In the

United States Court of Appeals

For the Seventh Circuit ____________________

No. 16-3350

LISA MITCHELL,

Plaintiff-Appellant,

v.

KEVIN KALLAS, et al.,

Defendants-Appellees.

____________________

Appeal from the United States District Court for the

Western District of Wisconsin.

No. 15-cv-108 — William M. Conley, Judge.

____________________

ARGUED JANUARY 10, 2018 — DECIDED JULY 10, 2018

____________________

Before WOOD, Chief Judge, HAMILTON, Circuit Judge, and 

BUCKLO, District Judge.*

WOOD, Chief Judge. Lisa Mitchell is a transgender person 

who has identified as a woman her entire life. After an arrest 

in Wisconsin, officials from the state’s Department of Corrections (“DOC”) repeatedly prevented Mitchell from obtaining 

 

*Of the Northern District of Illinois, sitting by designation.
2 No. 16-3350

access to the treatments she needed to express her gender 

identity. It took DOC over a year to evaluate Mitchell’s candidacy for hormone therapy, and even then, nothing happened. 

Instead, DOC refused to provide Mitchell with the treatment

its own expert recommended, on the ground that Mitchell 

was within a month of release from the prison. Although

DOC’s Mental Health Director, Dr. Kevin Kallas, encouraged

Mitchell to find a community provider to prescribe her hormones, DOC parole officers prevented Mitchell from following this advice. Still under state custody, the terms of Mitchell’s parole actually prohibited her from taking hormones or 

dressing as a woman.

Mitchell sued, contending that the prison doctors and the 

parole officers violated her constitutional rights. It is well established that persons in criminal custody are entirely dependent on the state for their medical care. Estelle v. Gamble, 

429 U.S. 97, 103 (1976). Prison officials thus have a constitutional duty to provide inmates with the care they require for 

their serious medical needs. Prison staff cannot bide their time 

and wait for an inmate’s sentence to expire before providing 

necessary treatments. This affirmative obligation ends when

imprisonment does, but state officials may not block a parolee

from independently obtaining health care. The only limitation 

is that the condition be serious enough to trigger constitutional protection; otherwise the nature of the disorder is irrelevant. Because the district court prematurely rejected some of 

Mitchell’s claims, we reverse in part.

I

In 2008, Mitchell received a diagnosis of gender dysphoria. A few years later, she was convicted of a crime and sent 

to Wisconsin’s Columbia Correctional Institution on October 
No. 16-3350 3

11, 2011, to serve her sentence. On November 25, 2011, Mitchell asked for hormone treatment. Her request initiated a multistep process that DOC outlined in its then-new policy on 

Health Care Treatment of Gender Identity Disorder. That policy was first implemented on December 19, 2011. Step one under the policy required Mitchell’s clinician to conduct a preliminary assessment. She did so, producing a written report 

about Mitchell on February 10, 2012. Next, the Gender Dysphoria Committee reviewed the report and decided to refer 

Mitchell’s request for hormone therapy to its outside consultant, Cynthia Osborne. Osborne is a social worker and assistant professor at Johns Hopkins University, in Maryland; she

specializes in providing gender-dysphoria evaluations. Since

Osborne visited the Wisconsin facilities roughly every two 

months, Dr. Kallas informed Mitchell that she would meet 

with Osborne in April. That interview did not occur until May 

22, 2012, however, nearly six months after Mitchell’s initial request for care. 

During the months leading up to and following the interview, Mitchell repeatedly inquired about her health care request. She asked Dr. Dawn Laurent, the prison’s Psychological Services Unit Supervisor, for an update on April 8, 2012.

