Source: s3://data.kl3m.ai/documents/govinfo/USCOURTS/USCOURTS-caed-1_15-cv-01251/USCOURTS-caed-1_15-cv-01251-2/pdf.json

Nature of Suit Code: 550
Nature of Suit: Prisoner - Civil Rights (U.S. defendant)
Cause of Action: 42:1983 Prisoner Civil Rights

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UNITED STATES DISTRICT COURT

EASTERN DISTRICT OF CALIFORNIA

DWAYNE DENEGAL,

Plaintiff,

v.

R. FARRELL, et al.,

Defendants.

CASE NO. 1:15-cv-01251-DAD-MJS (PC)

FINDINGS AND RECOMMENDATIONS

(1) FOR SERVICE OF COGNIZABLE 

CLAIMS; AND (2) TO DISMISS ALL 

OTHER CLAIMS WITH PREJUDICE 

(ECF No. 12)

FOURTEEN (14) DAY OBJECTION 

DEADLINE

Plaintiff Dwayne Denegal, also known as Fatima Shabazz, is a state prisoner 

proceeding pro se and in forma pauperis in this civil rights action brought pursuant to 42 

U.S.C. § 1983.

On September 14, 2015, the Court screened Plaintiff’s complaint and dismissed it,

with leave to amend, on the ground it failed to state a cognizable claim. (ECF No. 8.) 

Plaintiff’s first amended complaint is before the Court for screening.

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I. SCREENING REQUIREMENT

The Court is required to screen complaints brought by prisoners seeking relief 

against a governmental entity or officer or employee of a governmental entity. 28 U.S.C. 

§ 1915A(a). The Court must dismiss a complaint or portion thereof if the prisoner has 

raised claims that are legally frivolous or malicious, fail to state a claim upon which relief 

may be granted, or seek monetary relief from a defendant who is immune from such 

relief. 28 U.S.C. § 1915A(b)(1),(2). “Notwithstanding any filing fee, or any portion thereof, 

that may have been paid, the court shall dismiss the case at any time if the court 

determines that . . . the action or appeal . . . fails to state a claim upon which relief may 

be granted.” 28 U.S.C. § 1915(e)(2)(B)(ii).

II. PLEADING STANDARD

Section 1983 “provides a cause of action for the deprivation of any rights, 

privileges, or immunities secured by the Constitution and laws of the United States.”

Wilder v. Virginia Hosp. Ass'n, 496 U.S. 498, 508 (1990) (quoting 42 U.S.C. § 1983).

Section 1983 is not itself a source of substantive rights, but merely provides a method for 

vindicating federal rights conferred elsewhere. Graham v. Connor, 490 U.S. 386, 393-94 

(1989).

To state a claim under § 1983, a plaintiff must allege two essential elements: (1) 

that a right secured by the Constitution or laws of the United States was violated and (2) 

that the alleged violation was committed by a person acting under the color of state law.

See West v. Atkins, 487 U.S. 42, 48 (1988); Ketchum v. Alameda Cnty., 811 F.2d 1243, 

1245 (9th Cir. 1987).

A complaint must contain “a short and plain statement of the claim showing that 

the pleader is entitled to relief . . . .” Fed. R. Civ. P. 8(a)(2). Detailed factual allegations 

are not required, but “[t]hreadbare recitals of the elements of a cause of action, 

supported by mere conclusory statements, do not suffice.” Ashcroft v. Iqbal, 556 U.S. 

662, 678 (2009) (citing Bell Atlantic Corp. v. Twombly, 550 U.S. 544, 555 (2007)). 

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Plaintiff must set forth “sufficient factual matter, accepted as true, to state a claim to relief 

that is plausible on its face.” Id. Facial plausibility demands more than the mere 

possibility that a defendant committed misconduct and, while factual allegations are 

accepted as true, legal conclusions are not. Id. at 677-78.

III. PLAINTIFF’S ALLEGATIONS

Plaintiff is incarcerated at the California Substance Abuse Treatment Facility 

(“CSATF”), where the acts giving rise to her complaint occurred. She names the 

following defendants in their individual and official capacities: (1). Psychologist R. Farrell, 

Psy.D.; (2) Chief Psychologist R. Coffin, Psy.D.; (3) Clarence Cryer, CEO of CSATF 

Medical Department; (4) J. Lewis, Deputy Director, Policy and Risk Management, 

California Correctional Healthcare; and (5) J. Sunduram, Primary Care Physician on A 

Yard.

