at substantial risk of self-harm, including autocastration and suicidal thoughts or acts. Doc. 64-6 at 2-6, 17-18, 33-40; Doc. 68-8 at 5, 12; Doc. 88-2; Doc 98-2; Gordon Decl. Ex. L at EM1319, 1363-64, 1370-71; Gordon Decl. Ex. M, Excerpted Transcript of Deposition of Jessica Hicklin at 21:18-23:21, 39:11-21; see also Doc. 64-1 at ¶¶ 46, 52, 54, 59; Doc. 152 at ¶¶ 66, 107; Doc 145 at 18-19.
19. The documents and testimony produced in discovery do not support denying medically necessary gender dysphoria treatment based on cost, safety, or any other reason. See, e.g., Sturm Depo. at 145:4-149:1, 172:4-9; Ex. H at Hicklin v. Lombardi 00913-14, 00925-26, 00946-47, 00957-58, 05592-93; Corizon 30(b)(6) Depo. at 105:14-106:5, 113:1-114:9; Gordon Decl. Ex. N, Excerpted Deposition of Vevia Sturm, MDOC’s PREA Coordinator, at 55:22-57:7; Doc. 145 at 27-29; Doc. 154 at ¶ 6; Doc. 158 at ¶ 6.
ARGUMENT “The two principal criteria guiding the policy in favor of rendering declaratory judgments,” namely “(1) when the judgment will serve a useful purpose in clarifying and settling the legal relations in issue, and (2) when it will terminate and afford relief from the uncertainty, insecurity, and controversy giving rise to the proceedings,” are present here. See Alsager v. Dist. Court of Polk Cty., 518 F.2d 1161, 1163-64 (8th Cir. 1975) (internal citations omitted). Moreover, Ms. Hicklin’s motion for permanent injunction meets all four factors considered in
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the Eighth Circuit: (1) actual success on the merits; (2) threat of irreparable harm; (3) the harm to the movant outweighs any possible harm to others; and (4) an injunction serves the public interest. See Bank One, Utah v. Guttau, 190 F.3d 844, 847 (8th Cir. 1999). These factors are identical to those required for preliminary injunction, except that success on the merits must be actual instead of likely. Id.
As discussed in more detail below, the evidence establishes that Defendants’ actions violated the Eighth Amendment. Thus, this Court should so declare and should permanently enjoin Defendants from withholding medically necessary gender dysphoria treatments from Ms. Hicklin or enforcing the freeze-frame policy. I. Defendants Violated the Eighth Amendment by Knowingly Disregarding Ms.
Hicklin’s Serious Medical Needs. Despite knowing that Ms. Hicklin has serious medical needs, Defendants disregarded those needs by failing to provide her with medically necessary hormone therapy pursuant to an unconstitutional freeze-frame policy and by denying her medically necessary gender-affirming canteen items and permanent body hair removal—all in violation of the Eighth Amendment. A. Defendants Failed to Provide Ms. Hicklin Medically Necessary Hormone
Therapy Pursuant to the Freeze-Frame Policy, Which is Unconstitutional on Its Face and As Applied to Ms. Hicklin. “Under the Eighth Amendment, prisoners have the right to receive adequate medical care while incarcerated.” DePaola v. Clarke, No. 16-7360, 2018 WL 1219611, at *3 (4th Cir. Mar. 9, 2018). An incarcerated plaintiff can establish an Eighth Amendment violation by showing that “she had an objectively serious medical need and that the defendant knew of and disregarded that need.” Coleman v. Rahija, 114 F.3d 778, 784 (8th Cir. 1997) (citations omitted); see also Nelson v. Corr. Med. Servs., 583 F.3d 522, 529 (8th Cir. 2009). Both requirements are met here.
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There is no question that Ms. Hicklin suffers from an objectively serious medical condition—namely, her gender dysphoria—and the evidence shows that “Defendants [have been] deliberately indifferent to her serious medical need.” See Hicklin, 2018 WL 806764, at *11. Moreover, because the freeze-frame policy at issue fails by its very nature to account for the individual medical needs of transgender prisoners who suffer from the well-recognized serious medical condition of gender dysphoria, it violates the Eighth Amendment both on its face and as applied to Ms. Hicklin. See Soneeya v. Spencer, 851 F. Supp. 2d 228, 242 (D. Mass. 2012).
1. Ms. Hicklin’s gender dysphoria and risk of self-harm are objectively serious medical needs. An incarcerated person meets the objective requirement of the deliberate indifference standard by showing the existence of a serious medical need, Estelle v. Gamble, 429 U.S. 97, 104 (1976), or a substantial risk of future serious harm resulting from the action or inaction of prison officials, Helling v. McKinney, 509 U.S. 25, 35 (1993). Here, Ms. Hicklin has established both a serious medical need—serious psychological and physical symptoms of distress from untreated gender dysphoria—and a substantial risk of future serious harm—ongoing anguish, autocastration, and possibly suicide—if her medically necessary treatment is withheld. See Statement of Uncontroverted Facts, supra (“SUF”), at ¶¶ 3, 5, 6, 11, 14, 17, 18. Two separate psychiatrists diagnosed Ms. Hicklin with gender dysphoria and noted that she required specific treatment, including hormone therapy, in order to treat her condition. SUF ¶¶ at 2, 15. Defendants do not contest that Ms. Hicklin’s gender dysphoria is a serious medical need (Doc. 83 at 24). Nor could they, as courts have routinely held that a diagnosis of gender dysphoria alone may constitute a serious medical need. See Hicklin, 2018 WL 806764, at *10; see also White v. Farrier, 849 F.2d 322, 325 (8th Cir. 1988); Fields v. Smith, 712 F. Supp. 2d 830, 862 (E.D. Wis. 2010), aff’d, 653 F.3d 550 (7th Cir. 2011); Phillips v. Mich. Dep't of Corr.,
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731 F. Supp. 792, 800 (W.D. Mich. 1990), aff’d, 932 F.2d 969 (6th Cir. 1991) (same). Moreover, as this Court has already found, Ms. Hicklin’s gender dysphoria is especially severe. Hicklin, 2018 WL 806764, at *10.
Additionally, deprivation of medically necessary hormone therapy, permanent body hair removal, and gender-affirming canteen items places Ms. Hicklin at a very high risk of resorting to self-harm. SUF ¶¶ 3, 6, 10, 11, 14, 17, 18. Indeed, the record “indicates that Ms. Hicklin is at significant risk of self-harm and has attempted on one occasion to remove her own testicles with a tourniquet.” Hicklin, 2018 WL 806764, at *10. Moreover, her medical records show that lack of appropriate treatment for gender dysphoria caused her to experience serious psychological and physical symptoms and put her at substantial risk of self-harm, including auto-castration and suicidal thoughts or acts. SUF at ¶¶ 17, 18. Thus, the evidence establishes that Ms. Hicklin’s gender dysphoria and risk of self-harm are objectively serious needs. See De’lonta v. Angelone (“De’lonta I”), 330 F.3d 630, 634 (4th Cir. 2003) (internal citation omitted); Soneeya, 851 F. Supp. 2d at 244-52 (incarcerated plaintiff with gender identity disorder and history of suicide attempts and self-mutilation has a serious medical condition).
2. Defendants knew of Ms. Hicklin’s serious medical needs but disregarded them by denying her hormone therapy pursuant to the freezeframe policy. To prevail on the subjective prong of the deliberate indifference test, Ms. Hicklin need only show that Defendants “disregard[ed] a known risk to [her] health.” See Gordon ex rel. Gordon v. Frank, 454 F.3d 858, 862 (8th Cir. 2006). “Knowledge of risk may be inferred from the record.” Id. This indifference is impermissible “whether . . . manifested by prison doctors in their response to the prisoner’s needs or by prison guards in intentionally denying or delaying access to medical care or intentionally interfering with the treatment once prescribed.” Estelle, 429 U.S. at 104-05; see also Battista v. Clarke, 645 F.3d 449 (1st Cir. 2011).
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“Ms. Hicklin has presented compelling evidence that Defendants’ refusal to provide her with hormone therapy after her diagnosis is based on the Policy rather than on a medical judgment concerning Ms. Hicklin’s specific circumstances.” Hicklin, 2018 WL 806764, at *11. Defendants are aware of and do not contest Ms. Hicklin’s gender dysphoria diagnosis and they have knowledge of her escalating distress, anxiety, and thoughts of self-harm as a result of their failure to provide her adequate care. SUF at ¶¶ 2, 3, 6, 17, 18. Despite this knowledge, before this Court entered the preliminary injunction, Defendants failed to provide Ms. Hicklin medically necessary treatment for her gender dysphoria, including hormone therapy, even as their own mental health professionals repeatedly warned them of the serious risks posed to Ms. Hicklin by this continued denial.4 SUF at ¶¶ 15-17.
Moreover, the evidence shows that the freeze-frame policy, which requires automatic denial of hormone therapy to any transgender inmate who was not receiving it before entering MDOC, formed the basis of Defendants’ failure to provide hormone therapy for Ms. Hicklin. SUF at ¶¶ 12, 13, 15. “The denial of hormone therapy based on a blanket rule, rather than an individualized medical determination, constitutes deliberate indifference in violation of the Eighth Amendment.” Hicklin, 2018 WL 806764, at *11. See also Fields, 653 F.3d at 559; De’lonta I, 330 F.3d at 634-35; Allard v. Gomez, 9 F. App’x 793, 795 (9th Cir. 2001); Soneeya, 851 F. Supp. 2d at 249, 253; Houston v. Trella, No. 2:04-cv-1393, 2006 WL 2772748, at *8 (D.N.J. Sept. 22, 2006); Barrett v. Coplan, 292 F. Supp. 2d 281, 286 (D.N.H. 2003). This is
4 It is immaterial that Defendants provided Ms. Hicklin psychotherapy and psychotropic medications; prison officials may not avoid liability by adopting an “easier and less efficacious treatment” that does not adequately address an incarcerated individual’s serious medical needs. Estelle, 429 U.S. at 103-06; Langford v. Norris, 614 F.3d 445, 460 (8th Cir. 2010) (“a total deprivation of care is not a necessary condition for finding a constitutional violation”); see also De’lonta v. Johnson (De’lonta II), 708 F.3d 520, 526 (4th Cir. 2013); Fields, 653 F.3d at 556; Soneeya, 851 F. Supp. 2d at 246-50.
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because “[a]dequate care is based on an individualized assessment of an inmate’s medical needs in light of relevant medical considerations.” Soneeya, 851 F. Supp. 2d at 242. Additionally, such policies serve no legitimate governmental interest or penological purpose. See Hicklin, 2018 WL 806764, at *14. Thus, by their very nature, blanket policies like the freezeframe policy at issue are facially unconstitutional under the Eighth Amendment.
B. Defendants’ Refusal to Provide Ms. Hicklin Access to Permanent Body Hair Removal and Gender-Affirming Canteen Items Also Violated the Eighth Amendment. In line with the Standards of Care, and based on their own individualized assessments of Ms. Hicklin, Ms. Hicklin’s psychiatrist Dr. Stephens, and gender dysphoria expert Dr. Randi Ettner, both determined that access to permanent hair removal and gender-affirming canteen items are medically necessary for Ms. Hicklin. SUF at ¶ 16; see also id. at ¶¶ 8-9. Yet, without conducting an individualized evaluation, Defendants failed to provide her access to these items based on unfounded assertions that they are not medically necessary. Id. As this Court has concluded, “[t]he case law is clear – ‘gender-affirming’ canteen items and permanent hair removal are not merely cosmetic treatments but, instead, medically necessary treatments to address a serious medical disease.” Hicklin, 2018 WL 806764, at *12. Thus, Defendants’ refusal to provide Ms. Hicklin these items, despite know that doing so placed her at substantial risk of serious harm, constitutes deliberate indifference in violation of the Eighth Amendment. See, e.g., Alexander v. Weiner, 841 F. Supp. 2d 486, 493 (D. Mass. 2012); Soneeya, 851 F. Supp. 2d at 246-48; Konitzer v. Frank, 711 F. Supp. 2d 874, 909-11 (E.D. Wis. 2010). II. This Court Should Declare Defendants’ Actions Unconstitutional and Permanently Enjoin Them from Withholding Medically Necessary Gender Dysphoria Treatments from Ms. Hicklin and from Enforcing the Freeze-Frame Policy. Because Defendants’ actions and policy have violated the Eighth Amendment, this Court should declare their unconstitutionality and permanently enjoin them. While Defendants have
12

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stated that they are complying and intend to continue complying with the 2/9/18 Order and will no longer enforce the freeze-frame policy (Doc. 153 at 3:9-13; 4:24-5:9; 7:6-19), declaratory and injunctive relief are nevertheless warranted because Defendants could later reinstate the unconstitutional freeze-frame policy and withdraw Ms. Hicklin’s medically necessary gender dysphoria treatment. See Friends of the Earth, Inc. v. Laidlaw Envtl. Servs., Inc., 528 U.S. 167, 189 (2000) (a defendant’s voluntary cessation of a challenged practice ordinarily does not deprive a federal court of its power to determine the practice’s legality). Declaring Defendants’ failure to provide Ms. Hicklin medically necessary gender dysphoria care and their application of the freeze-frame policy (generally and to Ms. Hicklin specifically) unconstitutional would both settle the legal relations in issue and provide Ms. Hicklin—and other similarly situated inmates—relief from the uncertainty, insecurity, and controversy surrounding this issue in MDOC’s prison system. See Alsager, 518 F.2d at 1163-64.
Moreover, Ms. Hicklin has met all four factors required for this Court to issue a permanent injunction directing Defendants to provide Ms. Hicklin with care that her doctors deem medically necessary and enjoining the enforcement of the freeze-frame policy. See Bank One, 190 F.3d at 847; see also Brown v. Plata, 563 U.S. 493, 531-32 (2011) (the scope of an order is determined by the constitutional violations established); Fields, 653 F.3d at 559 (affirming injunction of facially unconstitutional hormone therapy ban); Mental Health Ass’n of Minn. v. Heckler, 720 F.2d 965, 972 (8th Cir. 1983) (courts can provide equitable relief commensurate to the scope of the harm).
First, Ms. Hicklin has established actual success on the merits because discovery has revealed that the material facts in this case are uncontroverted and that Ms. Hicklin should prevail as a matter of law. See Bank One, 190 F.3d at 847-50 (movant established actual success
13

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on the merits where there were no disputed facts and the movant was entitled to prevail on the legal questions); Amos v. Higgins, 996 F. Supp. 2d 810, 812-14 (W.D. Mo. 2014). Specifically, as discussed in Section I, supra, the evidence shows that Defendants knew of Ms. Hicklin’s serious medical needs and yet disregarded those needs by failing to provide her with medically necessary hormone therapy pursuant to a facially unconstitutional freeze-frame policy and by denying her medically necessary gender-affirming canteen items and permanent body hair removal. Therefore, this Court should find that Ms. Hicklin has established actual success on the merits.
Second, once a party has demonstrated actual success on the merits, the three remaining factors the Court must consider are identical to that required for a preliminary injunction: (1) the threat of irreparable harm to the movant; (2) the harm to be suffered by the nonmoving party if the injunction is granted; and (3) the public interest at stake. See, e.g., Bank One, 190 F.3d at 847. This Court has already concluded based on the preliminary injunction record that all three of these factors weigh in Ms. Hicklin’s favor. Hicklin, 2018 WL 806764, at *9-10, 13-14. Additional discovery conducted since Ms. Hicklin filed that motion has only strengthened that conclusion.
The evidence establishes that Ms. Hicklin remains at serious risk of irreparable harm should Defendants withdraw her medically necessary gender dysphoria treatments or continue to enforce the freeze-frame policy. SUF at ¶¶ 3, 6, 9-11, 14, 17, 18. See, e.g., Layton v. Elder, 143 F.3d 469, 472 (8th Cir. 1998) (granting injunction in favor of disabled plaintiffs because they would suffer irreparable harm if the programs and services of the county courthouse were not made accessible); see also Elrod v. Burns, 427 U.S. 347, 373 (1976); Norsworthy v. Beard, 87 F. Supp. 3d 1164, 1192-93 (N.D. Cal. 2015).
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Moreover, both the balance of harms and the public interest weigh strongly in favor of issuing a permanent injunction. See, e.g., Layton, 143 F.3d at 472. While Ms. Hicklin has shown serious risk of irreparable harm stemming from the freeze-frame policy and denial of medically necessary gender dysphoria treatment, the only potential harms identified by either MDOC or Corizon—security risks and costs—are unavailing. As an initial matter, “the challenge of housing thousands of inmates safely cannot impede on the constitutional rights of the individuals in MDOC custody.” Hicklin, 2018 WL 806764, at *13. Furthermore, Defendants have already been providing hormone therapy to other transgender prisoners and began providing this therapy to Ms. Hicklin after the 2/9/18 Order. SUF ¶¶ 13, 19; Doc. 153 at 3:9-13; 4:24-5:9. Thus, there is no evidence that a permanent injunction would pose any safety or security issues Defendants are not already handling. Id.; cf. Norsworthy, 87 F. Supp. 3d at 1194; Gammett v. Idaho State Bd. of Corr., No. CV05-257-S-MHW 2007 WL 2186896, at *16 (D. Idaho July 27, 2007).
Additionally, there is no evidence that providing gender dysphoria treatment to Ms. Hicklin and other persons in MDOC’s custody for whom it is medically necessary would be cost prohibitive. See Hicklin, 2018 WL 806764, at *13. In any event, prison officials cannot withhold medically necessary treatment based on cost. Barrett, 292 F. Supp. 2d at 286. Lastly, it is always in the public interest to prevent the violation of constitutional rights. Phelps-Roper v. Nixon, 545 F.3d 685, 690 (8th Cir. 2008), overruled on other grounds by Phelps-Roper v. City of Manchester, Mo., 697 F.3d 678 (8th Cir. 2012); Melendres v. Arpaio, 695 F.3d 990, 1002 (9th Cir. 2012); Phillips, 731 F. Supp. at 801.
CONCLUSION For the foregoing reasons, Ms. Hicklin respectfully requests that this Court grant her Motion for Declaratory Relief and a Permanent Injunction.
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Respectfully submitted this 30th day of March 2018.
s/ Demoya R. Gordon 1 Demoya R. Gordon* Richard Saenz* Lambda Legal Defense & Education Fund, Inc. 120 Wall Street, Floor 19 New York, NY 10005 Tel: 212-809-8585 Fax: 212-809-0055 dgordon@lambdalegal.org rsaenz@lambdalegal.org
Marla R. Butler* Sharon E. Roberg-Perez* Rajin S. Olson* Robins Kaplan LLP 800 LaSalle Avenue 2800 LaSalle Plaza Minneapolis, MN 55402 Tel: 612-349-8500 Fax: 612-339-4181 mbutler@robinskaplan.com sroberg-perez@robinskaplan.com rolson@robinskaplan.com
Frederick A. Braunstein* Robins Kaplan LLP 399 Park Avenue Suite 3600 New York, NY 10022 Tel: 212-980-7400 Fax: 212-980-7499 fbraunstein@robinskaplan.com
Kevin L. Schriener, #35490MO Law & Schriener, LLC 141 N. Meramec Avenue Suite 314 St. Louis, MO 63105 Tel: (314) 721-7095 Fax: (314) 863-7096 kschriener@schrienerlaw.com Attorneys for Plaintiff Jessica Hicklin
*Admitted pro hac vice
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CERTIFICATE OF SERVICE
IT IS HEREBY CERTIFIED that service of the foregoing Memorandum of Law in Support of Plaintiff’s Motion for Declaratory Relief and a Permanent Injunction was made on March 30, 2018 via the Court’s CM/ECF system to:
D. John Sauer, # 58721MO First Assistant and Solicitor David Dean, # 67190MO Assistant Attorney General Missouri Attorney General’s Office P.O. Box 861 St. Louis, MO 63188 Telephone: (314) 340-7652 Facsimile: (314) 340-7029 John.Sauer@ago.mo.gov David.Dean@ago.mo.gov Attorneys for Anne Precythe, Joan Reinkmeyer, Cindy Griffith, Stan Payne, Scott O’Kelly, and Latoya Duckworth J. Thaddeus Eckenrode, MoBar #31080 Eckenrode-Maupin 11477 Olde Cabin Rd Suite 110 St. Louis, MO 63141 Tel: 314-726-6670 Fax: 314-726-2106 jte@eckenrode-law.com kkp@eckenrode-law.com Attorneys for Corizon LLC, William McKinney, John Deghetto, Thomas Kevin Bredeman, Diana Larkin, Kimberley S. Randolph, Daly Smith, Stormi Moeller, Ernest Graypel, Elizabeth Atterberry, and Kim Foster
__s/_Demoya R. Gordon__
17

Case: 4:16-cv-01357-NCC Doc. #: 164-1 Filed: 03/30/18 Page: 1 of 3 PageID #: 1953

IN THE UNITED STATES DISTRICT COURT FOR THE EASTERN DISTRICT OF MISSOURI
EASTERN DIVISION

JESSICA HICKLIN, v.