Dr. Laurent did not respond. Instead, Mitchell’s assigned clinician wrote back, promising to follow up. Mitchell also wrote 

letters to Dr. Kallas. In his October 8 reply, Dr. Kallas informed Mitchell that Osborne’s report was “nearly complete” 

and should be finished “in a matter of days.” He explained 

that Osborne was just trying to get in touch with two people

whom Mitchell named as references. Dr. Kallas recognized 

that “considerable time ha[d] passed” and thanked Mitchell

for her patience. 
4 No. 16-3350

The long delay was not cost-free for Mitchell. While she

waited, her psychological health was deteriorating. In 

May 2012, she reported feeling unsafe with silverware. A clinician’s notes from July reflect that she was “not doing well 

regarding gender identity disorder issues.” Though she was 

receiving periodic counseling services, the notes from these 

sessions suggest that they focused on her other mental health 

conditions, such as her post-traumatic stress (the result of a 

violent hate crime committed against her when she was 18). 

To the extent Mitchell’s gender dysphoria was discussed, the 

notes primarily refer to the harassment Mitchell experienced 

and her desire to know the status of her treatment request.

Osborne did not submit a draft of her report until November 15, 2012. Curiously, the report was dated September 27. 

Mitchell received a copy of the draft on November 28, and the 

report was finalized on December 2. Though Osborne’s conclusions came a full year after Mitchell asked for hormone

treatment, her recommendations strongly supported Mitchell’s request. Osborne concluded that Mitchell “is an excellent 

candidate for hormone therapy” and predicted that this treatment would very likely improve Mitchell’s “functional stability and sense of psychological well-being.” Osborne expected 

that hormones would help not only with Mitchell’s gender 

dysphoria, but also with her post-traumatic stress as well. 

Based on Osborne’s unequivocal recommendation, Mitchell resubmitted her request for hormone therapy the same day 

that she reviewed the draft report. Dr. Kallas turned her down 

on January 2, 2013. His letter explained that she was not eligible for treatment because she was scheduled to be released 

that month. As a “point of information,” Dr. Kallas said, DOC 

starts inmates on hormone therapy only when they have at 
No. 16-3350 5

least six months left on their sentences, in order to allow for 

the several-month process of getting the person stabilized on 

the medication. Dr. Kallas encouraged Mitchell to seek hormone treatment upon her release; he even offered a copy of 

Osborne’s report and information about community providers.

But Mitchell was thwarted again after her release on January 8, 2013. When she tried to follow up on Dr. Kallas’s suggestion, her parole officers flatly forbade her from seeking 

hormone therapy. Indeed, as a condition of her parole, she

was required to dress and present as a man. Though Mitchell 

provided the agents with a copy of Osborne’s report and recommendations, the officers did not relent. 

On February 18, 2015, Mitchell filed a pro se complaint in 

federal court against Dr. Kallas, Dr. Laurent, and DOC parole 

officers Joseph Ruhnke, Brittany Wolfe, and Nicole Raisbeck. 

(Mitchell also initially sued two DOC Secretaries, but she has 

not appealed the dismissal of these defendants.) The district 

court understood the suit as one under 42 U.S.C. § 1983 alleging deliberate indifference to a serious medical need. As required by the Prison Litigation Reform Act (PLRA), the court 

began by screening Mitchell’s complaint. 28 U.S.C. 

§ 1915A(a). It concluded that Mitchell failed to state a claim 

against the parole officers under the Eighth Amendment (as 

applied to the states through the Fourteenth Amendment), 

and so it dismissed them without prejudice. Though the court 

allowed the claims against Drs. Kallas and Laurent to proceed, it later granted summary judgment for them. It determined that neither one was deliberately indifferent to Mitchell’s gender dysphoria, and regardless, both were entitled to 

qualified immunity. Mitchell filed an earlier appeal in which 
6 No. 16-3350

she challenged some aspects of her parole, but we dismissed 

on the ground that it was moot. Mitchell v. Wall, 808 F.3d 1174 

(7th Cir. 2015). The merits are now before us, and as there is 

no mootness problem this time, we consider whether the district court properly dismissed Mitchell’s claims.

