Case: 3:16-cv-00261-jdp Document #: 148 Filed: 12/08/20 Page 1 of 19
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`IN THE UNITED STATES DISTRICT COURT
`FOR THE WESTERN DISTRICT OF WISCONSIN
`
`
`
`
`
`
`
`MARK A. CAMPBELL,
`also known as NICOLE ROSE CAMPBELL,
`
`
`Plaintiff,
`
`v.
`
`
`KEVIN KALLAS, RYAN HOLZMACHER,
`JAMES GREER, GARY ANKARLO, JEFF ANDERS,
`MARY MUSE, MARK WEISGERBER,
`ROBERT HABLE, CATHY A. JESS, and
`CINDY O’DONNELL,
`
`
`Defendants.
`
`OPINION and ORDER
`
`16-cv-261-jdp
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`Plaintiff Nicole Rose Campbell, born Mark A. Campbell, now identifies as a woman.
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`She is incarcerated at Racine Correctional Institution, a male prison, where she is serving a
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`long sentence for a sex crime against a child. Campbell suffers from severe, unremitting gender
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`dysphoria, which causes her severe anguish and puts her at risk of self-harm. She has received
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`some treatment for gender dysphoria while incarcerated, including counselling and cross-gender
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`hormone therapy. She filed this lawsuit so that she could complete her transition with sex
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`reassignment surgery, which defendants have declined to provide. Campbell contends that in
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`refusing to provide the surgery, Wisconsin Department of Corrections officials have violated
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`her Eighth Amendment right to necessary medical care.
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`Campbell originally sought both damages and injunctive relief. But the court of appeals
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`held that the defendant officials in this case are entitled to qualified immunity. See Campbell v.
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`Kallas, 936 F.3d 536 (7th Cir. 2019). The court of appeals reasoned that any right that
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`Campbell has to sex reassignment surgery is not yet clearly established because, at the time
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`defendants denied Campbell the surgery, no prison in the United States had ever provided sex
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`Case: 3:16-cv-00261-jdp Document #: 148 Filed: 12/08/20 Page 2 of 19
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`reassignment surgery to an inmate. As a result, Campbell is not entitled to damages; her only
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`available remedy is injunctive relief against the DOC.
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`Many of the material facts were established as undisputed at summary judgment. All
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`agree that severe gender dysphoria is a serious medical need, that Campbell suffers from it, and
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`that sex reassignment surgery can in some cases effectively treat it. But two facts were disputed:
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`whether sex reassignment surgery was medically necessary for Campbell, and whether
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`defendants were deliberately indifferent to Campbell’s serious medical need in refusing to
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`provide the surgery. Those questions were tried to the court over three days in March 2020.1
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`This opinion sets out the court’s findings of fact and conclusions of law as required under
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`Federal Rule of Civil Procedure 52.
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`PRELIMINARY MATTERS
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`The court begins with final rulings on the parties’ motions in limine.
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`A. Campbell’s motions in limine
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`Campbell filed five motions in limine.
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`First, Campbell moved to limit the testimony of defendant Kevin Kallas, the DOC’s
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`director of mental health, on the treatment of gender dysphoria because he acknowledges that
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`he is not an expert in that subject, and he did not disclose an expert report. Dkt. 122. I’ll grant
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`the motion, but at trial Kallas did not give opinions about what specific treatments are
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`appropriate for gender dysphoria. I will admit and consider Kallas’s testimony about how the
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`1 Campbell has been ably represented in this litigation by pro bono counsel Ilana Vladimirova,
`Joseph Diedrich, Natalia Kruse, and Thomas Patrick Heneghan, of Husch Blackwell, LLP. The
`court thanks them for their work.
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`2
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`DOC provides treatment to transgender inmates and the problems that providing that
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`treatment pose in a correctional facility.
