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The U.S. Supreme Court’s decision not to hear the appeal of a transgender woman seeking treatment for gender identity disorder marks “the end of the road legally” for Michelle Kosilek’s quest for treatment while in prison, according to attorneys.

Gay & Lesbian Advocates & Defenders (GLAD) reported Monday that the nation’s highest court will not hear an appeal of a federal appeals court ruling overturning lower court rulings that entitled Kosilek, a convicted murderer, to a taxpayer-funded sex change operation.

According to GLAD, Kosilek has “self-mutilated” and twice attempted suicide “as a result of being denied treatment.”

GLAD attorney Joseph Sulman and Goodwin Procter LLP filed a petition for certiorari in March asserting that the First Circuit Court of Appeals had overstepped its role by allegedly retrying the facts of a 2012 trial and applying the wrong standard of legal review.

“The treatment of Michelle has been cruel and unusual, according to two lengthy, thoughtful, and closely reasoned judgements,” Sulman said in a statement. “The DOC’s behavior has been abominable as they have repeatedly defied their own experts in their eagerness to deny her desperately needed medical attention.”

In a split decision in December, Appeals Court Judge Juan Torruella wrote for the majority: “After carefully considering the community standard of medical care, the adequacy of the provided treatment, and the valid security concerns articulated by the DOC, we conclude that the district court erred and that the care provided to Kosilek by the DOC does not violate the Eighth Amendment.”

This version of the story corrects an error in the headline. The acronym for the organization is GLAD, not GLAAD.