Plaintiff,

ANNE PRECYTHE, et al.,
Defendants.

Case No. 4:16-CV-01357-NCC

DECLARATION OF DEMOYA R. GORDON I, Demoya R. Gordon, hereby declare and state as follows: 1. I am an attorney with Lambda Legal Defense and Education Fund, Inc. and I am one of the lawyers representing Plaintiff Jessica Hicklin in the above-captioned matter. 2. I submit this declaration in support of Plaintiff’s Motion for Declaratory Relief and a Permanent Injunction. 3. Attached hereto as Exhibit A is a true and correct copy of the Excerpted Transcript of the February 6, 2018 Deposition of Elizabeth Atterberry, Psy.D. in her capacity as Defendant Corizon LLC’s designated 30(b)(6) Representative. 4. Attached hereto as Exhibit B is a true and correct copy of the Excerpted Transcript of the November 15, 2017 Deposition of Defendant Elizabeth Atterberry, Psy.D, Corizon’s Regional Mental Health Director. 5. Attached hereto as Exhibit C is a true and correct copy of pages PL000712-13 of the Bates stamped copy of the World Professional Association for Transgender Health’s Standards of Care for the Health of Transsexual, Transgender, and Gender-Nonconforming
1

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EXHIBIT A

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Page 1

1

IN THE UNITED STATES DISTRICT COURT

FOR THE EASTERN DISTRICT OF MISSOURI

2

EASTERN DIVISION

3

4 JESSICA HICKLIN,

)

)

5

Plaintiff,

)

6 vs.

) ) Case No.

) 4:16-CV-01357-NCC

7

)

ANNE PRECYTHE, et al. ,

)

8

)

Defendants.

)

9

10

11

12

13

14

15

16

Jefferson City, MO

17

DEPOSITION OF ELIZABETH ATTERBERRY, PSY.D.

18

TAKEN ON BEHALF OF THE PLAINTIFF

19

February 6, 2018

20

21

22

23

24 Reported by: LISA BALLALATAK

25

Job No. 135754

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Page 6

1 sure I let you finish answering a question before I

2 start asking another one so that our court reporter

3 can get everything down today. And if I ask you any

4 question that you're unclear of the meaning and you

5 want some clarification from me, please do ask me

6 for it, and I'll do my best to clarify.

7

A. Okay.

8

Q. I am handing you what has been marked

9 Exhibit 101 for your deposition. Have you seen that

10 before? And feel free to thumb through it and

11 understand its contents.

12

A. Yes, I have.

13

Q. When did you see it?

14

A. Approximately two weeks ago.

15

Q. So you understand that this is a notice of

16 deposition of defendant Corizon in this case;

17 correct?

18

A. Correct.

19

Q. And so you understand that this deposition

20 is a bit different from your last deposition,

21 because in your last deposition, you were being

22 deposed as an individual; whereas, in this

23 deposition, you are being deposed as Corizon's

24 designee pursuant to this notice. Do you understand

25 that?

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Page 7

1

A. I do.

2

Q. Okay. So I might ask you some questions

3 that are or at least seem redundant from your last

4 deposition, but the reason is because this is a

5 different type of deposition, okay?

6

A. Okay.

7

Q. What did you do to prepare to testify as

8 Corizon's designee today?

9

A. The document that you just handed me. I

10 looked in the patient record -- medical chart, and I

11 reviewed some job descriptions.

12

Q. Anything else?

13

MR. PEEK: Depo transcripts.

14

A. Oh, yes. There were some deposition

15 transcripts that I reviewed.

16

Q. (By Ms. Butler) Okay. So to be clear --

17 you know, in a deposition, you're not expected to

18 have perfect recall of everything, but --

19

MS. BUTLER: Counsel, I will ask you not

20 to tell the witness how to testify, okay?

21

Q. (By Ms. Butler) So you said you read some

22 deposition transcripts as well.

23

A. Yes.

24

Q. All right. So I've got -- you looked at

25 the 30(b)(6) notice, which is Exhibit 101 in front

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1 dysphoria.

2

Q. Does Corizon understand that there is a --

3 an increased risk of suicide for individuals with

4 gender dysphoria?

5

A. Yes.

6

Q. What's Corizon's understanding as to why

7 there's an increased risk of suicide in individuals

8 with gender dysphoria?

9

A. Well, that state of dysphoria is chronic

10 and incessant. It's every day, all the time. The

11 levels of how strong that presentation is vary, but

12 with that constant feeling of discomfort. And

13 "discomfort" is a light word to use. The individual

14 does become at risk for wanting to end their life.

15

Q. And do you believe that that risk

16 increases as time goes on with a patient that's

17 diagnosed with gender dysphoria going untreated?

18

A. Yes.

19

Q. Do you believe that three years is a long

20 time to go untreated for a patient with gender

21 dysphoria?

22

A. It is concerning.

23

Q. Why is it concerning?

24

A. Because of that being one of the issues,

25 is that the increase of suicide is present, but,

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1 also, just the daily functioning of an individual,

2 even if they aren't suicidal, is impacted. And the

3 mood issues that come into play there can be

4 significant, and it's taxing on an individual.

5

Q. We talked about the PREA training. Are

6 there written materials associated with that

7 training?

8

A. Yes.

9

Q. Where are they kept?

10

A. In two places. There's a departmental

11 training, so that's MDOC.

12

Q. Okay. And the other?

13

A. And then the -- Corizon Health.

14

Q. Understood. So does -- is it the same

15 training that the -- that MDOC --

16

A. It's very similar, uh-huh.

17

Q. But there's two different sets of

18 materials?

19

A. Uh-huh.

20

Q. Does the training take place together or

21 separately, MDOC and Corizon?

22

A. For new employees, they would be getting

23 it together with the other topics, and then once

24 you're working at a facility, then the reviews come

25 up annually.

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1

Q. And where is that PowerPoint kept?

2

A. Here in this office at the Department of

3 Corrections Training Academy, and then at the

4 facilities with the institutional chiefs and also

5 the field training officers.

6

Q. Is Corizon aware of any inmates with

7 gender dysphoria who have attempted suicide while

8 being housed as an MDOC facility?

9

A. Yes.

10

Q. How many?

11

A. How many individuals have attempted

12 suicide?

13

Q. Yes. And let's kind of set a time period

14 here. Over the last five years, individuals with

15 gender dysphoria who have attempted suicide in an

16 MDOC facility.

17

A. I couldn't give you an exact number.

18

Q. More than ten?

19

A. No.

20

Q. More than five?

21

A. Somewhere in the middle would be --

22

Q. Between five and --

23

A. -- purely my speculation.

24

Q. Sorry. Somewhere between five and ten?

25

A. Somewhere between five and ten.

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1

Q. You've heard of the term "autocastration"?

2

A. Yes.

3

Q. Is Corizon aware of individuals who have

4 attempted, successfully or not, autocastration in an

5 MDOC facility over the last five years?

6

A. Yes.

7

Q. About how many?

8

A. I couldn't say for sure.

9

Q. More than ten?

10

A. No.

11

Q. In that same five-to-ten range?

12

A. Fewer than five.

13

Q. And my question was "attempted whether

14 successfully or not." Are you aware of any inmates

15 over the last five years who have successfully

16 engaged in autocastration?

17

A. No.

18

Q. In those instances where an inmate --

19 well, in the instances where an inmate attempted

20 autocastration, had there been a diagnosis of gender

21 dysphoria in all of those cases?

22

A. I don't believe so.

23

Q. And when an inmate attempts

24 autocastration, what is -- what actions does Corizon

25 engage in this response to that attempt?

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Page 102

1

Q. And I want to know, has that actually

2 happened?

3

A. Yes.

4

Q. Okay. On how many occasions are you aware

5 that that's actually happened?

6

A. I can't say for sure.

7

Q. And that process -- so starting with the

8 medical care and then through the referral to

9 psychiatry and the psychiatric treatment, is MDOC

10 informed of the attempted autocastration?

11

A. Yes.

12

Q. And what is MDOC's involvement in that

13 kind of cycle of treatment from the medical all the

14 way up through the psychiatric care that you've

15 described?

16

A. Notification.

17

Q. So anytime an inmate has attempted

18 autocastration, MDOC is notified of that?

19

A. Yes.

20

Q. Are they also notified if that individual

21 was also someone that's been diagnosed with gender

22 dysphoria?

23

A. It might be if it's specific to that

24 individual part of the notification information.

25

Q. What's the form of that notification?

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Page 103

1

A. To the Missouri Department of Corrections,

2 there's the section in DORS that is mental health.

3 So for the suicide attempt notification, the

4 assistant division direction over mental health

5 services needs to be notified, as well as the

6 contract monitor over the particular institution

7 where this has occurred. And then -- I don't know

8 in detail exactly on the medical side, but there

9 would be notification in similar fashion to the

10 assistant division director over medical services,

11 and then the corresponding director -- or contract

12 monitor over medical services.

13

Q. Have you ever met Ms. Hicklin?

14

A. No, I have not.

15

Q. This process that you described for an

16 attempted autocastration, does that same process

17 apply for a suicide attempt?

18

A. Yes.

19

Q. Besides the GDCSG that we've been talking

20 about throughout the day, are there any other

21 Corizon or -- let me start with Corizon. Are there

22 any other Corizon committees relating to the

23 diagnosis or treatment of individuals with gender

24 dysphoria?

25

A. No.

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Page 105

1 transgender committee meetings?

2

A. They do.

3

Q. Who?

4

A. The HSA -- the health services

5 administrator -- and the institution chief of mental

6 health services. Possibly, also the director of

7 nursing, the site medical director or the

8 psychiatrist.

9

Q. Do you know when the transgender committee

10 at Potosi last met with respect to Ms. Hicklin?

11

A. I do not.

12

Q. Do you know when they last met, period?

13

A. I do not.

14

Q. Do you know how many transgender inmates

15 in MDOC are currently receiving hormone therapy for

16 gender dysphoria?

17

A. I do not.

18

Q. Do you know of any?

19

A. There are some that no longer carry that

20 diagnosis, so I can't say for sure.

21

Q. And -- so when you say "there are some

22 that no longer carry that diagnosis" -- so does that

23 mean that they were once diagnosed with gender

24 dysphoria?

25

A. Yes.

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Page 106

1

Q. Was there any treatment for gender

2 dysphoria?

3

A. Yes.

4

Q. Including hormone therapy?

5

A. Yes.

6

Q. And is it because of the hormone therapy

7 that -- is it more than one individual that we're

8 talking about here?

9

A. I can't say for sure, but I -- in my

10 general awareness, there are multiple offenders who

11 receive hormone replacement therapy.

12

Q. So these are individuals who at one point

13 had a diagnosis for gender dysphoria, received

14 hormone treatment, and then is it because of the

15 hormone treatment that they no longer carry the

16 diagnosis for gender dysphoria?

17

A. I would believe that it's not solely

18 because of that but partially because of treatment,

19 yes.

20

Q. So at least in part, this hormone therapy

21 resulted in the individual no longer having gender

22 dysphoria -- the effects that go along with it;

23 correct?

24

A. Correct.

25

Q. If you wanted to learn how many

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1 receiving hormone treatment when they arrived at an

2 MDOC facility?

3

A. I couldn't say for sure until the -- we

4 generated the list and it was reviewed.

5

Q. Are you aware of any inmate who was

6 incarcerated at an MDOC facility and at the time of

7 incarceration, the person was not receiving hormone

8 treatment but who later, while incarcerated, upon a

9 diagnosis of gender dysphoria, received hormone

10 treatment?

11

A. I am not aware of any.

12

Q. And you are aware of individuals who came

13 to MDOC -- was incarcerated in a facility, diagnosed

14 with gender dysphoria while in the facility, and has

15 not received hormone treatment?

16

A. Yes.

17

Q. You're aware of individuals who came to an

18 MDOC facility on hormone treatment and that hormone

19 treatment continued?

20

A. Yes.

21

Q. Including individuals with gender

22 dysphoria?

23

A. Yes.

24

Q. For those individuals who are -- who are

25 in an MDOC facility, have a diagnosis of gender

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1 right? For one group, an individual who was not on

2 hormones is incarcerated as an MDOC facility -- as I

3 understand it, it's MDOC policy that that individual

4 will not start hormones if they weren't already on

5 hormones; correct?

6

A. I would say it's practice. I've never

7 seen a policy related to that.

8

Q. But that's been the practice?

9

A. Yes.

10

Q. Okay. And the practice is, as to an

11 individual who was already on hormones, those

12 hormones will continue when the individual is

13 incarcerated; correct?

14

A. If there's -- the assessment by the

15 medical team and the things that need to be reviewed

16 for continuity of care, yes.

17

Q. And as to the individual who was not on

18 hormones and hormones are not started when they're

19 incarcerated, the reason for it, I think you

20 testified, is concern over safety; correct?

21

A. Correct.

22

Q. And that's MDOC's concern?

23

A. Yes.

24

Q. Okay. Do you understand whether MDOC has

25 that same concern for the second category of people,

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1 people who were already on hormones and remain on

2 hormones when incarcerated?

3

A. I would believe they do.

4

Q. So do you understand why there's a

5 difference in the decision about whether or not

6 individuals in those two categories are going to

7 receive hormones?

8

A. I do not understand what the difference

9 is.

10

Q. Okay. Is it Corizon's position that --

11 well, I think you already testified, but it's

12 Corizon's position that -- strike that.

13

A. Okay.

14

Q. Strike that.

15

MS. BUTLER: I'm going to move to a

16 totally different subject, so why don't we take a

17 lunch break.

18

(A lunch recess was taken.)

19

(Deposition Exhibit No. 104 was marked for

20 identification.)

21

Q. (By Ms. Butler) So we are back from lunch,

22 Dr. Atterberry, and the court reporter has just

23 placed in front of you a document that's marked

24 Exhibit 104. The Bates numbers of this document are

25 PL000915 through PL001222. Just flip through it and

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Page 143

1

"My understanding is that in the past, the

2 DOC did not initiate hormone replacement therapy but

3 may have continued treatment regimens started prior

4 to incarceration."

5

Do you see that?

6

A. Yes.

7

Q. And that's consistent with Corizon's

8 understanding?

9

(Deposition Exhibit No. 105 was marked for

10 identification.)

11

A. To the best of what I understand, yes.

12

Q. (By Ms. Butler) Dr. Atterberry, you have

13 been handed what's been marked Exhibit 105 to your

14 deposition. Can you take a look at this and let me

15 know if you recognize it.

16

A. Yes, I do.

17

Q. What is it?

18

A. It's portions of the contract between

19 Corizon Health and Missouri Department of

20 Corrections.

21

Q. And is this portion of that contract, is

22 this also portions generated by Corizon?

23

A. Yes.

24

Q. The Bates numbers in this document for the

25 record are PL001701 through 1939. If you would turn

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EXHIBIT B

Case: 4:16-cv-01357-NCC Doc. #: 164-3 Filed: 03/30/18 Page: 2 of 8 PageID #: 1973

Page 1

1

2

IN THE UNITED STATES DISTRICT COURT

FOR THE EASTERN DISTRICT OF MISSOURI

3

EASTERN DIVISION

4

5 JESSICA HICKLIN,

)

)

6

Plaintiff,

)

)

7 vs.

) Case No.

) 4:16-CV-01357-NCC

8

)

ANNE PRECYNTHE, et al. ,

)

9

)

Defendants.

)

10

11

12

13

14

15

16

17

18

DEPOSITION OF ELIZABETH ATTERBERRY, PSY.D.

19

TAKEN ON BEHALF OF THE PLAINTIFF

20

NOVEMBER 15th, 2017

21

22

23

24

25 JOB NO. 133533

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Page 11

1 other than counsel or involving counsel, please feel

2 free to let me know that, okay?

3

A. Yes.

4

Q. Okay. Are you employed by Corizon?

5

A. I am.

6

Q. What is your current position?

7

A. Regional mental health director.

8

Q. What does "region" mean? What does that

9 region encompass?

10

A. Missouri.

11

Q. Anything other than Missouri?

12

A. No.

13

Q. Are you responsible for all of the

14 correctional centers that Corizon provides services

15 to in Missouri?