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`Second, Campbell moved to limit evidence of her criminal history. Dkt. 123. I’ll deny
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`the motion. To be clear: an inmate’s criminal history is irrelevant to whether she has a right to
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`necessary medical treatment. Because the matter was tried to the court, Campbell faces no
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`unfair prejudice from the discussion of her criminal history. Campbell is convicted of a sex
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`crime against a child, which the DOC reasonably considered in evaluating Campbell’s request
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`for sex reassignment surgery because Campbell will be placed in the state’s women’s prison if
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`she has the surgery. Criminal history is an appropriate consideration in determining prison
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`placement. And Cynthia Osborne, the consultant engaged by the DOC to evaluate Campbell,
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`considered Campbell’s criminal history, but ultimately it did not affect Osborne’s conclusions
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`about the appropriateness of sex reassignment surgery.
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`Third, Campbell moved to limit defense witnesses from providing expert testimony not
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`disclosed in a Rule 26(a) report. Dkt. 124. The court will grant the motion, and the ruling
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`applies to both sides. At trial, the court allowed some witnesses to testify on topics not disclosed
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`in expert reports, particularly Felicia Levine, one of Cambell’s witnesses, and Cindy Osborne,
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`a defense witness. But for purposes of its decision, the court will consider only testimony that
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`was at least generally disclosed in the expert’s report. The court will thus disregard Osborne’s
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`undisclosed testimony about autogynephilia, which Osborne offered in response to the court’s
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`question about any potential link between gender dysphoria and crime. That testimony was
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`also speculative and ultimately irrelevant.
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`3
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`Fourth, Campbell moved to exclude certain opinions from the DOC’s retained expert,
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`Dr. Chester Schmidt, as unreliable. Dkt. 125, at 3–10. The DOC withdrew Schmidt as a
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`witness, so the court will grant Campbell’s motion as unopposed.
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`Fifth, Campbell moved to exclude the testimony of the DOC’s security chief, Larry
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`Fuchs. Dkt. 126. Defendants originally named Fuchs’ predecessor, Mark Weisgerber, as their
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`expert on prison security. They disclosed Fuchs less than two months before trial. Defendants’
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`late disclosure of Fuchs was justified because Weisgerber retired after defendants made their
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`original expert disclosures. The court denied Campbell’s motion before trial, but it restricted
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`Fuchs’s testimony to what was disclosed in the Weisgerber report and allowed Campbell to use
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`Weisgerber’s deposition testimony for impeachment. (As it turned out, there was no significant
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`conflict between the Weisgerber report and Fuchs’s testimony.)
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`B. Defendants’ motions in limine
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`Defendants filed two motions in limine.
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`First, defendants sought to exclude deposition designations of certain individual
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`defendants, members of the transgender committee, which Campbell had offered to show their
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`lack of experience and knowledge of transgender issues. Defendants did not present any
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`testimony from these individuals, and defendants contend that their lack of knowledge about
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`transgender care is irrelevant. I’ll grant the motion. Defendants concede that some members of
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`the transgender committee are not well-informed about the treatment of gender dysphoria. The
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`purpose of the committee is to evaluate requests for treatment for gender dysphoria and
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`accommodations for transgender inmates. It includes members who provide psychological
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`counseling and treatment to inmates as well as members responsible for prison security. Most
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`of its members would disavow being experts in the treatment gender dysphoria, and the DOC
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`4
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`relies on expert consultants to address specific cases. So whether members of the committee
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`are themselves well-informed about the treatment gender dysphoria is ultimately irrelevant to
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`the issues before the court.
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`Second, defendants moved to exclude testimony about the medical necessity of breast
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`augmentation, electrolysis, and voice therapy. Dkt. 120. Defendants are correct: neither of
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`Campbell’s experts offered opinions about the medical necessity of breast augmentation,
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`electrolysis, and voice therapy in their reports. See Dkt. 63-1 (Levine report) and Dkt. 65-1
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`(Oriel report). At trial, Levine testified that these interventions can be necessary for some
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`transgender women and are necessary for Campbell. But because this opinion was not disclosed
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`in her report, the court will not consider that testimony. See Fed. R. Civ. P. 37(c)(1). As a result
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`of this ruling, Campbell has no admissible evidence that these interventions are medically
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`necessary for Campbell’s gender dysphoria, so the court will deny Campbell’s request that the
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`DOC be ordered to provide them.
