Adree Edmo v. Corizon, Inc.
935 F.3d 757
9th Cir.2019Background
- Plaintiff Adree Edmo, a transgender woman in Idaho custody, suffers from gender dysphoria and has twice attempted self-castration; she has received hormone therapy but not genital surgery.
- After extensive discovery and a three-day evidentiary hearing, the district court found Edmo’s experts credible, concluded gender confirmation surgery (GCS) was medically necessary for her, and entered a permanent injunction ordering the State to provide GCS within six months.
- Defendants (Idaho Department of Correction officials, Corizon, and several individual providers) appealed, arguing among other things that the injunction violated the Prison Litigation Reform Act (PLRA), that disagreement among medical professionals foreclosed Eighth Amendment liability, that irreparable harm was not shown, and that procedural/jury-rights errors occurred.
- The Ninth Circuit credited the district court’s factual findings, held that responsible prison authorities (notably Dr. Eliason) were deliberately indifferent in violation of the Eighth Amendment, and affirmed the injunction as to appropriate defendants.
- The court narrowed relief: it vacated the injunction as to Corizon and several individual defendants (Yordy, Siegert, Drs. Young, Craig, and Whinnery) for lack of record evidence of personal deliberate indifference, and required substitution of the current warden in the official-capacity injunction.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Whether the injunction complied with PLRA (need, narrowness, intrusiveness) and whether appeal is moot | Edmo: Injunction narrowly tailored to correct Eighth Amendment violation and was permanent | State: District court failed to make PLRA findings and failed to make order final within 90 days, so injunction expired and appeal is moot | Court: PLRA findings adequately appear in the order as a whole; district court granted permanent relief (not a preliminary injunction subject to 90-day expiration); appeal not moot |
| Whether denial of GCS to Edmo violated the Eighth Amendment (deliberate indifference) | Edmo: Gender dysphoria is a serious medical need; experts show GCS medically necessary; denial despite knowledge of severe harm is deliberate indifference | State: Treatment disagreement among professionals; denial reflects reasonable medical judgment, not constitutional violation; Gibson precedent argues categorical non-liability | Court: On the record and crediting district court findings, withholding GCS was medically unacceptable and constituted deliberate indifference (Dr. Eliason personally liable) — case-specific inquiry controls; Gibson’s categorical rule rejected |
| Whether Edmo showed irreparable harm to justify injunctive relief | Edmo: Ongoing severe distress, high risk of self-surgery and suicide; constitutional violation itself is irreparable | State: Delay, non-emergency nature, and absence of recent suicide attempts undermine urgency | Court: Credited expert testimony and facts; continuing severe psychological harm and risk of self-castration/suicide constitute irreparable harm; injunction appropriate |
| Procedural challenges: consolidation of hearing into merits and Seventh Amendment jury right | State: Court converted preliminary hearing into final trial without clear notice and deprived defendants of jury trial | Edmo: Parties had extensive discovery, evidentiary hearing, and were asked to address permanence; defendants failed to object | Court: Defendants had adequate notice (court twice indicated possible consolidation) and suffered no prejudice; failure to object waived any Seventh Amendment jury claim |
Key Cases Cited
- Estelle v. Gamble, 429 U.S. 97 (1976) (Eighth Amendment deliberate indifference to serious medical needs is unconstitutional)
- Brown v. Plata, 563 U.S. 493 (2011) (courts must remedy Eighth Amendment violations in prison healthcare)
- Winter v. Natural Resources Defense Council, 555 U.S. 7 (2008) (standards for injunctive relief)
- Jett v. Penner, 439 F.3d 1091 (9th Cir. 2006) (definition of serious medical need under Eighth Amendment)
- Kosilek v. Spencer, 774 F.3d 63 (1st Cir. 2014) (fact-specific Eighth Amendment analysis for GCS claims)
- De’lonta v. Johnson, 708 F.3d 520 (4th Cir. 2013) (recognizing GCS can be medically necessary and constitutionally required in some cases)
- Gibson v. Collier, 920 F.3d 212 (5th Cir. 2019) (contrasting decision holding denial of GCS cannot categorically violate Eighth Amendment)
- Monell v. Department of Social Services, 436 U.S. 658 (1978) (municipal liability principles referenced regarding corporate/private provider liability)