IN THE UNITED STATES DISTRICT COURT

CENTRAL DISTRICT OF ILLINOIS

URBANA DIVISION


NAYA GRACE TAYLOR,
Plaintiff,
v.
AJA LYSTILA, M.D.,
CARLE HEALTH CARE
INCORPORATED, an Illinois
corporation, d/b/a CARLE
PHYSICIAN GROUP,
CARLE FOUNDATION PHYSICIAN
SERVICES, LLC, and
THE CARLE FOUNDATION, an
Illinois corporation,
Defendants.
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Civil Action No. 2:14-cv-2072

Equitable Relief Is Sought




COMPLAINT

Plaintiff NAYA GRACE TAYLOR ( Plaintiff) for her Complaint against
Defendants AJA LYSTILA, M.D., CARLE HEALTHCARE INCORPORATED, d/b/a
CARLE PHYSICIAN GROUP, CARLE FOUNDATION PHYSICIAN SERVICES,
LLC, and THE CARLE FOUNDATION (collectively, Defendants), alleges the
following:
PRELIMINARY STATEMENT
1. This action seeks injunctive and declaratory relief, as well as damages,
to halt Defendants discrimination on the basis of Plaintiffs sex in violation of
section 1557(a) (Section 1557(a)) of the Patient Protection and Affordable Care Act
(codified at 42 U.S.C. 18116(a)) (Affordable Care Act). Specifically, Plaintiff
E-FILED
Tuesday, 15 April, 2014 02:59:14 PM
Clerk, U.S. District Court, ILCD
2:14-cv-02072-CSB-JEH # 1 Page 1 of 11

Taylor v. Lystila
Plaintiffs Original Complaint 2

seeks redress for Defendants violation of federal law by denying Plaintiff health
care services because she is a transgender woman.
JURISDICTION AND VENUE
2. This Court has subject matter jurisdiction pursuant to 28 U.S.C.
1331 because this action arises under section 1557(a) of the Affordable Care Act,
42 U.S.C. 18116(a).
3. Venue is proper in this district pursuant to 28 U.S.C. 1391 because
one or more of the Defendants reside in the Central District of Illinois and because
all or a substantial part of the events giving rise to the claims in this action
occurred and are occurring in the Central District of Illinois.
4. This matter is properly brought in the Urbana Division because the
entity Defendants are principally located in Champaign County, the Defendant
doctor maintains an office in Coles County, and the Plaintiff resides in Coles
County. Further, a substantial part of the events giving rise to the claims in this
action occurred and are occurring in Coles County.
5. Declaratory relief is authorized pursuant to 28 U.S.C. 2201 and 28
U.S.C. 2202. A declaration of the law is necessary and appropriate to determine
the respective rights and duties of the parties to this action.

PARTIES
6. Plaintiff Naya Grace Taylor (Naya) is a transgender woman who is a
citizen of Illinois residing in Mattoon.
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Taylor v. Lystila
Plaintiffs Original Complaint 3

7. Defendant Aja Lystila, M.D. (Dr. Lystila) is a citizen of Illinois who
maintains an office at 2512 Hurst Drive, Mattoon, IL 61938. Dr. Lystila is a medical
doctor licensed by the State of Illinois and board certified in Family Medicine by the
American Board of Family Medicine.
8. Defendant Carle Health Care Incorporated, d/b/a Carle Physician
Group, (the Physician Group) is a not-for-profit corporation organized under the
laws of the State of Illinois with its principal place of business at 611 W. Park,
Urbana, IL 61801. It may be served with process through its registered agent,
James C. Leonard, at the same address.
9. Defendant Carle Foundation Physician Services, LLC (Physician
LLC) is a domestic limited liability company organized under the laws of the State
of Illinois with its principal place of business at 611 W. Park, Urbana, IL 61801. It
may be served with process through its registered agent, James C. Leonard, at the
same address.
10. Defendant The Carle Foundation (Foundation) is a not-for-profit
corporation organized under the laws of the State of Illinois with its principal place
of business at 611 W. Park, Urbana, IL 61801. It may be served with process
through its registered agent, James C. Leonard, at the same address.
11. The Foundation is an integrated group of health care services (Carle
Group) that includes, as its subsidiaries (or otherwise related entities), the
Physician Group and the Physician LLC. The Carle Group provides its services
under the umbrella designation Carle and its logo, not readily identifying which
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Taylor v. Lystila
Plaintiffs Original Complaint 4

entities are participating in providing particular services. Upon information and
belief, Dr. Lystila is affiliated professionally with one or more of the entity co-
defendants.
12. Defendants provide health care services or participate in healthcare-
related programs or activities, at least a part of which directly or indirectly receive
federal financial assistance, including Medicaid and Medicare.