Her allegations may be summarized essentially as follows:

Plaintiff is a transgender woman.1 She experiences gender dysphoria and distress 

resulting from the incongruence between her male anatomy and female gender identity. 

She has lived openly as a female since 2000, and has been on feminizing hormones 

since 2014. She continues to experience dysphoria despite hormone therapy. She 

believes sex reassignment surgery is medically necessary treatment for her gender 

dysphoria. However, she has been denied such surgery by Defendants.

A. History Prior to Incarceration at CSATF

Plaintiff was born in 1963. During adolescence she felt uncomfortable with her 

male gender. As early as ten or eleven years of age, Plaintiff felt herself to be a female. 

She was antagonized by her parents for displaying a female identity. Plaintiff began 

“hanging out” with the transgender community in New York City. At age twelve, Plaintiff 

 

1

A transgender woman is “a person whose female gender identity is different from the male gender 

assigned to her at birth.” Norsworthy v. Beard, 87 F. Supp. 3d 1164, 1169 (N.D. Cal. 2015), appeal 

dismissed and remanded, 802 F.3d 1090 (9th Cir. 2015).

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had a sexual encounter with a male friend, came out to said friend, and then was beaten 

and raped by the friend and a group of other boys. 

By age fifteen, Plaintiff’s parents suspected she was gay. Plaintiff fathered a son. 

At age sixteen, she began dressing as a woman and became a prostitute and drug 

dealer. By age nineteen, she was incarcerated in the New York correctional system.

There, Plaintiff tried unsuccessfully to hide her gender identity. She was raped by 

inmates and staff.

Plaintiff eventually was released on parole and became more “outwardly visible” 

as a woman. Plaintiff began a relationship with a gay woman who Plaintiff lived with as 

“man and wife” and with whom Plaintiff had several additional children. Plaintiff’s partner 

often dressed as a male and Plaintiff as a female.

Plaintiff and her partner moved to Georgia, where Plaintiff again was incarcerated. 

Plaintiff hid her gender identity until release. Upon her release, Plaintiff began dating 

other transgender women. 

In 2000, Plaintiff’s mother died and she began living full-time as a woman.

Plaintiff moved to California in 2006. She was incarcerated in 2008 and released 

in 2010. Upon release, Plaintiff began experimenting with “black market” feminizing 

hormones. Plaintiff was arrested again later in 2010 and was housed in the Los Angeles 

County Jail. There, Plaintiff was focused on her case and did not pursue hormones. 

Plaintiff was transferred to the custody of the California Department of Corrections 

and Rehabilitation in 2010, and was placed in North Kern State Prison Reception in 

Delano, California. There, she attempted to see a “transgender doctor” but was unable 

to do so.

B. Incarceration at CSATF

Plaintiff transferred to CSATF on October 11, 2012.

In April 2013, Plaintiff submitted a medical services request to meet with the 

facility endocrinologist and be placed on feminizing hormones. She met with non-party 

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Dr. Kumar in May 2013. Dr. Kumar referred Plaintiff to mental health for evaluation as 

Plaintiff did not yet have a diagnosis of gender dysphoria.2

On May 15 and June 14, 2013, Plaintiff met with Defendant Farrell. However, 

Farrell did not immediately file a report and, as a result, Plaintiff’s hormone treatments

were delayed. Farrell eventually filed a report in which she recommended Plaintiff 

undergo a year of mental health treatment to discuss Plaintiff’s “sexual trauma” and 

difficulties associated with being transgender in prison. According to Plaintiff, Farrell 

disregarded Plaintiff’s gender identity by referring to her throughout his report as “he,” 

characterizing her as a homosexual because she is attracted to men,

3

and describing 

her “cross-dressing behavior.” Farrell omitted significant facts from his report, such as 

Plaintiff’s long-standing desire to live as a woman and her statements that she wished to 

have sex reassignment surgery.

