Reiyn Keohane v. Florida Department of Corrections Secretary
952 F.3d 1257
11th Cir.2020Background
- Reiyn Keohane, a transgender woman incarcerated in Florida, had been diagnosed with gender dysphoria and was on hormone therapy prior to incarceration; FDC initially denied continuation of hormones and requests to "socially transition" (long hair, makeup, female undergarments).
- FDC had a now-repealed "freeze-frame" policy: inmates would be maintained only at the level of change they had upon intake (no new gender-dysphoria treatments post-incarceration); Keohane’s hormone requests were denied under that policy for ~2 years.
- Keohane filed § 1983 suit alleging Eighth Amendment deliberate indifference and sought declaratory and injunctive relief (repeal of policy; hormone therapy; social-transition accommodations).
- After suit, FDC (1) referred Keohane to an endocrinologist and began hormone therapy, and (2) formally repealed the freeze-frame policy and adopted an individualized-assessment protocol; FDC continues largely to deny clothing/grooming accommodations but states it will grant them if deemed medically necessary.
- District court found (a) the freeze-frame policy unconstitutional and enjoined its reenactment, (b) FDC was deliberately indifferent for denying hormones and ordered continued hormones, and (c) FDC violated the Eighth Amendment by refusing social-transitioning accommodations.
- Eleventh Circuit: held the freeze-frame and hormone-denial claims moot in light of FDC’s post-suit policy repeal and provision of hormones; reversed the district court on social-transitioning—no Eighth Amendment violation based on record and deference to prison security and medical disagreement.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Validity/enjoinment of FDC’s former "freeze-frame" policy | Freeze-frame was a per se denial of medically necessary care and thus deliberate indifference | Policy was rescinded; repeal moots the challenge and FDC will not reenact | Moot: policy repeal and replacement with individualized-assessment protocol rendered the claim non-justiciable (voluntary-cessation exception did not apply) |
| Denial of hormone therapy during first two years | Withholding hormones posed substantial risk of self-harm and was deliberate indifference | FDC began hormones post-filing and will continue them; provision and assurances moot claim | Moot: FDC’s referral and ongoing provision of hormone therapy removed live controversy |
| Denial of social-transitioning accommodations (hair, makeup, undergarments) | Social transitioning is medically necessary to treat gender dysphoria; denial amounted to deliberate indifference | Medical professionals disagree; FDC provides meaningful alternative care (hormones, counseling, pronouns, housing, showers); security concerns in male facilities justify denial | Not liable on Eighth Amendment: factual disagreement among clinicians and legitimate security considerations mean denial did not rise to deliberate indifference |
Key Cases Cited
- Estelle v. Gamble, 429 U.S. 97 (1976) (deliberate indifference to serious medical needs violates the Eighth Amendment)
- Brown v. Johnson, 387 F.3d 1344 (11th Cir. 2004) (elements of deliberate-indifference claim; objective and subjective components)
- Harris v. Thigpen, 941 F.2d 1495 (11th Cir. 1991) (prisoners entitled to minimally adequate medical care; review standard)
- Flanigan’s Enters., Inc. v. City of Sandy Springs, 868 F.3d 1248 (11th Cir. 2017) (government repeal of challenged policy ordinarily moots claim; voluntary-cessation framework)
- Doe v. Wooten, 747 F.3d 1317 (11th Cir. 2014) (voluntary cessation by government does not automatically moot suit; burden on defendant to show no reasonable expectation of recurrence)
- Kosilek v. Spencer, 774 F.3d 63 (1st Cir. 2014) (prison medical-choice principles; courts should not substitute their judgment when two reasonable medical courses exist and security concerns are implicated)
- Bell v. Wolfish, 441 U.S. 520 (1979) (deference to prison administrators on policies needed for institutional security)
- Helling v. McKinney, 509 U.S. 25 (1993) (prospective Eighth Amendment relief considers current attitudes and conduct)
- Plata v. Brown, 563 U.S. 493 (2011) (constitutional requirement to provide adequate medical care in prisons)