Williams v. Kincaid et al.

ADAGender DysphoriaGender Affirming CareRehabilitation ActGross NegligenceVirginiaFourth CircuitSupreme CourtPrisonEighth AmendmentFourteenth AmendmentFailure to Accommodate

May 28

Written By Mack Karbon

Fourth Circuit Court of Appeals

On appeal from the U.S. District Court for the Eastern District of Virginia

CITATION: Williams v. Kincaid, 45 F.4th 759 (4th Cir. 2022), cert. denied, 143 S. Ct. 2414 (2023).

Case no. 1:20-cv-01397-CMH-IDD (E.D. VA)
Case no. 21-2030 (4th Cir.)
Case no. 22–633 (Sup. Ct)

STATUS: CLOSED

Case Summary

Kesha Williams, a transgender woman with gender dysphoria, spent six months incarcerated in the Fairfax County Adult Detention Center. Though prison deputies initially assigned her to women’s housing, they quickly moved her to men’s housing when they learned that she was transgender. There, she experienced delays in medical treatment for her gender dysphoria, extreme harassment by other inmates, and persistent and intentional misgendering and harassment by prison deputies. Williams’ requests for some accommodations — to shower privately and for body searches to be conducted by a female deputy — were denied. One deputy threatened to place her in solitary confinement if she resisted a search by a male deputy. Male inmates also harassed Williams, causing her to fear for her safety throughout her incarceration.

Following her release from the detention center, Williams filed a Sec. 1983 action against the Sheriff of Fairfax County, a prison deputy, and a prison nurse alleging violations of the Americans with Disabilities Act (“ADA”), the Rehabilitation Act, the United States Constitution, and state common law.

Defendants moved to dismiss Ms. Williams’ complaint. Specifically, they alleged that gender dysphoria is not a disability under the ADA because “it is an identity disorder not resulting from physical impairments.” The rationale for this argument is best explained in Ms. Williams’ opening brief before the Fourth Circuit:

In 1990, Congress chose to expressly exclude from its definition of “disability” in Americans with Disabilities Act “gender identity disorders not resulting from physical impairments, or other sexual behavior disorders.” 42 U.S.C. Sec. 12111(b)(1). Pursuant to the language of the statute, the exclusion does not apply to all gender identity disorders, but only those that do not result from physical impairments.

The district court agreed with the defendants and dismissed Ms. Williams complaint in its entirety. Ms. Williams appealed to the Fourth Circuit Court of Appeals.

The question before the Fourth Circuit was whether an individual with gender dysphoria must allege their condition resulted from a physical impairment to show they are a qualified individual with a disability under the ADA. This was a question of first impression for the federal appellate courts.

In her opening brief, Ms. Williams argued that “gender dysphoria” and “gender identity disorders” are wholly distinct. This is most strongly supported by the fact that, when the DSM was re-published in 2013, “gender identity disorder” had been removed and replaced by “gender dysphoria.” Ms. Williams explains:

Where gender identity disorder defined gender nonconformity itself as a medical condition, gender dysphoria is a clinical diagnosis that recognizes being transgender is not a medical condition – rather, the medical condition is the distress caused by having a gender identity that differs from one’s birth sex. [...] Notably, the diagnosis of gender dysphoria in DSM-V requires attendant disabling symptoms or manifestations of clinically significant emotional distress.

In sum, gender dysphoria, by its definition, is necessarily understood as a disabling condition that results in clinically significant impairment of major life activities. It is substantially different from the outdated diagnosis of gender identity disorder that existed at the time the exclusion in 42 U.S.C. Sec. 12211(b)(1) was drafted.

Ms. Williams further argued that, even if the court were to find that gender dysphoria was a “gender identity disorder,” there is an established physical basis for gender dysphoria that places it outside the category of “gender identity disorders not resulting from physical impairments.” The district court therefore erred in finding that Ms. Williams was required to plead additional facts demonstrating physical impairment, where such impairment is inherently a part of the condition.