II

As we noted earlier, because a person is deprived of her 

liberty while incarcerated, she “must rely on prison authorities to treat [her] medical needs.” Gamble, 429 U.S. at 103. Unable to call her own doctor or walk into a hospital, an inmate 

with medical problems will go without treatment unless the 

prison provides care. If prison medical staff exhibit deliberate 

indifference to an inmate’s serious medical condition, they 

subject her to unnecessary and wanton pain and suffering and 

thereby run afoul of the Eighth Amendment. Id. at 104–05; Petties v. Carter, 836 F.3d 722, 727–28 (7th Cir. 2016) (en banc). 

The state defendants do not dispute that Mitchell’s gender 

dysphoria is a serious medical condition or that she never received hormones while in DOC custody. They maintain, however, that no jury could find that they were deliberately indifferent to her condition. To establish deliberate indifference, a 

plaintiff must show that the defendant “actually knew of and 

disregarded a substantial risk of harm.” Petties, 836 F.3d at 

728. Failing to provide care for a non-medical reason, when 

that care was recommended by a medical specialist, can constitute deliberate indifference. Perez v. Fenoglio, 792 F.3d 768, 

778 (7th Cir. 2015). So too can inexplicable delays in treatment 

where the delays serve no penological purpose. Petties, 

836 F.3d at 730. The district court held that neither the 13-

month delay in evaluating Mitchell’s request nor its ultimate 

denial constituted deliberate indifference. Moreover, the 
No. 16-3350 7

court determined, the defendants were entitled to qualified 

immunity because there was no clearly established right to 

hormone treatment when requested. We take a fresh look at 

the district court’s conclusions, viewing the record in the light 

most favorable to Mitchell. See Orlowski v. Milwaukee Cnty., 

872 F.3d 417, 421 (7th Cir. 2017); Zimmerman v. Doran, 807 F.3d 

178, 182 (7th Cir. 2015).

A

We start with Dr. Laurent. For a defendant to be liable under section 1983, she must be personally responsible for the 

alleged deprivation of the plaintiff’s constitutional rights. Wilson v. Warren Cnty., 830 F.3d 464, 469 (7th Cir. 2016). The personal-involvement requirement is satisfied if the constitutional violation occurs at a defendant’s direction or with her 

knowledge or consent. Id. Here, the alleged deprivation of adequate medical care occurred because of the time it took to 

resolve Mitchell’s treatment request and the ultimate outcome—rejection. Dr. Laurent was not a member of the Gender 

Dysphoria Committee, nor did she take part in the decisions

to get a consultation from Osborne or to deny Mitchell’s request for hormones. 

Nonetheless, Dr. Laurent may be liable under section 1983 

if she acquiesced in the failure to provide necessary medical 

treatment. Minix v. Canarecci, 597 F.3d 824, 833–34 (7th Cir. 

2010). Dr. Laurent was the psychological services supervisor 

at the prison where Mitchell was housed. In that role, she 

signed treatment notes from sessions where Mitchell complained about her distress and the harassment she experienced as a result of her gender dysphoria. Though Dr. Laurent was not Mitchell’s assigned clinician, she did meet with 

Mitchell for one session. Additionally, in April 2012, Mitchell 
8 No. 16-3350

directly asked Dr. Laurent for an update on when she would 

meet with Osborne.

Yet, even assuming that she knew about Mitchell’s distress, there is no evidence that Dr. Laurent could have sped 

up Osborne’s evaluation or the Committee’s deliberations, or 

could have influenced the Committee’s final decision. In fact, 

there is evidence that as a psychologist, Dr. Laurent had no 

authority to order hormone therapy. Because Dr. Laurent was 

not sufficiently involved in the failure to provide hormone 

therapy, the district court properly granted summary judgment in her favor.

B

Next we turn to Dr. Kallas. As DOC’s Mental Health Director and a member of the Gender Dysphoria Committee, 

Dr. Kallas was directly involved in Mitchell’s treatment. He 

contacted Osborne for a consultation and sat on the Committee that ultimately denied Mitchell’s request.