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`FINDINGS OF FACT AND CONCLUSIONS OF LAW
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`A detailed factual background is in the court’s summary judgment order, Dkt. 96, so a
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`succinct summary is sufficient here. Campbell has been a prisoner in the custody of the DOC
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`since 2008. She is currently housed at the Racine Correctional Institution (RCI). Her
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`anticipated release date is in 2041. Campbell requested treatment for gender dysphoria, and
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`she began hormone therapy in 2013. She responded well to hormone therapy, but her gender
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`dysphoria still left her in anguish. She has requested sex reassignment surgery since 2013.
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`The DOC has a formal policy addressing treatment for gender dysphoria and for
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`accommodating transgender inmates, Division of Adult Institutions Policy 500.70.27. The
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`5
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`policy calls for a transgender committee (known as the “gender dysphoria” committee in pre-
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`2017 versions of the policy) to interpret and develop the DOC’s gender dysphoria policy and
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`to review inmate requests for specific services and treatments. Defendants are past or current
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`members of the committee.
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`At trial, the court heard testimony from seven witnesses: Campbell herself; her two
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`retained experts, Drs. Kathy Oriel and Felicia Levine; and the DOC’s four non-retained experts,
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`Cynthia Osborne (the DOC’s gender dysphoria consultant), Dr. Betsy Luxford (the DOC
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`physician who managed Campbell’s hormone therapy), Dr. Kevin Kallas (the DOC’s mental
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`health director), and Larry Fuchs (the DOC’s security chief).
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`A. Uncontested issues
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`The trial testimony confirmed key material facts that were established as undisputed at
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`summary judgment and stipulated by the parties before trial.
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`Campbell suffers from severe and unremitting gender dysphoria.
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`Gender dysphoria is a serious medical condition that causes severe anguish and
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`increases the risk of self-harm and suicide.
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`Sex reassignment surgery is not experimental or cosmetic. In the appropriate case, it is
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`an effective treatment for gender dysphoria. Sex reassignment surgery is not a necessary
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`treatment for all cases of gender dysphoria; some persons with gender dysphoria can be
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`adequately treated without surgery.
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`B. Contested issues
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`The contested issues at trial were whether sex reassignment surgery was medically
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`necessary for Campbell and whether defendants were deliberately indifferent in failing to
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`provide it.
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`6
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`Case: 3:16-cv-00261-jdp Document #: 148 Filed: 12/08/20 Page 7 of 19
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`1. Whether sex reassignment surgery is medically necessary for Campbell
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`a. The WPATH Standards of Care
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`The evidence of medical necessity in this case focused on Standards of Care for the
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`Health of Transsexual, Transgender, and Gender Nonconforming People, a document
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`published by the World Professional Association for Transgender Health to provide clinical
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`guidance to health professionals in the treatment of individuals with gender identity issues.2
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`For the purposes of this case, the most important part of Standards of Care is the list of specific
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`diagnostic criteria for various treatments for gender dysphoria, including sex reassignment
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`surgery. The qualifying criteria for complete sex reassignment surgery are:
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`1. Persistent, well documented gender dysphoria;
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`2. Capacity to make a fully informed decision and to consent for
`treatment;
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`3. Age of majority in a given country;
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`4. If significant medical or mental health concerns are present,
`they must be well controlled;
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`5. 12 continuous months of hormone therapy as appropriate to
`the patient’s gender goals (unless the patient has a medical
`contraindication or is otherwise unable or unwilling to take
`hormones).
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`6. 12 continuous months of living in a gender role that is
`congruent with their gender identity;
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`WPATH Standards of Care, at 60.
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`Defendants contended in their pre-trial brief that the WPATH Standards of Care did
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`not reflect a consensus, but only one side of the medical debate over sex reassignment surgery.
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`2 World Professional Association for Transgender Health, Standards of Care for the Health of
`Transsexual, Transgender, and Gender Nonconforming People (7th version), available at
`https://www.wpath.org/publications/soc
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`Case: 3:16-cv-00261-jdp Document #: 148 Filed: 12/08/20 Page 8 of 19
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`Dkt. 138, at 2. But that wasn’t borne out by the evidence at trial, and it contradicts the parties’
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`pre-trial stipulation that:
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`Among GD [gender dysphoria] specialists, the generally accepted
`standards of care for treating GD are contained in the World
`Professional Association for Transgender Health’s Standards of
`Care for the Health of Transsexual, Transgender, and Gender
`Nonconforming People (the “WPATH Standards of Care”).