FACTS
13. Gender identity is a deeply-rooted, internal psychological identification
as male or female. According to contemporary medical knowledge and the consensus
among experts in the field, gender identity cannot be changed and attempts to
change a persons gender identity are futile and unethical.
14. Although Naya Grace Taylor (Naya) was assigned the sex of male at
birth, she has a strong, consistent and deeply-rooted female gender identity. Naya
has gender dysphoria, formerly known as Gender Identity Disorder and sometimes
known as transsexualism.
15. Gender dysphoria is a recognized, serious medical condition identified
in the American Psychiatric Associations Diagnostic and Statistical Manual of
Mental Disorders (5th ed. 2013) (DSM-V).
16. The DSM-Vs diagnostic criteria for gender dysphoria are evidence of a
marked difference between the individuals expressed/experienced gender and the
gender others would assign him or her, and it must continue for at least six months.
2:14-cv-02072-CSB-JEH # 1 Page 4 of 11

Taylor v. Lystila
Plaintiffs Original Complaint 5

This condition causes clinically significant distress or impairment in social,
occupational, or other important areas of functioning.
17. Naya can recall having identified strongly as female since she was four
years old.
18. The World Professional Association for Transgender Health
(WPATH) is the leading professional association for surgeons, doctors, medical
researchers and others who specialize in the medical treatment of people with
gender dysphoria. Based on decades of clinical experience and research, WPATH
has promulgated medical standards of care for treating patients with gender
dysphoria.
19. The WPATH Standards of Care for Gender Identity Disorders
(Standards of Care) recognize that treatment is medically necessary for most
people with gender dysphoria. The Standards of Care provide for an individualized
assessment of medically necessary treatment for gender dysphoria. The components
of treatment may include the administration of hormone therapy; real-life
experience (living full-time presenting in the gender corresponding with the
persons gender identity); psychotherapy for purposes such as exploring gender
identity, role, and expression; and sex reassignment surgery.
20. Naya has been receiving health care related services from the Mattoon
clinic associated with the Carle Group for more than a decade. Until just recently,
Naya had been seeing Dr. Lystila as her primary health care provider at the clinic.
2:14-cv-02072-CSB-JEH # 1 Page 5 of 11

Taylor v. Lystila
Plaintiffs Original Complaint 6

The job of primary care physicians is to look after the overall health of their
patients.
21. In early 2013, after consulting with a licensed social worker who
counseled Naya that she was ready to begin hormone treatment, Naya decided to
seek female hormone therapy.
22. Naya ordered hormones herself on the internet and began self-
administering them without doctor supervision.
23. Self-administering feminizing endocrine agents, whether prescribed by
a clinician or obtained through other means such as internet purchase, can pose
risks to ones health if not appropriately monitored by a medical professional.
24. Naya approached Dr. Lystila about the treatment that had been
recommended, but Dr. Lystila refused her treatment because Dr. Lystila claimed
that she was not experienced in providing hormone treatments to transgender
patients.
25. When transgender patients present for care already taking feminizing
endocrine agents, a primary care clinician who is uncomfortable providing long-
term endocrine therapy should, at a minimum, provide a bridging prescription for
hormones while assisting the patient in finding a clinician who can provide access to
long-term care. The patients current regimen should be assessed for safety and
drug interactions, with safer medications or doses suggested when indicated.
26. In fall of 2013 at the request of a physician specialist Naya was also
seeing at the clinic, Naya asked Dr. Lystila to perform blood work to check her
2:14-cv-02072-CSB-JEH # 1 Page 6 of 11

Taylor v. Lystila
Plaintiffs Original Complaint 7

hormone levels. Although Dr. Lystila permitted her physicians assistant to draw
Nayas blood and order the results, she indicated they would not provide any
further blood work or monitoring in connection with Nayas transition-related care,
including hormone treatments or monitoring.
27. Upon information and belief, Dr. Lystila and other doctors at the clinic
regularly monitor the hormone levels of cisgender
1
patients.
28. Later in October 2013, Naya requested a prescription for transition-
related hormones on an emergency basis when her hormone delivery from the
internet was delayed. Dr. Lystila refused, claiming that no one at Carle was trained
in this type of hormone replacement.
29. In reality, many of the screening tasks involved in long-term hormone
maintenance fall within the scope of primary care rather than specialist care. Even
a primary care provider who has no experience with transgender health should be
able to manage endocrinologic manipulation of secondary sex characteristics with
the ability to consult an endocrinologist. Upon information and belief, the Carle
Groups clinics in Mattoon/Charleston have doctors who specialize in endocrinology,
gynecology, and womens services.
30. The prospect of abruptly discontinuing hormone therapy posed a
significant risk to Nayas health and caused her great distress.
31. Dr. Lystila has consistently refused to provide Naya any transition-
related care.

