Lambda Legal has filed a federal lawsuit against the Virginia Department of Corrections (VDOC) on behalf of a transgender man incarcerated at the Fluvanna Correctional Center for Women (FCCW) who has been denied medically necessary and gender-affirming care.

The lawsuit was filed in the U.S. District Court for the Western District of Virginia on behalf of Jason Yoakam, transgender man who was denied a bilateral mastectomy by the VDOC, which claimed the surgery was not medically necessary treatment for gender dysphoria. The VDOC also denied Mr. Yoakam treatment from qualified mental healthcare providers and other reasonable accommodations.

“The only thing I am asking is to be treated fairly and have access to the same standard of healthcare that other incarcerated people receive. It has been traumatizing, isolating, and stigmatizing to be denied health care services to treat the gender dysphoria that VDOC's own providers have diagnosed," said Yoakam.

Yoakam contends that the denial of surgery violates the U.S. Constitution's Eighth Amendment's prohibition on cruel and unusual punishment and argues that denying medical treatment on the basis of his transgender status violates the Equal Protection Clause of the Fourteenth Amendment.

Mr. Yoakam also raises statutory claims under the Americans with Disability Act and under Section 504 of the Rehabilitation Act based on his disability of gender dysphoria, a medical condition that some transgender people experience as significant distress when their gender identity is not congruent with the sex assigned at birth. The lawsuit also brings a claim under Section 1557 of the Affordable Care Act, a nondiscrimination provision in the federal civil rights law that prohibit discrimination in health care setting based on sex.

“Mr. Yoakam is not seeking special treatment, just access to medically necessary health care and reasonable accommodations for his gender dysphoria," said Richard Saenz, Senior Attorney and Criminal Justice and Police Misconduct Strategist at Lambda Legal. “Every incarcerated person has a right to basic health care based on their medical needs –and should not face discrimination because of their sex. We hope that the Court affirms that denial of this safe and medically effective treatment for transgender men like Mr. Yoakam is a clear violation of their constitutional and statutory rights."

Jason Yoakam
Background to the case

Mr. Yoakam suffers from severe gender dysphoria and experiences depression, anxiety, panic attacks, sleep and appetite disturbances, and physical pain related to his chest. In his pre-teen years, Mr. Yoakam began to bind his chest, a practice he continues to do today – which has caused him bleeding, scarring, and pain. His treating endocrinologist and a transgender health specialist at the University of Virginia have deemed chest surgery medically necessary treatment for him.

In August 2017, health care providers at Fluvanna diagnosed Mr. Yoakam with gender dysphoria. As part of his treatment, Mr. Yoakam has received hormone therapy and was provided a binder for his chest. However, the Virginia Department of Corrections denied a bilateral mastectomy, or chest surgery, for Mr. Yoakam on the basis that it was not medically necessary. The lawsuit alleges that VDOC has a de facto policy or practice to deny surgery for gender dysphoria. This denial runs counter to the World Professional Association of Transgender Health (WPATH)'s Standards of Care, under which Mr. Yoakam meets the criteria for surgery – documentation that he has provided to VDOC and yet was denied.

Lambda Legal and Robins Kaplan previously secured a pro bono victory on behalf of Jessica Hicklin, an incarcerated transgender woman, after a federal district court struck down a Missouri Department of Corrections (MDOC) policy as cruel and unusual punishment because it denied vital health care to transgender people. The ruling in that case, Hicklin v. Precythe, was believed to be the first to find that freeze-frame policies are unconstitutional.

Richard Saenz, Senior Attorney and Criminal Justice and Police Misconduct Program Strategist, Sasha Buchert, Senior Attorney, and Greg Nevins, Senior Counsel are handling the case for Lambda Legal, along with Kellie Lerner, Partner, Ellen Levish, Jessica Gutierrez, and Rebecca Zadaka of Robins Kaplan LLP, and local counsel Jeffrey Fogel of the Law Offices of Jeffrey E. Fogel.

Read more about the case here.

Read the brief complaint here.

