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In ‘Amazing’ Verdict, Jury Awards Transgender Woman Punitive Damages Against Suffolk County Jail

The landmark decision could help other transgender people in jails and prisons who have been denied access to hormone treatment, a violation of their constitutional rights.

Credit: Melissa Gira Grant

When Jessica Sunderland was incarcerated in Riverside Correctional Facility in Suffolk County, New York, she expected to continue the hormone treatment that her physician had prescribed. But Sunderland, a 32-year-old Iraq War veteran convicted of burglary in 2013, got nothing but excuses over the 16 months she was at the jail: They were waiting for her medical records, or they needed to consult outside experts. Without hormones, Sunderland was essentially forced to detransition.

“I had been transitioning for two years prior, and to have everything reverse itself … it was horrible,” Sunderland recalled in an interview with The Appeal this month. “It was very uncomfortable to deal with the physical changes.” After the excuses, she said, “I was told I wasn’t going to get it—at all” by the jail’s medical director, Vincent Geraci.

Realizing she would have to fight for the care she needed, Sunderland filed a federal civil rights suit in August 2013. This October, a jury found that Geraci along with another doctor at the jail, Dennis Russo, violated her constitutional rights and were liable for depriving her of care. They awarded her $280,000 in compensatory damages, plus $75,000 in punitive damages against Geraci.

This jury’s decision is groundbreaking, notes Sunderland’s attorney Joel Wertheimer. This is the first case, to his knowledge, “where a jury of eight peer citizens found, unanimously, that failure to provide hormone therapy to a transgender inmate violated her constitutional rights and entitled her to money damages.”

Wertheimer said that by awarding punitive damages, the jury sent a strong message. “Not only did those eight peers find that hormone therapy was necessary medical treatment, they found it was malicious to consciously deny it, indicating how seriously they took transgender health.”

Jails are especially hard to hold accountable because prisoners spent relatively little time there.

It’s not uncommon for trans prisoners to sue a correctional facility for access to hormone treatment, Chase Strangio, staff attorney with the ACLU’s LGBT & HIV Project told The Appeal. For people detained in prisons, jails and immigration detention, “there’s widespread healthcare denial for everyone, and when it comes to healthcare for trans folks, we are continuing to see systemic denials,” Strangio said. But of these facilities, jails are especially hard to hold accountable because prisoners spent relatively little time there, he said.

Strangio said there has been a growing trend of courts agreeing with trans prisoners seeking hormone access, but Strangio said he had never heard of a case like Sunderland’s, in which a jury awarded punitive damages, and he thinks it has the potential to help many more transgender people nationally protect their rights while incarcerated. “To get a jury verdict for a trans plaintiff, it’s an amazing thing.”

A ‘life-threatening’ risk

Sunderland served in the Army and was deployed to Iraq in 2008 and 2009. She was still in the Army Reserves and had a full-time job, she told The Appeal, when she was prescribed pain medication after a liver surgery in May 2012. “Everything kind of went downhill fast from there,” she said.

She was arrested for several burglaries and incarcerated at Suffolk County jail starting in September 2012. By the time she arrived at the jail, her physician at the VA had been prescribing her hormones for more than a year.

Geraci refused to continue providing this medication. Geraci claimed, in provider notes in Sunderland’s medical records accessed through the trial, that he believed her liver would be damaged by hormone treatment. But Geraci also “used the word ‘preference’—that it was my ‘preference,’” in an October 2013 note in her medical records, Sunderland said. In another note, he called her “she” in scare quotes.

Sunderland’s physician from the VA, Ann Danoff, testified that discontinuing Sunderland’s hormone medications created a risk that was potentially life-threatening.

During the trial, jail medical providers said that they were not familiar with the standards of care for transgender people seeking hormone therapy and admitted they took no steps to learn them. Neither did they communicate with the doctors who had prescribed Sunderland hormones. Sunderland’s physician from the Department of Veterans Affairs, Ann Danoff, testified that discontinuing Sunderland’s hormone medications created a risk that was potentially life-threatening. In prescribing her hormone therapy, she said, it was “quite important” to consider that Sunderland had tried to commit suicide when she was young.