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`Dkt. 130, ¶ 27.
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`That’s not to say WPATH itself and the WPATH Standards of Care document are
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`entirely beyond controversy. Osborne testified that, in her opinion, the WPATH organization
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`had moved from its original purpose of evaluating evidence about effective treatment for gender
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`identity issues toward excessively zealous advocacy. And she thought it was simplistic and naïve
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`for WPATH to take the position that the Standards of Care should apply fully to all
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`transgendered persons without regard institutional context. But, disputes about the
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`institutional mission of WPATH aside, Osborne endorsed the diagnostic and treatment criteria
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`in the Standards of Care, and she used those criteria in her professional work. The DOC itself
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`purports to follow the criteria in the WPATH Standards of Care in making treatment decisions
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`for transgender inmates.
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`The court finds that the diagnostic and treatment criteria in the WPATH standards of
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`care represent the consensus of qualified medical professionals regarding the appropriateness
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`of various treatments for gender dysphoria, including sex reassignment surgery. The criteria are
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`flexible clinical guidelines, to be applied and adapted by health professionals to the
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`circumstances of the patient.
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`b. Whether Campbell meets the WPATH criteria
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`Turning specifically to Campbell’s case, there is no dispute about the first three
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`WPATH criteria. Campbell’s severe gender dysphoria is persistent and well-documented; she’s
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`capable of informed decision-making; and she’s of age.
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`Campbell’s experts, Oriel and Levine, testified consistent with their reports that
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`Campbell meets the other WPATH criteria as well. The parties stipulated, and I agree, that
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`both experts are qualified in the area of treatment of gender dysphoria. I find their testimony
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`on this topic to be credible and well-supported. But neither Oriel nor Levine have experience
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`in treating transgender persons in prison. This is one of the reasons that I find Osborne’s
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`testimony to be particularly important, even though she is not herself an expert on prison
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`management. Osborne is trained as a social worker, and she is a certified sex therapist and sex
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`therapy supervisor. The treatment of transgender persons became a focus of her work about 20
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`years ago. She has evaluated about two hundred incarcerated people for gender dysphoria,
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`primarily for the Wisconsin DOC. The parties stipulated, and again I agree, that Osborne is
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`qualified in the area of treatment of gender dysphoria.
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`To put Osborne’s trial testimony in context, it’s useful to review the sequence of her
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`involvement in Campbell’s case. Osborne first evaluated Campbell at Kallas’s request in 2012.
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`At the time, Osborne concluded that sex reassignment surgery was “wholly contraindicated”
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`for several reasons. Dkt. 74. Campbell suffered from depression, and Osborne believed that
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`Campbell had a poor understanding of what it would be like to live full-time as a woman in
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`the community, which she would not be able to achieve within a correctional institution.
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`Osborne suggested that Campbell would benefit from counselling and hormone therapy.
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`Campbell then received mental health treatment and she began hormone therapy.
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`Luxford testified about Campbell’s successful hormone therapy. But Luxford wasn’t involved
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`in any decisions about surgery, so her testimony is useful only as background.
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`Campbell specifically requested sex reassignment surgery in 2013. But the DOC
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`declined to provide the surgery because, under DOC policy, she was unable to satisfy WPATH
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`criteria number six, which is sometimes referred to as the “real-life experience.” The DOC
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`decision was not based on an individualized assessment Campbell; it was a matter of formal
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`DOC policy:
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`Due to the limitations inherent in being incarcerated, a real-life
`experience for the purpose of gender-reassignment therapy is not
`possible for inmates who reside within a correctional facility.
`However, treatment and accommodations may be provided to
`lessen gender dysphoria.
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`DAI [Division of Adult Institutions] Policy No. 500-70-27 (Dkt. 75-9).
