Merlin C. Long v. Crispus C. Nix Sally Chandler-Halford, as Director of the Iowa Department of Corrections Thomas Hundley, Warden of Isp Paul W. Grossheim Paul W. Loeffelholz

Citation: 86 F.3d 761Docket: 95-1613

Court: Court of Appeals for the Eighth Circuit; July 15, 1996; Federal Appellate Court

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Merlin C. Long, serving a life sentence for murder at the Iowa State Penitentiary, initiated a lawsuit under 42 U.S.C. § 1983 against Iowa Department of Corrections officials, claiming inadequate treatment for his gender-identity disorder and seeking damages for alleged deliberate indifference. The District Court ruled that Long's condition did not constitute a serious medical need, and even if it did, the defendants were not deliberately indifferent. Furthermore, the court concluded that the defendants were entitled to qualified immunity regarding Long's damage claims. Long's requests to wear women's clothing and undergo hormone therapy or sex-change surgery were repeatedly denied by prison officials since 1981. Although Long arrived at the prison in drag and was initially allowed to wear women's attire, this privilege was revoked following complaints. Over the years, he sought various treatments but failed to cooperate with mental health evaluations, often presenting himself in a hostile manner. Subsequent evaluations concluded that he had no significant psychological issues that required attention, with reports indicating Long's lack of participation or refusal to engage in treatment. The Eighth Circuit affirmed the District Court's judgment.

Prison officials have responded appropriately to Long's treatment requests, including transferring him to the Iowa State Medical Facility (ISMF) in 1982 for evaluation after he requested treatment. Later that year, he chose to move to a Missouri maximum security prison that allowed him to wear women’s clothing. Upon returning to the Iowa State Penitentiary (ISP) in 1986, Long's complaints focused on not being allowed to keep his female clothing. Despite these requests, Long has not consistently pursued psychiatric treatment for his gender-identity disorder or depression, and in 1994, he declined an annual psychological evaluation, citing concerns about staff unsympathy and parole prospects.

Dr. Walter O. Bockting diagnosed Long with a gender-identity disorder, a sexual disorder, and an antisocial personality disorder, attributing some of Long's traits to a dysfunctional upbringing. In contrast, Dr. Paul W. Loeffelholz, the state's main expert, agreed with many of Bockting's diagnoses but differed on the primary psychiatric condition, asserting that Long's gender-identity disorder is intermittent and that his main issue is antisocial behavior. The experts disagreed on whether Long's desire to wear women's clothing is primarily for sexual arousal or to express a feminine identity. Despite acknowledging both motivations, Bockting concluded that Long does not qualify for hormone therapy or sex-change surgery, as he is not considered a transsexual.

Concerning treatment, Bockting recommended psychotherapy combined with tranquilizers for Long's depression and anxiety, suggesting limited opportunities for him to wear women’s clothing if necessary. Loeffelholz opposed this, noting Long's lack of cooperation with treatment and his failure to request help for his anxiety or depression.

The District Court found that Dr. Loeffelholz did not prescribe tranquilizers despite Dr. Bockting's recommendation, determining that this decision stemmed from a professional judgment difference rather than deliberate indifference to Long's serious medical needs. Consequently, the court ruled that the other defendants were justified in relying on medical staff opinions. Long contends that the District Court erred in deeming his gender-identity disorder as not a serious medical need and claims the defendants were deliberately indifferent. He argues for de novo review of the findings of fact and legal conclusions, referencing Falls v. Nesbitt. The court, however, clarifies that while mixed questions of law and fact can be reviewed de novo, factual findings are usually only overturned for clear error. It affirms that the District Court's factual findings are not clearly erroneous. On the merits, the court concludes that Long did not demonstrate that prison officials acted with deliberate indifference, which constitutes cruel and unusual punishment under the Eighth Amendment. The court tentatively accepts Long's gender-identity disorder as a serious medical need but does not decide this issue.

A prison official demonstrates deliberate indifference when they are aware of and ignore a prisoner's serious medical needs. Under the Eighth Amendment, failing to treat a medical condition does not constitute punishment unless officials know the condition poses an excessive risk to health and neglect to act. Prison doctors maintain the right to exercise independent medical judgment, and inmates are not entitled to specific treatments. The case indicates that Dr. Loeffelholz and the prison medical staff were aware of Long's psychological issues but did not exhibit deliberate indifference. Long's expert recommended psychotherapy and tranquilizers, but Dr. Loeffelholz accepted only psychotherapy. Evidence shows the medical staff made efforts to address Long's psychological problems, while Long refused to cooperate. Consequently, Long could not demonstrate that Dr. Loeffelholz was deliberately indifferent to his gender-identity disorder. 

Long's claim regarding the lack of tranquilizers is characterized as a disagreement over treatment rather than cruel and unusual punishment. His assertion that he is entitled to a specialized psychotherapist is rejected, as the prison staff is deemed competent to manage inmates' medical needs. The District Court noted that Long seeks to live according to his terms rather than adhere to prison regulations and has consistently resisted psychological evaluation, undermining any claim of deliberate indifference from the prison officials. Ultimately, the court found Long failed to prove that the prison officials were deliberately indifferent to his gender-identity disorder.

The judgment of the District Court is affirmed, as the court agrees with the conclusion that prison officials did not exhibit deliberate indifference to Long's gender-identity disorder. The case was overseen by Magistrate Judge Celeste F. Bremer, and it was tried by consent of both parties under 28 U.S.C. § 636(c). The court acknowledges that while a psychological disorder can be a serious medical need, Long is not classified as a transsexual, which diminishes the applicability of precedent set in White v. Farrier regarding serious medical needs. 

Furthermore, the court supports the District Court's finding that other defendants were entitled to rely on medical staff opinions when denying Long's requests to cross-dress. Long's assertion in his Reply Brief that his anxiety and depression are independent serious medical needs is dismissed as this argument was introduced too late in the proceedings. The case primarily focused on Long's gender-identity disorder, as indicated in his amended complaint.

Additionally, the Iowa State Penitentiary (ISP) employs three psychologists who can refer inmates for further evaluation and treatment as necessary. The court rejects Long's claim that the Eighth Amendment mandates the provision of a specialized psychotherapist for gender-identity issues, affirming that the ISP medical staff is equipped to address inmates' medical concerns. The District Court noted that Long's demand for the ability to cross-dress is a preference for personal expression within prison rather than a necessary medical treatment. Long's history of refusing psychological evaluations over the past twenty years led the court to conclude that he failed to demonstrate that prison officials were deliberately indifferent to his condition.

The District Court concluded that prison officials did not exhibit deliberate indifference to Long's gender-identity disorder, rendering the issue of their qualified immunity unnecessary for consideration. Although a psychological disorder can be a serious medical need, and prior cases have recognized transsexualism as such, the court noted that Long is not a transsexual, which impacts the applicability of the precedent set in White v. Farrier. The District Court also found that the other defendants were justified in relying on the medical staff's opinions when denying Long's requests to cross-dress. Long's assertion in his Reply Brief that his anxiety and depression are serious medical needs requiring cross-dressing treatment was not considered, as it was introduced too late in the process. The only serious psychological issue recognized in Long's amended complaint was his gender-identity disorder. Additionally, the institution has three full-time psychologists who can refer inmates to a licensed psychiatric hospital or outside specialists for further evaluation and treatment.