16

A. Yes.

17

Q. How many centers are those?

18

A. Twenty-two.

19

Q. How long have you held this position?

20

A. April of 2015.

21

Q. So before -- I would like to know about

22 what you did before April of 2015, but before we get

23 to that, I'd like to know what goes into your

24 position, what your work currently as regional

25 mental health director entails. Can you describe --

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Page 32

1

A. No.

2

Q. Have you ever asked to speak to

3 Ms. Hicklin?

4

A. No.

5

Q. Why not?

6

A. I don't frequently ask to do that for any

7 of the patients that the site staff are treating.

8

Q. And why is that?

9

A. It's not a function of my role to be

10 directly involved in the care.

11

Q. Understood. Now, again, without revealing

12 any HIPAA-protected information -- in speaking about

13 the two other individuals that you've been involved

14 in diagnosing gender dysphoria, are either of those

15 individuals receiving hormone therapy?

16

A. No.

17

Q. Are either of those individuals receiving

18 gender-affirming canteen items?

19

A. I do not know.

20

Q. Are you aware of any transgendered inmate

21 within the Missouri Department of Corrections

22 receiving hormone therapy?

23

A. Would you ask again?

24

Q. Are you aware of any transgendered inmate

25 within the Missouri Department of Corrections

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Page 33

1 receiving hormone therapy?

2

A. Yes.

3

Q. How many?

4

A. I do not know for sure.

5

Q. If you had to ballpark it, what would you

6 ballpark it at?

7

A. A dozen.

8

Q. Okay. Have you held other positions at

9 Corizon besides the position you hold now?

10

A. Yes.

11

Q. What are those positions?

12

A. Mental health director --

13

Q. What else?

14

A. -- over the central region.

15

Q. Mental health director over the central

16 region. What's the central region?

17

A. It can be parted up different ways, but at

18 the time, it included Northeast Correctional Center;

19 Fulton Reception and Diagnostic Center; Cramer

20 Therapeutic Treatment Community; Tipton Correctional

21 Center; Algoa Correctional Center; and Jefferson

22 City Correctional Center.

23

Q. But not Potosi Correctional Center;

24 correct?

25

A. Correct.

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Page 147

1 about her hair.

2

Q. What is -- what do you mean by

3 "rumination"?

4

A. It's not just a thought that happens

5 randomly; it's more incessant.

6

Q. So she can't put it out of her mind?

7

A. Correct.

8

We discuss when Ms. Hicklin had been seen

9 by psychiatry, August 9th, 2017, and was observed to

10 be fidgety. We discuss that there were multiple

11 stressors. The QMHP previously assigned had left,

12 and that Ms. Hicklin was worried about the length of

13 time it will take to be treated with hormone

14 replacement therapy. We discussed that Ms. Hicklin

15 had revealed to the psychiatrist that self-treating

16 intrusive thoughts were occurring, and this would be

17 self-castration. Also, Ms. Hicklin was not sleeping

18 much.

19

Q. Have you, in connection with your work at

20 Corizon, dealt with other gender dysphoria -- other

21 inmates with gender dysphoria who had thoughts of

22 self-castration?

23

A. Have I known of them?

24

Q. Have you known of them?

25

A. Yes.

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Page 148

1

Q. How many?

2

A. Two.

3

Q. While Corizon has provided medical care

4 and mental health services to Missouri Department of

5 Correction inmates, are you aware of whether

6 anyone -- any transgendered inmate with gender

7 dysphoria has successfully completed autocastration?

8

A. I believe so.

9

Q. When was that?

10

A. My recollection is that it occurred when I

11 was working with the previous vendor.

12

Q. As a mental health provider, do you have

13 any understanding of how hormone treatment would

14 impact the self-harmed thoughts -- the thoughts to

15 auto- -- to self-castrate?

16

A. Generally?

17

Q. Generally, what's your understanding?

18

A. Well, there's -- just the obvious mindset

19 of treatment/no treatment and the comfort that that

20 would bring to patient in having started a regimen.

21 And from there, it would be patient-specific, how

22 they're going to react to the medication. The risk,

23 I believe, would begin to decrease at some point

24 because there would be some body changes, some

25 things that would feel more feminine in this case.

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Page 149

1

Q. That would alleviate the dysphoria; right?

2

A. Yes.

3

Q. Were you asked to collect any documents in

4 connection with this case, other than those that you

5 brought today?

6

A. No.

7

Q. Outside of what you've already testified

8 about, and not including any conversations when

9 counsel was in the room, have you had any

10 communications with anyone at MDOC about treating

11 Ms. Hicklin's gender dysphoria?

12

A. I do not recall that I have.

13

Q. Okay.

14

MS. ROBERG-PEREZ: For now, I have no

15 further questions, but counsel may.

16

CROSS-EXAMINATION

17 BY MR. LEVY:

18

Q. Yeah, I have a couple.

19

Do you know what the relationship is

20 between department of corrections and Corizon?

21

A. Generally, yes.

22

Q. Yes. What is your understanding?

23

A. We are the health care vendor for the

24 Missouri Department of Corrections.

25

Q. And you provide that pursuant to a written

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EXHIBIT C

www.wpath.org

Standards of Care
for the Health of Transsexual, Transgender, and Gender Nonconforming People
The World Professional Association for Transgender Health
PL000640

7th Version

The Standards of Care
7th Version
of the neovagina differ substantially from those of a biologic vagina. This anatomic difference can affect intercourse if not understood by MtF patients and their partners (van Trotsenburg, 2009).
Lower urinary tract infections occur frequently in MtF patients who have had surgery because of the reconstructive requirements of the shortened urethra. In addition, these patients may suffer from functional disorders of the lower urinary tract; such disorders may be caused by damage of the autonomous nerve supply of the bladder floor during dissection between the rectum and the bladder, and by a change of the position of the bladder itself. A dysfunctional bladder (e.g., overactive bladder, stress or urge urinary incontinence) may occur after sex reassignment surgery (Hoebeke et al., 2005; Kuhn, Hiltebrand, & Birkhauser, 2007).
Most FtM patients do not undergo vaginectomy (colpectomy). For patients who take masculinizing hormones, despite considerable conversion of testosterone to estrogens, atrophic changes of the vaginal lining can be observed regularly and may lead to pruritus or burning. Examination can be both physically and emotionally painful, but lack of treatment can seriously aggravate the situation. Gynecologists treating the genital complaints of FtM patients should be aware of the sensitivity that patients with a male gender identity and masculine gender expression might have around having genitals typically associated with the female sex.
XIV
Applicability of the Standards of Care to People Living in Institutional Environments
The SOC in their entirety apply to all transsexual, transgender, and gender nonconforming people, irrespective of their housing situation. People should not be discriminated against in their access to appropriate health care based on where they live, including institutional environments such as prisons or long-/intermediate-term health care facilities (Brown, 2009). Health care for transsexual, transgender, and gender nonconforming people living in an institutional environment should mirror that which would be available to them if they were living in a non-institutional setting within the same community.
All elements of assessment and treatment as described in the SOC can be provided to people living in institutions (Brown, 2009). Access to these medically necessary treatments should not be denied on the basis of institutionalization or housing arrangements. If the in-house expertise of health professionals in the direct or indirect employ of the institution does not exist to assess

World Professional Association for Transgender Health

67

PL000712

The Standards of Care
7th Version
and/or treat people with gender dysphoria, it is appropriate to obtain outside consultation from professionals who are knowledgeable about this specialized area of health care.
People with gender dysphoria in institutions may also have co-existing mental health conditions (Cole et al., 1997). These conditions should be evaluated and treated appropriately.
People who enter an institution on an appropriate regimen of hormone therapy should be continued on the same, or similar, therapies and monitored according to the SOC. A “freeze frame” approach is not considered appropriate care in most situations (Kosilek v. Massachusetts Department of Corrections/Maloney, C.A. No. 92-12820-MLW, 2002). People with gender dysphoria who are deemed appropriate for hormone therapy (following the SOC) should be started on such therapy. The consequences of abrupt withdrawal of hormones or lack of initiation of hormone therapy when medically necessary include a high likelihood of negative outcomes such as surgical self-treatment by autocastration, depressed mood, dysphoria, and/or suicidality (Brown, 2010).
Reasonable accommodations to the institutional environment can be made in the delivery of care consistent with the SOC, if such accommodations do not jeopardize the delivery of medically necessary care to people with gender dysphoria. An example of a reasonable accommodation is the use of injectable hormones, if not medically contraindicated, in an environment where diversion of oral preparations is highly likely (Brown, 2009). Denial of needed changes in gender role or access to treatments, including sex reassignment surgery, on the basis of residence in an institution are not reasonable accommodations under the SOC (Brown, 2010).
Housing and shower/bathroom facilities for transsexual, transgender, and gender nonconforming people living in institutions should take into account their gender identity and role, physical status, dignity, and personal safety. Placement in a single-sex housing unit, ward, or pod on the sole basis of the appearance of the external genitalia may not be appropriate and may place the individual at risk for victimization (Brown, 2009).
Institutions where transsexual, transgender, and gender nonconforming people reside and receive health care should monitor for a tolerant and positive climate to ensure that residents are not under attack by staff or other residents.

68

World Professional Association for Transgender Health

PL000713

Case: 4:16-cv-01357-NCC Doc. #: 164-5 Filed: 03/30/18 Page: 1 of 32 PageID #: 1984
EXHIBIT D

Case: 4:16-cv-01357-NCC Doc. #: 164-5 Filed: 03/30/18 Page: 2 of 32 PageID #: 1985

Page 1

1

IN THE UNITED STATES DISTRICT COURT

FOR THE EASTERN DISTRICT OF MISSOURI

2

EASTERN DIVISION

3

4 JESSICA HICKLIN,

)

)

5

Plaintiff,

)

6 vs.

) ) Case No.

) 4:16-CV-01357-NCC

7

)

ANNE PRECYNTHE, et al. ,

)

8

)

Defendants.

)

9

10

11

12

13

14

15

16

17

DEPOSITION OF MATT STURM

18

TAKEN ON BEHALF OF THE PLAINTIFF

19

January 25th, 2018

20

21

22

23

24

25 JOB NO. 135753

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Page 26

1

A. Not to my recollection, no. Not directly.

2

Q. It's my understanding that Ms. Hicklin

3 sent letters to Scott O'Kelley and Deloise Williams,

4 both of whom worked directly under you. Do you

5 recall that?

6

A. I don't.

7

Q. Okay. I just know you said not directly,

8 so I wasn't sure if that's what you were alluding

9 to.

10

A. No. When I say "not directly," I mean I

11 saw transgender reports regarding Ms. Hicklin, but I

12 don't -- so when I say -- I would have responded to

13 those, but those were about Jessica but not to

14 Jessica.

15

Q. Do you have an understanding of what the

16 basis is for Ms. Hicklin's claims?

17

A. I believe so.

18

Q. What's your understanding?

19

A. That her gender dysphoria has reached a

20 point that she requires hormone therapy and gender

21 affirming property items.

22

Q. Anything else?

23

A. Not that I'm aware of.

24

Q. What's your current position at the

25 Missouri Department of Corrections?

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Page 27

1

A. Deputy department director.

2

Q. And how long have you held that position?

3

A. February of 2017.

4

Q. What was your position before you became

5 deputy department director?

6

A. Director of the division of offender

7 rehabilitative services -- or DORS for short.

8

Q. I was just going to ask you if it stands

9 for DORS for short.

10

A. Yes, ma'am.

11

Q. How long were you the DORS director?

12

A. February 2012 to February of 2017.

13

Q. Before you became the DORS director, were

14 you working at Missouri Department of Corrections?

15

A. Yes, ma'am.

16

Q. In what capacity?

17

A. Deputy division director in the division

18 of adult institutions.

19

Q. And how long were you the deputy division

20 director in the division of adult institutions?

21

A. I believe it was sometime in 2010, but I

22 don't recall specifically. Either late 2010, early

23 2011. I can't recall.

24

Q. So sometime in either late 2010 or early

25 2011 to February of 2012?

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Page 81

1 employees regarding Ms. Hicklin's request for gender

2 dysphoria, and it goes from April 20th, 2015,

3 through April 22nd, 2015. If you look at page 9- --

4 well, the bottom of page 911 is an e-mail -- the

5 first e-mail, you know, chronologically speaking in

6 the string which is from Cindy Griffith to Dwayne

7 Kempker from April 20th, 2015, and it continues on

8 page -- on to page 912, Cindy Griffith's e-mail

9 does. And the first sentence in the last paragraph

10 of the e-mail on 912 says:

11

"My understanding -- " this is Cindy

12 Griffith speaking.

13

"My understanding is that in the past, the

14 DOC did not initiate hormone replacement therapy,

15 but may have continued treatment regimens starting

16 prior to incarceration."

17

Is that statement accurate?

18

A. I believe that is correct, yes.

19

Q. The same being -- I want to be clear --

20 the statement being that in the past, the department

21 of corrections did not initiate hormone replacement

22 therapy but may have continued treatment regimens

23 started prior to incarceration. Is that correct?

24

A. That's correct.

25

Q. When this e-mail was sent in April of

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Page 99

1

Q. And is that something that you discussed

2 with director George Lombardi?

3

A. And Dave Dormeyer and -- yeah -- likely

4 legal.

5

Q. Okay.

6

A. Yes, ma'am.

7

Q. Okay. And at that point, Vevia Sturm is

8 saying, This is new, we've never initiated hormones

9 before; we've only continued hormones for people who

10 were receiving it before. So what came out of the

11 conversations that you were having with

12 George Lombardi and Dave Dormeyer with respect to

13 that question -- with respect to the question about

14 initiation of hormones?

15

A. Right. The determination made -- the

16 ultimate decision made by the director was that the

17 department would continue with that same process --

18 that same method.

19

Q. So the director, meaning George Lombardi;

20 correct?

21

A. Uh-huh.

22

Q. Okay.

23

A. Yes.

24

Q. So --

25

A. Sorry.

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Page 132

1

Q. 2016?

2

A. Possibly. I don't recall.

3

Q. Could it have been 2015?

4

A. It could have been.

5

Q. Would it have been before 2015?

6

A. I guess it's possible, but it's -- it

7 doesn't seem like it. I would think more 2015,

8 perhaps.

9

Q. How did you come to see the document

10 that's reflected on Hicklin versus Lombardi 00616?

11

A. This was the document -- or this is the

12 response that was prepared by the department to

13 provide to the transgender committee when hormone

14 therapy is recommended to be initiated.

15

Q. So what I hear you saying is this was

16 prepared by the department -- and by that do you

17 mean the Missouri Department of Corrections or any

18 specific part of the Missouri Department of

19 Corrections?

20

A. Yes, ma'am. No. I'm sorry. It's the

21 department of corrections.

22

Q. So the Missouri Department of Corrections

23 prepared the language in the document that's

24 reflected on Hicklin versus Lombardi 00616 to

25 provide guidance to the transgender -- the

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Page 133

1 site-specific transgender committee?

2

A. It's in response -- when a transgender

3 committee report arrives at central office and if

4 hormone therapy is requested to be initiated, this

5 is the response that is typically sent in response

6 to their transgender committee report.

7

Q. And when did this start being the response

8 that would be sent to a request to initiate hormone

9 therapy --

10

A. I don't recall when it was.

11

Q. Who drafted the language that's reflected

12 on Hicklin versus Lombardi 616?

13

MR. DEAN: If you know.

14

A. It was -- I can maybe better answer that

15 this was drafted to reflect the decision made by

16 executives -- the director with input from executive

17 staff, so I think several people probably had input

18 on it. I know I did. I saw it at that time and

19 legal, likely, Mr. Dormeyer. It was drafted to

20 reflect the ultimate decision by the director.

21

Q. (By Ms. Gordon) So you had input. I think

22 you said Dave Dormeyer.

23

A. To my recollection, yes.

24

Q. What was your input in the drafting of the

25 document reflected on Hicklin versus Lombardi 00616?

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1 policy that existed before; is that correct?

2

A. It's -- I guess it's a position but not a

3 procedure, but that's correct.

4

Q. Are you aware of any transgender inmates

5 with gender dysphoria who have received therapy in

6 Missouri Department of Corrections?

7

A. By "therapy," do you mean hormone therapy?

8

Q. Hormone therapy, yes.

9

A. Are you talking about those that entered

10 the facility or the institution already having a

11 valid prescription?

12

Q. I would assume so, since, you know, as

13 we've established, that's DOC's policy, but I guess

14 I'm just asking are you aware of transgender inmates

15 who have received hormone therapy in DOC?

16

A. None specifically, but I believe we have

17 some, yes.

18

Q. So you have no personal knowledge of a

19 specific person --

20

A. Right.

21

Q. -- but you do believe that you have

22 provided hormone therapy for transgender inmates?

23

A. Correct.

24

Q. Do you have an idea of how many?

25

A. I do not.

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Page 146

1

Q. And to your knowledge, all of those people

2 would have been receiving it before coming to

3 Missouri Department of Corrections?

4

A. To my knowledge, yes.

5

Q. Do you know where such inmates would be

6 housed?

7

A. I do not.

8

Q. You -- you had identified in the

9 conversations that you had with George Lombardi and

10 Dave Dormeyer and legal the fact that if you -- you

11 know, if you give someone hormone therapy, one of

12 the effects of that is they're likely to develop

13 female secondary characteristics such as breasts;

14 correct?

15

A. Correct.

16

Q. So given that, to your knowledge, there

17 are people who have been in the Missouri Department

18 of Corrections who have been getting hormone therapy

19 and thus would have developed these secondary sex

20 characteristics, such as breasts, what steps does

21 the Missouri Department of Corrections take to

22 protect such people from sexual abuse and

23 harassment?

24

A. All of the things I've mentioned already,

25 which is the transgender committee. That's the --

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1 one of the roles of that committee is to meet with

2 the offenders and make sure that they are living in

3 a prison environment, if they're having any issues

4 or concerns. The PREA hotline is available, and

5 then offenders are instructed to notify a staff

6 member if they're having -- doesn't mean that they

7 will, but they're instructed to -- or encouraged to

8 notify a staff member if they're having concerns or

9 issues or being harassed.

10

Q. I'm sorry. So, you know, I think you've

11 ticked off some of those before. In addition to

12 those mechanisms, the Missouri Department of

13 Corrections has at its disposal to try to protect

14 transgender people in its custody who are receiving

15 hormone therapy the housing options that you laid

16 out before; correct? And that's the restricted

17 housing, protective custody and --

18

A. General population.

19

Q. General population, if it's determined

20 that they can be in general population; is that

21 correct?

22

A. That's correct.

23

Q. Do you know -- well, okay. I think you've

24 already answered that.

25

If you wanted to find out where

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1 transgender inmates receiving hormone therapy in

2 Missouri Department of Corrections have been housed,

3 how would you go about doing that?

4

A. We would likely have to contact each

5 institution individually and ask the housing status

6 of each transgender offender located there.

7

Q. So I think you said you'd have to contact

8 the housing staff at each facility and ask them.

