## Facts

- Andrea Fields, Matthew (Jessica) Davison, and Vankemah Moaton were incarcerated in the Wisconsin Department of Corrections (DOC) and diagnosed with Gender Identity Disorder (GID).
- Before 2005, the DOC provided the plaintiffs hormone therapy as part of treatment for GID.
- Wisconsin enacted the Inmate Sex Change Prevention Act (Act 105), Wis. Stat. § 302.386(5m), barring the DOC from using state resources (and certain federal funds) to provide or facilitate hormonal therapy or sex-reassignment surgery for inmates.
- After Act 105 took effect, the plaintiffs lost access to hormone therapy.
- The plaintiffs presented evidence that withholding medically indicated hormone therapy (and, where appropriate, surgery) creates a substantial risk of serious mental-health harm, including severe depression, self-harm, and suicide.
- The plaintiffs sued DOC officials in their official capacities, seeking relief on Eighth Amendment grounds; the case was brought as a putative class action but proceeded on the named plaintiffs’ individual claims after class certification was denied.
- After a merits trial with expert testimony, the district court enjoined enforcement of Act 105 as unconstitutional under the Eighth Amendment and also found an Equal Protection violation.
- DOC officials appealed; the plaintiffs cross-appealed aspects of relief.

## Issues

1. Whether Act 105 is facially unconstitutional under the Eighth Amendment because it categorically bars medically necessary treatment (hormone therapy and sex-reassignment surgery) for inmates with GID.
2. Whether the statutory ban and resulting treatment decisions constitute deliberate indifference to prisoners’ serious medical needs under the Eighth Amendment.

## Decision

- The Seventh Circuit affirmed the judgment enjoining enforcement of Act 105.
- The court held Act 105 facially unconstitutional under the Eighth Amendment because it imposes a categorical ban on medically accepted treatments for a serious medical condition.
- The court concluded the statute manifests deliberate indifference by preventing prison medical staff from exercising professional medical judgment about medically necessary care.
- Because the Eighth Amendment ruling supported the injunction, the court did not reach the Equal Protection holding.

## Legal Principles

- The Eighth Amendment prohibits deliberate indifference to prisoners’ serious medical needs, including policies that intentionally deny access to medically necessary treatment.
- A legislature may not impose a blanket prohibition that forecloses medically accepted and sometimes necessary treatment for a serious condition, because such a ban overrides individualized medical judgment.
- Prior decisions rejecting Eighth Amendment claims on particular records do not establish a categorical rule that prisons never must provide hormone therapy or sex-reassignment surgery; medical necessity remains case-specific, and a statutory bar that eliminates clinical discretion can be unconstitutional on its face.
- Generalized cost, safety, or security assertions do not justify a categorical denial of otherwise medically necessary treatment where prison management measures can address risk without withholding care.

## Conclusion

The Seventh Circuit held that Wisconsin’s Act 105 violates the Eighth Amendment by categorically banning hormone therapy and sex-reassignment surgery for inmates diagnosed with GID, thereby preventing individualized medical judgment and constituting deliberate indifference to serious medical needs.


Fields v. Smith, 653 F.3d 550 (7th Cir. 2011)