BOISE, Idaho (AP) - Idaho must provide gender confirmation surgery to a transgender inmate living as a woman for years but who has continuously been housed in a men’s prison, a federal appeals court said Friday.

The 9th U.S. Circuit Court of Appeals agreed with a federal judge in Idaho that the state’s denying the surgery for 31-year-old Adree Edmo amounted to cruel and unusual punishment, a violation of the Eighth Amendment of the U.S. Constitution.

Under the ruling, Edmo would become the first Idaho inmate to receive gender confirmation surgery while in Idaho Department of Correction custody.

“This is a complete win for Ms. Edmo,” said her attorney, Lori Rifkin. “Our client is immensely relieved and grateful that the court recognized her basic right to medical treatment.”

Republican Gov. Brad Little said he planned to appeal to the U.S. Supreme Court.

“The court’s decision is extremely disappointing,” he said in a statement. “The hardworking taxpayers of Idaho should not be forced to pay for a convicted sex offender’s gender reassignment surgery when it is contrary to the medical opinions of the treating physician and multiple mental health professionals.”

However, the federal courts rejected Idaho’s experts and treatment decisions for Edmo.

“In contrast to Edmo’s experts, the State’s witnesses lacked relevant experience, could not explain their deviations from generally accepted guidelines, and testified illogically and inconsistently in important ways,” the appeals court said.

The appeals court also said that the record demonstrated that one of the psychiatrists treating Edmo in prison “acted with deliberate indifference to Edmo’s serious medical needs.”

Edmo is seeking monetary damages from the state and its contractors for violations of her Constitutional rights.

“Prison officials don’t get to pick how and who they treat based on their own biases and prejudices,” Rifkin said.

Federal courts for decades have ruled that society is obligated to provide medical care for those it incarcerates as they can’t provide it for themselves.

U.S. District Court Judge B. Lynn Winmill in December ruled that Edmo showed she had a serious medical need and that failure to treat her medical condition could result in significant further injury or the unnecessary and wanton infliction of pain.

Edmo has been housed in a men’s prison since she first began serving time on a charge of sexually abusing a child younger than 16 in 2012. She is scheduled for release in 2021.

She sued in 2017, contending that the state’s refusal to provide her with gender confirmation surgery amounts to cruel and unusual punishment and causes her severe distress because she has gender dysphoria. The condition occurs when the incongruity between a person’s assigned gender and their gender identity is so severe that it impairs their ability to function.

Rifkin said Edmo’s suffering was so great that she twice tried to cut off her own testicles in her prison cell.

There are currently 30 inmates with gender dysphoria in state custody, according to Winmill’s ruling in December. But Winmill and the 9th U.S. Circuit Court of Appeals said the rulings and analysis involving Edmo were specific to her case.

Winmill’s December ruling gave the state six months to provide Edmo with the surgery, which will restructure her physical characteristics to match her gender identity.

That order was stayed during the state’s appeal to the 9th Circuit Court. Rifkin said the stay will be lifted in three weeks, and Winmill has already scheduled a status conference.

However, the potential for Idaho’s appeal to the U.S. Supreme Court makes the timeframe for surgery unclear. Also, other federal appeals courts have ruled against inmates seeking gender confirmation surgery.

The Idaho Department of Correction and Idaho Office of the Attorney General declined to comment.

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