1
Cisgender is a term used to describe a person whose self-identity conforms with the gender that
corresponds to the sex he or she was assigned at birth i.e., someone who is not transgender.
2:14-cv-02072-CSB-JEH # 1 Page 7 of 11

Taylor v. Lystila
Plaintiffs Original Complaint 8

32. When Naya protested to the clinic that she was being denied
transition-related care by the clinic, she was told that the clinic did not have to
treat people like you.
33. After pursing the issue, Dianne Kauffman with the Carle Groups
clinic in Mattoon/Charleston told Naya that, because the clinic has Middle Eastern
doctors and they have religious beliefs, they do not have to treat people like you.

CLAIM FOR RELIEF
(Discrimination because of sex in violation
of section 1557(a) of the Affordable Care Act)
34. Plaintiff realleges and incorporates, as though fully set forth herein,
each and every allegation contained above.
35. To ensure equal access to health care under the Affordable Care Act,
Congress placed robust antidiscrimination requirements on health care providers
that profit from the billions of federal dollars flowing into the health care market.
36. One such safeguard is Section 1557(a), the non-discrimination
provision which expressly prohibits health care providers that receive federal funds,
as do Defendants, from discriminating against any individual on the basis of sex for
purpose of providing health services. Indeed, Section 1557(a) is the first federal civil
rights law to prohibit sex discrimination in health care.
37. More specifically, Section 1557(a) provides that [A] n individual shall
not, on the ground prohibited under title IX of the Education Amendments of
1972 (20 USC 1681 et seq.) be excluded from participation in, be denied benefits
of, or be subjected to discrimination under, any health program or activity, any part
2:14-cv-02072-CSB-JEH # 1 Page 8 of 11

Taylor v. Lystila
Plaintiffs Original Complaint 9

of which is receiving Federal financial assistance, including credits, subsidies or
contracts of insurance, or under any program or activity that is administered by an
Executive Agency or any entity established under this title (or amendments). The
enforcement mechanisms provided for and available under title IX shall apply
for purposes of violations of this subsection.
38. Section 1557(a)s sex discrimination prohibition extends to claims of
discrimination based on gender identity or failure to conform to stereotypical
notions of masculinity or femininity.
39. The Office of Civil Rights of the Department of Health and Human
Services has confirmed that, because sex, as it is used in this context, includes
gender identity, transgender individuals are entitled to protection against
discrimination in access to health care.
40. Defendants meet the qualifications for being a health program or
activity, any part of which is receiving Federal financial assistance under Section
1557(a).
41. Cisgender women similarly situated to Naya would not have been
denied hormone monitoring and treatment by the Carle Group and its physicians.
42. Defendants have violated and continue to violate Section 1557(a) of the
Affordable Care Act by intentionally causing Plaintiff to be excluded from
participation in, be denied the benefits of, or be subjected to discrimination under,
any health program or activity, any part of which is receiving Federal financial
2:14-cv-02072-CSB-JEH # 1 Page 9 of 11

Taylor v. Lystila
Plaintiffs Original Complaint 10

assistance based on sex, which is a prohibited ground of discrimination under Title
IX.
43. Plaintiff has been aggrieved by this violation of Section 1557(a) in the
denial of necessary medical care.
44. Declaratory and injunctive relief is required to define Nayas rights
under Section 1557(a), to remedy the Defendants violation of Section 1557(a), and
to secure ongoing compliance with the antidiscrimination provisions of the
Affordable Care Act.
45. Plaintiff has been harmed as a result of Defendants conduct and is
entitled to compensatory damages.

PRAYER FOR RELIEF
WHEREFORE, Plaintiff respectfully requests the Court to enter an Order
(a) Declaring that Defendants conduct in denying transition-related care
to Plaintiff Naya Grace Taylor because of her sex and transgender
status violates non-discrimination provisions of the Affordable Care
Act;
(b) Enjoining Defendants from denying transition-related care to Plaintiff
Naya Grace Taylor because of her sex and transgender status;
(c) Awarding damages in accordance with the proof presented;
(d) Awarding reasonable attorneys fees and costs pursuant to 42 U.S.C.
1988(b); and
(e) Awarding other equitable and further relief as the Court deems just
and proper.

