After a five-year legal battle, the U.S. District Court recently ruled that transgender people incarcerated in Connecticut prisons are entitled to gender-affirming health care.
Veronica-May Clark originally filed the case in 2019, and the American Civil Liberties Union offered to represent her in 2021. Clark, who has been incarcerated since 2007, alleges that her treatment by the Department of Correction was inconsistent after being diagnosed with gender dysphoria – a medical diagnosis for someone who suffers from the stress that can occur when their true gender does not match their outward appearance and/or the sex assigned to them at birth.
“At the end of the day, all she wants is health insurance,” Elana Bildner, Clark’s attorney with the ACLU of Connecticut, told The Connecticut Mirror. “She wants consistent, adequate and appropriate health insurance and wants to be able to count on getting the health insurance she needs long-term.”
She says that due to the DOC’s continued delay in processing her applications, her symptoms worsened and she inflicted severe self-harm and was hospitalized.
Unheard requests for care
In July 2009, Clark was sentenced to 75 years to life in a Connecticut prison for beating his estranged wife’s boyfriend to death with a pipe.
According to Bildner, Clark had “lived publicly as a woman” on and off throughout her life, but had never sought transitional care. When she was sentenced, Clark decided to identify as a cisgender man for her own safety in prison.
Seven years later, in April 2016, Clark requested treatment, including hormone therapy and gender reassignment surgery, and stated that she believed she suffered from gender dysphoria. A month later, a DOC health care provider diagnosed Clark with gender dysphoria, but she was not offered gender reassignment treatment, according to the lawsuit.
Clark attempted to self-harm in order to heal herself. According to the memorandum and witness statements, Clark attempted to castrate herself in her cell.
After the incident, a DOC psychologist evaluated Clark and confirmed that she suffered from gender identity disorder and was experiencing “severe psychological distress.” Clark resubmitted a request for treatment consistent with the diagnosis.
According to Bildner, the DOC had an “informal policy” that “anyone who had not received transitional care upon arrival at the prison could not receive it in prison.”
“She was battling something she couldn’t see,” Bildner said. “The DOC said, ‘Yes, you do (you have gender dysphoria),’ and then denied her any transitional care based on that unwritten rule.”
In the months following her hospitalization, Clark continued to request hormone therapy and gender reassignment surgery, describing her situation as “simply unbearable” and the treatment she received from DOC as “cruel and unusual.”
Later, in September 2017, Clark visited an endocrinologist at the University of Connecticut Health. Her doctor prescribed a low “starter dose” of spironolactone and estradiol: two drugs used for hormone therapy. The doctor asked for a follow-up in three months to track Clark’s progress and increase her dose to a therapeutic level.
Clark did not see the doctor again until August 2019.
The case
The inconsistent treatment despite her wishes prompted Clark to sue the DOC in April 2019 for violating her right to freedom from cruel and unusual punishment under the Eighth Amendment to the U.S. Constitution and her right to equal protection under the law under the Fourteenth Amendment to the U.S. Constitution, the lawsuit states.
The ACLU of Connecticut joined their team in 2021.
Bildner said the trial took place in two phases. The first phase, presided over by now-retired Judge Vanessa Bryant, was designed to “persuade the court that if prisons must provide health care, gender-affirming care is health care. Therefore, prisons must provide gender-affirming care.”
On September 15, 2023, the U.S. District Court granted summary judgment in Clark’s favor. The court concluded that DOC staff were “willfully indifferent to Ms. Clark’s serious medical needs.”
After this first decision, the case moved into its second “trial phase,” according to Bildner. This second phase lasted throughout July 2024.
“(During) the trial phase, the DOC attempted to persuade the judge to ‘forget the past’ because the matter was now under control and no longer required judicial intervention.”
The DOC presented evidence that since the September 2023 ruling, it has made increased efforts to provide Clark with the treatment she sought.
This story was originally published in the Connecticut Mirror on August 7, 2024.