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`Campbell continued to press her request for sex reassignment surgery. In 2014, Kallas
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`asked Osborne to evaluate Campbell again, this time to specifically evaluate Campbell for sex
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`reassignment surgery. Osborne interviewed Campbell in May and issued a thorough report in
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`August. Dkt. 75-10. Osborne’s 2014 report, read as a whole, endorses Campbell as a good
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`candidate for sex reassignment surgery. But Osborne identified what she described as two
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`“potential contraindications.”
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`One of these potential contraindications was that Campbell had not yet achieved the
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`maximum benefit from hormone therapy, which had somewhat alleviated Campbell’s gender
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`dysphoria distress. So Osborne recommended that Campbell’s hormone therapy be optimized
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`before taking the irreversible step of surgery. But Osborne also acknowledged that long-term
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`hormone therapy carried its own health risks, and she predicted that hormone therapy would
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`not be sufficient to relieve Campbell’s severe gender dysphoria. Osborne predicted that her
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`gender dysphoria would not remit without sex reassignment surgery. The parties have
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`stipulated that Campbell’s hormone levels were optimized in 2014. So when Campbell filed
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`this suit in 2016, that potential contraindication had been eliminated for about two years, and
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`by trial, it had been eliminated for six years.
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`The second potential contraindication was that Campbell would not be able to achieve
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`a real-life experience while incarcerated in a male prison, at least not as the real-life experience
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`had been conceived by community-based practitioners and patients. But Osborne’s report
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`included a long, thoughtful discussion of the real-life experience, in which Osborne expressed
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`doubt that a traditional real-life experience was necessary or helpful in the case of incarcerated
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`persons. Osborne identified the absence of the real-life experience only as a “potential”
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`contraindication for Campbell, in contrast to the clear contraindications that she had identified
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`in 2012.
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`Osborne had no further contact or involvement in Campbell’s treatment after the 2014
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`report, and that report included a complete statement of her analysis of Campbell’s case. But
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`her trial testimony clarified and explained three important points.
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`The first important explanation concerned the severity and nature of Campbell’s gender
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`dysphoria. Osborne explained that Campbell has the most severe form of gender dysphoria,
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`anatomic gender dysphoria, which means that the presence of male genitalia on her body causes
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`particularly severe anguish. Non-anatomic gender dysphoria can sometimes be treated without
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`surgery. But without sex reassignment surgery, Campbell’s anatomic gender dysphoria will
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`cause continuing severe mental anguish and she is at a substantial risk of self-mutilation or
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`suicide.
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`The second important explanation concerns why Osborne did not expressly recommend
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`sex reassignment surgery for Campbell. Osborne explained at trial that she had never in her
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`career made an explicit recommendation for sex reassignment surgery—for any patient,
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`whether in the community or in an institution. Her task was simply to identify contraindica-
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`tions and potential contraindications, leaving the decision to the patient. Osborne testified
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`that, among the eight to ten incarcerated persons that she had evaluated specifically for
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`suitability for sex reassignment surgery, she had found three whom she thought were good
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`candidates for surgery. Campbell was one of those three.
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`The third important explanation concerned the purpose of the real-life experience and
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`the need for that requirement among incarcerated persons. Osborne testified that the real-life
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`experience was a common-sense practice based more on tradition than any science. She was
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`aware of no systematic evidence that completion of a real-life experience led to better outcomes.
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`Nevertheless, Osborne believed that a real-life experience was an important part of the
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`treatment process for the majority of patients. But she acknowledged that departures from the
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`requirement of the real-life experience might be appropriate in an individual case, particularly
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`among incarcerated persons. Osborne had written a scholarly article in which she contended
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`that an incarcerated transgender woman could indeed live in a gender role typical of a woman
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`within the confines of a male prison, by embracing female-typical gender roles to the extent
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`possible. Dkt. 88-10 (Cynthia S. Osborne & Anne A. Lawrence, Male Prison Inmates With Gender
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`Dysphoria: When Is Sex Reassignment Surgery Appropriate? 45 Archives of Sexual Behavior 1649,
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`1656 (2016)). In the same article, Osborne questioned whether the real-life experience
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`requirement “has much practical or prognostic relevance for inmates” particularly for inmates
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`who, like Campbell, have many years of incarceration left to serve. Id.