FOURTH CIRCUIT DECISION

On August 16, 2022, the Fourth Circuit handed down the landmark decision reversing the district court’s decision and remanding the case for further proceedings. The court found that gender dysphoria was not a “gender identity disorder” for the purposes of ADA Sec. 12211(b)(1). Judge Diana Gribbon Motz, writing for the three-judge panel, powerfully rebuffed the district court and the defendants, stating:

Put simply, while the older DSM pathologized the very existence of transgender people, the recent DSM-5’s diagnosis of gender dysphoria takes as a given that being transgender is not a disability and affirms that a transgender person’s medical needs are just as deserving of treatment and protection as anyone else’s. [...] [N]othing in the ADA, then or now, compels the conclusion that gender dysphoria constitutes a “gender identity disorder” excluded from ADA protection. For these reasons, we agree with Williams that, as a matter of statutory construction, gender dysphoria is not a gender identity disorder.

The majority also agreed that Ms. Williams plausibly pled that her gender dysphoria resulted from a “physical impairment,” thus providing a secondary basis for the decision that the district court erred in finding that gender dysphoria is excluded from the definition of disability.

Judge Quattlebaum, dissenting from the majority’s decision on this issue, wrote to express his belief that gender dysphoria must constitute a “gender identity disorder” because, as defined by the outdated DSM-III-R, a diagnosis of gender identity disorder required evidence of “[p]ersistent discomfort and [a] sense of inappropriateness about one’s assigned sex.” He reasoned that this sense of “[p]ersistent discomfort” echoes the distress that defines a diagnosis of gender dysphoria under the DSM-5.

In the words of Judge Motz, “this contention simply misses the point.” Equating gender dysphoria and gender identity disorder “is like equating the now-obsolete diagnosis of hysteria with the modern diagnosis of general anxiety disorder simply because they share a common diagnostic criterium.”

The majority further reversed the district court’s holding that some of Ms. Williams’ claims were time-barred, and the holding that Ms. Williams failed to state a claim for gross negligence. With respect to the latter, the court found that the prison’s policy of segregating inmates by genitalia contravenes federal law - specifically the Prison Rape Elimination Act, which mandates that, when determining housing arrangements for transgender inmates, prison officials must “consider on a case-by-case basis whether placement would ensure the inmate’s health and safety, and whether the placement would present management or security problems.”

The Fourth Circuit’s decision reversed the district court’s determinations in their entirety. This was a resounding victory for Ms. Williams, and for trans and gender non-conforming individuals everywhere, who are more likely to suffer abuse and discriminatory mistreatment by law enforcement officials and agencies.

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PETITION FOR REHEARING EN BANC

Defendants petitioned the court for rehearing en banc, which the court DENIED on Oct 7, 2022. Judge Quattlebaum dissented from the decision, writing that, “With the stroke of a pen, we have judicially modified the Americans with Disabilities Act in a way that ignores the law that Congress enacted and the President signed into law 32 years ago.” Judge Wynn, writing for the majority, defended the decision denying rehearing and the panel’s decision in Williams. Regarding Judge Quattlebaum’s allegation, Judge Wynn countered that the Fourth Circuit “faithfully applied Congress’s mandate to construe the ADA broadly, and thus its exclusions narrowly. In interpreting the exclusion from coverage, the majority did not simply rely on changing definitions or societal norms; it looked to what Congress had meant by the exclusion in 1990 and concluded that Williams’s diagnosis did not fall within that meaning.”

Defendants appealed to the Supreme Court of the United States, which on June 30, 2023, DENIED cert over a dissent from Justice Alito. Today, the Fourth Circuit’s landmark opinion remains strong and intact.

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For reasons unknown, upon remand, the parties jointly stipulated to the dismissal of all of Ms. Williams claims with prejudice, which was ORDERED by the district court on November 16, 2023. The case is now closed.