Prisoners seek injunction, class action in NC gender transition suit

Prisoners challenging North Carolina’s ban on funding for their gender transition procedures are seeking an injunction and class action in their federal lawsuit.

Meanwhile, a US magistrate judge has granted top legislative leaders’ request to intervene in the case. Lawmakers will defend the ban approved last year in House Bill 805.

Five inmates initially filed suit in February against the secretary and medical director of the North Carolina Department of Adult Correction. A court filing Wednesday officially asked for the case to be treated as a class-action lawsuit.

The class would cover “all current and future people in DAC custody who have or will have gender dysphoria, and have been prescribed or may require cross-sex hormone therapy or gender-affirming surgery to treat gender dysphoria,” according to a memorandum supporting the motion. “Joinder of all individual class members is impracticable because there are likely dozens of putative class members in state custody, the class’s fluid composition will fluctuate day to day, and the class contains future members who cannot be identified now.”

A separate motion seeks an injunction blocking HB 805’s provisions.

“In 2024, this Court held that Defendants violated the Eighth Amendment by imposing a de facto ban on gender-affirming surgery for state prisoners suffering from gender dysphoria,” the prisoners’ lawyers wrote. “By categorically prohibiting potentially necessary medical treatment, Defendants failed to provide ‘the individualized medical evaluation the Eighth Amendment requires.’”

“Now the state legislature has effectively codified this surgery ban and restricted the use of hormone therapy, a treatment that the North Carolina Department of Adult Correction (DAC) has long recognized may be medically necessary to treat gender dysphoria,” the court filing continued. “This statute, known as HB805, prohibits state funds from being ‘used, directly or indirectly, for the performance of or in furtherance of surgical gender transition procedures, or to provide puberty-blocking drugs or cross-sex hormones to any prisoner’ in state custody. These treatments are only permitted if a patient would suffer ‘imminent physical harm.’”

The plaintiff prisoners “are currently prescribed hormone therapy, and some are candidates for gender-affirming surgery,” their lawyers wrote. “They have faced abrupt stoppages in their hormone therapy since the law’s passage and experienced predictable suffering as a result. Their requests for surgery have been summarily denied.”

The prisoners are citing the Eighth Amendment in seeking an injunction against the ban in HB 805. “Plaintiffs are not asking the Court to order any particular course of treatment for any particular person,” the court filing explained. “They are simply asking that their serious medical condition – gender dysphoria – be treated according to medical necessity like any other condition.”

US Magistrate Judge Carleton Metcalf issued an order Thursday allowing top legislative leaders to intervene in the case. Lawmakers filed a March 6 motion in the case Kwiatkowski v. Dismukes.

“[T]he presence of executive-branch named defendants — here, officials of the North Carolina Department of Adult Correction — does not adequately represent the legislative branch’s unique interests in defending the challenged law,” lawmakers’ lawyers wrote in a memorandum supporting the motion.

The lawsuit filed in February challenges provisions of HB 805, approved in 2025 over Gov. Josh Stein’s veto.

“Plaintiffs’ complaint alleges that North Carolina’s law prohibiting the use of state funds for gender transition procedures for prisoners incarcerated in North Carolina state prisons … violates the Eighth Amendment of the United States Constitution,” according to the court filing. “Plaintiffs seek a declaration that the challenged Statute violates the Eighth Amendment and preliminary and permanent injunctions forbidding the statute’s full implementation or enforcement.”

Lawmakers cited the US Supreme Court’s 2022 decision in Berger v. North Carolina State Conference of the NAACP. That precedent allowed legislative leaders to intervene in a federal lawsuit challenging the state’s voter identification law.

“The same structural incentives that undergirded the Supreme Court’s conclusion in Berger that ‘different officials’ are likely to advance ‘different interest and perspectives’ apply equally here,” lawmakers’ lawyers wrote. “Indeed, Governor Josh Stein vetoed the very legislation that Plaintiffs challenge, which was enacted only because the General Assembly overrode his veto. And the named defendants are politically accountable to Governor Stein: he has the power to appoint the heads of principal departments, including the Secretary of the North Carolina Department of Adult Correction.”

“Just as in Berger, then, Proposed Intervenors are entitled to intervene and advance their distinct interest in ‘defending the law vigorously on the merits without an eye to crosscutting administrative concerns,’” the court filing explained.

In a separate document answering the complaint, lawmakers object to class certification that would extend the lawsuit beyond the five named plaintiffs: AJ Kwiatkowski, Ashlee Inscoe, Pumpkin Snuggs, Lulubell Frazier, and Tremayne Izzard.

Lawmakers argue that the suit “fails to state a claim upon which relief can be granted and should be dismissed” and that its claims “are barred, in whole or in part, by lack of standing, ripeness, or mootness.”

“There is medical uncertainty concerning the proper treatment of gender dysphoria, and the North Carolina Legislature has authority to regulate the treatment of gender dysphoria,” lawmakers’ lawyers argued.

“HB 805 constitutes a valid exercise of the State’s legislative authority over appropriations and correctional administration,” the court filing continued. “HB 805 is rationally related to legitimate governmental interests, including (1) allocation of limited public resources, (2) regulation of public expenditures, (3) correctional administration, (4) and the State’s authority to define publicly funded medical care.”

“Federal courts must afford substantial deference to legislative judgments concerning correctional policy and public expenditures,” lawmakers’ lawyers added.

The plaintiffs face the “imminent loss of essential healthcare” due to HB 805, according to the initial complaint filed on Feb. 6. The law prohibits the use of state funds for surgical gender transition procedures, puberty-blocking drugs, and cross-sex hormones for any prisoner in the state system.

“HB805 only permits gender-affirming hormone therapy or surgery if, absent that treatment, a patient will experience ‘imminent physical harm,’ with no consideration of a patient’s mental or behavioral health or longer-term physical consequences. It provides no exceptions for a patient’s mental health,” the lawsuit continued.

“HB805 presents a medically unjustified barrier to gender-affirming medical care in North Carolina prisons regardless of an individual patient’s needs,” the plaintiffs’ lawyers wrote. “To allow gender-affirming care only when a patient faces imminent physical harm is a gross departure from the standard of care and has no basis in sound medical practice.”

“Prisoners seek injunction, class action in NC gender transition suit” was originally published on www.carolinajournal.com.