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Court: Trans inmate must receive gender reassignment surgery

Panel says denying procedure to prisoner cruel and unusual punishment

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National LGBT Bar Association, Gay News, Washington Blade

The First Circuit Court of Appeals ruled a trans inmate must receive gender reassignment surgery. (Image via wikimedia)

A federal appeals court ruled on Friday that a transgender inmate incarcerated for murdering her spouse must receive taxpayer-funded gender reassignment surgery that was prescribed by her doctors.

In a 2-1 decision, a three-judge panel on the First Circuit Court of Appeals ruled that denying the procedure to Michelle Kosilek, who was sentenced to life in prison for murdering his spouse in 1990, amounts to cruel and unusual punishment under the Eight Amendment to the U.S. Constitution.

The 90-page ruling was written by U.S. Circuit Judge Ojetta Rogeriee Thompson, an Obama appointee, who asserted the Massachusetts Department of Corrections denied Kosilek essential medical care by withholding from her gender reassignment surgery.

“Those findings — that Kosilek has a serious medical need for the surgery, and that the DOC refuses to meet that need for pretextual reasons unsupported by legitimate penological considerations — mean that the DOC has violated Kosilek’s Eighth Amendment rights,” Thompson writes.

The ruling upholds a decision from U.S. District Judge Mark Wolf in 2012 asserting Kosilek has a right to gender reassignment surgery. The decision was controversial — even among progressive leaders. Then-U.S. Senate candidate Elizabeth Warren (D-Mass.) said she didn’t think the surgery was a good use of taxpayer dollars.

Transgender rights groups lauded the decision from the First Circuit on the basis that prisoners — even those who are transgender — have a right to medical care during their incarceration.

Mara Keisling, executive director of the National Center for Transgender Rights, said the ruling “affirms the increasing consensus among the courts” that transgender-related health care is a right protected under the Constitution.

“Prisoner or not, people should have access to the healthcare they need,” Keisling said. “For some of us, that means sex reassignment surgery. While we celebrate today’s ruling, we know there’s more advocacy needed to ensure that all transgender people have access to basic and necessary healthcare.”

Ilona Turner, legal director for the Transgender Law Center, said the First Circuit ruling upholds a constitutional right to essential medical treatment in prison.

“It is well established that the failure to provide essential medical care to people in prison is unconstitutional and amounts to torture,” Turner said. “This decision affirms that we as a society do not allow people to be tortured when they are in government custody.”

Afflicted with drug and alcohol problems at an early age, Kosilek in 1992 was sentenced to life in prison after strangling her spouse Cheryl McCaul, a volunteer counselor at a drug rehabilitation facility. The incident took place after McCaul caught Kosilek wearing her clothing.

Kosilek is serving her sentence in MCI-Norfolk, a medium security male prison, where she legally changed her name from Robert to Michelle. She must receive gender reassignment surgery through taxpayer-provided funds because, as an inmate in prison, she lacks access to her own finances for the procedure.

The estimated cost for male-to-female reassignment is $7,000 to $24,000. A footnote in the First Circuit decision notes that figure “pales in comparison to the amount of money it seems the state will be expending to defend this lawsuit.”

U.S. Circuit Judge Juan Torruella, a Reagan appointee who wrote the dissent in the decision, said he doesn’t find any reason to require Massachusetts to provide gender reassignment surgery to Kosilek when other treatments are available.

“[G]iving due consideration to countervailing security concerns and based on a review of the record that shows the DOC’s proposed care was not outside the realm of professionalism, I cannot say that the DOC has failed to adequately care for Kosilek’s GID or callously ignored her pain,” Torruella writes.

The decision could be appealed to the full First Circuit or the U.S. Supreme Court. The office of Massachusetts Attorney General Martha Coakley declined to comment on the next steps in the lawsuit.

Cara Savelli, a spokesperson for the Massachusetts Department of Correction, said the court ruling is under review.

“We are closely reviewing the lengthy decision issued today by the First Circuit Court of Appeals on this matter to determine next steps,” Savelli said.

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Blade welcomes spring intern

Sam Epner is freshman at American University

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Sam Epner (Photo courtesy of Sam Epner)

The Washington Blade this month welcomed Sam Epner as its spring intern.

Sam is a freshman at American University and is studying journalism and creative writing. Sam is originally from California.

“D.C. has become my home, and reporting on the District is one of the most important parts of my life,” said Sam.

Sam’s internship will end at the end of April.

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Federal Government

Top Democrats reintroduce bill to investigate discrimination against LGBTQ military members

Takano, Jacobs, and Blumenthal sponsored measure

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U.S. Rep. Mark Takano (D. Calif.) speaks at a Hispanic Federation press conference outside U.S. Capitol on July 9, 2024. (Washington Blade photo by Michael Key)

Multiple high-ranking members of Congress reintroduced the Commission on Equity and Reconciliation in the Uniformed Services Act into the U.S. House of Representatives and the U.S. Senate, aiming to establish a commission to investigate discriminatory policies targeting LGBTQ military members.

Three leading Democratic members of Congress — U.S. Rep. Mark Takano (D-Calif.), who is the House Veterans’ Affairs Committee’s ranking member and chairs the Congressional Equality Caucus; U.S. Sen. Richard Blumenthal (D-Conn.), who is the Senate Veterans’ Affairs Committee’s ranking member; and U.S. Rep. Sara Jacobs (D-Calif.) — introduced the bill on Tuesday.