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`Osborne testified that the purpose of the real-life experience was to ensure the patient’s
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`commitment to the gender transition and to confirm that the patient could adjust to life in the
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`new gender role without aggravating psychological problems such as depression or creating new
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`ones. Osborne expressed concern that sometimes incarceration itself might trigger gender
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`confusion, and sex reassignment surgery would be inappropriate as a response to what might
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`be a temporary condition. Osborne’s testimony, and her 2014 report, make clear that she had
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`none of these concerns in Campbell’s case. Campbell’s psychological conditions were well
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`managed. Her gender dysphoria had an early onset, well before incarceration. And she has
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`demonstrated resolute commitment to gender transition, having lived, to the fullest extent
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`possible, as a woman in male prisons for years.
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`I find that Campbell suffers from severe unremitting anatomical gender dysphoria. Her
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`gender dysphoria is a serious medical need, for which sex reassignment surgery is the only
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`effective treatment.
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`2. Deliberate indifference
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`The second contested issue at trial was whether defendants have been “deliberately
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`indifferent,” that is, whether they have consciously disregarded Campbell’s serious medical
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`need for effective treatment for her gender dysphoria.
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`There is no question that defendants were aware that Campbell suffered from gender
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`dysphoria: she had persistently requested treatment for it, and Kallas had commissioned two
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`reports from Osborne asking her to evaluate Campbell’s gender dysphora. The 2014 report was
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`requested specifically to evaluate Campbell’s suitability for sex reassignment surgery.
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`Osborne’s 2014 report identified Campbell as a good candidate for sex reassignment
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`surgery and concluded that the symptoms of gender dysphoria would not remit without
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`surgery. The reason defendants denied Campbell’s request is clear: DOC policy flatly
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`prohibited sex reassignment surgery for inmates. The policy cited the inability to achieve a real-
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`life experience in prison as the basis for the rule. But this determination was not based on any
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`assessment of Campbell’s needs. The DOC had implemented by policy the same blanket rule
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`against sex reassignment surgery that was held to be unconstitutional as enacted as a state
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`statute. Fields v. Smith, 653 F.3d 550 (7th Cir. 2011).
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`At trial, Kallas testified that it would be irresponsible to disregard the fact that, post-
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`surgery, a female transgender inmate would be transferred to Taycheedah, the state’s female
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`prison. And, thus, as a psychiatric professional, he had to consider whether a transgender
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`inmate would be able to adapt to a female prison, which differed from male prisons.3 Kallas
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`expressed concern that if Campbell didn’t adjust to life at Taycheedah, she might wish to return
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`to her current institution. But once Campbell has sex reassignment surgery, there will be no
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`going back. These are reasonable considerations, although I am not persuaded that this is what
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`motivated the decision to deny sex reassignment surgery to Campbell. Osborne made clear in
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`her report that she entertained no uncertainty about Campbell’s diagnosis or Campbell’s
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`commitment to the transition. Kallas himself is not an expert in the treatment of gender
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`dysphoria, and he did not at any time provide treatment to Campbell.
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`The transgender committee did not deny sex reassignment surgery to Campbell because
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`anyone determined that she would not be able to adapt to life in Taycheedah. No professional
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`3 The differences reflected unsurprising stereotypes: inmates at female prisons were more
`emotional and formed more complex social and intimate relationships; inmates in male prisons
`were more physical. Inmates in female prisons included many mothers, who tend to be hostile
`to those who have committed crimes against children. But Kallas acknowledged that those who
`have committed crimes against children face hostility in male prisons, too.
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`with expertise in the treatment of gender dysphoria had ever determined that Campbell would
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`not be able to adapt to a female prison, that she was likely to regret the transition, or that she
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`was otherwise not an appropriate candidate for sex reassignment surgery. The committee
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`simply applied the policy.
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`The institutional decision was an understandable one, in 2014, because prisons in the
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`United States did not provide sex reassignment surgery to transgender inmates. But the
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`historical context does not change the facts established in this case: Campbell suffered from a
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`serious medical need, of which prison officials were well aware, and those officials denied her
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`the treatment known to be effective. To be clear, an inmate is not entitled under the Eighth
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`Amendment to demand her chosen treatment if other effective treatment is provided. Arnett v.