In October 2013, Plaintiff filed a 602 health care appeal requesting that she be 

given a diagnosis of gender dysphoria and transferred to an institution better suited to 

handle transgender inmates. Plaintiff was interviewed by Defendant Coffin on November 

25, 2013

4

in relation to her appeal. Coffin informed Plaintiff of Farrell’s report. Coffin also 

informed Plaintiff that he was on a panel putting together CDCR’s treatment protocols for 

transgender inmates. Plaintiff’s appeal was granted in part. Her request for hormones 

was considered pending while she completed a twelve month mental health program. 

Plaintiff asked Coffin whether the twelve month program was necessary. Coffin informed 

her that the program was necessary because many inmates had started hormones and 

later decided to stop, costing the state money. He told her that engaging in the program 

was the only way to receive feminizing hormones. Plaintiff also expressed to Coffin her 

 

2

Plaintiff refers sometimes to gender identity disorder, a diagnosis which was in place at the time of some 

of the events at issue here, but which is now referred to as gender dysphoria. For consistency, the Court 

will use the term gender dysphoria. 

3

As Plaintiff points out, she identifies as female and a female attracted to men is not characterized as

homosexual.

4

Plaintiff states that the interview occurred on November 25, 2015. However, this appears to be a 

typographical error.

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desire to be a woman and to undergo sex reassignment surgery. Coffin informed Plaintiff 

that he was unaware of any inmate in the country being provided such surgery.

By March 2014, Plaintiff had not received feminizing hormones or started the 

twelve month mental health program. Plaintiff filed another medical appeal. She was 

interviewed during her appeal by non-party L. Bluford. Bluford informed Plaintiff she 

would have to attend the mandatory mental health program and that this requirement 

could not be bypassed. She further was informed, however, that she could not begin the 

program until a gender dysphoria report had been prepared by Defendant Coffin. The 

appeal was granted in part, pending Coffin’s report.

Several more months of inaction followed. Plaintiff submitted a medical request to 

Bluford and again was interviewed. Plaintiff was assured she would be placed in the 

mental health program. Shortly after this interview, Plaintiff was placed on feminizing 

hormones. Plaintiff never participated in the “mandatory” twelve month mental health 

program.

On March 29, 2015, Plaintiff submitted a health care services request form 

requesting to meet with a doctor specializing in transgender patients to discuss her 

physical transition to a woman and sex reassignment surgery. Plaintiff received a return 

copy of her request on March 31, 2015 with an unrecognizable signature. The response 

stated that, as per Defendant Dr. Sunduram, the State of California does not offer sex 

reassignment surgery.

On April 13, 2015, Plaintiff submitted a 602 appeal seeking sex reassignment 

surgery. She was interviewed by Coffin on April 23, 2015. Coffin noted in his report that 

Plaintiff was receiving regular hormone shots without incident. He did not make note of

Plaintiff’s interest in surgery. Plaintiff raised with Coffin the case of Norsworthy v. Beard, 

87 F. Supp. 3d 1164, 1169 (N.D. Cal. 2015), appeal dismissed and remanded, 802 F.3d 

1090 (9th Cir. 2015), and expressed her continued interest in sex reassignment surgery. 

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Coffin stated that he was not aware of the case, despite his having been a named 

defendant in it. Coffin bypassed Plaintiff’s appeal to the second level.

Defendant Cryer reviewed Plaintiff’s appeal at the second level and denied the 

request on the grounds that (1) Plaintiff had not engaged in hormone therapy while 

unincarcerated; (2) she had not engaged in hormone therapy for at least one year5; and 

(3) there was no evidence-based literature in support of the procedure in Plaintiff’s case.

Defendant Lewis denied Plaintiff’s appeal at the third level of review.

Finally, Plaintiff alleges that CDCR’s Department Operations Manual bars sex 

reassignment surgery for inmates in custody as follows: “Implementation of surgical 

castration, vaginoplasty, or other such procedures shall be deferred beyond the period of 

incarceration. Surgical procedures shall not be the responsibility of the Department.” 

CDCR Department Operations Manual § 91010.26. Title 15, section 3350.1 of the 

California Code of Regulations also bars sex reassignment surgery. Defendant Lewis, as 

Deputy Director of the Policy and Risk Management Department, perpetuated these

policies. Plaintiff alleges that non-transgender women nonetheless are able to receive 

vaginoplasty for medically necessary reasons. 

