Federal judge permanently blocks enforcement of anti-trans healthcare bill in Georgia’s prisons

A federal judge has permanently blocked Georgia from enforcing a state law that banned hormone replacement therapy (HRT) for transgender people in state prisons, ruling the policy unconstitutional.

In her order on a class action lawsuit brought by transgender individuals incarcerated in Georgi’s prisons, U.S. District Court Judge for the Northern District of Georgia Victoria M. Calvert found that Senate Bill 185 banned hormone replacement therapy in violation of the Eighth Amendment, which protects against cruel and unusual punishment.

“This case is very much about supporting our trans community members who are very marginalized—one of the most marginalized groups in our communities, even more so because they are behind cages,” said Emily C. R. Early, one of the plaintiffs’ attorneys and associate director at the Southern Regional Office of the Center for Constitutional Rights. “Treatment for gender dysphoria can be life-saving, just like insulin is for diabetes.”

The injunction requires the Georgia Department of Corrections (GDC) to continue offering hormone replacement therapy when deemed medically necessary for those suffering from gender dysphoria “without regard to S.B. 185 compliance.”

Unlike a preliminary injunction, a permanent injunction has no expiration date and will remain in place unless overturned by a higher court. 

Swift legal challenge blocks HRT ban, state appeals the decision

Gov. Brian Kemp signed SB 185 into law on May 8. The bill prohibited the use of “state funds or resources” toward gender affirming care, like hormone replacement therapy, for individuals incarcerated by the Georgia Department of Corrections. 

In July, Centurion Health—a private health care provider contracted to run medical programs in Georgia’s prisons—began notifying incarcerated individuals receiving hormone replacement therapy to address gender dysphoria that they could either quit cold turkey or begin a tapering process to “detransition” off their hormone therapy. 

GDC staff told plaintiffs that they could not continue receiving therapy even if they paid for it out of pocket. 

The Center for Constitutional Rights and Bondurant Mixson & Elmore LLP filed a class action lawsuit in August on behalf of five plaintiffs incarcerated in Georgia prisons who had been receiving or were seeking to begin hormone replacement therapy. Plaintiffs also filed an emergency motion for a preliminary injunction. 

In September, U.S. District Court Judge for the Northern District of Georgia Victoria M. Calvert issued a preliminary injunction against enforcing SB 185’s ban on hormone replacement therapy. In her decision on the preliminary injunction, Calvert wrote, “The state’s categorical ban on receiving hormone therapy is in tension with case law recognizing that, in appropriate circumstances, hormone therapy can be medically necessary for gender dysphoria.” 

At the time the plaintiffs filed their lawsuit, there were over 100 people receiving hormone replacement therapy and 340 people diagnosed with gender dysphoria in Georgia’s prison system. The plaintiffs argued that for some patients, hormone replacement therapy is medically necessary to treat gender dysphoria, which, if left untreated, can lead to depression, self-harm, self-genital mutilation and suicide. Calvert wrote in her Dec. 3 decision that the defendants failed to present “any evidence which negates or contradicts the Plaintiffs’ evidence.”

The preliminary injunction instructed the defendants—Georgia Department of Corrections officials and Centurion of Georgia, LLC—to “immediately cease tapering hormone therapy doses” and allow individuals suffering from gender dysphoria to be assessed and treated with hormone replacement therapy when deemed medically necessary “without concern for SB 185.”

Defendants appealed to the U.S. Court of Appeals for the Eleventh Circuit for a stay of the preliminary injunction, but the court did not rule on the appeal before the preliminary injunction was set to expire. 

Under the Prison Litigation Reform Act, preliminary injunctions regarding prison conditions expire after 90 days, unless made final. For the SB 185 preliminary injunction, the 90-day window ended Wednesday, prompting Calvert to issue the permanent injunction.

Defendants have filed an appeal of the permanent injunction, Early said. 

Hormone replacement therapy continued to be denied for months, despite preliminary injunction

Despite the preliminary injunction issued in September, some plaintiffs continued to be denied hormone replacement therapy by prison medical officials. 

Naeomi Kaiór Madison, a transgender woman incarcerated at Johnson State Prison in Wrightsville, Georgia, received a physical copy of the preliminary injunction order from her attorneys, which she provided to GDC staff. Though she had the order in hand, prison officials remained dismissive, according to an affidavit she wrote on Nov. 5. 

“My GDC-Assigned Counselor at Johnson State Prison did not believe me, despite me showing her the physical court order,” Madison wrote. “She suggested I got the court order ‘off of Google’ and refused to look up the case online at my request.” 

On Nov. 7, over two months after the preliminary injunction was granted, Isis Benjamin, a transgender woman incarcerated at Coastal State Prison in Garden City, Georgia, wrote, “Although I have continued to put in weekly requests for a hormone therapy evaluation, to date I have received no response.”

Another plaintiff, a transgender man who was granted anonymity by the Court, wrote on Nov. 7 that GDC at Lee Arrendale Prison in Alto, Georgia, had restored his access to hormone replacement therapy. However, the man reported that “at least three transgender people I know in the custody of GDC are currently attempting to start HRT, but have been told by prison officials at Arrendale and elsewhere that GDC is no longer offering HRT shots.” 

Plaintiffs argued that GDC should be required to post notices and share information with other transgender individuals incarcerated within its facilities regarding access to hormone replacement therapy.  

Calvert declined the plaintiff’s request, saying it “should be limited to dissemination of notice via medical and mental health appointments.” 

The plaintiffs argued that GDC and Centurion should be required to give “periodic compliance reports.” 

Calvert declined the request in the permanent injunction order, writing, “Defendants and their counsel have not given the Court any impression that they would not comply with the Court’s orders.” 

Hormone replacement therapy is just one of the medical treatments banned under SB 185. 

“There are other pieces of the law that we sued against or sought to ban, just not through the preliminary injunction or permanent injunction,” Early said. 

There remains a provision against gender-affirming surgeriems. 

However, Early said, that aspect of the case likely won’t be heard by the district court until after the appeal against the hormone replacement therapy injunction has been settled.