Sebastian Kothmann is a female who identifies as a man. From April 13, 2010, until April 23, 2011, Kothmann was incarcerated in the Lowell Correctional Institution (LCI), a female prison operated by the Florida Department of Corrections, where Luz Rosario was employed as the Chief Health Officer. Six years prior to his incarceration at LCI, Kothmann was diagnosed with Gender Identity Disorder (GID). In addition to receiving hormone therapy, Kothmann underwent a number of surgical procedures—a hysterectomy, oophorectomy, and double mastectomy— as part of his medical treatment for GID. Upon arrival at LCI, Kothmann informed medical staff of his diagnosis and ongoing sex reassignment therapy. Rosario denied the request and Kothmann sued.
Rosario filed a motion to dismiss or, in the alternative, a motion for summary judgment. With respect to the motion to dismiss, the district court determined that Kothmann’s complaint alleged that Rosario had refused Kothmann treatment for his GID, which was sufficient to state a plausible claim that Rosario violated Kothmann’s clearly established Eighth Amendment rights. The district court denied Rosario’s alternative summary judgment motion without prejudice as premature. Rosario appealled to the U.S. Court of Appeals for the 8th Circuit. On appeal, Rosario argues that she deserves qualified immunity because no law clearly establishes that inmates have a right to receive hormone therapy as treatment for GID, because Kothmann has failed to allege facts showing Rosario was deliberately indifferent to Kothmann’s serious medical needs, and because Florida Department of Corrections policy prohibited Rosario from prescribing hormones to Kothmann.
The 11th Circuit affirmed the refusal to dismiss the case, noting that it is well settled in the 11th Circuit that intentionally refusing to provide medically necessary treatment constitutes deliberate indifference and violates the Eighth Amendment. For purposes of the motion to dismiss, the court accepted as true the complaint’s allegations that Rosario knew hormone treatment to be the accepted, medically necessary treatment for Kothmann’s GID. Thus, at the time of Kothmann’s incarceration in 2010, the state of the law was sufficiently clear to put Rosario on notice that refusing to provide Kothmann with what she knew to be medically necessary hormone treatments was a violation of the Eighth Amendment.