Trial News

A transgender female inmate who experienced emotional distress after being housed with men and denied hormone treatments may bring claims under the ADA, the Fourth Circuit held. The court ruled that while gender identity disorder does not constitute a disability under the statute’s text, gender dysphoria, characterized by “clinically significant distress,” does. (Williams v. Kincaid, 2022 WL 3364824 (4th Cir. Aug. 16, 2022).)

Plaintiff Kesha Williams, a transgender woman, changed her legal name and updated her driver’s license to reflect her gender as female. In addition, she had been receiving hormone therapy in the form of daily pills and biweekly injections for 15 years. When Williams was incarcerated for six months at the Fairfax County Adult Detention Center in Virginia, she was initially placed in women’s housing and given women’s uniforms. During a preliminary medical examination, she informed a prison nurse that she is transgender, suffers from gender dysphoria, and had brought her hormone medication with her.

Noting that Williams still had male genitalia, the prison nurse labeled her as “male,” moved her to the men’s side of the prison, and required her to wear the men’s uniform. After that, nursing staff failed to provide Williams with her hormone medication for two weeks, and she began to experience “significant mental and emotional distress.”

While Williams eventually received her medication after requesting a nurse visit and completing a second medical release, nursing staff twice more during her six-month incarceration failed to provide her with the approved and scheduled medication. Williams also was subjected to a search by a male deputy despite her request for a female deputy. She alleged that the search resulted in a bruise to her breast and that the male deputy “mocked” her afterward.

After Williams was released from prison, she filed a §1983 action in Virginia federal district court against Fairfax County Sheriff Stacey Kincaid and a prison nurse and deputy, alleging violations of the ADA, the Rehabilitation Act, the U.S. Constitution, and state law. Kincaid moved to dismiss the ADA and the Rehabilitation Act claims, arguing that in its language excluding “gender identity disorders not resulting from physical impairments” from the definition of a disability, the ADA excludes protections for gender dysphoria. The district court agreed and dismissed the claims; it also dismissed the other claims, finding them barred by the statute of limitations or insufficiently pleaded.

Williams appealed to the Fourth Circuit, which held, as a matter of first impression, that gender dysphoria does not fall within the definition of a gender identity disorder under the ADA and that there is no exclusion from protections for those suffering from gender dysphoria. The court found that Congress amended the ADA in 2008 and directed courts to “construe the amended [ADA] as broadly as possible,” while construing the ADA’s exclusions narrowly. (Summers v. Altarum Inst., Corp., 740 F.3d 325 (4th Cir. 2014); Alexander v. Carrington Mortg. Servs., LLC, 23 F.4th 370 (4th Cir. 2022).)

The court also agreed with Williams’s contention that gender dysphoria differs from a gender identity disorder. First, it noted, when the ADA was adopted in 1990, being transgender alone was considered a mental illness. However, in 2013, the American Psychiatric Association removed the term “gender identity disorder” from its DSM-5 and added a new term, “gender dysphoria”—a condition characterized by “clinically significant distress” that “may result in intense anxiety, depression, suicidal ideation, and even suicide.” Gender dysphoria, the court said, is characterized by “distress and other disabling symptoms” and not just by transgender identity. It added that many but not all transgender people suffer from gender dysphoria.

The court concluded that gender dysphoria and gender identity disorder are distinct. It added that given Congress’s instruction to broadly construe the ADA’s coverage, courts “cannot add to the ADA’s list of exclusions when Congress has not chosen to do so itself.” Given that, the court found, Williams’s ADA claim is not barred by the statute’s gender identity disorder exclusion.

“The Fourth Circuit became the first federal appellate court to rule that gender dysphoria is covered by the ADA” with this decision, said attorney Joshua Erlich, of Arlington, Va., who represents Williams. He added that “gender dysphoria is a common diagnosis for trans individuals who experience stress and discomfort due to having a gender identity that differs from the sex assigned to them at birth. Critically, this holding applies to any individual seeking accommodations for gender dysphoria, including in employment, public accommodations, and in any other context in which the ADA provides disability protections.”

GLAD Transgender Rights Project director Jennifer Levi, of Boston, who co-authored an amicus brief on behalf of several LGBTQ organizations, said, “The Williams opinion is an important win for the transgender community. The ADA contains archaic language that is often misconstrued to mean that transgender people—including those who have or have had gender dysphoria or are regarded as having gender dysphoria—are not covered by the law. That is wrong, as the Williams majority explained. The ADA has been an important source of protections for people with stigmatized medical conditions for decades. Transgender people need those protections, too. While it is the first federal appeals court to make that clear, the decision confirms what several federal district courts have now also said.”

Shannon Minter, amicus brief co-author and legal director at the National Center for Lesbian Rights in San Francisco, said, “The decision is significant not only for the plaintiff and other transgender women who are incarcerated but for all transgender people in the Fourth Circuit, who are now protected by a powerful federal anti-discrimination law.” He said he “expects that other courts considering similar claims will look to the Fourth Circuit’s decision as persuasive authority and will reach a similar conclusion. Transgender people are part of our society, and this decision is an important step toward fully including and protecting them.”