Battista v. Clarke
2011 U.S. App. LEXIS 10308
| 1st Cir. | 2011Background
- Battista, anatomically male but with gender identity disorder, was civilly detained for treatment after a 1983 Massachusetts conviction for rape, robbery, and kidnapping.
- Massachusetts Treatment Center houses male detainees including civilly committed residents; Battista is housed there and demands gender-appropriate treatment, including hormone therapy and female clothing.
- Treatment recommendations since 1997–2004 indicated GID treatment, including hormones, but the Department delayed evaluating and treating Battista.
- Security concerns—risk of sexual contact and assault—underlay the Department's reluctance to provide hormone therapy and female attire.
- District court issued a December 2008 preliminary injunction and August 2010 order mandating hormone therapy; defendants sought appellate review.
- The First Circuit evaluated whether the Department’s delay/denial amounted to deliberate indifference or unreasonable professional judgment, balancing safety and medical needs.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Standard of review for deliberate indifference vs professional judgment | Battista asserts deliberate indifference under Eighth/Due Process standards. | Department argues deference to security-based professional judgment and administrative discretion. | Deliberate indifference or unreasonable professional judgment established. |
| Whether hormone therapy must be provided under the injunction | Hormone therapy is medically necessary for GID; denial violates care standards. | Security risks justify withholding therapy pending safety assessments. | District court injunction requiring hormone therapy affirmed. |
| Were Department actions and delays justifiable professional judgments under Youngberg/Farmer | Delays/misrepresentations undermined professional judgment and harmed Battista. | Judgments balanced security concerns with medical needs and were reasonable. | Department failed to provide reasonable professional judgment; actions were not within acceptable bounds. |
Key Cases Cited
- Farmer v. Brennan, 511 U.S. 825 (U.S. 1994) (deliberate indifference standard for medical care in custody cases)
- Estelle v. Gamble, 429 U.S. 97 (U.S. 1976) (medical care claims under Eighth Amendment)
- Youngberg v. Romeo, 457 U.S. 307 (U.S. 1982) (professional judgment standard for civilly committed persons)
- Cameron v. Tomes, 990 F.2d 14 (1st Cir. 1993) (balancing security and administrative concerns with individual welfare)
- DesRosiers v. Moran, 949 F.2d 15 (1st Cir. 1991) (deliberate neglect evidenced by denial, delay, or interference with care)
- Ketchum v. Marshall, 963 F.2d 382 (10th Cir. 1992) (discussion of deliberate indifference vs professional judgment (dissenting/related) )