Thomas Troiano, the director of the jail’s mental health unit, acknowledged in his testimony that transgender people who don’t get access to hormones face a heightened risk of self-harm and suicide. In Troiano’s January 2013 notes in Sunderland’s medical records regarding hormones, he stated they would be denied. In at least one note, he misgendered her, writing, “There will be no movement on that front and this won’t happen while he’s incarcerated here at Suffolk County.”

Though some of the jail nurses appeared to have tried to help Sunderland, Geraci continued to deny her care. “The real problem was, the man in charge was the worst offender of all,” Sunderland’s attorney David B. Shanies told The Appeal. During the trial, he confronted Geraci with a series of Facebook posts spreading memes mocking transgender people, which Geraci had liked. They included a post by conservative writer Dinesh D’Souza reading “If Rachel Dolezal isn’t black how is Caitlyn Jenner a woman? Good question!” and an image about “men in women’s bathrooms” used to campaign for anti-trans discrimination laws.

Suffolk County Chief Deputy Sheriff Michael Sharkey referred questions for the jail medical staff to the Suffolk County Department of Health Services, which did not respond directly to questions sent by The Appeal to the department and to Geraci and Troiano. They provided a statement from Dr. James Tomarken, Suffolk County Department of Health Commissioner, that said, “It is the policy of Suffolk County Department of Health that unless there are overriding medical reasons, hormone treatment is provided when indicated.”

‘An important precedent’

Sunderland isn’t the only one who was denied hormone treatment at the jail, her attorneys say. At trial, they cited jail medical records for nine prisoners who they said had received no or inadequate hormone treatment, and say they have since found two more. They now represent two other transgender women who were in the jail in that time, including one with a medical indifference claim similar to Sunderland’s and who is also seeking punitive damages.

The Suffolk County Law Department, in a statement to The Appeal, said, “With respect to the allegation that eleven prisoners were refused or delayed hormone treatment, that is an inaccurate representation of the evidence that was presented at trial.” The county has made a motion to set aside the verdict, the department added.

It’s something that the jail is going to remember, and other jails are going to think about.

Chase Strangio ACLU’s LGBT & HIV Project

It’s unusual for a jury to award punitive damages in a case like this, as they did against Geraci. “It’s something that the jail is going to remember, and other jails are going to think about,” said Strangio of the ACLU. “When jails are sued by people they think have no one on their side, and they start losing, there are practical changes that happen.”

Even before the verdict, Sunderland’s suit prompted the Suffolk County jail to start hormone treatment for other transgender prisoners, Shanies has learned. 

But being denied medical care wasn’t the only problem Sunderland faced in jail. She was housed with men and says she was held in a segregated unit, confined for 21 hours a day for her entire time at the jail.

Shanies said that beyond hormone access, there’s a long way to go when it comes to fair treatment of transgender prisoners at the jail. “We’ve seen no indication that there’s anybody in Suffolk County who wants to have that conversation,” Shanies explained. “And it needs to happen.”

When asked about these issues and the recent verdict, a spokesperson for the Suffolk County Sheriff’s Office told The Appeal that the office does not comment on pending litigation.

By the time the verdict came down in October, Sunderland had been released from both the Suffolk County jail and the state prison where she served out her sentence—there, unlike the jail, she received hormone treatment. Now, she’s living back in Suffolk County, looking for work, having completed a training program in medical records billing.

Though Sunderland knew early on that she probably wouldn’t get the jail to give her hormones in her time remaining there, she said she pursued the suit in part because it might help other trans prisoners still being mistreated at the jail.

“If it could happen to me, it could pretty much happen to anyone else,” she said.

In all, it took five years for Sunderland to prevail in court.  Her jury verdict “is a really incredible win,” said Strangio of the ACLU. “Obviously for her, because she never should have gone through this, but it also sets an important precedent.”