Gender Dysphoria Covered by Disability Act, Federal Court Rules

RICHMOND, Va. — A federal ruling that gender dysphoria is covered under the Americans with Disabilities Act could help block conservative political efforts to restrict access to gender-affirming care, advocates and experts say.

A panel of the 4th U.S. Circuit Court of Appeals last week became the first federal appeals court in the nation to find that landmark 1990 federal law protects transgender people who experience anxiety and distress. other symptoms due to the disparity between their assigned sex and gender identity.

The ruling could become a powerful tool to challenge legislation restricting access to medical care and other accommodations for transgender people, including employment and government benefits, advocates said.

“This is a very important and positive decision to increase people’s access to gender-affirming care,” said Rodrigo Heng-Lehtinen, executive director of the National Center for Transgender Equality.

The ruling is binding in states covered by the Richmond-based 4th Circuit — Maryland, North Carolina, South Carolina, Virginia and West Virginia — but will inevitably be cited in cases in other states, Kevin Barry said. professor of law at Quinnipiac University. .

The decision came in the case of a transgender woman who sued the sheriff of Fairfax County in Virginia for harboring her in a jail with men. The decision is not limited to transgender people challenging prison policies, but also broadly applies to all areas of society covered by the Disability Rights Act, including employment, government benefits and services and public housing, Barry said.

“This decision de-stigmatized a health issue – gender dysphoria – and it says what Congress did in 1990 was not OK,” Barry said.

The sheriff’s office did not respond to phone messages seeking comment.

Some Republican leaders who have led efforts to limit access to transitional treatment for young people have called it a form of child abuse. Texas Governor Greg Abbott, for example, this year ordered the state’s child welfare agency investigate reports of gender-affirming care for children as abuse.

A new rule in Florida limits Medicaid coverage for treatments of gender dysphoria in youth and adults. The public health agency previously released a report saying puberty blockers, cross-sex hormones and sex reassignment surgery have not been shown to be safe or effective in treating gender dysphoria.

And Florida Governor Ron DeSantis, who is widely touted as a potential 2024 Republican presidential candidate, recently tweeted that children shouldn’t be able to take puberty blockers “or mutilate their bodies by changing their gender.”

But major medical entities contradict those positions, Heng-Lehtinen said.

“This health care is politically under attack in much of the country, but medically all of the credible professionals involved – the American Psychiatric Association, the American Medical Association and others – have all recognized for years that it is ‘is basically about primary care,’ Heng -Lehtinen said.

In the case before the 4th Circuit, Kesha Williams was first assigned to live on the women’s side of the Fairfax County Jail when she arrived in 2018.

Williams told the nurse that she was transgender, suffered from gender dysphoria and had received hormone treatments for the past 15 years. But after explaining that she had not undergone genital surgery, she said, she was assigned to the men’s section under a policy that inmates must be classified according to their organs. genitals.

In her lawsuit, Williams said she was harassed and her prescribed hormone medication repeatedly delayed or ignored. Deputies ignored her requests to refer to her as a woman and instead referred to her as “sir”, “sir”, “he” or “sir”, she said. Her requests for a private shower and body searches by a female MP were denied, she said.

A federal judge granted a motion by the sheriff’s office to dismiss the lawsuit, ruling that because the Americans with Disabilities Act excluded “gender identity disorders not resulting from physical impairments,” Williams could not sue. under the law.

A panel of three 4th Circuit judges reversed that decision, sending the case back to the United States District Court.

The 4th Circuit panel said in its August 16 decision that there is a distinction between gender identity disorder and gender dysphoria. The court cited advances in medical understanding that led the American Psychiatric Association to remove gender identity disorder from the current Diagnostic and Statistical Manual of Mental Disorders and add gender dysphoria, defined in the textbook as the “clinically significant distress” experienced by some transgender people. . Symptoms can include intense anxiety, depression, and suicidal ideation.

The modern diagnosis of gender dysphoria “affirms that the medical needs of a transgender person are just as deserving of treatment and protection as those of anyone else,” Judge Diana Gribbon Motz wrote in the opinion. majority.

Judge A. Marvin Quattlebaum Jr. dissented in part.

“Whether we focus on when Congress passed the ADA or look beyond today, the distinction Williams attempts to make between gender identity disorder and gender dysphoria fails” , Quattlebaum wrote.

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