9

A. To my knowledge -- I don't know that

10 there's a more efficient way of getting that

11 information.

12

Q. Before I had asked you if during the

13 conversations with George Lombardi, Dave Dormeyer,

14 you, legal, about the policy that is reflected on

15 Hicklin versus Lombardi 00616 -- well, scratch that.

16 Let me just ask you.

17

During those conversations with

18 George Lombardi, Dave Dormeyer, you, legal, was

19 there a belief that initiating hormone therapy for

20 transgender inmates with gender dysphoria posed a

21 greater safety and security risk than would be posed

22 by continuing hormone therapy for someone who is

23 already on there?

24

MR. DEAN: Object to the form. Asked and

25 answered.

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1

A. Not that I recall.

2

Q. (By Ms. Gordon) Are -- okay. So

3 Jessica Hicklin is a transgender woman. That means

4 she was assigned the sex at birth -- the sex of male

5 at birth, she has right now secondary sex

6 characteristics that are masculine in nature, which

7 causes her distress clinically called gender

8 dysphoria because she identifies as a woman. Are

9 there any people like that, meaning people who are

10 assigned the sex at birth but whose internal sense

11 of their gender is -- sorry.

12

Are there any people who are assigned the

13 sex of male at birth but whose internal sense of

14 their gender is female, are any of those people

15 housed in female facilities in Missouri Department

16 of Corrections?

17

A. Not to my knowledge.

18

Q. Okay. And this -- I just want to be

19 clear. Even if they're receiving hormone therapy

20 and may or may not have developed secondary sex

21 characteristics like breasts, to your knowledge,

22 none of those people are being housed in female

23 facilities; isn't that correct?

24

A. That is correct.

25

Q. In developing the policy reflected on

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1 for which the Missouri Department of Corrections

2 will not initiate a particular treatment but will

3 only continue it if it was being received before the

4 person entered Missouri Department of Corrections?

5

A. Not that I'm aware of. The only caveat

6 being certain types of medications.

7

Q. Could you explain that, please?

8

A. Those with addictive qualities are

9 typically not prescribed in a prison setting.

10

Q. So medications with addictive qualities

11 are particularly not prescribed to a prison

12 situation. That's what you said?

13

A. Correct.

14

Q. So trying to kind of analogize the

15 prescription of medications that have an addictive

16 potential, is there any medication that falls into

17 that class -- medication that someone can become

18 addicted to that Missouri Department of Corrections

19 will continue if you are already getting it but

20 won't start you on it?

21

A. I'm unaware. I cannot answer that.

22

Q. You don't know?

23

A. I don't know.

24

Q. Okay. So if we turn back to Exhibit 79,

25 which is the NCCHC's position statement regarding

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1 transgender, transsexual, and gender nonconforming

2 in health care settings. If you turn to the third

3 page, No. 13 of the 19 items that fall under health

4 management in this position statement says:

5

"Gender dysphoric patients who have not

6 received hormone therapy prior to incarceration

7 should be evaluated by a health care provider

8 qualified in the area of gender-related health care

9 to determine their treatment needs."

10

Do you see that?

11

A. I do.

12

Q. Jessica Hicklin has been evaluated by a

13 Corizon psychiatrist; is that correct?

14

A. To my knowledge, yes.

15

Q. And those Corizon psychiatrists have

16 recommended that she be provided hormone therapy to

17 treat her gender dysphoria; is that correct?

18

A. That's my understanding, yes.

19

Q. And Corizon's Gender Dysphoria Clinical

20 Supervision Group, which I think you testified

21 earlier is a review group, has also determined that

22 hormone therapy is medically necessary for

23 Jessica Hicklin; is that correct?

24

A. I believe that's correct, yes.

25

Q. If you turn to item No. 14 on that same

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1 page, it says:

2

"When determined to be medically necessary

3 for a particular patient, hormone therapy should be

4 initiated and regular laboratory monitoring should

5 be conducted according to community medical

6 standards."

7

Do you see that?

8

A. I do.

9

Q. That has not been done in

10 Jessica Hicklin's case to your knowledge; is that

11 correct?

12

A. Correct.

13

Q. If you turn to the second page, number

14 six, the second sentence there says:

15

"Policies that make treatments available

16 only to those who received them prior to

17 incarceration or that limit transition and/or

18 maintenance are inappropriate and out of step with

19 medical standards and should be avoided."

20

Do you see that?

21

A. I do.

22

Q. Per the language that's on Hicklin versus

23 Lombardi 00616, which actually says that initiating

24 hormone therapy for treatment of gender dysphoria is

25 inappropriate, it would seem to be in direct

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1 contradiction with Item No. 6 of Exhibit 79;

2 correct?

3

A. Correct.

4

Q. Have you -- forgive me if you've already

5 answered this question, because I forget if I've

6 asked you. Have you ever contacted the NCCHC

7 regarding treatment of gender dysphoria?

8

A. I have not.

9

Q. To your knowledge, has anyone at

10 Missouri Department of Corrections ever contacted

11 the NCCHC regarding treatment of gender dysphoria?

12

A. I don't know.

13

Q. Okay. Do you know -- well, scratch that.

14

Do you know if anyone at Corizon has

15 contracted the NCCHC regarding treatment of gender

16 dysphoria?

17

A. I don't know the answer to that.

18

Q. In developing the policy that's reflected

19 in Hicklin versus Lombardi 00616, was the NCCHC

20 contacted or consulted?

21

A. Not that I'm aware of.

22

Q. Item No. 107, the second page of

23 Exhibit 79 says:

24

"Medical staff should ensure that

25 commissary items consistent with an individual's

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1

Q. Dr. Stephens. Did you discuss the content

2 of it with anyone?

3

A. Not to my recollection.

4

Q. We saw that the PCC transgender committee

5 had previously sent a memo discussing Dr. Stephens'

6 presentation from January of 2016 on to you,

7 Vevia Sturm, and at that time, Dwayne Kempker. Do

8 you recall we saw that?

9

A. Yes.

10

Q. Was the final decision regarding what kind

11 of treatment Ms. Hicklin would receive for her

12 gender dysphoria, was that -- was the final decision

13 on that, was that to rest with your committee, the

14 three of you; you, Vevia Sturm, and Dwayne

15 Kempker/Ian Wallace?

16

A. Yes.

17

Q. So the central DOC committee, which I

18 understand is not the formal name.

19

A. Correct.

20

Q. But the three of you in the central office

21 had the final say on what would be provided for

22 Jessica Hicklin for her gender dysphoria; is that

23 correct?

24

A. Yes. That's the avenue to deliver that

25 direction.

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1

Q. Was anyone above the three of you -- you,

2 Vevia Sturm, Dwayne Kempker, and then Ian Wallace,

3 was there anyone above you that would weigh in on

4 the kind of treatment that Jessica Hicklin would

5 get?

6

A. That decision had already been made, but

7 those discussions were discussed earlier with the

8 director, so that's the direction, so the response

9 is -- the response of the direction comes through

10 that committee. So there's no one else that reviews

11 it, to answer your question.

12

Q. Okay. So if I'm understanding what you're

13 saying, it wouldn't go any further than you,

14 Vevia Sturm, and whoever the division director for

15 the department of adult institution was at any given

16 time -- it wouldn't go beyond that because the

17 policy we saw on Hicklin 00616 had been already been

18 established and it was already -- the procedure that

19 that would be the response in a situation where

20 we're talking about initiation as opposed to

21 continuation of hormone therapy; is that correct?

22

A. The position, yes.

23

Q. The next e-mail on Hicklin versus Lombardi

24 00942 is from Vevia Sturm to Cindy Griffith, and

25 you're also there and so was Ian Wallace and

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1 Jamie Crump was copied, and it says:

2

"Hi, Cindy. I apologize for the delay.

3 Can you please resend the report, and we will review

4 and respond ASAP."

5

Do you see that?

6

A. I do.

7

Q. And if you turn to Hicklin versus

8 Lombardi 944, that same e-mail that we just saw from

9 Vevia Sturm on Hicklin versus Lombardi 942 on

10 July 5th, 2016, where she says, "Hi, Cindy. I

11 apologize for the delay. Can you please resend the

12 report, and we will review and respond ASAP," that

13 same e-mail appears on the bottom of Hicklin versus

14 Lombardi 00944; correct?

15

A. Correct.

16

Q. And then there's an e-mail from

17 Jamie Crump with a response, but there is no

18 substantive -- there's nothing in the body of that

19 e-mail. Presumably, he was resending the report per

20 Vevia Sturm's request; right?

21

A. That would be my assumption.

22

Q. And turning back to Hicklin versus

23 Lombardi 00924, Cindy Griffith's e-mail refers to

24 the last review held on January 13th, 2016; correct?

25

A. I assume so, yes.

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1

Q. You can see it?

2

A. Which page are you on?

3

Q. 00942. Cindy Griffith's e-mail. She

4 refers to January 13, 2016, transgender review for

5 Jessica Hicklin.

6

A. Okay.

7

Q. And it's in response to that that

8 Vevia Sturm says, Sorry for the delay, could you

9 please resend; correct?

10

A. Correct.

11

Q. So, presumably, Jamie Crump was resending

12 the transgender committee's recommendations from

13 January 2016; correct?

14

A. Correct.

15

Q. And then there's an e-mail from you on

16 July 6th, 2016, and it says:

17

"The female personal property is DAI's

18 call. As for the request for hormone replacement

19 therapy, DORS's official response is below."

20

And then we see the same text reproduced

21 in your e-mail that we saw on Hicklin versus

22 Lombardi 00616; correct?

23

A. Correct.

24

Q. And that's consistent with what you've

25 testified, that per this policy, that was the

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1 response in a situation like this one, where it

2 would involve initiation of hormone therapy for

3 gender dysphoria; correct?

4

A. Our position, yes.

5

Q. When you say "our position" -- I'm

6 sorry --

7

A. It's not a procedure; it's a policy. It's

8 not an actual procedure; it's the department's

9 position.

10

Q. And what's the distinction, just so I

11 understand?

12

A. Well, it's -- this doesn't exist in a

13 procedure, so the department's position, much like

14 NCCHC has positions, this is what their position is;

15 this is what our position is.

16

Q. So what I hear you saying is this isn't

17 written down in any official policy or procedure

18 that the Missouri Department of Corrections has?

19

A. That's -- to the best of my knowledge,

20 correct.

21

Q. Okay. And that's why, from your

22 perspective, the word "policy" is not accurate

23 because it's not a written policy that Missouri

24 Department of Corrections has?

25

A. That is correct.

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1

Understanding that you've never spoken to

2 Jessica Hicklin, never corresponded with her in any

3 way -- scratch that.

4

Based on what you know about

5 Jessica Hicklin, from whatever source, is there

6 anything about Jessica Hicklin specifically to your

7 knowledge that makes her more of a safety or

8 security concern than any other transgender inmate?

9

A. Not that I'm aware of.

10

Q. Mr. Sturm, you have been handed what was

11 previously marked as Exhibit 52, and I'll represent

12 to you that these are six pages of notes and a memo

13 pertaining to meetings of the Gender Dysphoria

14 Clinical Supervision Group's discussions related to

15 Jessica Hicklin. These were provided during

16 Dr. Elizabeth Atterberry's deposition.

17

A. Okay.

18

Q. Have you ever seen any of the documents

19 that comprise Exhibit 52?

20

A. Not that I recall.

21

Q. To your knowledge, is the gender dysphoria

22 clinical supervision group, that's a Corizon group;

23 correct?

24

A. To my knowledge, yes.

25

Q. So to your knowledge, Missouri Department

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1 of Corrections -- scratch that.

2

To your knowledge, no Missouri Department

3 of Corrections employee or representative sits on

4 that clinical supervision group?

5

A. That is my understanding.

6

Q. Okay. And is it your understanding that

7 the Gender Dysphoria Clinical Supervision Group

8 reviews the site-specific recommendations with

9 respect to gender dysphoria treatment for a given

10 inmate, and then the Gender Dysphoria Clinical

11 Supervision Group then makes their recommendations

12 to the site-specific transgender committees?

13

A. That's my belief, yes.

14

Q. Okay. Put that aside for now.

15

Turning back to Exhibit 82. Turning to

16 Hicklin versus Lombardi 945, the first -- the first

17 e-mail chronologically on this page, which is at the

18 bottom, is from Vevia Sturm on September 15, 2016,

19 to Jamie Crump cc'ing you and Ian Wallace. Do you

20 see that?

21

A. I do.

22

Q. And, again, you, Vevia Sturm, and at this

23 point, Ian Wallace comprised the three people at the

24 central office that would review the transgender

25 committee's recommendations for transgender inmate;

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1 correct?

2

A. Correct.

3

Q. Vevia Sturm says:

4

"Good morning, Jamie. The committee has

5 reviewed the Gender Dysphoria Clinical Supervision

6 Group's recommendation regarding hormone therapy for

7 Offender Hicklin; however, after careful

8 consideration, hormone therapy is denied. This

9 decision a based on the following --" and then we

10 see the same language that we saw on Hicklin versus

11 Lombardi 616, and that was also included in your

12 e-mail on Hicklin versus Lombardi 00494; correct?

13

A. Correct.

14

Q. How did the Gender Dysphoria Clinical

15 Supervision Group's recommendation regarding hormone

16 therapy for Jessica Hicklin reach the three of

17 you -- Vevia Sturm, you, and Ian Wallace -- at this

18 point in September of 2016?

19

A. I don't recall. My understanding is it

20 may have been included in the transgender -- the

21 site transgender committee recommendations, but I

22 don't know.

23

Q. But you don't recall?

24

A. I don't.

25

Q. Okay.

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1

A. I don't see it here, so ...

2

Q. Did you, Vevia Sturm, and Ian Wallace have

3 a discussion regarding the Gender Dysphoria Clinical

4 Supervision Group's recommendation of hormone

5 therapy for Jessica Hicklin?

6

A. No.

7

Q. So the response here from Vevia Sturm was

8 pursuant to the position that had already been

9 determined with respect to initiation of hormone

10 therapy for gender dysphoria; correct?

11

A. You are correct.

12

Q. The next e-mail on the same page, Hicklin

13 versus Lombardi 0945, is from Vevia Sturm to

14 Jamie Crump, and it's dated November 1st, 2016. Do

15 you see that?

16

A. I do.

17

Q. And it says:

18

"Hello, Jamie. After speaking with

19 Matt Sturm, DORS director, he asked that I convey to

20 you that the committee would like for you to hold

21 off on informing Offender Hicklin of the review

22 committee's response. I will let you know when we

23 would like for you to move forward. Thank you.

24 Vevia Sturm."

25

When did you have the conversation with

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1

A. I do not.

2

Q. Okay. Turn to Hicklin versus Lombardi

3 00950. This is a memo that goes through to 00953.

4 It's dated January 30th, 2017, it's from Stan Payne

5 to Ian Wallace, Matt Sturm, and Vevia Sturm, and

6 it's -- the subject is "Transgender committed,

7 Hicklin, Jessica James."

8

Midway on the first page, Hicklin versus

9 Lombardi 00950, it says that a transgender committee

10 was convened on January 20th, 2017, and then it

11 lists the folks who comprise the committee for that

12 meeting. Do you see that?

13

A. I do.

14

Q. And if you turn to Hicklin versus Lombardi

15 00951, about halfway down the page, there's a

16 sentence that starts, "On January 26th, 2017, my

17 office received --" do you see that?

18

A. Yup.

19

Q. "My office received an e-mail from

20 Elizabeth Atterberry, Psy. D., Gender Dysphoria

21 Clinical Supervision Group, GDCSG. She indicated

22 that this group met on January 25th, '17 and found

23 that -- " and then there are two bullets there. And

24 the first bullet says, "The offender is requesting

25 cross-gender hormone treatment. It is the opinion

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1 of the GDCSG that cross-gender hormone treatment is

2 needed as part of an individualized treatment plan,

3 as the offender is suffering from significant

4 distress or impairment due to a diagnosis of gender

5 dysphoria and to reduce risk of possible behavioral

6 disturbances which can result due to gender

7 dysphoria.

8

Do you see that?

9

A. I do.

10

Q. The second bullet says, "The offender is

11 requesting a hair removal device. It is the opinion

12 of the GDCSG that a hair removal device is not

13 needed." Do you see that?

14

A. I do.

15

Q. Then below that -- well, in brackets there

16 it notes that the findings are actually attached,

17 and if you look to the next two pages here, those

18 appear to be a memo from Elizabeth Atterberry to

19 Stan Payne recounting these finds of the GDCSG

20 committee. Do you see that?

21

A. I do.

22

Q. Okay. So if you turn back to Hicklin

23 versus Lombardi 00951, under those two bullet points

24 and the note saying the GDCSG findings are attached,

25 it says, "The central office PREA review committee

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1 deemed hormone replacement therapy [hrt] not

2 appropriate in the prison setting and, therefore,

3 not approved."

4

Do you see that?

5

A. I do.

6

Q. And, again, that refers to the e-mails

7 that you had conveyed that we saw on Hicklin versus

8 Lombardi 944 and that Vevia Sturm also conveyed on

9 Hicklin versus Lombardi 945; correct?

10

A. Correct.

11

Q. This is in January of 2017. Had there

12 been any additional conversation among you, Matt

13 Sturm -- sorry -- you, Ian Wallace, and Vevia Sturm

14 regarding the recommendation of hormone therapy for

15 Jessica Hicklin since Vevia Sturm sent her e-mail to

16 Jamie Crump on 00945 in September of 2016?

17

A. Not that I recall.

18

Q. To your knowledge, had there been any

19 further discussions involving George Lombardi

20 between the time that the policy that we saw on

21 Hicklin versus Lombardi 00616 was developed and the

22 Gender Dysphoria Clinical Supervision Group weighing

23 in and stating that they thought that hormone

24 therapy should be provided to Jessica Hicklin, was

25 there any additional conversation with

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1 George Lombardi in light of the GDCSG's

2 recommendation about provision of hormone therapy?

3

A. Not to my recollection, no.

4

Q. After the GDCSG renders its opinion

5 regarding hormone therapy for Jessica Hicklin, are

6 you aware of any additional conversations inside of

7 DOC regarding provision of hormone therapy for

8 Jessica Hicklin taking into consideration the

9 GDCSG's recommendation?

10

A. Not that I recall, no.

11

Q. Have you spoken -- scratch that.

12

Have you ever spoken to anyone on the

13 GDCSG about their recommendation that Jessica be

14 provided hormone therapy?

15

A. Not that I recall, no.

16

Q. Has Vevia Sturm ever spoken to anyone on

17 the GDCSG regarding the recommendation for hormone

18 therapy for Jessica Hicklin?

19

MR. DEAN: Objection. Speculation.