We begin with the question whether Dr. Kallas is entitled 

to qualified immunity. A prison official is immune from suit

if the constitutional right at issue was not clearly established 

at the time of the violation, and thus a reasonable officer 

would not have known that his conduct was unlawful. Orlowski, 872 F.3d at 421. In deciding whether a right was clearly 

established, it is essential to assess the case at the right level 

of specificity. White v. Pauly, 137 S. Ct. 548, 551–52 (2017). But 

this particularity requirement does not go so far as to mandate 

a mirror-image precedent from the Supreme Court or this 

court. Ziglar v. Abbasi, 137 S. Ct. 1843, 1866–67 (2017) (stating 

that the “very action in question” need not have been found 

to be unlawful (citation omitted)). As we put it recently, the 
No. 16-3350 9

Eighth Amendment duty “need not be litigated and then established disease by disease or injury by injury.” Estate of 

Clark v. Walker, 865 F.3d 544, 553 (7th Cir. 2017) (rejecting a 

highly specific framing of the right at stake); see also Estate of 

Perry v. Wenzel, 872 F.3d 439, 460 (7th Cir. 2017) (same).

Dr. Kallas urges that he is entitled to qualified immunity 

because no binding decision guarantees inmates the right to a 

speedier gender dysphoria evaluation or short-term hormone 

therapy prior to release. That formulation, however, frames 

the right too narrowly. Dr. Kallas has conceded (consistently 

with other cases) that Mitchell’s gender dysphoria was a serious medical need. See Fields v. Smith, 653 F.3d 550, 556 

(7th Cir. 2011); Maggert v. Hanks, 131 F.3d 670, 671 (7th Cir. 

1997); Meriwether v. Faulkner, 821 F.2d 408, 413 (7th Cir. 1987). 

The first question is thus whether a prison doctor would have 

known that it was unconstitutional never to provide a person 

with the appropriate treatment for her particular case (and for 

many others)—hormone therapy. Fields, 653 F.3d at 556.

Prison officials have been on notice for years that leaving 

serious medical conditions, including gender dysphoria, untreated can amount to unconstitutional deliberate indifference. E.g., Arnett v. Webster, 658 F.3d 742, 753 (7th Cir. 2011)

(refusing to provide a prescribed treatment or to follow a specialist’s advice can violate the Eighth Amendment); Fields, 

653 F.3d at 556 (“Refusing to provide effective treatment for a 

serious medical condition serves no valid penological purpose and amounts to torture.”). An absence of treatment is

equally actionable whether the inmate’s suffering is physical 

or psychological. See Meriwether, 821 F.2d at 413. Because circuit precedent clearly established that a total absence of treat-
10 No. 16-3350

ment for the serious medical needs created by gender dysphoria is unconstitutional, Dr. Kallas may not claim qualified immunity for the denial of Mitchell’s request for care.

The question remains, however, whether on this record 

such a total denial of care could be found by a jury. The facts 

in this respect are disputed. On the one hand, Mitchell never 

received the hormone therapy that Osborne, on DOC’s behalf, 

concluded that she needed. Instead, while Mitchell waited for 

a response to her plea, she got nothing but occasional visits 

with psychologists. Although Dr. Kallas argues that these visits were themselves “treatment,” the notes from those sessions indicate that they were not focused on her gender dysphoria, but instead were primarily designed to deal with her 

post-traumatic stress and the harassment she faced. And more 

broadly, psychological visits are not automatically a substitute for other medical treatments. See De’lonta v. Johnson, 708 

F.3d 520, 525–26 (4th Cir. 2013) (providing “some treatment” 

does not necessarily mean providing “constitutionally adequate

treatment”); Fields, 653 F.3d at 556. No one would say that a 

psychologist could treat someone’s epilepsy, nor would we 

say that a counseling session is a substitute for high blood 

pressure medication, even though stress can have an adverse 

effect on blood pressure. In some cases, a psychological condition, such as bipolar disorder, should not be treated by 

counseling alone: medication can be essential. So it is with her 

gender dysphoria, Mitchell says. And even if the therapy sessions addressed Mitchell’s gender dysphoria to a degree, she 

may still recover if they did nothing actually to treat her condition. See Arnett, 658 F.3d at 751; see also 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 
No. 16-3350 11

do nothing to treat the underlying disorder [gender dysphoria].”). Given the opinions of the prison doctors and Osborne, 

Mitchell has presented enough evidence to move forward. 

