Updated at 6:30 p.m., Aug. 1 with testimony from Illinois Department of Corrections officials — The American Civil Liberties Union of Illinois wants a federal judge to order the state of Illinois to change its practices for providing medical treatment to transgender prisoners.

Current policies fail to provide adequate health care to prisoners diagnosed with gender dysphoria, according to opening arguments made Wednesday by the ACLU in a federal court in East St. Louis. Illinois Department of Correction practices deny and delay medically necessary treatment for years, leading to “profound suffering” and increasing the risks of self-harm and suicide for transgender prisoners, the ACLU’s motion argues.

The ACLU’s motion, filed in May in the Southern District of Illinois' U.S. District Court, requests a preliminary injuction. It's the latest development in a class-action lawsuit that five transgender women represented by the ACLU filed against the department last year.

Judge Nancy Rosenstengel will rule on the ACLU’s motion after a hearing this week, which will evaluate whether the policies amount to “cruel and unusual punishment.” If the injunction is granted, the department would be required to begin changing its policies prior to the completion of the lawsuit. The case is currently scheduled to go before a jury in April 2020.

The motion argued this week requests that the department begin offering prompt medical treatment consistent with national standards of care for transgender individuals. It also requests that the department train its staff in how to interact with transgender inmates and appoint a medical expert experienced in treating gender dysphoria to oversee any policy changes.

Lawsuit allegations

The ACLU’s suit says that the Department of Corrections:

Arbitrarily delays or denies prescribing hormonal, surgical and other medically necessary treatments.

Doesn’t follow medical standards for hormone therapy medications or dosages.

Doesn’t adequately monitor patients’ blood levels after prescribing hormones.

Has no qualified medical professionals on the committee that makes medical decisions about transgender patients’ care.

Rarely approves requests to transfer transgender women from men’s to women’s prisons.

“Our clients are really in an emergency situation, which is why we’re seeking immediate or preliminary relief,” said John Knight, an attorney with ACLU of Illinois who is representing the women. “Our clients and all transgender prisoners in Illinois are getting treatment that is just so wildly outside the proper treatment that is required under the medical standards that they’re suffering needlessly.”

An attorney for the state, Lisa Cook, said in court Wednesday that while all prisoners deserve quality medical care, the ACLU’s requests were unfeasible because the transgender prisoner population is small, and the system lacks statewide policies on how to treat gender dysphoria.

She also argued the department cannot provide transgender health care specialists at every facility to oversee the care of about 100 transgender prisoners systemwide when the overall prison population totals nearly 40,000.

The department’s Transgender Care Review Committee makes all decisions regarding medical care for gender dysphoria. The committee evaluates recommendations from psychiatric staff at individual institutions and summaries of patients’ medical histories.

The Department of Corrections chief of psychiatry Dr. William Puga directs the committee and testified Thursday that it wants “all our patients to get the care they need. We’re not trying to stonewall. There’s usually a good logic and a good rationale behind those decisions.”

Puga said sometimes mental health instability or physical health problems could require delays in treatment. An attorney for the ACLU noted during the hearing that many of the committee’s decisions contradict procedures outlined in the leading international standard of care for transgender prisoners.

Puga testified that the department has initiated a number of attempts to improve experiences of transgender inmates in the last year. Among those were educational training for correctional staff, and finalizing new policies for how to medically treat transgender prisoners, he said.

Puga also said that the state dedicates more resources to prisoners experiencing gender dysphoria than they do to most other forms of mental health, adding that the prison system is “doing above and beyond [for transgender prisoners] what we’re doing for anybody else.”

When pressed on when the prisons’ treatment plans for transgender patients are consistent with international standards of care, Puga said he defers to other members of the committee to make many medical decisions.

The ACLU contends that none of the members of the review committee have the qualifications necessary to make informed medical decisions for transgender prisoners.

A spokeswoman for the Illinois attorney general's office, which is defending the department, said she could not comment while the case is ongoing.

Similar petitions for preliminary injunctions have succeeded in Idaho and California. Transgender inmates have filed lawsuits against departments of correction over medical treatment in other states, including Indiana and Wisconsin.

The class action lawsuit does not seek a damage award or financial compensation for past prisoners. Instead, any rulings related to the case will affect policies for people currently detained in Illinois prison facilities run by the Department of Corrections.

“We’re trying to get this system fixed so that the current suffering stops, and the risks to people are also stopped,” Knight said.

Nick Telep contributed to this report.

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