Albany

Vyvenne Jasmyn Ward, 51, has spent almost two decades in prison on rape convictions.

Near the end of her second prison term — this one for raping a woman in a Cortland alleyway — Ward asked for and eventually started getting hormone treatments to transition from a man to a woman.

“After a legal struggle involving a number of complaints … I finally gained both an evaluation and recommendation for the commencement of hormone therapy on July 3, 2015,” she wrote in a recent letter to the Times Union.

But later that month, after her prison sentence was completed, she was committed to the Central New York Psychiatric Center’s sex offender unit. She is being held there indefinitely after a court proceeding found she has a psychological abnormality that puts her at risk of committing another offense.

Ten years after New York lawmakers approved a controversial civil confinement program under which sex offenders are locked up in hospitals, officials are confronting the thorny question of how to handle the cases of people who were imprisoned for rape and are now transitioning genders.

Ward is working with at least two other transgender residents at CNYPC and she says they, too, have had to battle for treatment.

While prison inmates for years have been able to get hormones, the practice has been more complicated for those in civil confinement.

The program is based on the idea that these people have served their prison sentences — that is, paid their debts to society. But, before release, they are deemed mentally ill and transferred as patients to secure psychiatric hospitals, under the control of mental health workers rather than prison guards.

The state Office of Mental Health, which runs the civil confinement program, won’t say how many transgender people it has under its jurisdiction. Agency officials contend they are prohibited by law from releasing that information, although the law does not prevent the release of general data.

“Federal and state health information privacy laws prohibit the Office of Mental Health from identifying or providing medical information that could lead to the identification of any individual we serve,” OMH spokesman James Plastiras said. “This would include information regarding the number of individuals in a specific program who are transgender or transitioning.”

Others, though, complain the response is symptomatic of the secrecy surrounding those in civil confinement.

While considered to be patients, rather than prison inmates, they remain locked up and have limited access to the outside world through phone calls and letters.

Jim Murphy, a prison reform activist and member of the state Catholic Conference’s Criminal Justice Committee, said the state has locked people away and assured everyone they are "taking care of their civil rights and no, you can't look and see what's going on."

The unique status of those in civil confinement also impacts their ability to bring cases to the state Division of Human Rights.

Ward is trying to bring her case before the DHR’s office in Rochester but said an Office of Mental Health lawyer is arguing the DHR does not have jurisdiction.

“They are equating me with being a prisoner who is in prison,” Ward wrote.

She also disclosed her personal struggles, including an episode in which she attempted self-mutilation to change her sex organs from male to female, before hospital officials agreed to provide the hormone therapy.

The treatments cost about $30 per month, although there can be other costs which would follow Medicaid guidelines.

Ward also said she is tagged as being a “grievance thinker” when she brings up her transgender status during group therapy sessions at the hospital, which is located in Marcy.

“I’m seeing this all over the country,” said Moira Meltzer Cohen, a New York City-based lawyer who is helping Ward.

As civil confinement units nationwide house more transgender residents, Meltzer Cohen believes the gaps in their treatment plans are becoming clear.

“There’s no policy for treatment,” she said.

OMH officials insist there are protocols for transgender people in civil confinement. They point to specialized treatment teams and note that they’ve contracted with two consultants who specialize in gender dysphoria — a medical diagnosis that identifies the unhappiness people experience when they feel their outward appearance of gender does not align with their mental and emotional state.

Because New York has no “cisgender" women in civil confinement custody — that is, individuals who were born with female anatomy and who identify as female — transgender women are currently placed in facilities populated by men.

While all patients have private showers, advocates believe transgender patients may be at a heightened risk to be sexually victimized if they don't have a say in where they are held.

“You (should) ask them where they are going to feel safest,” said Ronica Mukerjee, a nurse practitioner who treats transgender patients.

rkarlin@timesunion.com 518 454 5758 @RickKarlinTU