To the extent that Mitchell may be complaining about the 

length of time it took for the assessment to be completed, as 

opposed to the lack of treatment, our answer is different. It is 

true that delays in care for “non-life-threatening but painful 

conditions may constitute deliberate indifference if the delay 

exacerbated the injury or unnecessarily prolonged an inmate’s pain.” Arnett, 658 F.3d at 753; see also McGowan v. Hulick, 612 F.3d 636, 640 (7th Cir. 2010). Yet prisons have limited 

resources, and that fact makes some delay inevitable. Petties, 

836 F.3d at 730. For a delay in treatment to qualify as deliberate indifference, we must weigh “the seriousness of the condition and the ease of providing treatment.” Id. As we have 

said, the serious nature of gender dysphoria is not disputed 

here. But the ease of evaluating the appropriateness of hormone therapy remains to be considered. There is little evidence about the typical length of these evaluations, either in 

prisons or in the community. The few courts that have considered this question (some after the events in question) have 

determined that even longer delays in evaluating an inmate’s 

candidacy for hormone treatment did not amount to deliberate indifference. See Arnold v. Wilson, No. 1:13cv900, 2014 

WL 7345755, at *6 (E.D. Va. Dec. 23, 2014) (24-month delay in 

prescribing hormones); Rowe v. Corr. Med. Servs., Inc., 

No. 1:08-cv-827, 2010 WL 3779561, at *6–7 (W.D. Mich. Aug. 

18, 2010) (15-month delay). Because Dr. Kallas was not on notice that a 13-month evaluation would violate Mitchell’s 

Eighth Amendment right, he is entitled to qualified immunity 

on any possible claim of unreasonable delay.
12 No. 16-3350

That is not to say that this delay cannot be criticized. Far 

from it. The lack of any sense of urgency, or even of the need 

for prompt follow-through, is quite disturbing. But on these 

facts, no clearly established law would have signaled to 

Dr. Kallas that this delay amounted to deliberate indifference. 

C

With respect to Dr. Kallas, that leaves the question 

whether he was deliberately indifferent in failing to treat 

Mitchell’s condition during the entirety of her stay at DOC, 

even after Osborne recommended that Mitchell receive hormone therapy. Mitchell accuses Dr. Kallas of doing nothing 

while the evaluation process was ongoing, and then (through 

the Committee) denying her request because she was going to 

be released within a month. Dr. Kallas claimed that DOC had 

an unwritten rule that an inmate may start hormone therapy

only if she has six months left on her sentence, and he denied 

her request on that basis. He later explained in an affidavit 

that this period was intended to allow time to figure out the

proper hormone dosage while monitoring both physical and 

psychological side effects. 

The first problem is that this requirement appears nowhere in DOC’s written policy on gender dysphoria. This

conspicuous absence from DOC’s freshly-minted policy

raises the factual question whether DOC actually had such a 

practice. Moreover, the question remains whether Dr. Kallas 

and the Committee exercised medical judgment in applying 

the policy to Mitchell’s request. Neither professional disagreement nor medical malpractice constitutes deliberate indifference. Cesal v. Moats, 851 F.3d 714, 721, 724 (7th Cir. 2017).

Thus, if the trier of fact finds that there was such a policy and 
No. 16-3350 13

that Dr. Kallas and the Committee had a medical basis for deciding not to start Mitchell’s hormone treatments, then Dr. 

