By Rebecca Boone Associated Press

BOISE – A federal judge says Idaho must provide gender confirmation surgery to a transgender inmate who has been living as a woman for years but who has continuously been housed in a men’s prison.

Barring any appeals, under the ruling Adree Edmo will become the first Idaho inmate to receive gender confirmation surgery while in Idaho Department of Correction custody.

The ruling in Idaho’s U.S. District Court was handed down by Judge B. Lynn Winmill on Thursday. Winmill said the Idaho Department of Correction and Corizon’s refusal to provide Edmo with the surgery puts her at risk of irreparable harm.

“For more than forty years, the Supreme Court has consistently held that consciously ignoring an prisoner’s serious medical needs amounts to cruel and unusual punishment in violation of the Eighth Amendment,” Judge B. Lynn Winmill wrote in his ruling issued Thursday.

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, Winmill found. She also showed that prison officials were aware of and failed to respond to her pain and medical needs, causing her to suffer harm.

The state has six months to provide Edmo with the surgery, which will restructure her physical characteristics to match her gender identity. Idaho Department of Correction spokesman Jeff Ray said IDOC will be addressing some of the issues raised by the ruling – including whether the state will appeal, and where Edmo will be housed after her surgery – in the days to come. There are currently 30 inmates with gender dysphoria in state custody, according to the ruling.

“I hope that this makes clear to IDOC and also to prison systems around the country that they can’t deny medically necessary care to transgender prisoners – that is a requirement under our constitution,” said Amy Whelan, an attorney with the National Center for Lesbian Rights, which represented Edmo in the lawsuit. “They need to start evaluating people appropriately, and providing care to them.”

Not all transgender people have gender dysphoria, Winmill noted in the ruling, and not all transgender people desire or need surgery to make their physical body match their gender identity. But for some, gender dysphoria – which occurs when the incongruity between a person’s assigned gender and their gender identity is so severe that it impairs their ability to function – can only be fully addressed through surgery.

Edmo had already undergone some treatment for her gender dysphoria, including long-term hormone therapy. She has also tried to present herself as feminine while incarcerated, modifying her undergarments, styling her hair and wearing makeup. Prison officials gave her disciplinary reports for those actions, however, and as a result she was denied parole, according to the lawsuit.

Edmo testified that she feels depressed, embarrassed and disgusted by her male genitalia. Her gender dysmorphia was so severe that in 2015 she tried to remove her testicles using a disposable razor blade. She was unsuccessful at that time, though she continued to be troubled by thoughts of self-castration. In December 2016 she made another attempt, studying anatomy, boiling her razor blade in an attempt to make it sterile and managing to remove one of her testicles before she began to lose too much blood and called for help.

That’s when prison officials had her transported to a nearby hospital, where the testicle was repaired.

“I think the thing that makes this case so important is that this is a procedure that is necessary for some transgender inmates, and in fact is lifesaving care, but it’s almost universally denied and banned by prisons across the country,” Whelan said. “There is no state that I’m aware of that has ever provided the surgery without being ordered by a court to do so.”

Winmill also noted that Corizon, the Brentwood, Tennessee-based private company that handles medical care for inmates in Idaho and 21 other states, has never provided gender confirmation surgery at any of its facilities in the United States.