Wisconsin prison officials who denied an inmate's requested gender confirmation surgery could not have anticipated the decision might violate her rights and are therefore immune from damages in a lawsuit, a federal appeals court ruled.

The 2-1 decision from the 7th U.S. Circuit Court of Appeals reversed a pretrial ruling by a Madison federal judge that the officials were not covered by qualified immunity.

"The Eighth Amendment requires prison healthcare professionals to exercise medical judgment when making decisions about an inmate’s treatment. And they cannot completely deny the care of a serious medical condition," Judge Diane Sykes wrote for the majority of the three-judge panel.

"But cases recognizing those broad principles could not have warned these defendants that treating an inmate’s gender dysphoria with hormone therapy and deferring consideration of sex-reassignment surgery violates the Constitution."

In dissent, Chief Judge Diane Wood wrote that whether qualified immunity protects officials who don't provide care for serious conditions should not be litigated "disease by disease, or injury by injury."

She said a jury should decide the factual question of whether the Department of Corrections' medical director was deliberately indifferent to Campbell's condition, which hasn't improved with hormones alone and still leads to threats of self‐castration.

Sykes found it "doubtful that a prisoner can prove a case of deliberate indifference when, as here, prison officials followed accepted medical standards."

Mark Campbell, 48, identifies as a woman and uses the name Nicole Rose Campbell. Since 2007, she is serving a 34-year sentence for sexual assault of a child.

She does receive hormone treatment, counseling and some women's clothing in prison. Since 2013, Campbell has sought gender reassignment surgery. Not everyone with gender dysphoria wants or needs surgery for treatment, or meets the strict medical requirements to be recommended for surgery.

Since 2011, at least 160 state inmates have sought services related to transgender dysphoria; less than a dozen of them requested surgery.

An outside gender dysphoria consultant retained by the Department of Corrections said Campbell would be a potential candidate.

But there's a catch: National standards of care suggest patients get a year of "real-life experience" as their identified gender before committing to surgery. That would be difficult, if not impossible, in a men's prison

The outside expert in transgender health agreed the DOC has no data or experience on which to "predict outcomes, prevent harm and maintain safety" related to letting Campbell try living fully as a woman in a men's prison.

But she suggested that for some long-term inmates like Campbell, perhaps the "real-life experience" could be reconsidered and suggested the DOC explore options for a workable approach to the experience within its facilities.

Until then, DOC has denied the surgery, electrolysis and makeup to Campbell, the latter two as not medically necessary.

Previously, the 7th Circuit upheld a judge's decision declaring Wisconsin's 2005 Sex Change Prevention Act unconstitutional. The law banned both hormone therapy and surgery for transgender inmates.

The current policy, requiring a 12-month "real-life experience" deemed impossible in prison effectively still bans gender reassignment surgery for inmates, though it theoretically would allow surgery under rare circumstances.

Her 2016 lawsuit claims DOC officials were deliberately indifferent to her serious medical needs, in violation of the Eighth Amendment ban on cruel and unusual punishment.

The suit can still go forward on the claims for injunctive relief like court-ordered treatments, even if the defendants are immune from damages.

RELATED:Transgender inmate can sue over denial of hormone treatment, U.S. Appeals Court rules

Contact Bruce Vielmetti at (414) 224-2187 or bvielmetti@jrn.com. Follow him on Twitter at @ProofHearsay.