Plaintiff alleges that the denial of sex reassignment surgery violates her rights to 

adequate medical care under the Eighth Amendment and to equal protection under the 

Fourteenth Amendment to the United States Constitution. She seeks a declaration that 

title 15, section 3350.1 of the California Code of Regulations and Department Operations 

Manual § 91010.26 are unconstitutional. She also seeks injunctive relief preventing 

Defendants from interfering with Plaintiff’s medical care and requiring them to provide 

adequate medical care.

IV. ANALYSIS

A. Eighth Amendment

The Eighth Amendment’s prohibition against cruel and unusual punishment 

 

5

At the time, Plaintiff had undergone six months of hormone therapy.

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protects prisoners not only from inhumane methods of punishment but also from 

inhumane conditions of confinement. Morgan v. Morgensen, 465 F.3d 1041, 1045 (9th 

Cir. 2006) (citing Farmer v. Brennan, 511 U.S. 825, 847 (1994) and Rhodes v. 

Chapman, 452 U.S. 337, 347 (1981)). While conditions of confinement may be, and 

often are, restrictive and harsh, they must not involve the wanton and unnecessary 

infliction of pain. Morgan, 465 F.3d at 1045 (citing Rhodes, 452 U.S. at 347). 

Prison officials have a duty to ensure that prisoners are provided adequate 

shelter, food, clothing, sanitation, medical care, and personal safety, Johnson v. Lewis, 

217 F.3d 726, 731 (9th Cir. 2000) (citations omitted), but not every injury that a prisoner 

sustains while in prison represents a constitutional violation, Morgan, 465 F.3d at 1045. 

To maintain an Eighth Amendment claim, inmates must show deliberate indifference to a 

substantial risk of harm to their health or safety. E.g., Farmer, 511 U.S. at 847; Thomas 

v. Ponder, 611 F.3d 1144, 1151-52 (9th Cir. 2010); Foster v. Runnels, 554 F.3d 807, 

812-14 (9th Cir. 2009); Morgan, 465 F.3d at 1045; Johnson, 217 F.3d at 731; Frost v. 

Agnos, 152 F.3d 1124, 1128 (9th Cir. 1998).

For claims arising out of medical care in prison, Plaintiff “must show (1) a serious 

medical need by demonstrating that failure to treat [his] condition could result in further 

significant injury or the unnecessary and wanton infliction of pain,” and (2) that “the 

defendant’s response to the need was deliberately indifferent.” Wilhelm v. Rotman, 680 

F.3d 1113, 1122 (9th Cir. 2012) (citing Jett v. Penner, 439 F.3d 1091, 1096 (9th Cir. 

2006)). 

“Indications that a plaintiff has a serious medical need include the existence of an 

injury that a reasonable doctor or patient would find important and worthy of comment or 

treatment; the presence of a medical condition that significantly affects an individual’s 

daily activities; or the existence of chronic or substantial pain.” Colwell v. Bannister, 763 

F.3d 1060, 1066 (9th Cir. 2014) (citation and internal quotation marks omitted); accord

Wilhelm v. Rotman, 680 F.3d 1113, 1122 (9th Cir. 2012); Lopez v. Smith, 203 F.3d 1122, 

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1131 (9th Cir. 2000).

Deliberate indifference, which is the subjective element of an Eighth Amendment 

claim, is shown by “(a) a purposeful act or failure to respond to a prisoner’s pain or 

possible medical need, and (b) harm caused by the indifference.” Wilhelm, 680 F.3d at 

1122 (citing Jett, 439 F.3d at 1096). The requisite state of mind is one of subjective 

recklessness, which entails more than ordinary lack of due care. Snow v. McDaniel, 681 

F.3d 978, 985 (9th Cir. 2012), overruled in part on other grounds, Peralta v. Dillard, 744 

F.3d 1076, 1082-83 (9th Cir. 2014); Wilhelm, 680 F.3d at 1122. “Medical malpractice 

does not become a constitutional violation merely because the victim is a prisoner.” 

