United States District Court, M.D. Georgia, Macon Division
Under 42 U.S.C. § 1983 Before the U.S. Magistrate Judge
REPORT AND RECOMMENDATION
Charles H. Weigle, United States Magistrate Judge
the Court is a motion for summary judgment filed by
Defendants Gregory Dozier, Sharon Lewis, and Kenneth Sanford.
(Doc. 48). Because Defendants are entitled to qualified
immunity from Plaintiff Robbin Amanda Bayse's civil
rights claims, it is RECOMMENDED that the
motion for summary judgment be GRANTED.
Robbin Amanda Bayse, also known as Robert Bayse, is an inmate
of the Georgia Department Corrections (“GDC”) and
currently incarcerated at Valdosta State Prison. Plaintiff
was born biologically male but has been living as a
transgender female for at least the past twenty-seven
years. (Bayse Dep., Doc. 48-3, p. 41). Plaintiff
was diagnosed with gender dysphoria in September 2015
(Id., p. 18) and has also been diagnosed with major
depressive disorder and borderline personality disorder (Dr.
Moody Decl., Doc. 48-7, ¶ 5). Plaintiff also experiences
anxiety, sleeplessness, nightmares, and auditory
hallucinations. (Id., ¶ 6); (Doc. 48-3, p. 19).
uncontested definition of gender dysphoria is outlined in the
American Psychiatric Association's Diagnostic and
Statistical Manual of Mental Disorders (DSM-5).
See (Compl., Doc. 1, p. 10); (Ga. Dept. Corrs. SOP,
Doc. 48-5, p. 2); cf. (Mot. Summ. J., Doc. 48-2, p.
13 n.2 (citing DSM-5)). The DSM-5 defines gender dysphoria as
“[a] marked incongruence between one's
experienced/expressed gender and assigned gender, of at least
6 months' duration, as manifested by at least two of the
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 secondary 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).
Psychiatric Ass'n, Diagnostic and Statistical Manual of
Mental Disorders (DSM-5) 452-53 (5th ed. 2013); see also
Gibson v. Collier, 920 F.3d 212, 217 (5th Cir. 2019)
(discussing DSM-5's definition of gender dysphoria);
Freeman v. Dunn, No. 2:06-CV-122-WKW, 2018 WL
3235794, at *87 n.245 (M.D. Ala. July 2, 2018) (same). The
DSM-5 adds, “The condition is associated with
clinically significant distress or impairment in social,
occupational, or other important areas of functioning.”
DSM-5, at 452-53.
has a documented history of self-harm and attempted suicide,
which predates her diagnosis of gender dysphoria and her
incarceration. See, e.g., (Doc. 61-9); (Doc. 48-3,
p. 70). Plaintiff first attempted suicide at seven years old,
after witnessing an aunt kill herself and due to a perception
that people were not “trying to understand who I
was.” (Doc. 48-3, p. 70). Plaintiff has attempted
self-castration three times, either by cutting or
“tying” her genitals. (Doc. 61-9, pp. 2, 4, 8-9).
One doctor noted, “[Plaintiff Bayse] described having
had a long[-]time hatred of his male genitals and has
struggled with the urge to castrate himself.”
(Id., p. 7). On one occasion, Plaintiff cut her face
in response to prison officials' alleged refusal to allow
her to wear makeup. (Id., p. 10); see also
(Doc. 48-3, p. 55).
as per GDC policy, is currently being treated for her gender
dysphoria and other psychiatric disorders pursuant to a
treatment plan. (Doc. 48-7, ¶¶ 4-5); (Treatment
Plan, Doc. 54-4). GDC Standard Operating Procedure 507.04.68
provides, in relevant part, that gender dysphoric inmates
“will receive thorough medical and mental health
evaluations from appropriately licensed and qualified medical
and mental health professionals, ” who will then
develop a treatment plan “that promotes the physical
and mental health of the patient” in accordance with
“accepted standards of care.” (Doc. 1-3, p. 1).
The treatment plan must be approved by the Statewide Medical
Director and Statewide Mental Health Director before
implementation, then regularly reviewed and updated as
necessary. (Id., p. 2). In addition, gender
dysphoric inmates are to “receive a current individual
assessment and evaluation, ” and “[t]reatment
options will not be precluded solely due to level of services
received, or lack of services, prior to incarceration.”
the treatment plan, Plaintiff has received hormone therapy
and other medications, such as Risperdal to treat her
auditory hallucinations. (Doc. 48-7, ¶ 6). Plaintiff has
also attended a trauma group and counseling sessions,
expressed herself through art and journaling, and engaged in
“mindful exercise.” (Docs. 54-4; 54-6, pp. 2- 8).
Hormone therapy has caused Plaintiff to “develop
breasts, soft skin and other female secondary sex
characteristics.” (Bayse Decl., Doc. 8, ¶ 3).
Plaintiff also wears traditionally feminine accessories, such
as earrings and bracelets; applies makeup, eyeliner, and lip
gloss; and colors her fingernails and toenails. (Doc. 48-3,
pp. 96-98). Plaintiff testified that her earrings are made
from a “candy wrapper and a hair comb tooth, ”
her bracelet is made from “a little rope, ” and
she colors her nails using colored pencils. (Id.);
(Doc. 8, ¶ 10). Plaintiff was wearing these accessories
during her deposition. (Doc. 48-3, pp. 96-98). She also wears
her hair longer than the mandated hair-length limit of three
inches. (Id., pp. 92-99); (Doc. 61-15). Plaintiff
claims that she is barred from obtaining
“gender-affirming clothing, grooming, or commissary
items, ” such as colored pencils, which she claims are
medically necessary to treat her gender dysphoria and ease
the “mental anguish” she experiences at
“being forced to live as a male.” (Doc. 8,
has contested the adequacy of her treatment plan and
consistently demanded sex reassignment surgery
(“SRS”) throughout her incarceration, see,
e.g., (Docs. 54-6, p. 17; 61-2, p. 8; 61-5, pp. 5, 9;
61-6, pp. 10-12; 61-12, p. 6), stating that she feels
“trapped in the wrong body” (Doc. 8, ¶ 3).