Photo by Sara Dubler on Unsplash

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LGBTQ+ Healthcare Issues

The Dobbs decision, otherwise known as the court case that overturned Roe v. Wade, has resulted in confusing medical situations for many patients. On top of affecting access to abortions for straight, cisgender women, it presents heightened risks for LGBTQ+ healthcare as a whole. Flipping the switch on reproductive rights and privacy rights is a far-reaching act that makes quality care harder to find for an already underserved community.

As the fight against the Dobbs decision continues, it’s important to shed light on the full breadth of its impact. We’ll discuss specific ways that the decision can affect LGBTQ+ healthcare and offer strategies for overcoming these challenges.

How the Right to Bodily Privacy Affects LGBTQ+ Healthcare

When the original Roe v. Wade decision was made, the bodily privacy of people across the United States was protected. Now that bodily autonomy is no longer guaranteed, the LGBTQ+ community must brace itself for a potential loss of healthcare rights beyond abortions. This includes services like feminizing and masculinizing hormone therapy (particularly for transgender youth) that conservative lawmakers have been fighting against this year, as well as transition-related procedures. Without privacy, gender-affirming care may be difficult to access without documentation of sex as “proof” of gender.

As essential services for the LGBTQ+ community become more difficult to access, perhaps the most immediate effect we’ll see is eroding trust between healthcare providers and LGBTQ+ patients. When providers aren’t working in the best interest of patients — just like in cases of children and rape victims denied abortions — patients may further avoid preventative care in a community that already faces discrimination in doctor’s offices.

The Dobbs Decision Isn’t Just a Women’s Issue

While the Dobbs decision is often framed as a women's issue — specifically, one that affects cisgender women — it impacts the transgender and non-binary community just as much. All people who are capable of carrying a pregnancy to term have lost at least some ability to choose whether or not to give birth in the U.S.

For transgender and non-binary individuals, this decision comes with the added complexity of body dysmorphia. Without abortion rights, pregnant trans men and some non-binary people may be forced to see their bodies change, and be treated as women by healthcare providers and society as a result.

The Dobbs decision also opens up the possibility for government bodies to determine when life begins — and perhaps even to add legal protections for zygotes and embryos. This puts contraceptives at risk, which could make it more difficult to access gender-affirming care while getting the right contraceptives based on sex for LGBTQ+ individuals.

Overturning Reproductive Rights Puts IVF at Risk

Queer couples that dream of having their own children often have limited options beyond adoption. One such option is in vitro fertilization, or IVF, which involves implanting a fertilized egg into a uterus.

While IVF isn’t directly affected by the Dobbs decision, it could fall into a legal gray area depending on when states determine that life begins. Texas, for example, is already barring abortions as early as six weeks. To reduce embryo destruction, which often occurs when patients no longer want more children, limits could be placed on the number of eggs that can be frozen at once.

Any restrictions on IVF will also affect the availability of surrogacy as an option for building a family.

How Can LGBTQ+ Individuals Overcome Healthcare Barriers?

While the Dobbs decision may primarily impact abortion rights today, its potential to worsen LGBTQ+ healthcare as a whole is jarring. So how can the community be prepared?

If you’re struggling to find LGBTQ+-friendly providers near you, using telemedicine now can be an incredibly effective way to start developing strong relationships with far-away healthcare professionals. Telemedicine eliminates the barrier of geography and can be especially helpful for accessing inclusive primary care and therapy. Be sure to check if your insurance provider covers telemedicine.

If you’re seriously concerned about healthcare access in your area — especially if the Dobbs decision affects your whole state or you need regular in-person services that may be at risk — it may be time to consider moving now. While not everyone has the privilege to do so, relocating gives you the ability to settle in areas where lawmakers better serve your needs. However, this decision shouldn’t be taken lightly, so preparing and making progress on a moving checklist now can help you avoid issues later.

The Dobbs Decision Isn’t LGBTQ+-Friendly

The Supreme Court of the United States has proven the power of its conservative majority with the overturning of Roe v. Wade. However, the effects of the Dobbs decision don’t stop at affecting cisgender women’s abortion rights. In states with bans, it also leads to forced birth for trans men and non-binary individuals. Plus, the Dobbs decision increases the risk of other rights, like hormone therapy and IVF, being taken away.

Taking steps now, whether it’s choosing a virtual provider or considering a move, can help you improve your healthcare situation in the future.