Estelle v. Gamble, 429 U.S. 97, 106 (1977); Snow, 681 F.3d at 987-88; Wilhelm, 680 

F.3d at 1122. 

Finally, “[a] difference of opinion between a physician and the prisoner - or 

between medical professionals - concerning what medical care is appropriate does not 

amount to deliberate indifference.” Snow, 681 F.3d at 987 (citing Sanchez v. Vild, 891 

F.2d 240, 242 (9th Cir. 1989)); Wilhelm, 680 F.3d at 1122-23 (citing Jackson v. 

McIntosh, 90 F.3d 330, 332 (9th Cir. 1986)). Rather, Plaintiff “must show that the course 

of treatment the doctors chose was medically unacceptable under the circumstances 

and that the defendants chose this course in conscious disregard of an excessive risk to 

[his] health.” Snow, 681 F.3d at 988 (citing Jackson, 90 F.3d at 332) (internal quotation 

marks omitted).

Plaintiff’s allegation that she suffers from untreated symptoms of gender 

dysphoria is sufficient to allege a serious medical condition. See Norsworthy, 87 F. 

Supp. 3d at 1170, 1187; see also Allard v. Gomez, No. 00-16947, 2001 WL 638413 (9th 

Cir. June 8, 2001); Meriwether v. Faulkner, 821 F.2d 408, 412-12 (7th Cir.1987) (and 

cases cited therein); Kosilek v. Spencer, 774 F.3d 63, 86 (1st Cir. 2014) (en banc).

Plaintiff also has sufficiently alleged that Defendants Farrell and Coffin were 

deliberately indifferent to Plaintiff’s medical need when they delayed her access to 

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feminizing hormones. Plaintiff alleges that Defendant Farrell characterized Plaintiff, a 

transgender female, as a homosexual male cross-dresser. Taken as true as they must 

be at this stage of the proceedings, such allegations raise serious questions as to 

whether Farrell was reasonably qualified to evaluate Plaintiff’s alleged gender dysphoria 

and need for feminizing hormones. See Norsworthy, 87 F. Supp. 3d at 1178 (citing 

expert opinion that such comments reflect “a profound misunderstanding of, and lack of 

scientific information regarding, the nature, assessment, and treatment of gender 

dysphoria”); Hoptowit v. Ray, 682 F.2d 1237, 1252-53 (9th Cir.1982) (“Access to the 

medical staff has no meaning if the medical staff is not competent to deal with the 

prisoners’ problems.”), abrogated on other grounds by Sandin v. Conner, 515 U.S. 472, 

(1995). 

Ordinarily, such a simple lack of appreciation for the nature of Plaintiff’s condition, 

standing alone, might amount to negligence, but would not be sufficient to support an 

Eighth Amendment claim. Here, however, Plaintiff alleges more than mere negligence.

She asserts that both Farrell and Coffin told her she was obligated to undergo a lengthy 

mental health program before beginning hormones; Coffin attributed the need for that 

delay to financial concerns. Together, Farrell and Coffin delayed processing Plaintiff’s 

paperwork for more than a year and thereby prevented her from beginning a

“mandatory” mental health program which ultimately was found not to have been

mandatory after all. (Plaintiff began receiving hormone treatments without having 

completed that program.) These facts suggest a lack of genuine medical basis for 

delaying Plaintiff’s access to hormones. According to Plaintiff, the delay caused her 

needless suffering and created even further delay in her being evaluated for sex 

reassignment surgery. 

The pleadings also allege that Defendants Coffin, Cryer, Lewis, and Sunduram 

were involved in the decision to deny Plaintiff sex reassignment surgery based solely 

upon an institutional policy foreclosing such surgery regardless of medical need. The

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policy is set forth in title 15, section 3350.1(b) of the California Code of Regulations and

section 91010.26 of the Department Operations Manual. Section 3350.1(b) provides that 

castration and vaginoplasty are per se medically unnecessary, with the exception of

vaginoplasty for the treatment for cystocele or rectocele, conditions affecting only 

cisgender women. According to Plaintiff, section 91010.26 provides that “Implementation 

of surgical castration, vaginoplasty, or other such procedures shall be deferred beyond 

the period of incarceration. Surgical procedures shall not be the responsibility of the 

Department.”

