Federal Judge: California Must Provide Trans Inmate with Access to Gender-Affirming Surgery

A federal judge has ruled that a transgender inmate in California must be granted access to gender-affirming surgery that her prison doctors have deemed medically necessary.

In a first for the state, California's Department of Corrections has been ordered by a federal judge to grant a transgender prisoner access to gender-affirming sugery, reports the Associated Press.

On Thursday, U.S. District Judge Jon S. Tigar ruled that trans inmate Michelle-Lael Norsworthy's constitutional rights had been violated when a state prison denied her access to gender confirmation surgery in 2012. Norsworthy's prison doctor and psychiatrist have determined that gender-affirming surgery is a medically necessary part of Norsworthy's transition-related healthcare, in addition to the psychotherapy and hormone treatments she is currently recieving.

Norsworthy, 51, is serving time for a 1987 second-degree murder conviction, and has been diagnosed by prison staff with "gender dysphoria" — the clinical term for those experiencing severe distress from a mismatch between one's internal gender identity and external anatomy. Psychotherapy, hormone therapy, and gender-confirming surgeries are all considered by the American Medical Associaiton and American Psychological Association to be "medically necessary" treatment for this distress, which can result in anxiety, depression, and suicidal ideation if a person goes without treatment.

Providing such care to transgender inmates, however, has remained a controversial issue in the U.S., with many states deciding not to provide transition-related care, or drawing a line at providing surgery, while still allowing access to psychiatric and hormone therapy.

Prior to Thursday's ruling, Norsworthy found herself in a position similar to that of Massachusetts trans inmate Michelle Kosilek, who this year had a 2012 decision to grant her access to gender-affirming surgery — the first decision of its kind anywhere in the U.S. — overturned.

Kosilek, convicted of murdering her wife in 1990, has seen the brutality of her crime color debates, with strong LGBT rights advocates like Massachusetts Sen. Elizabeth Warren and out former Repr. Barney Frank publicly stating that Kosilek should not have access to the care her doctors deem medically necessary. Many detractors have argued that taxpayer dollars should not be used to provide trans prisoners with transition-related surgery, falsely claiming that such procedures are unnecessary or simply cosmetic.

Meanwhile, trans advocates have bristled at those implications, arguing that incarceration should not preclude a person from recieving medical care recommended by their doctor. A similar debate has swirled around the country's most famous transgender inmate: military prisoner Chelsea Manning, who was imprisoned in an all-male facility in 2010 for leaking classified military information to WikiLeaks and has since been petitioning for access to transition-related health care.

The Thursday decision concerning Norsworthy's surgical care has already met its own resistance concerning the use of taxpayer money, with Joyce Hayhoe, a spokeswoman for the federal receiver who controls California prison medical care, claiming to the AP that costs for Norsworthy's surgery could run "as high as $100,000." The Department of Corrections also expressed concerns about being able to protect Norsworthy from physical or sexual assault in men's prisons.

The San Francisco-based Transgender Law Center, however, pointed out that the cost estimate was "a gross exaggeration," telling the AP that Medi-Cal, California's health care program for low-income residents, has covered gender-affirming surgeries for years. The center's executive director, Kris Hayashi, informed Los Angeles' KABC TV station that the costs would more realistically run between $30,000 to $40,000.

Following the reversal of the Massachusetts decision granting Kosilek access, California will now become the only U.S. state that interprets denial of medically necessary gender-affirming surgery to be a violation of the Eighth Amendment — which defines denial of health care and uncessary infliction of pain (including psychological) as "cruel and unusual punishment."

According to KABC, California's Department of Corrections is considering filing an appeal of the ruling.