Kallas will not be liable. If the factfinder alternatively concludes that there was no such policy, or that Dr. Kallas failed 

to assess whether application of the policy was appropriate in 

Mitchell’s case, then it would follow that he did not exercise 

his medical judgment and was deliberately indifferent. “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 v. Precynthe, No. 4:16-cv-01357, 2018 WL 806764, at *11 

(E.D. Mo. Feb. 9, 2018); accord Kosilek v. Spencer, 774 F.3d 63,

91 (1st Cir. 2014); De’lonta v. Angelone, 330 F.3d 630, 635 

(4th Cir. 2003); Allard v. Gomez, 9 F. App’x 793, 794–95 (9th Cir. 

2001).

We have no reason to doubt that hormone therapy poses a 

health risk if not properly controlled. But the same could be 

said about medications for countless other conditions. It 

seems exceedingly unlikely that DOC would refuse to commence a course of treatment for an inmate who was about to 

leave, just because continuity of care protocols would require

a hand-off to a different provider. Would it really refuse to 

address breathing problems, or cardiac problems, or even a 

broken leg, just because one doctor begins the treatment and 

another completes it? At this stage, the parties disagree about 

the critical question whether DOC could have provided 

Mitchell with something more than counseling services—perhaps a limited prescription for hormones—to bridge the gap 

between her release from custody and the time when she 

found a new provider in the community.
14 No. 16-3350

In sum, there remain material disputes about whether 

Dr. Kallas and the Committee balanced the pros and cons of 

starting Mitchell on hormones, or if they just looked at the calendar and reflexively dismissed her request. The district court 

should not have granted summary judgment on Mitchell’s 

claim for the refusal to provide care. 

III

Finally, we consider Mitchell’s argument that the parole 

officers were improperly dismissed from this case. The district court concluded that Mitchell failed to allege sufficient 

facts to support a finding that the parole officers were personally involved in making decisions about her gender dysphoria 

treatment or that they were obligated to provide her such 

treatment.

Reading Mitchell’s pro se complaint in the light most favorable to her, as we must, Perez, 792 F.3d at 776, we conclude 

that she did state a claim against the parole officers. Mitchell’s 

complaint did not suggest that her parole officers had a legal 

duty to arrange hormone therapy for her. Rather, her argument was that the officers impermissibly forbade her from 

dressing as a woman and seeking hormone treatment on her 

own. She alleged that the agents had ample notice that a bar 

on taking hormones would harm her. They had a copy of her 

medical records and Osborne’s report, which even mentioned

that hormone treatment would help ward off recidivism.

We have not yet addressed whether parole officers can be 

liable for deliberate indifference to a parolee’s serious medical 

need, though we have found that their actions implicate the 

Eighth Amendment in some situations. See Hankins v. Lowe, 

786 F.3d 603, 606 (7th Cir. 2015) (holding that parolee stated 
No. 16-3350 15

an Eighth Amendment claim that her parole officer subjected 

her to restrictive conditions past the expiration of her term of 

parole). One district court has contemplated that parole officers can be liable for deliberate indifference by placing conditions on a plaintiff that prevent her from taking the medically 

indicated course of care. Stewart v. Raemisch, No. 09-C-123, 

2009 WL 3754173, at *3 (E.D. Wis. Nov. 4, 2009) (entertaining 

a suit against a parole agent where parolee was required to 

seek employment but could not for medical reasons). And we 

have held that custodial prison staff violate the Eighth 

Amendment by interfering with or preventing necessary 

medical care. McDonald v. Hardy, 821 F.3d 882, 888 (7th Cir. 

2016); see also Gamble, 429 U.S. at 104–05. Though parole officers may have no duty under Gamble to provide a parolee 

with medical care or ensure that she receives it, they at least 

may be constitutionally obligated not to block a parolee who 

is trying to arrange such care for herself without any basis in 

the conditions of parole. See 429 U.S. at 105 (deliberate indifference to a serious medical issue “[r]egardless of how evidenced” states a cause of action under section 1983). From 

that perspective, Mitchell pleaded enough to proceed on the 

theory that the parole officers acted with deliberate indifference to her gender dysphoria by blocking her from getting 

care.

