Johnson v. Sanders, 121 F.4th 80

Plaintiff Lamone Johnson, a transgender woman, was prescribed hormone replacement therapy (HRT) for gender dysphoria while incarcerated in Oklahoma, and remained on HRT as she was transferred between facilities for over a year.
After a psychological evaluation by Dr. Jones concluded Johnson did not meet criteria for gender dysphoria (citing personality disorders instead), Dr. Sanders (prison physician) discontinued HRT per Oklahoma Department of Corrections (ODOC) policy, which required a gender dysphoria diagnosis for such treatment.
Johnson filed multiple grievances regarding the cessation of HRT, alleging mental and physical harm, and arguing for a new psychological assessment or specialist referral. These were denied or rejected on procedural grounds or in reliance on Dr. Jones's report.
Johnson brought a § 1983 Eighth Amendment deliberate indifference claim against Dr. Sanders and Nurse Larimer for discontinuation of HRT, seeking monetary damages only.
The district court granted summary judgment to defendants, finding that no deliberate indifference could be shown when the policy required discontinuation after a negative diagnosis, and that the claim amounted to a disagreement over care, not a constitutional violation.
On appeal, the Tenth Circuit affirmed the district court’s decision, finding no triable facts showing deliberate indifference under any of Johnson’s three asserted theories.

Issue	Plaintiff’s Argument	Defendant’s Argument	Held
Discontinuation of HRT	Stopping long-term HRT was deliberate indifference to care.	Action was required by ODOC policy after negative diagnosis.	No deliberate indifference; Dr. Sanders followed policy.
Complete denial of care	Was denied all effective gender dysphoria therapies.	Johnson received care, just not the preferred HRT or counseling.	No evidence of denial of all care; not constitutionally required to provide plaintiff’s preferred treatment.
Gatekeeping (Second Opinion)	Defendants should’ve arranged for further or outside diagnosis after negative report.	There was no obligation to question Dr. Jones’s evaluation; policy set the process.	Defendants were not deliberately indifferent; no record of knowledge or strong suspicion that diagnosis was wrong.
Reliance on Policy	Policy does not override constitutional duties.	Following policy negates indifference, shows lack of bad faith.	Policy compliance relevant but not dispositive; here, no evidence of subjective knowledge of risk.

Estelle v. Gamble, 429 U.S. 97 (1976) (deliberate indifference to serious medical needs of prisoners is an Eighth Amendment violation)
Farmer v. Brennan, 511 U.S. 825 (1994) (deliberate indifference standard includes both objective and subjective components)
Perkins v. Kan. Dep’t of Corr., 165 F.3d 803 (10th Cir. 1999) (mere disagreement with medical treatment does not constitute an Eighth Amendment violation)
Sealock v. Colorado, 218 F.3d 1205 (10th Cir. 2000) (gatekeeper liability for 'denial of access' to proper medical assessment)