It is well settled that prison officials may not deny medically necessary treatment 

even if the treatment conflicts with prison policy. Colwell v. Bannister, 763 F.3d 1060, 

1063 (9th Cir. 2014) (“[T]he blanket, categorical denial of medically indicated surgery 

solely on the basis of an administrative policy . . . is the paradigm of deliberate 

indifference.”) Here, the alleged blanket prohibition of specified medical procedures 

conflicts with the requirement that medical care be individualized and based on the 

particular prisoner’s medical needs. See Norsworthy, 87 F. Supp. 3d at 1191 (citing 

Kosilek, 774 F.3d at 91); Rosati v. Igbinoso, 791 F.3d 1037, 1039-40 (9th Cir. 2015) 

(reversing dismissal at the screening stage where Plaintiff plausibly alleged that she was 

denied sex reassignment surgery because of prison’s “blanket policy against SRS”); 

Allard, 2001 WL 638413, at *1 (reversing grant of summary judgment where there were 

issues of fact “as to whether hormone therapy was denied Allard on the basis of an 

individualized medical evaluation or as a result of a blanket rule, the application of which 

constituted deliberate indifference to Allard’s medical needs”). 

Defendant Sunduram clearly denied Plaintiff’s request for surgery on the basis of 

these policies and without consideration for Plaintiff’s medical need. His sole reason for 

the denial: the State of California does not offer sex reassignment surgery.

The reasons for the denial by Coffin, Cryer, and Lewis are less clear. However, 

the existence of a clear institutional policy prohibiting sex reassignment surgery is 

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sufficient at the pleading stage to allege that these defendants denied Plaintiff sex 

reassignment surgery with absolute disregard of, i.e., deliberate indifference to, Plaintiff’s

serious medical need. See Norsworthy, 87 F. Supp. 3d at 1191; Rosati, 791 F.3d at 

1039-40. While the Court does not purport to suggest that it has found sex reassignment 

surgery to be medically necessary or appropriate in Plaintiff’s case, the existence of a 

blanket policy prohibiting such procedure certainly raises questions as to whether these 

Defendants conducted a good faith, individualized evaluation of Plaintiff’s medical 

needs. Accordingly, the Court finds that Plaintiff states a cognizable claim against 

Defendants Coffin, Cryer, Lewis, and Sunduram for denying her sex reassignment 

surgery. 

The Court does not find a cognizable deliberate indifference claim for denial of 

sex reassignment surgery by Defendant Farrell. Although Plaintiff’s desire for such 

surgery may have been discussed with Defendant Farrell, it was not the purpose of the 

visit. Indeed, Plaintiff does not contend that such surgery would have been medically 

indicated at the time she saw Farrell, given her lack of professionally managed hormone 

therapy. The Standards of Care for the Health of Transsexual, Transgender, and Gender 

Non-Conforming People, developed by the World Professional Association for 

Transgender Health and relied on by Plaintiff in support of her request for sex 

reassignment surgery, counsel against surgery in such circumstances.

Accordingly, Plaintiff has stated cognizable claims for inadequate medical care 

against Defendants Farrell, Coffin, Cryer, Lewis, and Sunduram.

B. Equal Protection

The Equal Protection Clause requires that persons who are similarly situated be 

treated alike. City of Cleburne, Tex. v. Cleburne Living Ctr., Inc., 473 U.S. 432, 439 

(1985). An equal protection claim may be established by showing that the defendant 

intentionally discriminated against the plaintiff based on the plaintiff's membership in a 

protected class, Serrano v. Francis, 345 F.3d 1071, 1082 (9th Cir. 2003), Lee v. City of 

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Los Angeles, 250 F.3d 668, 686 (9th Cir. 2001), or that similarly situated individuals were 

intentionally treated differently without a rational relationship to a legitimate state 

purpose, Village of Willowbrook v. Olech, 528 U.S. 562, 564 (2000); see also Lazy Y 

Ranch Ltd. v. Behrens, 546 F.3d 580, 592 (9th Cir. 2008); North Pacifica LLC v. City of 

Pacifica, 526 F.3d 478, 486 (9th Cir. 2008). The level of scrutiny applicable to 

classifications based on transgender status has not been determined by the United 

States Supreme Court. Courts in this circuit have reached differing conclusions as to the 

level of scrutiny to be applied. See Norsworthy, 87 F. Supp. 3d at 1119-20

(discrimination against transgender individuals is subject to intermediate scrutiny, which 

requires that the classification be substantially related to an important governmental 

interest and supported by an “exceedingly persuasive justification”); but see Jamison v. 