20

You can answer, if you know.

21

A. I don't know.

22

Q. (By Ms. Gordon) If Vevia Sturm had spoken

23 to the GDCSG about their recommendation, would you

24 expect to have known about that conversation?

25

A. I'd say depending on the relevance of it,

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1 likely.

2

Q. (By Ms. Gordon) Well, the relevance of it

3 would have been to the question of should we provide

4 hormone therapy to this inmate?

5

A. Then not that I'm aware of.

6

Q. When you say "not that I'm aware of," I'm

7 confused as to which question you're answering.

8

A. I'm not aware if she spoke to the gender

9 dysphoria group.

10

Q. Right. So I guess my question is, would

11 you have known that -- is it likely that you would

12 have known that if she had talked to the Gender

13 Dysphoria Clinical Supervision Group?

14

A. My answer is, if it was something relevant

15 to the group, which you've defined as hormone

16 therapy, then, yes, I probably would have known, and

17 I was not made aware of anything, so my assumption

18 is she did not.

19

Q. Do you know if Ian Wallace spoke to the

20 GDCSG about their recommendation of hormone therapy

21 for Jessica Hicklin?

22

A. I do not know.

23

Q. Is that something that you likely would

24 have known, if Ian Wallace had spoke to the GDCSG

25 about hormone therapy for Jessica Hicklin?

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1

A. Likely.

2

Q. The GDCSG came into being, based on

3 previous testimony, around the fall of 2016, and I

4 believe you said earlier that that comports with

5 your knowledge of this committee; correct?

6

A. Yes.

7

Q. Would that have overlapped at any point

8 with Dwayne Kempker's stint as one of the three

9 people at the central office?

10

A. What date did you say?

11

Q. It was, like, fall -- August or September

12 of 2016.

13

A. I don't recall when --

14

Q. When he stopped --

15

A. -- Dwayne retired and when Ian started.

16

Q. Okay. So assuming that there was --

17

A. So July of -- I'm sorry -- July of 2016,

18 Ian was on the list and Dwayne was not, so in the

19 fall of 2016, Dwayne would have already been gone.

20

Q. Okay.

21

(A recess was taken.)

22

(Deposition Exhibit No. 83 was marked for

23 identification.)

24

Q. (By Ms. Gordon) Mr. Sturm, you've been

25 handed What's been marked Exhibit 83. It's a

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EXHIBIT E

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UNITED STATES DISTRICT COURT EASTERN DISTRICT OF MISSOURI
EASTERN DIVISION

JESSICA HICKLIN, Plaintiff,
v. ANNE PRECYTHE, et. al.,
Defendants.

)

)

)

)

)

Case No. 4:16-cv-01357-NCC

)

)

)

)

DEFENDANTS’ RESPONSES TO PLAINTIFF’S SECOND SET OF REQUESTS FOR ADMISSION Defendants Anne Precythe, Joan Reinkemeyer, Cindy Griffith, Stan Payne, Scott O’Kelly and Latoya Duckworth (“MDOC Defendants”), by and through counsel and pursuant to Federal Rule of Civil Procedure 36, hereby respond to Plaintiff’s Second Set of Requests for Admission as follows:

3. Request for Admission No. 3:
Admit that the statement at HICKLIN V. LOMBARDI 00616 is the current, Missouri Department of Correction position on initiating hormone therapy for inmates diagnosed with Gender Dysphoria.
Response: MDOC Defendants object to this Request as vague and ambiguous. The document identified as HICKLIN v. LOMBARDI 00616 includes numerous “statements.” Subject to and without waiving the foregoing objections: Denied.

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4. Request for Admission No. 4:
Admit that the statement at Hicklin v. Lombardi 00616 was the Missouri Department of Correction’s position on initiating hormone therapy for inmates diagnosed with gender dysphoria in 2017.
Response: MDOC Defendants object to this Request as vague and ambiguous. The document identified as HICKLIN v. LOMBARDI 00616 includes numerous “statements.” Subject to and without waiving the foregoing objections: Admitted.
5. Request for Admission No. 5:
Admit that the statement at Hicklin v. Lombardi 00616 was the Missouri Department of Correction’s position on initiating hormone therapy for inmates diagnosed with gender dysphoria in 2016.
Response: MDOC Defendants object to this Request as vague and ambiguous. The document identified as HICKLIN v. LOMBARDI 00616 includes numerous “statements.” Subject to and without waiving the foregoing objections: Admitted.
6. Request for Admission No. 6:
Admit that the statement at Hicklin v. Lombardi 00616 was the Missouri Department of Correction position on initiating hormone therapy for inmates diagnosed with gender dysphoria in 2015.
Response: MDOC Defendants object to this Request as vague and ambiguous. The document identified as HICKLIN v. LOMBARDI 00616 includes numerous “statements.” Subject to and without waiving the foregoing objections: Admitted.
7. Request for Admission No. 7:
Admit that the Missouri Department of Corrections will not initiate hormone therapy for inmates who are diagnosed with Gender Dysphoria, and for whom hormone therapy has been recommended by a Corizon mental health provider.

Case: 4:16-cv-01357-NCC Doc. #: 164-6 Filed: 03/30/18 Page: 4 of 7 PageID #: 2019
Response: Denied.
8. Request for Admission No. 8:
Admit that the Missouri Department of Corrections will continue hormone therapy for inmates who—prior to incarceration within the Department—were diagnosed with Gender Dysphoria, and were prescribed hormone therapy.
Response: Admitted.
9. Request for Admission No. 9:
Admit that the former Director of the Missouri Department of Corrections, George Lombardi, approved the position on initiating hormone therapy for inmates diagnosed with Gender Dysphoria that is stated in HICKLIN v. LOMBARDI 00616.
Response: Objection. This Request seeks information irrelevant to any claim in Plaintiff’s First Amended Complaint. George Lombardi is not named as a defendant in Plaintiff’s First Amended Complaint. Moreover, the phrase “approved the position” is vague, ambiguous, undefined, and subject to multiple conflicting interpretations.
10. Request for Admission No. 10:
Admit that the current Director of the Missouri Department of Corrections, Anne Precythe, approves of the position on initiating hormone therapy for inmates diagnosed with Gender Dysphoria that is stated in HICKLIN v. LOMBARDI 00616.
Response: Objection. The phrase “approves of the position” is vague, ambiguous, undefined, and subject to multiple conflicting interpretations. Subject to and without waiving these objections: Denied.

Case: 4:16-cv-01357-NCC Doc. #: 164-6 Filed: 03/30/18 Page: 5 of 7 PageID #: 2020
11. Request for Admission No. 11:
Admit that the former Director of Adult Institutions of the Missouri Department of Corrections, Dave Dormire, assisted in developing, and executing on, the position on initiating hormone therapy for inmates diagnosed with Gender Dysphoria that is stated in HICKLIN v. LOMBARDI 00616.
Response: Objection. This Request seeks information irrelevant to any claim in Plaintiff’s First Amended Complaint. Dave Dormire is not named as a defendant in Plaintiff’s First Amended Complaint. Moreover, the phrase “executing on the position” is vague, ambiguous, undefined, and subject to multiple conflicting interpretations.
12. Request for Admission No. 12:
Admit that the current Director of Adult Institutions of the Missouri Department of Corrections, Alana Boyles, assists in executin on the position on initiating hormone therapy for inmates diagnosed with Gender Dysphoria that is stated in HICKLIN v. LOMBARDI 00616.
Response: Objection. The phrase “assists in executin on the position” [SIC] is vague, ambiguous, undefined, and subject to multiple conflicting interpretations. Subject to and without waiving these objections: Denied.

Case: 4:16-cv-01357-NCC Doc. #: 164-6 Filed: 03/30/18 Page: 6 of 7 PageID #: 2021
Respectfully submitted,
JOSHUA D. HAWLEY Attorney General
~Lo
David D. Dean, #67190MO Assistant Attorney General Missouri Atty General's Office P .O. Box 861 St. Louis, MO 63188
Telephone: (314) 340-7950 Facsimile: (314) 340-7029 David.Dean@ago.mo.gov
Attorneys for Defendants Anne Precythe, Cindy Griffith, Joan Reinkemeyer, Scott O'Kelly, Stan Payne, Latoya Duckworth

Case: 4:16-cv-01357-NCC Doc. #: 164-6 Filed: 03/30/18 Page: 7 of 7 PageID #: 2022
CERTIFICATE OF SERVICE
I hereby certify that on this 19th day of March 2018, the foregoing was served by e-mail upon the following.
Sharon E. Roberg-Perez Robins Kaplan LLP 2800 LaSalle Avenue Minneapolis, MN 55402 sroberg-perez@}robinskaplan. com
Demoya Renee Gordon Richard Saenz Lambda Legal Defense 120 Wall St., 19th Fl. New York, NY 10005-3919 dgordon@lambdalegal.org rsaenz@}lambdalegal.org
Kevin L. Schriener Law and Schreiner, LLC 141 N. Meramec Ave., Ste. 314 St. Louis, MO 63105 kschriener@schrienerlaw.com
Kyle Anthony Palazzolo Lambda Legal Defense 105 W. Adams St., Ste. 2600 Chicago, IL 60603 kpalazzolo@lambdalegal. org Attorneys for Plaintiff
J. Thaddeus Eckenrode Kevin Peek ECKENRODE-MAUPIN 11477 Olde Cabin Rd., Ste. 110 St. Louis, MO 63141 jte@eckenrode-law.com kkp@eckenrode-law.com Attorneys for Defendant Corizon, LLC
Assistant Attorney General

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EXHIBIT F

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EXHIBIT G

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GF 0046

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GF 0107

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GF 0127

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GF 0151

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GF 0155

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EXHIBIT H

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Laird, Jackie
From:
Sent
To:
Cc: Subject

Griffith, Cindy Wednesday, April 22, 2015 7:47 AM Larkin, Diana; Senter, Phil Crump, Jamie; Payne, Stanley; Laird, Jackie FW: PCC Offender Request for Gender Dysphoria Treatment

You may have received this information from elsewhere, but wanted to pass along.

From: Sturm, Matt
Sent: Tuesday, April 21, 2015 4:24 PM To: Kempker, Dwayne; Dormire, Dave Cc: Earls, Alan; Prudden, Cyndi; Williams, Richard; Briesacher, Matt; Collins, Cari; Rost, David E; Williams, Deloise;
Griffith, Cindy; O'Kelley, Scott
Subject: RE: PCC Offender Request for Gender Dysphoria Treatment
FYI - Corizon is not moving forward with hormone treatment or with surgery. He was diagnosed with gender dysphoria, but that in itself does not warrant hormone treatments or surgery. After discussing this today w ith Corizon MH and Medical, there are no plans to proceed with hormone treatment or surgery. Of course, the offender may legally challenge that decision. Thank you.

From: Kempker, Dwayne
Sent: Tuesday, April 21, 2015 8:17AM To: Dormire, Dave Cc: Earls, Alan; Prudden, Cyndi; Williams, Richard; Briesacher, Matt; Collins, Cari; Sturm, Matt; Rost, David E; Williams,
Deloise; Griffith, Cindy; Garrison, Julie
Subject: FW: PCC Offender Request for Gender Dysphoria Treatment
Director Dormire,
Please see the below notification from Warden Griffith. To summarize, Phychiatrist Dr. Throop assigned offender Hicklin the diagnosis of gender dysphoria and referred him to Dr. Eyman for cross-sex hormone treatment. Reportedly Dr. Eyman has not yet given any direction or prescription.
Do you have any direction related to this?
([)wayne o/. 1(emp~r
Deputy Division Director /Zone II Division of Adult Institutions

From: Griffith, Cindy
Sent: Monday, April 20, 2015 4:30PM To: Kempker, Dwayne Cc: Payne, Stanley Subject: PCC Offender Request for Gender Dysphoria Treatment

Offender James Hicklin #527993 has been assigned to PCC since 1997 with a life without parole sentence for

Murder 1st degree, and has been assigned to our Incentive Unit for a number of years. Due to recent court

cases and his age at the time of his offense, he believes that he will have his sentence modified and receive a

release date in the next year or so.

CONFIDENTIAL

1

HICKLIN V. LOMBARDI 00911

Case: 4:16-cv-01357-NCC Doc. #: 164-9 Filed: 03/30/18 Page: 3 of 18 PageID #: 2036
Any t ime in the past when questioned, he has refused to identify as trangendered, but recently told medical staff (in his attached notarized request) that he wants to start hormone treatments to pursue his goal of becoming female prior to his anticipated release. Note that his proposal also includes a request to purchase "Gender Affirming" canteen items as well as a body hair removal method. Our transgender committee will address his housing, work, and program assignments on Thursday, 4/23/15, but we will need guidance on the Department's stance on his other requests.
Hicklin appears to have obtained the support of a Corizon psychiatrist, Dr. Throop, who assigned Hicklin the psychiatric diagnosis of gender dysphoria on 3/23/15. Dr. Throop also recommended referral to an endocrinologist for consideration to initiate cross-sex hormone treatment. I have been advised that Dr. Throop sent his recommendation to Dr. Eyman with Corizon, and that it is Dr. Eyman who makes the decision. If Dr. Eyman approves, then our onsite medical staff are required to follow through with the treatment. To my knowledge, no response has been received from Dr. Eyman.
My understanding is that in the past the DOC did not initiate hormone replacement therapy, but may have continued treatment regimens started prior to incarceration. (Offender Hicklin has no history of prior treatment). I am unaware whether any other DOC offender has made similar requests, and if so, our normal response. I have copied Stan Payne, our new PREA Site Coordinator for his information. We would appreciate your review of this matter, and any advice on how to respond.

CONFIDENTIAL

2

HICKLIN V. LOMBARDI 00912

Case: 4:16-cv-01357-NCC Doc. #: 164-9 Filed: 03/30/18 Page: 4 of 18 PageID #: 2037

DEPARTMENT OF CORRECTIONS POTOSI CORRECTIONAL CENTER ***MEMORANDUM***

DATE: TO:

April24, 2015
Dwayne Kempker, Deputy Director, DAI Matt Sturm, Director, DORS Vevia Sturm, DOC PREA Coordinator

FROM:
SUBJECT: Transgender Committee- HICKLIN, JAMES #527993
Offender James Hicklin arrived to the Missouri DOC on 4-29-97 to serve a life without parole sentence for Murder 1st degree. He has resided at the Potosi Correctional Center since 6/5/97.
For most of his sentence he has been assigned to general population, but file material reflects one assignment to protective custody from May 2003 to February 2004. He claims to have been sexually assaulted by other offenders three times in his first two years of incarceration. As a result he states he was hesitant to self-identify as transgender until recently - even though he claims to have experienced gender dysphoria issues for the past 25 years. He recently received a diagnosis of gender dysphoria from Dr. Throop, and in turn he has submitted a request to start hormone replacement therapy, which has been denied at this time. Offender Hicklin has scored as a Sigma on the Adult Internal Risk Assessment (AIRA).
Per IS5-3.1 Offender Housing Assignments, a transgender committee was convened on 4/23/15. · This committee consisted of:
• Cindy Griffith, Warden • Stanley Payne, Deputy Warden - Offender Management • William McKinney, MD, Medical Director • Diana Larkin, Health Services Administrator • Kim Randolph, Regional Director of Operations - Corizon • Phil Senter, Institutional Chief of Mental Health Services
Offender Hicklin was interviewed prior to the meeting, and was asked for his input regarding his housing unit assignment. He is currently assigned to general population, and resides in the incentive unit due to his above average institutional adjustment. He resides in a two-man cell with an offender with a capital punishment sentence (AIRA score of Kappa). Hicklin is very satisfied with his current housing and cell assignment, but is concerned that if his cellmate receives a warrant of execution he may then be celled with an incompatible cellmate. He has no interest in protective custody assignment, has no current concerns for his safety/privacy and prefers to remain in general population. He has made a list of offenders in Housing Unit SA that he feels he would be compatible withC,OanNdFisIDawEaNreToIAf tLhe cell assignment request process alreadHy IinCpKlaLcIeNfoVr .GLPOoMffeBndAeRrsDsIho0u0ld91th3e

Case: 4:16-cv-01357-NCC Doc. #: 164-9 Filed: 03/30/18 Page: 5 of 18 PageID #: 2038
need arise. Housing unit wing showers have half barriers for privacy, and he expressed no issues with the shower setup. If he were to be placed in a facility with multi-person shower facilities he would prefer to shower alone. He currently works in the PRIJviE offender tv/video studio, and has no concerns with the assignment. The PRIME studio is monitored by camera and by staff patrolling the area. No Alpha-classified offenders are currently assigned to the studio. Hicklin also expressed no concern with offender programming, as a staff member is always present.
Offender Hicklin~s statements were shared with the transgender committee, and his input was considered. Committee members indicated that there are neither mental health nor medical reasons that would necessitate specific cell, work or program assignment for Hicklin.
The committee finds that his current assignment is suitable. He knows to request protective custody should the need arise. He has fared well thus far in general population and does not anticipate any issues. He plans to submit for assignment with the general population cellmate ofhis choice i£'when the need arises. He is aware that he will double cell with an otherwise compatible cellmate if he is placed in segregation for some reason in the future.
A six month review of Offender Hicklin's assignment was tentatively set for October 23, 2015.
cc: Committee members listed above file

CONFIDENTIAL

HICKLIN V. LOMBARDI 00914

Case: 4:16-cv-01357-NCC Doc. #: 164-9 Filed: 03/30/18 Page: 6 of 18 PageID #: 2039

DEPARTMENT OF CORRECTIONS
POTOSI CORRECTIONAL CENTER
***MEMORANDUM***

DATE: TO:

November 2, 2015
Dwayne Kempker, Deputy Director, DAI Matt Sturm, Director, DORS Vevia Sturm, DOC PREA Coordinator

FROM : SUBJECT: Transgender Committee - HICKLIN, JESSICA JAMES #527993

Offender Jessica James Hicklin arrived to the Missouri DOC on 4-29-97 to serve a life without parole sentence for Murder 151 degree. He has resided at the Potosi Correctional Center since 6:. 5-97.
For most of his sentence he has been assigned to general population, but file material reflects one assignment to protective custody from May 2003 to February 2004. He Claims to have been sexually assaulted by other offenders three times in his first two years of incarceration, and that as a he was hesitant to self-identify as transgender until recently - even though he claims to have
experienced gender dysphoria issues for the past 25 years. He recently received ·a. diagnosi~ of gender
dysphoria from Dr. Throop, and in tum he has submitted a request to start hormone replacement therapy, which has been denied at this time. Offender Hicklin has scored as a Sigma on the Adult Internal Risk Assessment (AIRA).

