After a historic legal settlement that will allow a California inmate to undergo sex-reassignment surgery, the state's prisons will implement the nation's first guidelines that would authorize surgical procedures sought by transgender inmates who are suffering from severe mental problems.
The guidelines call for panels of state health professionals to review appeals for sex-reassignment surgery from inmates whose doctors say their patients are under significant distress because of a mental condition known as gender dysphoria. The inmate must have been taking hormones for at least a year and have consistently expressed a desire to change his or her biological gender before an operation can be approved.
Prison officials have estimated the cost of the state-funded operations as high as $100,000. But the Transgender Law Center in San Francisco, which has represented two inmates in suits against the state, says each operation would cost $15,000 to $30,000.
The policy change was announced Tuesday by Clark Kelso, a court-appointed receiver who manages health care for California prisons. The state Department of Corrections and Rehabilitation, which will carry out the policy, said it worked on it with Kelso and his staff.
The department says it has about 385 transgender inmates, most of them male-to-female, who are undergoing hormone therapy.
"By adopting this groundbreaking policy, California has set a model for the rest of the country and ensured transgender people in prison can access life-saving care when they need it," said Kris Hayashi, executive director of the Transgender Law Center.
In August, the state settled a lawsuit by Shiloh Quine that cleared the way for the first sex-reassignment surgery in any state prison system that was based on medical diagnoses. Another state had performed the operation on an inmate, but only after she had castrated herself.
Quine, 56, serving a life sentenced for murder, was born male but has identified as female for most of her life, and has attempted suicide multiple times, according to a medical expert appointed by the state. She has been on hormone therapy since 2009. The state's expert agreed with a mental health professional hired by the inmate's lawyers that Quine needed surgery -- a first for the prison system, which has opposed all previous surgery requests.
The settlement of her suit allowed Quine to transfer to a women's prison and required the state to "review and revise its policies" for transgender inmates. The revisions allow transgender inmates to have access to clothing that reflects their identified gender and items like makeup as well as medical care.
The Department of Corrections and Rehabilitation has denied having an across-the-board policy against gender surgery and said it evaluates cases individually. But in another inmate's case, U.S. District Judge Jon Tigar of San Francisco said in April that the department had chosen medical experts who would justify an absolute ban on the operations.
That case involved Michelle-Lael Norsworthy, 51, whose doctors had recommended sex-reassignment surgery that was denied by prison officials, who said she was doing fine with hormones. Tigar ordered the surgery, finding that the prison system had been "deliberately indifferent" to Norsworthy's medical needs, but the operation was put off when the state parole board abruptly approved the inmate's release after repeatedly denying parole since 1998 for a 1987 murder conviction.
A federal appeals court questioned the timing of the decision and said Tigar could consider renewing his order to the prison system to pay for the surgery. But the Transgender Law Center said Norsworthy, now living in a halfway house in San Francisco, is also eligible to have the surgery through Medi-Cal.
"I am beyond proud to have been part of the movement to make this policy happen," Norsworthy said in a statement released by the law center.
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