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`Webster, 658 F.3d 742, 754 (7th Cir. 2011). Defendants had provided Campbell some
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`ameliorating treatment in the form of hormone therapy, counselling, and a few lifestyle
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`accommodations. But the consultant engaged by the DOC to evaluate Campbell for surgery
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`made clear that the ameliorating treatment was not sufficient to alleviate Campbell’s gender
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`dysphoria. And at trial, defendants did not dispute that without surgery, Campbell was left in
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`continuing anguish that surgery could alleviate.
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`At trial, Kallas and Fuchs, the security director, testified about the practical challenges
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`posed by providing Campbell with sex reassignment surgery. Kallas and Fuchs identified no
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`practical challenge that was any greater than housing a transgender woman in a male prison.
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`Nor did defendants contend that providing the surgery would be impractical or unreasonably
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`expensive. Campbell’s evidence, which defendants did not dispute, was that the cost of the
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`surgery was about $20,000, far less than treatment for other serious medical conditions that
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`the DOC routinely provides.
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`Case: 3:16-cv-00261-jdp Document #: 148 Filed: 12/08/20 Page 16 of 19
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`I find that defendants consciously disregarded Campbell’s need for treatment for her
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`severe anatomic gender dysphoria by denying her the one effective treatment. They did so as
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`a matter of DOC policy without an individualized assessment of her suitability for sex
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`reassignment surgery. I find further that no reasonable professional with expertise in the
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`treatment of gender dysphoria would conclude that Campbell was not an appropriate candidate
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`for sex reassignment surgery.
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`Persons in criminal custody are entirely dependent on the state for their medical care.
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`Estelle v. Gamble, 429 U.S. 97, 103 (1976). For that reason, prison officials have a constitutional
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`duty to provide inmates with the care they require for their serious medical needs. “If prison
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`medical staff exhibit deliberate indifference to an inmate’s serious medical condition, they
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`subject her to unnecessary and wanton pain and suffering and thereby run afoul of the Eighth
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`Amendment.” Mitchell v. Kallas, 895 F.3d 492, 498 (7th Cir. 2018).
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`I conclude, based on the record of the case as a whole and the facts that I have found
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`at trial, that defendants were deliberately indifferent to Campbell’s need for treatment for a
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`serious medical need, and thus defendants violated Campbell’s rights under the Eighth
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`Amendment.
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`REMEDY
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`The final issue is the remedy. Campbell is not entitled to damages as a result of the
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`court of appeals’ decision that defendants are entitled to qualified immunity. Under the Prison
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`Litigation Reform Act, any injunction “shall extend no further than necessary to correct the
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`violation of the Federal right of a particular plaintiff or plaintiffs.” 18 U.S.C. § 3626(a)(1)(A).
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`The usual requirements apply. Campbell is entitled to an injunction if she has suffered
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`Case: 3:16-cv-00261-jdp Document #: 148 Filed: 12/08/20 Page 17 of 19
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`irreparable injury; monetary damages are inadequate; an injunction is warranted in light of the
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`balance of hardships; and the public interest would not be disserved. eBay Inc. v. MercExchange,
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`L.L.C., 547 U.S. 388 (2006).
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`The first two elements are met because Campbell continues to suffer from gender
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`dysphoria, which causes her anguish and puts her at risk of self-harm or suicide. Monetary
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`damages, even if they were available, would not alleviate her suffering. At trial, Kallas testified
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`that he was working on a new DOC policy that would allow Wisconsin inmates to receive sex
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`reassignment surgery under certain conditions. But, regardless of Kallas’s recent efforts, DOC
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`policy has not yet changed, and it is not clear whether it will. I find that, without an injunction,
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`Campbell will endure additional suffering, even if the DOC ultimately revises its transgender
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`policy.
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`The third element is also met. Defendant’s have identified no practical impediment to
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`providing sex reassignment surgery to Campbell. The surgery is no more expensive or difficult
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`than other treatment that the DOC routinely provides.
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`The fourth element is also met. The rights of transgender persons and sex reassignment
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`surgery remain politically controversial, even outside the prison context. And some members
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`of the public are outraged at any effort to improve the health and well being of inmates. But
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`the t