Davue, No. CIV S–11–2056 WBS DAD P., 2012 WL 996383 at *3 (E.D. Cal. Mar. 23, 

2012) (holding that discrimination against transgender individuals is determined under 

the rational basis test).

Plaintiff alleges that Defendants discriminate against transgender women by 

denying surgery (vaginoplasty) that is available to cisgender women and that this 

difference in treatment is unsupported by any legitimate state purpose. These 

allegations are sufficient at the pleading stage to state an equal protection claim, even 

under the rational basis test. Thus, while the Court ultimately may need to determine the 

level of scrutiny applicable to Plaintiff’s claims, it need not do so now. 

As stated, however, Defendant Farrell did not participate in the decision to deny 

Plaintiff sex reassignment surgery. Accordingly, this claim runs only against Defendants 

Coffin, Cryer, Lewis, and Sunduram.

V. CONCLUSION AND RECOMMENDATIONS

Based on the foregoing, Plaintiff’s first amended complaint alleges cognizable 

Eighth Amendment claims against Defendants Farrell, Coffin, Cryer, Lewis, and 

Sunduram; and cognizable Fourteenth Amendment claims against Defendants Coffin, 

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Cryer, Lewis, and Sunduram. The first amended complaint states no other cognizable 

claims. Plaintiff previously was advised of the legal standards applicable to her claims 

and afforded the opportunity to cure noted defects. Further leave to amend appears 

futile and should be denied on that basis. 

Accordingly, it is HEREBY RECOMMENDED that:

1. Plaintiff proceed on her Eighth Amendment medical indifference claims 

against Defendants Farrell, Coffin, Cryer, Lewis, and Sunduram; and her Fourteenth 

Amendment Equal Protection claims against Defendants Coffin, Cryer, Lewis, and 

Sunduram; 

2. All other claims asserted in the complaint be dismissed with prejudice;

3. Service be initiated on the following Defendants:

R. FARRELL – Psychologist, CSATF

R. COFFIN – Chief Psychologist, CSATF

CLARENCE CRYER – Medical Department CEO, CSATF

J. LEWIS – Deputy Director, California Correctional Healthcare

J. SUNDURAM – Primary Care Physician, CSATF

4. The Clerk of the Court should send Plaintiff five USM-285 forms, five

summons, a Notice of Submission of Documents form, an instruction sheet and a copy 

of the first amended complaint filed November 16, 2015;

5. Within thirty (30) days from the date of adoption of these findings and 

recommendations, Plaintiff should complete and return to the Court the notice of 

submission of documents along with the following documents:

a. One completed summons for each Defendant listed above,

b. One completed USM-285 form for each Defendant listed above,

c. Six (6) copies of the endorsed first amended complaint filed

November 16, 2015; 

6. Upon receipt of the above-described documents, the Court should direct 

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the United States Marshal to serve the above-named Defendants pursuant to Federal 

Rule of Civil Procedure 4 without payment of costs.

These findings and recommendations will be submitted to the United States 

District Judge assigned to the case, pursuant to the provisions of Title 28 U.S.C. 

§ 636(b)(1). Within fourteen (14) days after being served with the findings and 

recommendations, the parties may file written objections with the Court. The document 

should be captioned “Objections to Magistrate Judge’s Findings and Recommendations.” 

A party may respond to another party’s objections by filing a response within fourteen 

(14) days after being served with a copy of that party’s objections. The parties are 

advised that failure to file objections within the specified time may result in the waiver of 

rights on appeal. Wilkerson v. Wheeler, 772 F.3d 834, 839 (9th Cir. 2014) (citing Baxter 

v. Sullivan, 923 F.2d 1391, 1394 (9th Cir. 1991)).

IT IS SO ORDERED.

Dated: July 7, 2016 /s/Michael J. Seng 

UNITED STATES MAGISTRATE JUDGE

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