Supreme Court of Alaska Rejects State's Request to Involuntarily Shave Head of Inmate With Lice, Finding Hairstyle is an Important Component of Identity and Self-Expression

How should a court handle a State's request to shave the head of a non-consenting inmate with lice? That was the question of first impression addressed by the Supreme Court of Alaska in its recent opinion in Matter of Lila B., 2025 WL 1272921 (Alaska 2025).

In Lila B., 

A police officer detained Lila B. on an emergency basis for a mental health evaluation and transported her to a correctional center. Several days later the Department of Corrections petitioned for an order authorizing Lila's hospitalization for evaluation....A superior court master issued the order, and after another three days Lila was transferred to the Alaska Psychiatric Institute (API) for evaluation.

API staff saw that Lila was suffering from a severe infestation of head lice, and they decided she should stay in the hospital admissions area until the infestation could be treated. Staff members encouraged her to let them apply a permethrin shampoo treatment to her hair, which was heavily matted. She responded that allowing them to touch or treat her hair would violate her religious beliefs, though she did not specify a belief system. After failing to secure her cooperation, API staff decided they would have to shave her head before she could be admitted to a hospital unit.

In addressing whether the State could proceed with the shaving of Lila B.'s head, the Supreme Court of Alaska first noted that

Hairstyle is an important component of identity and self-expression. An individual may wear hair of a certain style or length as an expression of gender identity, religious practice, or culture. During an involuntary commitment, which is a “massive curtailment of liberty,” hairstyle may be one of the few means of self-expression the patient has left.

The court then concluded that the State could only shave Lila B.'s head if it could prove by clear and convincing evidence that shaving her head was the least restrictive means of furthering the State's compelling interest in preventing the spread of lice to patients and staff. The court then concluded that the State had failed to satisfy this standard, ruling as follows:

We conclude that the evidence before the superior court did not clearly and convincingly establish that shaving Lila's head was the least restrictive way to accommodate the State's legitimate concerns. The court relied on Czech's testimony that a permethrin treatment “may miss” any active lice that were embedded in Lila's hair mats, but the court also acknowledged that “[i]f shampoo alone would kill the active lice, the court would not conclude that API's proposed treatment was least restrictive.” Czech testified that a permethrin treatment “should kill the active lice immediately” and “should be good for approximately 10 days” before another infestation, from a new hatch of nits, could take hold. Lila's authorized detention at this stage was only 72 hours. Even assuming that nits would begin to hatch during that 72-hour period, Czech did not testify that hospital staff could not reapply a permethrin treatment during that time. And even if permethrin alone would not have killed all active lice, the State's evidence did not establish that using a permethrin treatment in conjunction with a head covering or some measure of physical isolation would have been ineffective to further the government's compelling interest in preventing the spread of lice.

Relying on Czech's testimony, the superior court further found that “API is unable to effectively isolate [Lila].” Czech's testimony established that API would be unable to accommodate “true isolation” as was necessary during the COVID-19 pandemic. However, his testimony failed to demonstrate, by clear and convincing evidence, that API could not segregate Lila from other patients in such a way as to prevent the transmission of lice. A less strict form of isolation could have furthered the State's compelling interest, particularly if API staff first applied a permethrin treatment to reduce the severity of the lice infestation. In short, we do not read Czech's testimony as providing clear and convincing evidence that no combination of permethrin, head-covering, and reasonable limitations on contact with others could have advanced the State's compelling interest in protecting patients and staff from transmission during the period of Lila's detention.

-CM