2:14-cv-02072-CSB-JEH # 1 Page 10 of 11

Taylor v. Lystila
Plaintiffs Original Complaint 11

Dated: April 15, 2014 Respectfully submitted,

LAMBDA LEGAL DEFENSE AND
EDUCATION FUND, INC.

by: /s/ Kenneth Dale Upton, Jr.
Kenneth Dale Upton, Jr.
Lead Counsel

KENNETH DALE UPTON, JR.
3500 Oak Lawn Avenue, Suite 500
Dallas, TX 75219
Telephone: (214) 219-8585
Facsimile: (214) 219-4455
E-mail: kupton@lambdalegal.org
-and-
CHRISTOPHER R. CLARK
105 West Adams, Suite 2600
Chicago, IL 60603
Telephone: (312) 663-4413
Facsimile: (312) 663-4307
E-mail: cclark@lambdalegal.org
-and-
M. DRU LEVASSEUR
120 Wall Street, 19th Floor
New York, NY 10005-3919
Telephone: (212) 809-8585
Facsimile: (212) 809-0055
Email: dlevasseur@lambdalegal.org

ATTORNEYS FOR PLAINTIFF
NAYA GRACE TAYLOR


CERTIFICATE OF SERVICE

This is the Original Complaint. Waiver of service will be requested for each
defendant in accordance with Fed. R. Civ. P. 4(d)(1)(A) or, in the absence of waiver,
Summons will be served as further required by that rule.
_____s/ Kenneth Dale Upton, Jr. __
2:14-cv-02072-CSB-JEH # 1 Page 11 of 11

JS 44 (Rev. 12/12)
CIVIL COVER SHEET
The JS 44 civil cover sheet and the inIormation contained herein neither replace nor supplement the Iiling and service oI pleadings or other papers as required by law, except as
provided by local rules oI court. This Iorm, approved by the Judicial ConIerence oI the United States in September 1974, is required Ior the use oI the Clerk oI Court Ior the
purpose oI initiating the civil docket sheet. (SEE INSTRUCTIONS ON NEXT PAGE OF THIS FORM.)
I. (a) PLAINTIFFS DEFENDANTS
(b) County oI Residence oI First Listed PlaintiII County oI Residence oI First Listed DeIendant
(EXCEPT IN U.S. PLAINTIFF CASES) (IN U.S. PLAINTIFF CASES ONLY)
NOTE: IN LAND CONDEMNATION CASES, USE THE LOCATION OF
THE TRACT OF LAND INVOLVED.

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II. BASIS OF JURISDICTION (Place an X in One Box Only) III. CITIZENSHIP OF PRINCIPAL PARTIES (Place an X in One Box for Plaintiff
(For Diversity Cases Only) and One Box for Defendant)
u 1 U.S. Government u 3 Federal Question PTF DEF PTF DEF
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oI Business In This State
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CONTRACT TORTS FORFEITURE/PENALTY BANKRUPTCY OTHER STATUTES
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u 120 Marine u 310 Airplane u 365 Personal Injury - oI Property 21 USC 881 u 423 Withdrawal u 400 State Reapportionment
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u 153 Recovery oI Overpayment Liability PERSONAL PROPERTY u 710 Fair Labor Standards u 861 HIA (1395II) u 850 Securities/Commodities/
oI Veteran`s BeneIits u 350 Motor Vehicle u 370 Other Fraud Act u 862 Black Lung (923) Exchange
u 160 Stockholders` Suits u 355 Motor Vehicle u 371 Truth in Lending u 720 Labor/Management u 863 DIWC/DIWW (405(g)) u 890 Other Statutory Actions
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u 448 Education u 555 Prison Condition
u 560 Civil Detainee -
Conditions oI
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u 1 Original
Proceeding
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Cite the U.S. Civil Statute under which you are Iiling (Do not cite jurisdictional statutes unless diversity):

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(See instructions):
JUDGE DOCKET NUMBER
DATE SIGNATURE OF ATTORNEY OF RECORD
FOR OFFICE USE ONLY
RECEIPT # AMOUNT APPLYING IFP JUDGE MAG. JUDGE
Naya Grace Taylor
Coles, IL
Kenneth D. Upton, Jr.
LAMBDA LEGAL DEFENSE AND EDUCATION FUND, INC.
3500 Oak Lawn Avenue, Suite 500, Dallas, TX 75219; 214-219-8585
Aja Lystila, M.D., Carle Health Care Incorporated, Carle Foundation
Physician Services, LLC, and The Carle Foundation
42 U.S.C. 18116(a)
Discrimination based on sex under Section 1557 of the Patient Protection and Affordable Care Act
Injunctive Relief
04/15/2014 s/ Kenneth Dale Upton, Jr.
E-FILED
Tuesday, 15 April, 2014 02:59:14 PM
Clerk, U.S. District Court, ILCD
2:14-cv-02072-CSB-JEH # 1-1 Page 1 of 1