Per IS5-3.1 Offender Housing Assignments; a transgender committee was conve11ed on October26, 2015. This committee consisted of:

• Stanley Payne, Deputy Warden - Offender Management • Dawn Wade, Director of Nursing • Phil Senter, Institutional Chief of Mental Health Services • Jami Ross, QMHP (observing with Phil Senter)

Offender Hicklin was interviewed prior to the meeting, and was asked for his input regarding his housing unit assignment. He is currently assigned to general population, and resides in the incentive

unit due to his above average fustitutional adjustment. ·He resides irt a two-mali cell .with an offender

with a capital punishment sentence (Barnett, David #9901350 AIRA - Kappa).. Hicklin is very satisfied with his current housing and cell assignment, but .is concerned that if his cellmate receives a

warrant of execution he may then be celled with an incompatible cellmate·. He has no interest in

protective custody assignment, has no current concerns for his safety/privacy and prefers to remain in general population. He is aware of the cell assignment request process already iri place for GP offenders should the need arise. Housing unit wing showers have half barriers for privacy, ~nd he expressed no issues with the shower setup. If he were to be placed in a facility with muiti·-pe..son shower facilities he would prefer to shower alone. He currently works in the PRIMEoffender

CONFIDENTIAL

HICKLIN V. LOMBARDI 00925

Case: 4:16-cv-01357-NCC Doc. #: 164-9 Filed: 03/30/18 Page: 7 of 18 PageID #: 2040
tv/video studio, and has no concerns with the assignment. The PRIME studio is monitored by camera and by staff patrolling the area. No Alpha-classified offenders are currently assigned to the studio. Hicklin also expressed no concern with offender programming, as a staffmeniber is always present.
Offender Hicklin's statements were shared with the transgender committee, and his input was considered. Committee members indicated that there are neither mental health nor medical reasons that would necessitate specific cell, work or program assignment for Hicklin.
Hicklin had a legal name on August 6, 2015 to Jessica James Hicklin. He indicated thatthere were no issues with his legal name change in regards to his incarceration. He stated to me that staff have been very respectful.
The committee finds that his current assignment is suitable. He knows to recp.Iest protective cu5tody should the need arise. He has fared well thus far in general population and does not anticipate any issues. He plans to submit for assignment with the general population cellmate ofhis:c;hoice if/when the need arises. He is aware that he will double cell with an otherwise compatible cellmate if he is placed in segregation for some reason in the future.
A six month review of Offender Hicklin's assignment was tentatively set forApri122, 2016.
cc: Committee members Jisted above file

CONFIDENTIAL

HICKLIN V. LOMBARDI 00926

Case: 4:16-cv-01357-NCC Doc. #: 164-9 Filed: 03/30/18 Page: 8 of 18 PageID #: 2041
From: Griffith, Ondy
Sent: Tuesday, July 05, 2016 1:42PM To: Sturm, Matt; Sturm, Vevia; Wallace, Ian
Cc: Crump, Jamie
Subject: f\N: (enaypt] HRT
Offender Hicklin's last t ransgender review was held on 1/13/16 . To my knowledge the recommendations of the local transgender committee are under review at your level. I don't see any point in having the committee meet aga in until we know the outcome of the last one. Any thoughts or direction would be appreci ated .
- - -- - -- - -- ---
From: Crump, Jamie
Sent: Tuesday, July 05, 2016 11:58 AM To: Griffith, Ondy Subject: f\N: [enoypt] HRT
From: Stephens, Evelynn
Sent: Friday, July 01, 2016 4:14PM To: Polk, Carolyn; McKinney, William; Crump, Jamie Subject: [encrypt] HRT
As the patient Hicklin 527993 has successfully completed over 6 months of therapy while living as a female and still has a strong desire for hormone therapy with likey decrease of agitation and anxiety surrounding diagnosed gender dysphoria if this therapy was to start. I have resubmitted a medical referral. If the Gender Dysphoria Committee would like to discuss this at alii am more than happy to meet. I feel this referral needs to be done in accordance with the APA 2012 guidelines and I would be negligent in my duties as this patient's provider if I did not make it. If anyone has any questions let me know!
Dr. Stephens

CONFIDENTIAL

2
HICKLIN V. LOMBARDI 00941

Case: 4:16-cv-01357-NCC Doc. #: 164-9 Filed: 03/30/18 Page: 9 of 18 PageID #: 2042

Crump, Jamie
From:
Sent To: Subject

Griffith, Cindy Tuesday, July 05, 2016 3:27 PM Crump, Jamie
RE: [encrypt] HRT

The last paragraph me ntioned that we would start the wait period after the "standard of care" was provided to Hicklin (weekly psychotherapy, etc). So even though Dr. Stephens mentions 6 months of therapy, you will want to ask her to specify the type/frequency of his therapy at the next transgender review to see if it met the APA standard of care . Looks like he is now due for th e 6 month review by policy, but hopefully we 'll have someth ing back from the central office committee prior to the review?
-·--- ---·- ---··· .- ---··-·--·-- ·----·--··--·- - - - - - - · · - - -- - - · - - - -· - - - - -
From: Crump, Jamie
Sent: Tuesday, July 05, 2016 3:17 PM
To: Sturm, Vevia; Griffith, Cindy; Sturm, Matt; Wallace, Ian
Subject: RE: [encrypt] HRT

--- -------- --- - - - - - - -- - - --- -·----·---·----- --- - - - ---- - -- - - · - - - - -- -
From: Sturm, Vevia
Sent: Tuesday, July OS, 2016 1:46PM
To: Griffith, Cindy; Sturm, ,_Matt; Wallace, Ian Cc: Crump, Jamie
Subject: RE: [encrypt] HRT

Hi Cindy,

I apologize for the delay. Can you pl ease resend th e report and we will review and respond ASAP.

Thanks, Vevia
- - - -·- --- - ----·-··-··----·-- - -- - ---- -- ·- ---·-···· -··- -·-- - From: Griffith, Ondy Sent: Tuesday, July OS, 2016 1:42 PM To: Sturm, Matt; Sturm, Vevia; Wallace, Ian Cc: Crump, Jamie Subject: FW: [encrypt] HRT

Offender Hicklin's last tran sgender review was held on 1/13/16. To my knowledge the recomm endations of the local transgender committee are under review at your level. I don't see any point in having the committee meet again until we know the outcome of the last one. Any thoughts or direction would be appreciated .

- - --.-------------- -- ·
From: Crump, Jamie
Sent: Tuesday, July OS, 2016 11:S8 AM
To: Griffith, Ondy
Subject: FW: [encrypt] HRT

-- -- ·- - - - - - - -- - - -- -

CONFIDENTIAL

1
HICKLIN V. LOMBARDI 00942

Case: 4:16-cv-01357-NCC Doc. #: 164-9 Filed: 03/30/18 Page: 10 of 18 PageID #: 2043 -------------···-- - -----------·- - - -
From: Stephens, Evelynn
Sent: Friday, July 01, 2016 4:14 PM
To: Polk, Carolyn; McKinney, William; Crump, Jamie
Subject: [encrypt] HRT
As the patient Hicklin 527993 has successfully completed over 6 months of therapy while living as a female and still has a strong desire for hormone therapy with likey decrease of agitation and anxiety surrounding diagnosed gender dysphoria if this therapy was to start. I have resubmitted a medical referral. If the Gender Dysphoria Committee would like to discuss this at alii am more than happy to meet. I feel this referral needs to be done in accordance with the APA 2012 guidelines and I would be negligent in my duties as this patient's provider if I did not make it. If anyone has any questions let me know !
Dr. Stephens

CONFIDENTIAL

2
HICKLIN V. LOMBARDI 00943

Case: 4:16-cv-01357-NCC Doc. #: 164-9 Filed: 03/30/18 Page: 11 of 18 PageID #: 2044

Crump, Jamie .
From:
Sent: To: Cc: Subject:

Wallace, Ian Wednesday, July 06, 2016 12:34 PM Griffith, Cindy Crump, Jamie; Sturm, Matt FW: [encrypt] HRT

Please find the attached from Director Sturm.
From: Sturm, Matt
Sent: Wednesday, July 06, 2016 8:14AM To: Sturm, Vevia; Wallace, Ian Subject: RE: [encrypt] HRT
The female personal property is DAI's call. As for the request for Hormone Replacement Therapy, DORS' official response is below:
PREA is designed to keep all offenders safe from sexual assault and harassment, particularly those at greater risk of sexual victimization. The Department has adopted and is comm itted to enforce PREA zero tolerance of sexual abuse and harassment by complying with all PREA standards and making every effort to keep our offenders safe. The Department believes the initiation of Hormone Replacement Therapy (HRT) is not appropriate in a prison environment. An attempt at such transition in the prison venue severely compromises the safety of the offender and places them at substantial risk of sexua l abuse and harassment. Therefore, after carefu lly balancing the potential benefit of HRT therapy to an offender, the increased risk to their personal safety as well as impact on the safety and security of other offenders and staff, we conclude such therapy is not appropriate in a prison setting and is not approved. Although HRT therapy is not approved, Mental Health is directed to and shall continue to provide all counseling and support deemed necessary.
Matt From: Crump, Jamie
Sent: Tuesday, July 05, 2016 3:17PM To: Sturm, Vevia; Griffith, Cindy; Sturm, Matt; Wallace, Ian Subject: RE: [encrypt] HRT

From: Sturm, Vevia
Sent: Tuesday, July 05, 2016 1:46PM To: Griffith, Ondy; Sturm, Matt; Wallace, Ian Cc: Crump, Jamie Subject: RE: [encrypt] HRT
Hi Cindy,
I apologize for the delay. Can you please resend the report and we will review and respond ASAP .
Thanks, Vevia

CONFIDENTIAL

1
HICKLIN V. LOMBARDI 00944

Case: 4:16-cv-01357-NCC Doc. #: 164-9 Filed: 03/30/18 Page: 12 of 18 PageID #: 2045

Crump, Jamie
From: Sent To: Subject

Sturm, Vevia Tuesday, November 01, 2016 12:02 PM Crump, Jamie FW: Offender Hicklin #527993

Hello Jamie,

After speaking with Matt Sturm, DORS Director, he has asked that I convey to you that the committee would like for you to hold off on informing Offender Hicklin of the Review Committee's response. I will let you know when we would like for you to move forward .

Thank you,

Vevia Sturm PREA Coordinator (573) 522-3335
From: Sturm, Vevia Sent: Thursday, September 15, 2016 8:44AM To: Crump, Jamie Cc: Sturm, Matt; Wallace, Ian Subject: Offender Hicklin #527993

- - - ·-·--····------ - -···· - - -- ···· ---·-· ·---- -------·--- -- ·--·----

Good Morning Jamie,

The committee has reviewed the Gender Dysphoria Clinical Supervision Group's recommendation regarding hormone therapy for Offender Hicklin, however, after careful consideration, hormone therapy is denied. This decision was based on the following:

PREA is designed to keep all offenders safe from sexual assault and harassment, particularly those at greater risk of sexual victimization. The Department has adopted and is committed to enforce PREA zero tolerance of sexual abuse and harassment by complying with all PREA standards and making every effort to keep our offenders safe. The Department believes the initiation of Hormone Replacement Therapy {HRT) is not appropriate in a prison environment. An attempt at such transition in the prison venue severely compromises the safety of the offender and places them at substantial risk of sexual abuse and harassment. Therefore, after carefully balancing the potential benefit of HRT therapy to an offender, the increased risk to their personal safety as well as impact on the safety and security of other offenders and staff, we conclude such therapy is not appropriate in a prison setting and is not approved. Although HRT therapy is not approved, Mental Health is directed to and shall continue to provide all counseling and support deemed necessary.

Sincerely,
Vevia Sturm
PREA Coordinator (573) 522-3335

CONFIDENTIAL

1
HICKLIN V. LOMBARDI 00945

Case: 4:16-cv-01357-NCC Doc. #: 164-9 Filed: 03/30/18 Page: 13 of 18 PageID #: 2046

DEPARTMENT OF CORRECTIONS POTOSI CORRECTIONAL CENTER
***MEMORANDUM***

DATE: TO:

July 18, 2016
Ian Wallace, Deputy Director, DAI Matt Sturm, Director, DORS Vevia Sturm OC PREA Coordinator

FROM: SUBJECT: Transgender Committee- HICKLIN, JESSICA JAMES #527993

Offender Jessica James Hicklin arrived to the Missouri DOC on 4-29-97 to serve a life without parole sentence for Murder 1st degree. He has resided at the Potosi Correctional Center since 6-5-97.

For most of his sentence, he has been assigned to general population, but file material reflects one assignment to protective custody from May 2003 to February 2004. He claims to have been sexually assaulted by other offenders three times in his first two years of incarceration, and that as a homosexual, he was hesitant to self-identify as transgender until recently- even though he claims to have experienced gender dysphoria issues for the past 25 years. He recently received a diagnosis of gender dysphoria from Dr. Throop, and in tum he has submitted a request to start hormone replacement therapy, which has been denied at this time. Offender Hicklin has scored as a Sigma on the Adult Internal Risk Assessment (AIRA). Hicklin had a legal name change on August 6, 2015 to Jessica James Hicklin. He indicated that there were no issues with his legal name change in regards to his incarceration. He stated to me that staff has been very respectful.

Per IS5-3 .1 Offender Housing Assignments, a transgender committee was convened on July 15, 2016. This committee consisted of:

• Jamie Crump, Deputy Warden I PREA Site Coordinator • Carolyn Polk, ICMHS • Dr. Evelyn Stephens

Offender Hicklin was interviewed on July 15, 2016 prior to this report and was asked for his input

regarding his housing unit assignment, programming and any issues with showering in his housing

unit. He is currently assigned to general population, and resides in the incentive unit due to his

above average institutional adjustment. He resides in a two-man cell with an offender with a capital

punishment sentence (Barnett, David #9901350 AIRA - Kappa). Hicklin is very satisfied with his

current housing and cell assignment, but is concerned that ifhis cellmate receives a warrant of

execution he may then be celled with an incompatible cellmate. He has no interest in protective

custody assignment, has no current concerns for his safety/privacy and prefers to remain in general

population. He is aware of the cell assignment request process already in place for GP offenders

should the need arise. Housing unit wing showers have half barriers for privacy, and he expressed no

CONFIDENTIAL

HICKLIN V. LOMBARDI 00946

Case: 4:16-cv-01357-NCC Doc. #: 164-9 Filed: 03/30/18 Page: 14 of 18 PageID #: 2047
issues with the shower setup. If he were to be placed in a facility with multi-person shower facilities he would prefer to shower alone. He currently works in the PRIME offender TV/video studio, and has no concerns with the assignment. Hicklin assured me that he knows the correct avenues to take should he encounter any problems, i.e. notifYing an officer, contacting his FUM or writing to the Administration.
The PRIME studio is monitored by camera and by staff patrolling the area. No Alpha-classified offenders are currently assigned to the studio. Hicklin also expressed no concern with offender programming if he were to wish to participate. Hicklin stated that he currently facilitates the ICVC program with a staff member present which has presented no issues.
Hicklin did mention that he should be hearing something from the courts in the near future in reference to his lawsuit requesting hormone treatment. He stated he filed an IRR PCC-15-478, which has been exhausted at all levels.
Offender Hicklin's statements were shared with the transgender committee, and his input was considered. Committee members indicated that there is neither mental health nor medical reasons that would necessitate specific cell, work or program assignment for Hicklin.
The committee finds that his current assignment is suitable. He knows to request protective custody should the need arise. He has fared well thus far in general population and does not anticipate any issues. He plans to submit for assignment with the general population cellmate of his choice if/when the need arises. He is aware that he will double cell with an otherwise compatible cellmate if he is placed in segregation for some reason in the future.
A six month review of Offender Hicklin's assignment was tentatively set for January 15, 20 17.

cc: Committee Members listed above Cindy Griffith, Warden File
CONFIDENTIAL

HICKLIN V. LOMBARDI 00947

Case: 4:16-cv-01357-NCC Doc. #: 164-9 Filed: 03/30/18 Page: 15 of 18 PageID #: 2048

DEPARTMENT OF CORRECTIONS POTOSI CORRECTIONAL CENTER
***MEMORANDUM***

DATE:

August 3, 2017

TO: FROM:

Alan Earls, Deputy Director, DAI Joan Reinkemeyer, Director, DORS Vevia Sturm, DOC PREA Coordinator
df~~
Stan Payne, Deputy Warden I PREA Site Coordinator- PCC

SUBJECT: Transgender Committee - HICKLIN, JESSICA JAMES #527993

Offender Jessica James Hicklin arrived to the Missouri DOC on 4-29-97 to serve a life without parole sentence for Murder 1st degree. He has resided at the Potosi Correctional Center since 6-5-97.

For most of his sentence, he has been assigned to general population, but file material reflects one assignment to protective custody from May 2003 to February 2004. He claims to have been sexually assaulted by other offenders three times in his first two years of incarceration, and that as a homosexual, he was hesitant to self-identify as transgender until recently- even though he claims to have experienced gender dysphoria issues for the past 25 years. He has received a diagnosis of gender dysphoria from Dr. Throop, and in tum he has submitted a request to start hormone replacement therapy, which has been denied at this time. Offender Hicklin has scored as a Sigma on the Adult Internal Risk Assessment (AIRA). Hicklin had a legal name change on August 6, 2015 to Jessica James Hicklin. He indicated that there were no issues with his legal name change in regards to his incarceration. He stated to me that staff has been very respectful.

