Edmo v. Idaho Dep't of Corr.
358 F. Supp. 3d 1103
D. Idaho2018Background
- Adree Edmo, a male-to-female transgender prisoner in Idaho, has diagnosed gender dysphoria and has received cross-sex hormones with maximal feminizing effect but continues to experience severe genital-focused dysphoria, two self-castration attempts, cutting, and suicidality.
- Plaintiff sought a preliminary (mandatory) injunction ordering Idaho Department of Correction (IDOC) and contractor Corizon to provide gender confirmation surgery (GCS) as medically necessary treatment.
- WPATH Standards of Care (recognized international guidelines) describe criteria and treatment options for gender dysphoria, and state that standards apply to incarcerated individuals and that prison care should mirror community care.
- Experts for plaintiff (Drs. Ettner and Gorton) concluded Edmo meets WPATH criteria for GCS and that surgery is medically necessary to prevent severe self-harm; defendants’ experts disputed she met WPATH criteria and raised concerns about coexisting mental-health issues and the 12‑month role‑living requirement.
- The court found plaintiff’s experts credible, concluded defendants misapplied or ignored WPATH standards, identified a de facto practice of refusing GCS in IDOC/Corizon, and granted a preliminary injunction requiring GCS within six months.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Whether denial of GCS violates Eighth Amendment (deliberate indifference to serious medical need) | Edmo's gender dysphoria is a serious medical need; GCS is medically necessary and refusal creates a substantial risk of serious harm (self-castration, suicide) | Providers reasonably concluded GCS not medically necessary due to uncontrolled mental-health issues and unmet WPATH criteria | Court: Likely success on Eighth Amendment claim; defendants were deliberately indifferent and must provide GCS |
| Applicability and interpretation of WPATH Standards for prisoners | WPATH applies equally in institutional settings; Edmo meets all WPATH criteria (including 12‑month real‑life role while incarcerated) | Defendants say Edmo fails certain WPATH criteria (mental‑health stability, 12‑month living in congruent role outside prison) | Court: WPATH applies in prison; Edmo meets/exceeds criteria; defendants’ contrary interpretations given little weight |
| Risk of irreparable harm absent injunction | Ongoing severe psychological harm and imminent risk of successful self-castration or suicide warrant emergency relief | Defendants did not show that providing surgery would cause undue harm or that irreparable harm is unlikely | Court: Irreparable harm established (psychological injury and high risk of self-harm); favors injunction |
| Scope/standard for mandatory preliminary injunction under PLRA | Emergency relief warranted despite its mandatory nature because facts and law clearly favor Edmo | Defendants invoked stricter standard for mandatory relief and PLRA constraints (narrow/least intrusive) | Court: Applied stricter standard, found it met; ordered GCS within six months while complying with PLRA requirements |
Key Cases Cited
- Winter v. Natural Resources Defense Council, Inc., 555 U.S. 7 (injunction standard)
- Farmer v. Brennan, 511 U.S. 825 (Eighth Amendment deliberate indifference test)
- Estelle v. Gamble, 429 U.S. 97 (prisoners' right to adequate medical care)
- Hudson v. McMillian, 503 U.S. 1 (seriousness of physical/psychological harm for Eighth Amendment)
- McGuckin v. Smith, 974 F.2d 1050 (definition of "serious medical need" in Ninth Circuit)
- Toguchi v. Chung, 391 F.3d 1051 (deliberate indifference and choices among treatments)
- Norsworthy v. Beard, 87 F. Supp. 3d 1164 (prisoner GCS; rejection of blanket denials and certain defense expert views)
- Marlyn Nutraceuticals, Inc. v. Mucos Pharma GmbH & Co., 571 F.3d 873 (higher scrutiny for mandatory injunctive relief)