The U.S. Court of Appeals for the 1st Circuit has upheld an order requiring the Massachusetts Department of Corrections to give hormone therapy to an inmate diagnosed with gender identity disorder. The court ruled that prison officials acting with deliberate indifference to the inmate’s medical needs, in violation of the Eight Amendment.

The May 20 unanimous ruling in Battista v. Clarke affirmed an August 2010 modified preliminary injunction by the District of Massachusetts. The injunction ordered the corrections department to give Sandy Jo Battista, who is anatomically male but self-identifies as female, endocrinologist-recommended hormone therapy treatment within seven days.

Judge Michael Boudin wrote the opinion for the court, joined by retired U.S. Supreme Court Justice David Souter, who heard the case by designation, and Senior Judge Norman Stahl.

In February 1983, Battista was convicted and sentenced to 12 to 20 years for the rape of a child under 16, unarmed robbery and kidnapping. Battista was temporarily committed in December 2001, then civilly committed to the Massachusetts Treatment Center for Sexually Dangerous Persons in May 2003 for one day to life as a sexually dangerous person.

According to Boudin’s opinion, a Department of Corrections consultant diagnosed Battista with gender identity disorder in 1997, but the department “offered no further evaluation or treatment until 2004.” He noted, “Prior to this case, Battista filed two suits seeking GID treatment and accumulated expert opinions confirming the seriousness of her condition and recommending accommodations including hormone therapy.”

Boudin wrote: “Battista filed her complaint in the present suit in July 2005 and in October 2005 sought to castrate herself with a razor blade. The suit, against various officials of the Department, charged deliberate indifference to her medical needs in violation of the Eighth and Fourteenth Amendments and 42 U.S.C. 1983 (2006), as well as state law, including Mass. Gen. Laws ch. 12, 11H-11I. In particular, Battista sought an injunction requiring that hormone therapy and female garb and accessories be provided to her.”

Several years of litigation followed the corrections department’s subsequent refusal to administer the drugs, which it based on concerns over Battista’s safety. The department argued that a more feminine appearance would make Battista more susceptible to assaults by other inmates.

Boudin noted that the district court stayed its injunction during the department’s appeal “solely because the district court feared harm to Battista if hormone therapy were begun and later stopped again.”

In his opinion, Boudin wrote: [E]ven without an evil motive, the district court could reasonably find that there had been ‘denial,’ ‘delay’ and ‘interference’ under Eighth Amendment precedent, and that a reasonable professional judgment had not been exercised under Youngberg [v. Romeo].” Youngberg was a 1982 U.S. Supreme Court case concerning the rights of the involuntarily committed and mentally retarded.

Boudin also wrote that the corrections department has long “refused to take the [gender identity disorder] diagnosis and request for hormone therapy seriously.”

In addition to the department’s resistance in other cases, “the defendants went back and forth apparently looking for an out” when their own medical advisers supported treatment for Battista, Boudin wrote. “It may take some education to comprehend that [gender identity disorder] is a disorder that can be extremely dangerous. But the education seems to have taken an unduly long time in this instance, especially in light of [Battista's] self- mutilation attempt.”

Boudin concluded, “In the end, there is enough in this record to support the district court’s conclusion that ‘deliberate indifference’ has been established — or an unreasonable professional judgment exercised — even though it does not rest on any established sinister motive or ‘purpose’ to do harm. Rather, the Department’s action is undercut by a composite of delays, poor explanations, missteps, changes in position and rigidities — common enough in bureaucratic regimes but here taken to an extreme.”

The government’s lawyer, Richard McFarland, a senior litigation attorney at the Massachusetts Department of Corrections, did not respond to requests for comment.

Diane Wiffin, corrections department spokeswoman, said the department doesn’t comment on pending litigation.

Neal Minahan, a Boston associate at McDermott Will & Emery, which represented Battista pro bono, said the opinion recognizes that “a more than six-year delay in filling a prescription is inexcusable.”

“That violated our client’s constitutional right to medical care while civilly committed,” Minahan said.

Minahan said it’s important that the 1st Circuit recognized that gender identity disorder could be extremely dangerous if left untreated. “[The court said that] failing to adequately treat gender ID disorder can give rise to a constitutional violation.”

Sheri Qualters can be contacted at