Court Opinion

ID: 9363260
Source: CourtListenerOpinion
Date Created: 2023-01-13 18:58:17.392256+00
Date Added: 2024-06-11T17:15:30.169222
License: Public Domain

NOT FOR PUBLICATION                           FILED
                    UNITED STATES COURT OF APPEALS                       DEC 19 2022
                                                                      MOLLY C. DWYER, CLERK
                                                                       U.S. COURT OF APPEALS
                           FOR THE NINTH CIRCUIT

LYRALISA LAVENA STEVENS,                        No.    19-15838

                Plaintiff-Appellant,            D.C. No.
                                                1:17-cv-01002-AWI-SAB
 v.

JEFFREY A. BEARD; et al.,                       MEMORANDUM*

                Defendants-Appellees.

                   Appeal from the United States District Court
                      for the Eastern District of California
                   Anthony W. Ishii, District Judge, Presiding

                     Argued and Submitted December 9, 2022
                            San Francisco, California

Before: GRABER, GOULD, and WATFORD, Circuit Judges.

      Lyralisa Stevens is a transgender prisoner who suffers from gender

dysphoria. The California Department of Corrections and Rehabilitation (CDCR)

has treated her condition with hormone therapy but, until 2019, had refused her

requests for gender-affirming surgery. After the CDCR denied her request for

gender-affirming surgery in 2016, Stevens brought this 42 U.S.C. § 1983 action

      *
             This disposition is not appropriate for publication and is not precedent
except as provided by Ninth Circuit Rule 36-3.
                                                                            Page 2 of 8

alleging that prison officials’ deliberate indifference to her serious medical needs

violates the Eighth Amendment. The district court granted the prison officials’

motion to dismiss based on claim preclusion and failure to state a claim. We

reverse.

      1. In 2011, California state courts rejected Stevens’s habeas petition and

held that she was not entitled to gender-affirming surgery under the Eighth

Amendment. Under the Full Faith and Credit statute, 28 U.S.C. § 1738, we give

this decision the same preclusive effect that it would receive under California law.

See Gonzales v. Cal. Dep’t of Corr., 739 F.3d 1226, 1230 (9th Cir. 2014).

California’s claim preclusion doctrine requires that the later lawsuit involve (1)

“the same ‘cause of action’ as the first [suit],” (2) “a final judgment on the merits

in the first lawsuit,” and (3) the same parties or parties in privity. San Diego

Police Officers’ Ass’n v. San Diego City Emps.’ Ret. Sys., 568 F.3d 725, 734 (9th

Cir. 2009). California employs a “primary rights” theory to determine whether the

cause of action is the same. When the earlier and later suits involve “the same

injury to the plaintiff and the same wrong by the defendant,” the same cause of

action is present. Brodheim v. Cry, 584 F.3d 1262, 1268 (9th Cir. 2009) (quoting

Eichman v. Fotomat Corp., 197 Cal. Rptr. 612, 614 (Ct. App. 1983)). “What is

critical to the analysis ‘is the harm suffered; that the same facts are involved in

both suits is not conclusive.’” San Diego, 568 F.3d at 734 (quoting Agarwal v.
                                                                          Page 3 of 8

Johnson, 603 P.2d 58, 72 (Cal. 1979)). Applying this approach, the district court

determined that the California habeas decision precludes the current action because

“both claims appear to involve the same harm of not receiving [gender-affirming

surgery].” But the state-court decision in 2011 did not forever foreclose the

possibility that the CDCR might be required to provide Stevens with gender-

affirming surgery in the future.

       California law is clear that claim preclusion “extends only to the facts and

conditions as they existed at the time the judgment was rendered.” Lord v.

Garland, 168 P.2d 5, 11 (Cal. 1946). It does not “prevent a re-examination of the

same question between the same parties where, in the interval between the first and

second actions, the facts have materially changed or new facts have occurred

which may have altered the legal rights or relations of the litigants.” In re Fain,

188 Cal. Rptr. 653, 657 (Ct. App. 1983) (quoting Hurd v. Albert, 3 P.2d 545, 549

(Cal. 1931)).

      In this case, Stevens alleges that in 2013—two years after the California

habeas decision—she was diagnosed with a pituitary adenoma and chronic gliosis,

new injuries that she claims are the result of her continued hormone therapy.

Stevens contends that these new conditions alter the Eighth Amendment analysis in

two ways. First, she alleges that these new side effects caused prison officials to

reduce her estrogen intake, exacerbating her gender dysphoria. Second, she claims
                                                                            Page 4 of 8

that receiving gender-affirming surgery would allow her to treat her gender

dysphoria with a lower estrogen intake, reducing the risk that these side effects will

recur.

         The prison officials argue that the California courts were aware of the risks

of these side effects when they denied Stevens’s prior habeas petition and therefore

insist that circumstances have not changed in a meaningful way. We disagree.

The facts that once-hypothetical risks have now materialized and that Stevens’s

medical condition has worsened as a result are significant developments. Stevens

has suffered a new injury—her worsened medical condition—and a new wrong—

CDCR’s denial of gender-affirming surgery in 2016. Thus, this is a new cause of

action. The 2011 California decision does not preclude Stevens from challenging

the prison’s 2016 denial of gender-affirming surgery in the face of this new

medical record.

