Philip Rosati v. Dr. Igbinoso
2015 U.S. App. LEXIS 10860
| 9th Cir. | 2015Background
- Plaintiff Philip Walker Rosati (now Mia Rosati), a transgender California state prisoner, alleges severe gender dysphoria and repeated attempts at self-castration despite hormone therapy.
- Rosati claimed sexual reassignment surgery (SRS) is the medically necessary treatment and that prison officials denied SRS, violating the Eighth Amendment (deliberate indifference to serious medical needs).
- The district court screened and dismissed Rosati’s pro se § 1983 complaint without leave to amend for failure to state a claim; Rosati appealed represented by counsel.
- State defendants conceded the district court erred in dismissing without leave to amend; the Ninth Circuit nonetheless examined the merits of the pleading.
- The complaint alleged a blanket policy of denying SRS in California prisons (state conceded no California prisoner has received SRS) and that denial was based on a physician assistant’s recommendation lacking transgender expertise.
- The Ninth Circuit reversed and remanded, holding the complaint plausibly stated an Eighth Amendment claim and directing the district court to address Rosati’s Equal Protection claim on remand.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Whether complaint states an Eighth Amendment deliberate indifference claim | Rosati: severe gender dysphoria and dangerous self-harm; denial of medically necessary SRS constitutes deliberate indifference | Defendants: denial lawful; dismiss for failure to state a claim (and argued WPATH not fully accepted) | Reversed: complaint plausibly alleges deliberate indifference and should not have been dismissed without leave to amend |
| Whether denial based on blanket policy or inadequate evaluation suffices for liability | Rosati: categorical denial and refusal to provide competent specialist evaluation show conscious disregard | Defendants: relied on medical judgment/policy and lack of doctor’s recommendation | Held: blanket denial or denial based solely on non-expert recommendation can plausibly show reckless disregard |
| Whether lack of a treating physician’s recommendation defeats claim | Rosati: state prevented access to competent evaluator, so lack of recommendation is result of denial | Defendants: no doctor’s recommendation means no demonstrable need for SRS | Held: plausible that state’s refusal to provide specialist evaluation explains absence of recommendation; complaint survives dismissal |
| Whether district court properly dismissed without leave to amend | Rosati: pro se pleading should be construed liberally and given opportunity to amend | Defendants: dismissal appropriate | Held: dismissal without leave to amend was error; state conceded error; court reversed and remanded |
Key Cases Cited
- Estelle v. Gamble, 429 U.S. 97 (Eighth Amendment deliberate indifference to serious medical needs)
- Ashcroft v. Iqbal, 556 U.S. 662 (pleading standard: plausibility)
- Akhtar v. Mesa, 698 F.3d 1202 (construing pro se pleadings liberally; leave to amend standard)
- Jackson v. McIntosh, 90 F.3d 330 (denial of treatment must be medically unacceptable and in conscious disregard of excessive risk)
- Colwell v. Bannister, 763 F.3d 1060 (blanket categorical denials of medically indicated treatment can be paradigmatic deliberate indifference)
- Pyles v. Fahim, 771 F.3d 403 (failure to obtain specialty expertise can support an inference of deliberate indifference)
- Hoptowit v. Ray, 682 F.2d 1237 (medical staff competence and access to competent care relevant to Eighth Amendment claims)
- De'lonta v. Johnson, 708 F.3d 520 (prisoner’s lack of access to specialist evaluation can explain absence of surgical recommendation)
- Kosilek v. Spencer, 774 F.3d 63 (treatment for gender dysphoria and Eighth Amendment analysis)
- Fields v. Smith, 653 F.3d 550 (constitutional limits on statutes denying gender dysphoria treatment)