Per IS5-3.1 Offender Housing Assignments, a transgender committee was convened on July 25, 2017. This committee consisted of:

• Stan Payne, Deputy Warden I PREA Site Coordinator • Carolyn Polk, ICMHS • Tom Pearson, FUM • Diana Larkin, HSA

Offender Hicklin was interviewed on July 25,2017 prior to this report and was asked for his input

regarding his housing unit assignment, programming and any issues with showering in his housing

unit. He is currently assigned to general population, and resides in the incentive unit due to his

above average institutional adjustment. He resides in a two-man cell with an offender with a capital

punishment sentence (Barnett, David #9901350 AIRA- Kappa). Hicklin is very satisfied with his

current housing and cell assignment, but is concerned that if his cellmate receives a warrant of

execution he may then be celled with an incompatible cellmate. He has a couple of other offenders in

mind for cellmates if/when the need should arise. He has no interest in protective custody

assignment, has no current concerns for his safety/privacy and prefers to remain in general

CONFIDENTIAL

HICKLIN V. LOMBARDI 00957

Case: 4:16-cv-01357-NCC Doc. #: 164-9 Filed: 03/30/18 Page: 16 of 18 PageID #: 2049
population. He is aware of the cell assignment request process already in place for GP offenders should the need arise. Housing unit wing showers have half barriers for privacy, and he expressed no issues with the shower setup. If he were to be placed in a facility with multi-person shower facilities he would prefer to shower alone. He currently works in the PRIME offender TV/video studio, and has no concerns with the assignment. Hicklin assured me that he knows the correct avenues to take should he encounter any problems, i.e. notifying an officer, contacting his FUM or writing to the Administration.
The PRIME studio is monitored by camera and by staff patrolling the area. No Alpha-classified offenders are currently assigned to the studio. Hicklin also expressed no concern with offender programming if he were to wish to participate. Hicklin stated that he currently facilitates the ICVC program with a staff member present which has presented no issues.
Hicklin did mention that he should be hearing something from the courts in the next couple weeks in reference to his lawsuit requesting hormone treatment.
Offender Hicklin's statements were shared with the transgender committee, and his input was considered. Committee members indicated that there is neither mental health nor medical reasons that would necessitate specific cell, work or program assignment for Hicklin. There have been no PREA allegations or investigation pertaining to offender Hicklin.
The committee finds that his current assignment is suitable. He knows to request protective custody should the need arise. He has fared well thus far in general population and does not anticipate any issues. He plans to submit for assignment with the general population cellmate of his choice if/when the need arises. He is aware that he will double cell with an otherwise compatible cellmate if he is placed in segregation for some reason in the future.
A six month review of Offender Hicklin's assignment was tentatively set for January 25, 2018.
cc: Cindy Griffith, Warden File

CONFIDENTIAL

HICKLIN V. LOMBARDI 00958

Case: 4:16-cv-01357-NCC Doc. #: 164-9 Filed: 03/30/18 Page: 17 of 18 PageID #: 2050 Hicklin v. Lombardi 05592

Case: 4:16-cv-01357-NCC Doc. #: 164-9 Filed: 03/30/18 Page: 18 of 18 PageID #: 2051 Hicklin v. Lombardi 05593

Case: 4:16-cv-01357-NCC Doc. #: 164-10 Filed: 03/30/18 Page: 1 of 4 PageID #: 2052
EXHIBIT I

Case: 4:16-cv-01357-NCC Doc. #: 164-10 Filed: 03/30/18 Page: 2 of 4 PageID #: 2053

Case: 4:16-cv-01357-NCC Doc. #: 164-10 Filed: 03/30/18 Page: 3 of 4 PageID #: 2054

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Case: 4:16-cv-01357-NCC Doc. #: 164-11 Filed: 03/30/18 Page: 1 of 4 PageID #: 2056
EXHIBIT J

Case: 4:16-cv-01357-NCC Doc. #: 164-11 Filed: 03/30/18 Page: 2 of 4 PageID #: 2057

Case: 4:16-cv-01357-NCC Doc. #: 164-11 Filed: 03/30/18 Page: 3 of 4 PageID #: 2058

Case: 4:16-cv-01357-NCC Doc. #: 164-11 Filed: 03/30/18 Page: 4 of 4 PageID #: 2059

Case: 4:16-cv-01357-NCC Doc. #: 164-12 Filed: 03/30/18 Page: 1 of 4 PageID #: 2060
EXHIBIT K

Case: 4:16-cv-01357-NCC Doc. #: 164-12 Filed: 03/30/18 Page: 2 of 4 PageID #: 2061

Case: 4:16-cv-01357-NCC Doc. #: 164-12 Filed: 03/30/18 Page: 3 of 4 PageID #: 2062

Case: 4:16-cv-01357-NCC Doc. #: 164-12 Filed: 03/30/18 Page: 4 of 4 PageID #: 2063

Case: 4:16-cv-01357-NCC Doc. #: 164-13 Filed: 03/30/18 Page: 1 of 6 PageID #: 2064
EXHIBIT L

Case: 4:16-cv-01357-NCC Doc. #: 164-13 Filed: 03/30/18 Page: 2 of 6 PageID #: 2065

Case: 4:16-cv-01357-NCC Doc. #: 164-13 Filed: 03/30/18 Page: 3 of 6 PageID #: 2066

Case: 4:16-cv-01357-NCC Doc. #: 164-13 Filed: 03/30/18 Page: 4 of 6 PageID #: 2067

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Case: 4:16-cv-01357-NCC Doc. #: 164-14 Filed: 03/30/18 Page: 1 of 6 PageID #: 2070
EXHIBIT M

Case: 4:16-cv-01357-NCC Doc. #: 164-14 Filed: 03/30/18 Page: 2 of 6 PageID #: 2071 JESSICA HICKLIN 7/12/2017 Page 1

1

IN THE UNITED STATES DISTRICT COURT

FOR THE EASTERN DISTRICT OF MISSOURI

2

EASTERN DIVISION

3

4 JESSICA HICKLIN,

5

Plaintiff,

6 vs.

7 WILLIAM MCKINNEY, et al.,

8

Defendants.

) ) ) ) Cause No. ) 4:16-cv-01357-NCC ) ) ) )

9

DEPOSITION OF JESSICA HICKLIN

10

Taken on behalf of the Defendants

July 12, 2017

11

Pamela G. Williams, CCR 880

12

(The deposition commenced at 10:30 a.m.)

13

14

15

16

17

18

19

20

21

22

23

24

25

MIDWEST LITIGATION SERVICES

www.midwestlitigation.com

Phone: 1.800.280.3376

Fax: 314.644.1334

Case: 4:16-cv-01357-NCC Doc. #: 164-14 Filed: 03/30/18 Page: 3 of 6 PageID #: 2072 JESSICA HICKLIN 7/12/2017 Page 21

1

A. Uh-huh.

2

Q. Depression. And I think I saw somewhere, but

3 I could be wrong, have you been diagnosed with bipolar at

4 all?

5

A. At one time in the past I was, but my current

6 psychiatrist, as far as I understand her records, says that

7 this is not a -- my only standing mental health diagnosis

8 and condition is gender dysphoria.

9

Q. Okay. And that's why I asked. I wanted to

10 clarify that. I guess, as it relates to gender dysphoria,

11 could you tell me a little bit about the anxiety that you

12 experience? I know that's a complicated question. If you

13 want me to clarify, I can do my best.

14

A. If you would please clarify a little bit,

15 because the anxiety is a broad umbrella. I mean, I can

16 explain the anxiety, but there are what -- what part of the

17 anxiety are you asking about?

18

Q. That's fair. As we noted -- as we just said,

19 anxiety is considered kind of a symptom of gender dysphoria

20 and anxiety itself has symptoms. What have you

21 experienced, what anxiety symptoms have you experienced?

22

A. That helps to clarify. Geez, it's a little

23 long, but I have difficulty sleeping at night a lot of

24 times. Eating disorder or disturbances. A lot of times I

25 don't have appetite. And it depends, you know, like any

MIDWEST LITIGATION SERVICES

www.midwestlitigation.com

Phone: 1.800.280.3376

Fax: 314.644.1334

Case: 4:16-cv-01357-NCC Doc. #: 164-14 Filed: 03/30/18 Page: 4 of 6 PageID #: 2073 JESSICA HICKLIN 7/12/2017 Page 22

1 mental health condition or symptom, you know, there are

2 highs and lows. So the symptoms or the experience of it

3 I'll use when it's at its heighth, that way it's easier to

4 understand.

5

Sometimes I get what I would describe as like

6 a panic attack in the sense of, you know, elevated heart

7 rate, short breath. Depending upon the day and the level

8 of the anxiety, I find myself wanting to isolate because

9 I'm very short tempered or -- that's probably the best way

10 to describe it. I have a hard time dealing with other

11 people when my sense of disgust with the things that are

12 not correct. So that's -- the anxiety relates to my

13 ability to communicate with other people.

14

Depending, again, on the day and the level of

15 the anxiety, sometimes I fixate on the need to be treated.

16 And so that interferes with my work or, you know, other

17 things I may be doing.

18

I think that's a good general umbrella of the

19 symptoms.

20

Q. Yeah. And these are all symptoms that you've

21 experienced in the past couple of years?

22

A. Yes, sir.

23

Q. Have you experienced these symptoms prior to

24 that, that you recall?

25

A. Yes, sir.

MIDWEST LITIGATION SERVICES

www.midwestlitigation.com

Phone: 1.800.280.3376

Fax: 314.644.1334

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1

Q. Okay. And regarding the depression, could you

2 give me kind of a brief description on that, symptoms of

3 that. Like, do you have trouble getting out of bed, things

4 of that nature?

5

A. Yes. Again, like the anxiety, depression is

6 something that has its ups and downs. On the bad times, it

7 fluctuates between a sense of not being motived to do

8 anything. So, yes, the not get out of bed, normal what

9 people understand depression to be. But when it becomes

10 really severe, and -- as well as with the anxiety, as well,

11 for clarification, I start fixating on thoughts of treating

12 myself.

13

Rarely, but from time to time when the

14 depression gets so bad and it seems hopeless, I get senses

15 of feeling of hopelessness, there are thoughts of, you

16 know, suicide. I'll admit those are more spread out,

17 that's not a every day thought but, you know, thoughts of

18 treating myself and things like that are much more common.

19

When my depression is at a height again, I

20 like to isolate because I don't feel I have the energy

21 to -- to engage in social communication.

22

Q. Okay. Do you believe that all of your anxiety

23 and depression is attributed to gender dysphoria?

24

A. I believe that all of my anxiety is. My

25 depression, I would believe probably 80 percent, if you're

MIDWEST LITIGATION SERVICES

www.midwestlitigation.com

Phone: 1.800.280.3376

Fax: 314.644.1334

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1

Q. Okay. And you would consider all those items

2 to be gender affirming?

3

A. Yes, sir.

4

Q. Okay.

5

A. To -- and perhaps this clarifies, I've had a

6 conversation with family about such things. And basically,

7 if I was going to get up and go to work this morning in the

8 normal world as a woman, the things I would use.

9

Q. Are the items on the --

10

A. Are basically the things we're requesting.

11

Q. Okay. Have you had any suicidal ideations

12 recently? And recently, I mean in the past three or four

13 months?

14

A. Yes, in the last three or four months.

15

Q. And can you tell me how often?

16

A. It's roughly an every two or three month

17 perhaps. And, of course, that depends upon what's going on

18 in life and specifically, honestly, my sense of progress in

19 this arena. But generally speaking, you could say every

20 two to three months I'll have a couple bad days, so

21 that's --

22

Q. About how often do you see therapy? Or, I'm

23 sorry, how often do you see the mental health people?

24

A. Up until very recently, I saw a therapist --

25 basically, it's two weeks apart. I would see a

MIDWEST LITIGATION SERVICES

www.midwestlitigation.com

Phone: 1.800.280.3376

Fax: 314.644.1334

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EXHIBIT N

Case: 4:16-cv-01357-NCC Doc. #: 164-15 Filed: 03/30/18 Page: 2 of 5 PageID #: 2077

Page 1

1

IN THE UNITED STATES DISTRICT COURT

FOR THE EASTERN DISTRICT OF MISSOURI

2

EASTERN DIVISION

3

4 JESSICA HICKLIN,

)

)

5

Plaintiff, )

)

6 vs.

) Case No. 4:16-CV-01357-NCC

)

7 ANNE PRECYTHE,

)

et al.,

)

8

)

Defendants. )

9

10

11

12

Jefferson City, MO

13

DEPOSITION OF VEVIA STURM
14

Taken on Behalf of the Plaintiff
15

February 2, 2018
16

17

18

19

20

21

22

23

24 Reported by: KELLENE K. FEDDERSEN 25 Job No. 137078

TSG Reporting - Worldwide 877-702-9580

Case: 4:16-cv-01357-NCC Doc. #: 164-15 Filed: 03/30/18 Page: 3 of 5 PageID #: 2078

Page 55

1

A. That is fair.

2

Q. And so an official procedure, for

3 example your PREA policy, that was approved by the

4 executive committee, right?

5

A. Yes.

6

Q. Okay.

7

A. Yes.

8

Q. And the executive committee that

9 approved the PREA policy in July of 2017, that

10 included Director Precythe, right?

11

A. Correct.

12

Q. And Mr. Sturm?

13

A. Yes.

14

Q. And Alana Boyles?

15

A. I don't know.

16

Q. And Cari Collins?

17

A. Yes.

18

Q. But you just don't have any

19 information about who approved the policy or the

20 position that's Exhibit 94?

21

A. I have no idea.

22

Q. Okay. So this is a position that you

23 were -- that was given to you, it is not a position

24 that you had any input on, right?

25

A. Correct.

TSG Reporting - Worldwide 877-702-9580

Case: 4:16-cv-01357-NCC Doc. #: 164-15 Filed: 03/30/18 Page: 4 of 5 PageID #: 2079

Page 56

1

Q. Even though you're PREA coordinator?

2

A. Correct.

3

Q. Okay.

4

A. Hormone therapy really doesn't have

5 anything to do with PREA. PREA doesn't address

6 hormone therapy.

7

Q. So you testified that if a

8 transgendered individual comes in to MDOC already

9 prescribed hormones by a doctor, that in that case

10 MDOC continues the therapy?

11

A. Correct.

12

Q. Do you know why?

13

A. I don't.

14

Q. In connection with PREA compliance,

15 is there any monitoring at MDOC to see if

16 individuals who come in on hormone therapy, is

17 there any monitoring to track their safety relative

18 to the safety of individuals who are transgendered

19 who are not on hormone therapy?

20

A. I don't know what you're asking. I'm

21 confused.

22

Q. Okay. So part of PREA compliance is

23 tracking the safety of transgendered individuals?

24

A. Safety, yes.

25

Q. And is there any data that your

TSG Reporting - Worldwide 877-702-9580

Case: 4:16-cv-01357-NCC Doc. #: 164-15 Filed: 03/30/18 Page: 5 of 5 PageID #: 2080

Page 57

1 office collects to see if individuals on hormone

2 therapy are more or less safe compared to

3 individuals who are not on hormone therapy?

4

A. No.

5

Q. I believe you've just testified that

6 PREA doesn't address hormone therapy.

7

A. It does not.

8

Q. I'm going to ask the reporter to mark

9 what will be marked Exhibit 95.

10

(EXHIBIT 95 WAS MARKED FOR

11 IDENTIFICATION BY THE REPORTER.)

12 BY MS. ROBERG-PEREZ:

13

Q. You've testified about PREA

14 standards.

15

A. Uh-huh.

16

Q. Are these the PREA standards?

17

A. Yes, they are.

18

Q. And again, for the record, these

19 standards don't anywhere address hormone therapy,

20 right?

21

A. They do not.

22

Q. Okay. Earlier you testified that

23 there is a PREA Resource Center that you refer to

24 to make sure that MDOC is in compliance.

25

A. For interpretive guidance, yes.

TSG Reporting - Worldwide 877-702-9580

Case: 4:16-cv-01357-NCC Doc. #: 164-16 Filed: 03/30/18 Page: 1 of 3 PageID #: 2081

IN THE UNITED STATES DISTRICT COURT FOR THE EASTERN DISTRICT OF MISSOURI
EASTERN DIVISION

JESSICA HICKLIN, v.

Plaintiff,

ANNE PRECYTHE, et al.,
Defendants.

Case No. 4:16-CV-01357-NCC

[PROPOSED] ORDER GRANTING PLAINTIFF’S MOTION FOR DECLARATORY RELIEF AND A PERMANENT INJUNCTION
This matter came before the Court on Plaintiff Jessica Hicklin’s (“Plaintiff” or “Ms. Hicklin”) Motion for Declaratory Relief and a Permanent Injunction. The Court, having considered the briefing and evidence submitted in connection with Plaintiff’s Motion and the arguments of counsel, finds as follows:
On February 9, 2018, this Court issued a Memorandum and Order granting in part Plaintiff’s Motion for Preliminary Injunction and ordering Defendants to provide Ms. Hicklin with care that her doctors deem to be medically necessary treatment for her gender dysphoria, including hormone therapy, access to permanent body hair removal, and access to genderaffirming canteen items (Doc. 145).
In support of her previous Motion for Preliminary Injunction (Doc. 63), and the currently pending Motion for Declaratory Relief and a Permanent Injunction (Doc. __ ), Plaintiff has presented evidence to show that Defendants violated the Eighth Amendment by knowingly disregarding Ms. Hicklin’s serious medical needs and through the enforcement of Missouri

Case: 4:16-cv-01357-NCC Doc. #: 164-16 Filed: 03/30/18 Page: 2 of 3 PageID #: 2082
Department of Corrections’ (“MDOC”) policy, practice, custom, or usage of banning the provision of hormone therapy to any transgender inmate who was not receiving such therapy before entering MDOC (“the freeze-frame policy”).
The Court finds that Plaintiff has presented evidence to show that the freeze-frame policy at issue fails by its very nature to account for the individual medical needs of transgender prisoners who suffer from gender dysphoria, and therefore violates the Eighth Amendment both on its face and as applied to Ms. Hicklin.
The Court finds that providing the declaratory relief requested would both settle the legal relations in issue and provide relief from the uncertainty, insecurity, and controversy surrounding this issue within MDOC. The Court finds that Plaintiff has presented evidence to show that she has suffered irreparable injury as a result of Defendants’ failure to provide her with medically necessary treatment for her gender dysphoria and their application of the freeze-frame policy and will again suffer such injury if the requested relief is not granted.
The Court finds that Plaintiff has demonstrated actual success on the merits of her claims of violation of her Eighth Amendment rights due to Defendants’ denial of medically necessary treatment for her gender dysphoria and application of the freeze-frame policy generally and to Ms. Hicklin specifically. The Court further finds that the balance of harms favors the Plaintiff, as she will suffer irreparable harm if the requested relief is not granted while Defendants would not be harmed if the requested relief is ordered. Given the deprivation of constitutional rights that Plaintiff has suffered and will suffer if Defendants withhold medically necessary gender dysphoria treatment from her or continue to enforce the freeze-frame policy, the public interest favors entry of such an order.
2

Case: 4:16-cv-01357-NCC Doc. #: 164-16 Filed: 03/30/18 Page: 3 of 3 PageID #: 2083

IT IS THEREFORE ORDERED that Plaintiff’s Motion for Declaratory Relief and a Permanent Injunction is hereby GRANTED and it is further ORDERED that:
(1) Defendants’ failure to provide Ms. Hicklin medically necessary care related to her gender dysphoria violates the Eighth Amendment to the United States Constitution;
(2) MDOC’s policy, practice, custom, or usage of banning the provision of hormone therapy to any transgender inmate who was not receiving such therapy before entering MDOC (“the freeze-frame policy”) violates the Eighth Amendment to the United States Constitution, both on its face and as applied to Ms. Hicklin;
(3) For as long as Ms. Hicklin remains in the custody of MDOC, Defendants shall provide her with care that her doctors deem to be medically necessary treatment for her gender dysphoria, including hormone therapy, access to permanent body hair removal, and access to gender-affirming canteen items;
(4) Defendants are permanently enjoined from enforcing the freeze-frame policy; (5) Defendants shall pay Ms. Hicklin’s costs, expenses, and reasonable attorneys’ fees pursuant to 42 U.S.C. § 1988 and other applicable laws; and (6) Ms. Hicklin shall not be required to post a bond or security.