         2. Stevens has plausibly asserted an Eighth Amendment claim by alleging

“deliberate indifference to serious medical needs.” Estelle v. Gamble, 429 U.S. 97,

104 (1976). We have held that gender dysphoria can be a serious medical need,

see Edmo v. Corizon, Inc., 935 F.3d 757, 785 (9th Cir. 2019) (per curiam), and the

district court did not suggest otherwise. It instead concluded that Stevens failed to

allege that the prison officials were deliberately indifferent to her serious medical

needs because two medical committees at the prison determined that hormone
                                                                           Page 5 of 8

therapy adequately treated her gender dysphoria. Although Stevens had alleged

that the physicians who had evaluated her in 2010 would disagree with that

assessment, the district court reasoned that a difference of medical opinion does

not constitute deliberate indifference.

      This analysis prematurely terminated the litigation. While showing a

difference of medical opinion is not sufficient to state an Eighth Amendment

violation, the existence of conflicting assessments does not necessarily defeat a

claim of deliberate indifference. “[T]hat is true only if the dueling opinions are

medically acceptable under the circumstances.” Edmo, 935 F.3d at 786. Whether

an opinion is medically acceptable under the circumstances is a fact-intensive

question that requires analysis of the physicians’ credentials, the bases for their

opinions, and the medical standards in the field. See id. 786–87. At this stage in

the litigation, we do not know whether any member of the prison’s medical

committees had experience in treating gender dysphoria, and their decisions

denying Stevens’s request for gender-affirming surgery are entirely devoid of

reasons. All we know is that, according to Stevens’s allegations, the committees’

decisions are contrary to the “WPATH Standards of Care,” which represent “the

consensus of the medical and mental health communities regarding the appropriate

treatment for transgender and gender dysphoric individuals.” Id. at 769.
                                                                          Page 6 of 8

      On this record, it would be improper to assume the reasonableness of the

committees’ assessment. Stevens instead should be permitted to conduct discovery

so that she can attempt to prove her claim that the committees’ decisions were

“medically unacceptable under the circumstances” and that the defendants acted

“in conscious disregard of an excessive risk to [her] health.” Hamby v. Hammond,

821 F.3d 1085, 1092 (9th Cir. 2016) (quoting Snow v. McDaniel, 681 F.3d 978,

988 (9th Cir. 2012)).

      3. The prison officials argue that, regardless of the analysis above, we

should dismiss this action through a two-step process. First, they contend that we

must dismiss as moot Stevens’s request for injunctive relief because the CDCR

approved Stevens for gender-affirming surgery in 2019. Second, they urge us to

dismiss her remaining request for damages based on qualified immunity. We hold

that Stevens’s claim for injunctive relief is not moot and decline to resolve the

qualified immunity issue in the first instance.

      Regarding mootness, a defendant’s voluntary cessation does not moot a case

unless (1) “it can be said with assurance that there is no reasonable expectation that

the alleged violation will recur,” and (2) “interim relief or events have completely

and irrevocably eradicated the effects of the alleged violation.” Fikre v. FBI, 904

F.3d 1033, 1037 (9th Cir. 2018) (cleaned up). The latter condition is not satisfied

here. Even though the CDCR approved her for gender-affirming surgery more
                                                                            Page 7 of 8

than three years ago, Stevens still has not received that surgery and continues to

suffer hardships resulting from the alleged wrongful denial in 2016. In the face of

this prolonged delay, the district court has the authority to grant effective relief by

ensuring that Stevens promptly obtains the treatment that she contends (and that

the prison now recognizes) is medically necessary. See Bayer v. Neiman Marcus

Grp., Inc., 861 F.3d 853, 862 (9th Cir. 2017).

      The prison officials insist that they are proceeding as quickly as possible and

that the long delay is due to an outside surgeon’s lack of availability, not their own

foot-dragging. This uncorroborated assertion is insufficient to meet the

defendants’ “heavy burden of establishing that there remains no effective relief a

court can provide.” Id. If the district court determines on remand that preparation

for the surgery is proceeding at an appropriate pace and that the prison officials are

operating in good faith, it can stay proceedings. But the case is not moot and the

federal courts retain jurisdiction over Stevens’s claim for injunctive relief so long

as she has not received the surgery.1

1
  Defendants in this case include the CDCR Secretary and Undersecretary, as well
as members of the medical committees that denied Stevens’s surgery request in
2016. It is possible that the injunctive relief claim is moot as it relates to the
committee members because those defendants decide only whether a surgery is
necessary and exercise no authority over its scheduling or administration. Because
the parties did not adequately brief this argument before us, the district court on
remand will be better positioned to make this determination.
                                                                            Page 8 of 8

      As to Stevens’s claim for damages, we decline to address the issue of

qualified immunity in the first instance. See Am. President Lines, Ltd. v. Int’l

Longshore & Warehouse Union, 721 F.3d 1147, 1157 (9th Cir. 2013). The prison

officials remain free to raise that issue before the district court on remand.

      REVERSED and REMANDED.