She claims that her several requests to see a
“qu[a]lified physician, psychiatrist or
psychologist” for treatment have been
“futile.” (Bayse Decl., Doc. 22, ¶¶ 3,
7). The perceived inadequacy of her treatment has caused her
to develop an eating disorder and “placed [her] at
increased risk of suicide, self-mutilation and
self-castration.” (Id., ¶¶ 8-9). One
psychologist, Dr. Kelly Hern, noted that Plaintiff had
exhibited an “obsessive ‘need' for
reassignment surgery.” (Doc. 61-6, p. 9). In response
to her persistent requests for SRS, medical staff have
challenged Plaintiff's perception that SRS would cure her
mental disorders. Dr. Hern, for example, informed Plaintiff
about research against the surgery. (Id., p. 5). Dr.
Hern also dismissed the idea that that the prescribed
medication was to “cover up” her problems and
told Plaintiff that SRS “is not an option as
yet.” (Id.). Madia West, the Mental Health
Director at Johnson State Prison, also “challenged
ideation that gender reassignment would end all
problems” and continued to discuss “gender
relevant issues” with Plaintiff. (Doc. 54-6, p. 31).
CLAIMS AND REQUESTED RELIEF
claims that Defendants, in violation of the Eighth Amendment,
acted with deliberate indifference to her gender dysphoria by
refusing to provide her with SRS and by only allowing her
access to unqualified medical and mental health
professionals. Plaintiff also contends that the GDC has a
policy prohibiting physicians from recommending and providing
has also brought a claim under the Fourteenth Amendment's
equal protection clause, arguing that the GDC has a policy
prohibiting male-to-female transgender inmates from obtaining
a vaginoplasty but allowing inmates born biologically female
to undergo the procedure.
relief, Plaintiff requests an injunction for adequate medical
care, including SRS; an injunction to “enjoin
Defendants from interfering with the discretion” of
Plaintiff's treating physicians and mental health staff;
a declaration that the GDC's policy against SRS and the
treatment of transgender inmates is unconstitutional; $450,
000 in compensatory damages, jointly and severally; $250, 000
in punitive damages, jointly and severally; and attorneys
fees and costs. (Doc. 1, p. 7). Plaintiff sues Defendants in
both their individual and official capacities.
filed her complaint on January 26, 2018. (Doc. 1). On
screening, the Court ordered Plaintiff's deliberate
indifference claims under the Eighth Amendment and equal
protection claims under the Fourteenth Amendment to proceed
for further factual development. (Doc. 12). On June 24, 2018,
Plaintiff moved for a preliminary injunction and temporary
restraining order, seeking SRS and other treatments she
considered to be medically necessary to treat her gender
dysphoria. (Doc. 19). The Court denied Plaintiff's motion
on the grounds that she had not shown a substantial
likelihood of success on the merits, as she could not show
that the treatments were medically necessary to treat her
condition. (Doc. 43, adopting Doc. 35). On January 25, 2019,
Defendants moved for summary judgment. (Doc. 48).
this action, Plaintiff, in addition to several motions and
responsive filings, has filed several affidavits and
declarations, each discussing, and often repeating, specific
details regarding her treatment, alleged deprivations, and
her life experiences in general. See (Docs. 8, 9,
22, 29, 46, 47, 58, 63). Each of these affidavits and
declarations has been reviewed and considered for purposes of
SUMMARY JUDGMENT STANDARD
is entitled to summary judgment “if the movant shows
that there is no genuine dispute as to any material fact and
that the movant is entitled to judgment as a matter of
law.” Fed.R.Civ.P. 56(a). “An issue of fact is
‘material' if it is a legal element of the claim
under the applicable substantive law which might affect the
outcome of the case.” Allen v. Tyson Foods,
Inc., 121 F.3d 642, 646 (11th Cir. 1997) (citing
Anderson v. Liberty Lobby, Inc., 477 U.S. 242, 248
(1986)). A factual dispute is genuine if the evidence is such
that a reasonable jury could return a verdict for the
nonmoving party; however, “the mere existence of a
scintilla of evidence in support of the position will be
insufficient.” Johnson v. Bd. of Regents of Univ.
of Georgia, 263 F.3d 1234, 1243 (11th Cir. 2001)
(quoting City of Delray Beach v. Agricultural Ins.
Co., 85 F.3d 1527, 1530 (11th Cir. 1996)).
party moving for summary judgment bears the burden of
informing the Court of the basis for its motion, and of
citing “the pleadings, depositions, answers to
interrogatories, and admissions on file, together with the
affidavits, if any, ” that support summary judgment.
Celotex Corp. v. Catrett, 477 U.S. 317, 322-24
(1986). In resolving motions for summary judgment, the Court
must view the evidence in the light most favorable to the
nonmoving party. Tolan v. Cotton, 572 U.S. 650, 657
(2014). “The evidence of the non-movant is to be
believed, and all justifiable inferences are to be drawn in
his favor.” Anderson, 477 U.S. at 255.