_________________________

_________________________________________ NOELLE C. COLLINS UNITED STATES MAGISTRATE JUDGE

3

 
 Case: 4:16-cv-01357-NCC Doc. #: 176 Filed: 05/22/18 Page: 1 of 11 PageID #: 2248

UNITED STATES DISTRICT COURT EASTERN DISTRICT OF MISSOURI
EASTERN DIVISION

)

JESSICA HICKLIN,

)

)

Plaintiff,

)

)

v.

)

)

ANNE PRECYNTHE, JOAN

)

REINKEMEYER, CINDY GRIFFITH,

)

STAN PAYNE, SCOTT O’KELLY, L.P.C., )

LATOYA DUCKWORTH, and

)

CORIZON, LLC.,

)

)

)

Defendants.

)

Case No. 4:16-CV-01357-NCC

MEMORANDUM AND ORDER AND
PERMANENT INJUNCTION

This matter is before the Court on Plaintiff Jessica Hicklin’s Motion for Declaratory

Relief and a Permanent Injunction (Doc. 163). The Motion is fully briefed and ready for

disposition. The parties have consented to the jurisdiction of the undersigned United States

Magistrate Judge pursuant to 28 U.S.C. § 636(c) (Doc. 57). For the following reasons, Plaintiff’s

Motion will be GRANTED, in part and DENIED, in part.

I. Background On August 22, 2016, Plaintiff Jessica Hicklin (“Ms. Hicklin”)1 filed this action for injunctive and declaratory relief pursuant to 42 U.S.C. § 1983 against Defendant Corizon, LLC2

1 The parties have agreed to use female pronouns when addressing Plaintiff Jessica Hicklin.
2 Defendant was originally improperly named as Corizon Health, Inc.

Case: 4:16-cv-01357-NCC Doc. #: 176 Filed: 05/22/18 Page: 2 of 11 PageID #: 2249
(“Corizon”), the Individual Corizon Defendants,3,4 and the MDOC Defendants5 for their alleged deliberate indifference to Ms. Hicklin’s serious medical needs (Doc. 19). Ms. Hicklin specifically alleges that despite knowing that she has gender dysphoria, a serious medical condition, Defendants refused to provide Ms. Hicklin with medically necessary care including hormone therapy, permanent hair removal, and access to “gender-affirming” canteen items (Id. at 2-3). Ms. Hicklin further asserts that Defendants refuse to provide her with hormone therapy, citing a policy or custom of providing hormone therapy only to those transgender inmates who were receiving it prior to incarceration (the so-called “freeze-frame policy”) (Id.).
On April 4, 2017, Ms. Hicklin filed a Motion for Preliminary Injunction (Doc. 63) requesting a preliminary injunction order that (1) directs Defendants to provide Ms. Hicklin with care that her doctors deem to be medically necessary treatment for gender dysphoria, including but not limited to providing her hormone therapy, access to permanent body hair removal, and access to “gender-affirming” canteen items; and (2) enjoins Defendants from enforcing the unconstitutional policies, customs, or practices that deny inmates with gender dysphoria individualized medically necessary treatment and care, which are contrary to widely accepted standards of care and the recommendations of Ms. Hicklin’s treating mental health professionals (Doc. 64 at 5). After oral argument, on February 9, 2018, the Court granted, in part, and denied, in part, Ms. Hicklin’s Motion and entered a preliminary injunction requiring Defendants to
3 At the time, the Individual Corizon Defendants were William McKinney, Glen Babich, T.K. Bredeman, Diana Larkin, Kimberley S. Randolph, Dawn Wade, Stormi Moeller, Shirley Eyman, Elizabeth Atterberry, and Kim Foster.
4 Corizon and the Individual Corizon Defendants will be collectively referred to as the “Corizon Defendants.”
5 Initially, the MDOC Defendants were George Lombardi, Dwayne Kempker, Ian Wallace, Cindy Griffith, Stan Payne, Scott O'Kelly, and Deloise Williams.
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provide Ms. Hicklin with care that her doctors deem to be medically necessary treatment for her gender dysphoria, including hormone therapy, access to permanent body hair removal, and access to “gender-affirming” canteen items (Doc. 145).
The parties subsequently stipulated to an amendment of the case management order and requested a status hearing (Docs. 146-148). After a status hearing with the parties, the Court entered an amended case management order which afforded Ms. Hicklin additional time to amend her complaint (Doc. 149). With leave of the Court, Ms. Hicklin filed her First Amended Complaint for Declaratory and Injunctive Relief on February 26, 2018 (Doc. 152). In relevant part, in her First Amended Complaint, Ms. Hicklin clarifies that she is not only challenging the application of the freeze-frame policy to her but also the constitutionality of the policy on its face (See Doc. 152 at 32-33).
On March 30, 2018, Ms. Hicklin filed the current Motion for Declaratory Judgment and Permanent Injunction (Doc. 163). Ms. Hicklin requests that the Court enter judgment in her favor (1) declaring that Defendants’ refusal to provide Ms. Hicklin medically necessary care related to her gender dysphoria violates the Eighth Amendment to the United States Constitution; (2) declaring that Missouri Department of Corrections’ policy, practice, custom, or usage of banning the provision of hormone therapy to any transgender inmate who was not receiving such therapy before entering MDOC (“the freeze-frame policy”) violates the Eighth Amendment to the United States Constitution, both on its face and as applied to Ms. Hicklin; (3) entering permanent injunctive relief requiring all Defendants to provide Ms. Hicklin with care that her doctors deem medically necessary, including hormone therapy, permanent hair removal, and access to gender-affirming canteen items; (4) entering permanent injunctive relief enjoining the enforcement of the freeze-frame policy by all Defendants; and (5) awarding Ms. Hicklin costs,
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expenses, reasonable attorneys’ fees, and any other relief the Court deems just and proper (Id.). Ms. Hicklin also requests oral argument on the Motion (Id.).
On April 4, 2018, the MDOC Defendants6 filed a response to Ms. Hicklin’s motion indicating that they do not oppose Ms. Hicklin’s motion or the relief therein requested, “upon the understanding that MDOC Defendants’ obligation to provide medical care to Ms. Hicklin will be discharged through the Missouri Department of Corrections’ medical contractor, Corizon Health, Inc. or its successors” (Doc. 165 at 1) (emphasis in original). The MDOC Defendants further note that they reserve the right to challenge the reasonableness of attorney’s fees accrued by counsel for Plaintiff (Id.). Finally, the MDOC Defendants indicate that they “take no position on Plaintiff’s ‘Statement of Uncontroverted Facts’ or any other material included in Plaintiff’s Memorandum of Law in Support of Plaintiff’s Motion for Declaratory Relief and Permanent Injunction” (Id. at 2).
Corizon also responded to Ms. Hicklin’s motion indicating that they “do not oppose” Ms. Hicklin’s motion or the relief requested therein (Doc. 167 at 1) (emphasis in original). However, Corizon reserves the right to challenge the reasonableness of any attorney fee application made by counsel for Plaintiff and also objects to paragraphs 6, 10, 11, 15, and 16 of Ms. Hicklin’s statement of uncontroverted facts (Doc. 168). Ms. Hicklin filed a reply to respond to the Corizon Defendants’ objections (Doc. 170).
On April 12, 2018, the parties stipulated to the dismissal of the current Individual Corizon Defendants — Defendants William McKinney, M.D., John Deghetto, M.D., Thomas Kevin Bredeman, D.O., Diana Larkin, R.N., Kimberley S. Randolph, R.N., B.S.N., C.C.H.P., Daly Smith, Stormi Moeller, R.N., Ernest Graypel, M.D., Elizabeth Atterberry, and Kim Foster,
6 The MDOC Defendants are currently Anne Precythe, Joan Reinkemeyer, Cindy Griffith, Stan Payne, Scott O’Kelly and Latoya Duckworth.
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L.P.C. (Doc. 169) without prejudice. The Court acknowledged the parties’ stipulation and dismissed these defendants on April 19, 2018 (Doc. 175). Further, as a preliminary matter, the Court will deny Ms. Hicklin’s request for oral argument in light of the Defendants responses indicating they do not object to Ms. Hicklin’s requested relief.
II. Relevant Undisputed Facts7 Ms. Hicklin is a transgender woman in the custody of the Missouri Department of Corrections (“MDOC”) housed at Potosi Correctional Center, a facility for male inmates. Ms. Hicklin suffers from gender dysphoria (previously known as gender identity disorder or transsexualism), a medical condition characterized by clinically significant distress due to the incongruence between a person’s gender identity — their innate sense of their own gender — and the sex they were assigned at birth. Ms. Hicklin has exhibited symptoms of severe gender dysphoria, including recurring intrusive thoughts of removing her testicles. A. Gender Dysphoria and the Standards of Care Gender dysphoria appears in the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. Gender dysphoria is an objectively serious medical need. Individuals with untreated gender dysphoria experience clinically significant depression, anxiety, and mental impairment, and, when left untreated, may also experience additional serious medical problems including suicidality and the compulsion to engage in selfcastration and self-harm. The World Professional Association for Transgender Health’s Standards of Care for the Health of Transsexual, Transgender, and Gender-Nonconforming People (the “Standards of
7 The facts are taken from Ms. Hicklin’s Statement of Uncontroverted Facts (Doc. 164 at 2-7) as well as the Corizon Defendants’ Response to Ms. Hicklin’s Statement of Uncontroverted Facts (Doc. 168) and Ms. Hicklin’s reply addressing the Corizon Defendants’ objections (Doc. 170). Because the parties largely consented to, or did not object to, Ms. Hicklin’s Statement of
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Care”) are “the internationally recognized guidelines for the treatment of persons with gender dysphoria.” Numerous professional medical organizations, including the American Medical Association, the American Psychological Association, the American Psychiatric Association, and the National Commission on Correctional Health Care, endorse the Standards of Care. The Standards of Care explicitly state that they are equally applicable to patients in prison. Under the Standards of Care, persons with gender dysphoria should be individually assessed by qualified health care providers and referred for treatment, which can include: (1) living in another gender role that is consistent with one’s gender identity; (2) hormone therapy to feminize or masculinize the body; and/or (3) surgery to change primary and/or secondary sex characteristics. Changes in gender expression, including clothing and grooming that affirm one’s gender identity and permanent body hair removal, can alleviate gender dysphoria. Hormone therapy is an accepted treatment of gender dysphoria, and the denial of hormone therapy for patients for whom such therapy is medically necessary may lead to significant deterioration and impairment in patients, including a high likelihood of depression, suicidal ideation, and surgical self-treatment by autocastration (removal of the testicles) or autopenectomy (removal of the penis).
Counseling can provide support for some individuals with gender dysphoria, but it is not necessarily a sufficient substitute for medical intervention. However, providing counseling and/or psychotropic medication to a severely gender dysphoric patient whose condition warrants medical intervention is a departure from the standards of care as recognized by the parties. Inadequate treatment of this condition, such as treatment not based on an individualized assessment, puts a person at serious risk of psychological and physical harm.
Uncontroverted Facts, the Court copies the majority of the facts section verbatim. 6

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B. The Freeze-Frame Policy At all relevant times prior to this Court’s February 9, 2018 Preliminary Injunction Order, MDOC maintained and enforced the freeze-frame policy. Pursuant to the freeze-frame policy, decisions regarding whether to initiate hormone therapy for transgender prisoners like Ms. Hicklin are not based on individualized assessments of each prisoner’s medical needs. Instead, hormone therapy is automatically denied to any transgender prisoner with gender dysphoria who was not receiving such therapy before entering MDOC — despite being provided for those who were receiving such therapy prior to entering MDOC. The Standards of Care state that a freezeframe approach is not considered appropriate care and warn that “the consequences of . . . lack of initiation of hormone therapy when medically necessary include a high likelihood of negative outcomes such as surgical self-treatment by auto-castration, depressed mood, dysphoria, and/or suicidality.” C. Ms. Hicklin’s Treatment for Gender Dysphoria Corizon psychiatrists Dr. Meredith Throop (“Dr. Throop”) and Dr. Evelynn Stephens (“Dr. Stephens”) diagnosed Ms. Hicklin with gender dysphoria and prescribed medically necessary hormone therapy for her in 2015. However, for almost three years, Defendants did not provide hormone therapy for Ms. Hicklin due to the freeze-frame policy. Also, despite medical professional recommendations to the contrary, Defendants did not provide Ms. Hicklin access to medically necessary permanent body hair removal and gender-affirming canteen items (i.e., canteen items made available to other female inmates). Both Dr. Throop and Dr. Stephens have noted that not treating Ms. Hicklin in accordance with the Standards of Care put her at risk of serious harm. Medical records show that lack of appropriate treatment for gender dysphoria caused Ms. Hicklin to experience serious psychological and physical symptoms (including panic attacks, anxiety, racing heartbeat,
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shortness of breath, sleep disturbance, lack of appetite, headaches, and excessive sweating) and put her at substantial risk of self-harm, including auto-castration and suicidal thoughts or acts. The documents and testimony produced in discovery to the Plaintiff do not support denying medically necessary gender dysphoria treatment based on cost, safety, or any other reason.
III. Analysis8 The availability of declaratory relief is a matter of federal law, governed by the Declaratory Judgment Act (“the Act”). The Act provides that in a “case of actual controversy within its jurisdiction . . . any court of the United States . . . may declare the rights and other legal relations of any interested party seeking such declaration.” 28 U.S.C. § 2201. The Act “granted the federal courts discretion to make a declaration of rights; it did not impose a duty to do so.” Alsager v. Dist. Court of Polk Cty., 518 F.2d 1161, 1163 (8th Cir. 1975) (internal quotation marks omitted). “The two principal criteria guiding the policy in favor of rendering declaratory judgments are (1) when the judgment will serve a useful purpose in clarifying and settling the legal relations in issue, and (2) when it will terminate and afford relief from the uncertainty, insecurity, and controversy giving rise to the proceedings.” Id. at 1163-64 (8th Cir.) (internal citations omitted). To succeed on a request for a permanent injunction, Ms. Hicklin must establish: (1) actual success on the merits; (2) threat of irreparable harm; (3) the harm to the movant outweighs any possible harm to others; and (4) an injunction serves the public interest. See Bank One, Utah v. Guttau, 190 F.3d 844, 847 (8th Cir. 1999) (citing Dataphase Systems, Inc. v. C.L. Systems,
8 While the Court expanded on the legal standard, in light of the consensus of the parties, the analysis and requested relief are taken largely verbatim from Ms. Hicklin’s proposed order (Doc. 164-16).
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Inc., 640 F.2d 109, 113 (8th Cir. 1981) (en banc)). These factors are identical to those required for preliminary injunction, except that success on the merits must be actual instead of likely. Id.
In support of her previous Motion for Preliminary Injunction (Doc. 63), and the currently pending Motion for Declaratory Relief and a Permanent Injunction (Doc. 163), Ms. Hicklin has presented evidence to show that Defendants violated the Eighth Amendment by knowingly disregarding Ms. Hicklin’s serious medical needs and through the enforcement of the freezeframe policy.
The Court finds that Plaintiff has presented evidence to show that the freeze-frame policy at issue fails by its very nature to account for the individual medical needs of transgender prisoners who suffer from gender dysphoria, and therefore violates the Eighth Amendment both on its face and as applied to Ms. Hicklin.
The Court finds that providing the declaratory relief requested would both settle the legal issues and provide relief from the uncertainty and controversy surrounding this issue within MDOC.
The Court finds that Plaintiff has presented evidence to show that she has suffered irreparable injury as a result of Defendants’ failure to provide her with medically necessary treatment for her gender dysphoria and their application of the freeze-frame policy and will again suffer such injury if the requested relief is not granted.
The Court finds that Plaintiff has demonstrated actual success on the merits of her claims of violation of her Eighth Amendment rights due to Defendants’ denial of medically necessary treatment for her gender dysphoria and application of the freeze-frame policy generally and to Ms. Hicklin specifically. The Court further finds that the balance of harms favors the Plaintiff, as she will suffer irreparable harm if the requested relief is not granted while Defendants would not be harmed if the requested relief is ordered. Given the deprivation of constitutional rights
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that Plaintiff has suffered and will suffer if Defendants withhold medically necessary gender dysphoria treatment from her or continue to enforce the freeze-frame policy, the public interest favors entry of such an order.
IV. Conclusion Accordingly, IT IS HEREBY ORDERED that Plaintiff Jessica Hicklin’s Motion for Declaratory Relief and a Permanent Injunction (Doc. 163) is GRANTED, in part and DENIED, in part. IT IS FURTHER ORDERED that a PERMANENT INJUNCTION is entered in this case, as follows: (1) Defendants’ failure to provide Ms. Hicklin medically necessary care related to her gender dysphoria violates the Eighth Amendment to the United States Constitution; (2) MDOC’s policy, practice, custom, or usage of banning the provision of hormone therapy to any transgender inmate who was not receiving such therapy before entering MDOC (“the freeze-frame policy”) violates the Eighth Amendment to the United States Constitution, both on its face and as applied to Ms. Hicklin; (3) For as long as Ms. Hicklin remains in the custody of MDOC, Defendants shall provide Ms. Hicklin with care that her doctors deem medically necessary treatment for her gender dysphoria, including hormone therapy, permanent hair removal, and access to gender-affirming canteen items; (4) Defendants are permanently enjoined from enforcing the freeze-frame policy; and (5) Defendants shall pay Ms. Hicklin’s costs, expenses, and reasonable attorneys’ fees pursuant to 42 U.S.C. § 1988 and other applicable laws. IT IS FURTHER ORDERED that Plaintiff Jessica Hicklin shall file documentation in support of an award of reasonable attorney’s fees and costs incurred in this action within
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Case: 4:16-cv-01357-NCC Doc. #: 176 Filed: 05/22/18 Page: 11 of 11 PageID #: 2258 fourteen (14) days of the date of this order. Defendants may thereafter file responses to Plaintiff’s request within fourteen (14) days of Ms. Hicklin’s filing and Ms. Hicklin shall file a reply, if she chooses, no later than seven (7) days thereafter.
IT IS FURTHER ORDERED that, in light of the Court’s decision herein, any other remaining pending motions (Docs. 126, 131, 141, 142) are DENIED, without prejudice, as moot.
Dated this 22nd day of May, 2018.
/s/ Noelle C. Collins
NOELLE C. COLLINS UNITED STATES MAGISTRATE JUDGE
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