In its ruling on Mitchell’s motion to reconsider, the district 

court offered an additional reason for dismissing the parole 

officers: it was concerned that the claims against the parole 

officers and those against the doctors were not sufficiently related to continue in the same lawsuit. When screening prisoners’ complaints under the PLRA, courts can and should sever 

an action into separate lawsuits or dismiss defendants who 

are improperly joined under Federal Rule of Civil Procedure
16 No. 16-3350

20(a)(2). Owens v. Hinsley, 635 F.3d 950, 952 (7th Cir. 2011). A

prisoner may join defendants in the same action only if the 

claims against each one “aris[e] out of the same transaction, 

occurrence, or series of transactions or occurrences ... .”

FED. R. CIV. P. 20(a)(2)(A); George v. Smith, 507 F.3d 605, 607 

(7th Cir. 2007).

The question then is whether Mitchell’s claim against the 

parole officers should have been brought in a separate lawsuit. Out of concern about unwieldy litigation and attempts to 

circumvent the PLRA’s fee requirements, we have urged district courts and defendants to beware of “scattershot” pleading strategies. E.g., Owens v. Evans, 878 F.3d 559, 561 (7th Cir. 

2017); Owens v. Godinez, 860 F.3d 434, 436 (7th Cir. 2017). We

target for dismissal “omnibus” complaints—often brought by 

repeat players—that raise claims about unrelated conduct 

against unrelated defendants. E.g., Evans, 878 F.3d at 561;

Hinsley, 635 F.3d at 952.

Mitchell’s complaint stands in stark contrast to these scattershot suits. Mitchell has focused on a series of events stemming from one issue: her inability to get hormone therapy 

while she remained in state custody. One of the defendants’ 

arguments underscores that Mitchell’s claims belong together. In an attempt to disclaim deliberate indifference, Dr. 

Kallas stresses that he gave Osborne’s report to Mitchell, 

along with information about Wisconsin providers, so that 

she could seek hormone therapy in the community once she 

was released on parole. The parole officers, however, told her 

she was not allowed to follow through on Dr. Kallas’s advice.

She thus suffered an ongoing denial of treatment arising out 

of one fundamental occurrence, well within the bounds of 

Rule 20(a)(2). The fact that Mitchell has different theories of 
No. 16-3350 17

liability against the different defendants does not diminish

the fact that her claims are sufficiently related. “The two sets 

of claims are against different defendants, but they belong in 

the same suit because they arise out of the same set of connected transactions.” Terry v. Spencer, 888 F.3d 890, 894 (7th 

Cir. 2018). Given Mitchell’s allegations of a fairly continuous 

period in which two sets of defendants denied or interfered 

with her access to needed medical treatment, it is easy to imagine that if the claims were tried separately, each set of defendants could try to shift blame to the other. Handling the 

claims against both sets of defendants in one case minimizes 

the risk of unfairness from such inconsistent defenses succeeding in separate trials.

The fact that the district court dismissed Mitchell’s claim 

against the parole agents without prejudice does not change 

our conclusion, nor does the fact that her claim probably 

would not be time-barred under Wisconsin’s generous sixyear statute of limitations. See Kennedy v. Huibregtse, 831 F.3d 

441, 442 (7th Cir. 2016). Mitchell was entitled not to split her 

claims against these two sets of defendants. On remand, she 

will be entitled to proceed against both Dr. Kallas and the parole officers. 

IV

Punishment for Mitchell’s crimes cannot extend to the 

deprivation of the medical treatment she requires for her serious gender dysphoria. The Wisconsin DOC staff must approach Mitchell’s request for treating gender dysphoria with 

the same urgency and care as it would any other serious medical condition. We AFFIRM the judgment in favor of Dr. Laurent, but we REVERSE with respect to Dr. Kallas and Parole 
18 No. 16-3350

Agents Ruhnke, Wolfe, and Raisbeck, and REMAND for proceedings consistent with this opinion.