The bill, they say, would establish a commission to investigate the historic and ongoing impacts of discriminatory military policies on LGBTQ servicemembers and veterans.

This comes on the one-year anniversary of the Trump-Vance administration’s 2025 Executive Order 14183, titled “Prioritizing Military Excellence and Readiness,” which essentially banned transgender servicemembers from openly serving in the Armed Forces, leading to the forced separation of thousands of capable and dedicated servicemembers.

In a joint statement, Takano, Blumenthal, and Jacobs shared statistics on how many service members have had their ability to serve revoked due to their sexual orientation:

“Approximately 114,000 servicemembers were discharged on the basis of their sexual orientation between WWII and 2011, while an estimated 870,000 LGBTQ servicemembers have been impacted by hostility, harassment, assault, and law enforcement targeting due to the military policies in place,” the press release reads. “These separations are devastating and have long-reaching impacts. Veterans who were discharged on discriminatory grounds are unable to access their benefits, and under the Trump administration, LGBTQ+ veterans and servicemembers have been openly persecuted.”

The proposed commission is modeled after the Congressional commission that investigated and secured redress for Japanese Americans interned during World War II. Takano’s family was among the more than 82,000 Japanese Americans who received an official apology and redress payment under that commission.

The press release notes this is a major inspiration for the act.

“Qualified servicemembers were hunted down and forced to leave the military at the direction of our government,” said Takano. “These practices have continued, now with our government targeting transgender servicemembers. The forced separation and dishonorable discharges LGBTQ+ people received must be rectified, benefits fully granted, and dignity restored to those who have protected our freedoms.”

“LGBTQ+ servicemembers have long been the target of dangerous and discriminatory policies—resulting in harassment, involuntary discharge, and barriers to their earned benefits,” said Blumenthal. “Establishing this commission is an important step to understand the full scope of harm and address the damage caused by policies like ‘Don’t Ask, Don’t Tell.’ As LGBTQ+ servicemembers and veterans face repugnant and blatant bigotry under the Trump administration, we will keep fighting to secure a more equitable future for all who serve our country in uniform.”

“Instead of righting wrongs and making amends to our LGBTQ+ service members and veterans who’ve suffered injustices for decades, I’m ashamed that the Trump administration has doubled down: kicking trans folks out of the military and banning their enlistment,” said Jacobs. “We know that LGBTQ+ service members and veterans have faced so much ugliness — discrimination, harassment, professional setbacks, and even violence — that has led to unjust discharges and disparities in benefits, but we still don’t have a full picture of all the harm caused. That needs to change. That’s why I’m proud to co-lead this bill to investigate these harms, address the impacts of discriminatory official policies like ‘Don’t Ask, Don’t Tell’ and the transgender military ban, and ensure equity and justice for our LGBTQ+ service members and veterans.”

Takano and Jacobs are leading the bill in the House, while Blumenthal is introducing companion legislation in the Senate.

Takano’s office has profiled and interviewed LGBTQ servicemembers who were harmed by discriminatory policies in the uniformed services.

The Commission on Equity and Reconciliation in the Uniformed Services Act is supported by Minority Veterans of America, Human Rights Campaign, Equality California, SPARTA, and the Transgender American Veterans Association.

In recent weeks, thousands of trans military members were forcibly put into retirement as a result of Trump’s executive order, including five honored by the Human Rights Campaign with a combined 100 years of service, all due to their gender identity: Col. Bree B. Fram (U.S. Space Force), Commander Blake Dremann (U.S. Navy), Lt. Col. (Ret.) Erin Krizek (U.S. Air Force), Chief Petty Officer (Ret.) Jaida McGuire (U.S. Coast Guard), and Sgt. First Class (Ret.) Catherine Schmid (U.S. Army).

Multiple career service members spoke at the ceremony, including Takano. Among the speakers was Frank Kendall III, the 26th U.S. Air Force secretary, who said:

“We are in a moment of crisis that will be worse before it is better. Members of my father’s and mother’s generation would ask each other a question: what did you do during the war? Someday we will all be asked what we did during this time. Please think about the answer that you will give.”

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Virginia

From the Pentagon to politics, Bree Fram fighting for LGBTQ rights

Transgender veteran running for Congress in Va.

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(Photo courtesy of Bree Fram)

After being ousted from military service, Col. Bree Fram — once the highest-ranking openly transgender officer in the Pentagon — is now running for Congress.

Fram, who lives in Reston, Va., brings more than two decades of public service to her campaign. From the battlefield to the halls of the Pentagon, she spent more than 20 years working inside the federal government, often advocating for LGBTQ people and other marginalized communities from within the system.

Fram spoke with the Washington Blade about her decision to run amid sustained attacks against her — and against the LGBTQ community more broadly — from the Trump-Vance administration and far-right officials.

She said her commitment to public service began more than 22 years ago, shaped in large part by watching the Sept. 11, 2001, terrorist attacks.

“I had grown up expecting that there was this beautiful American peace stretching into the world for the foreseeable future, and that kind of image was shattered,” Fram told the Blade. “I realized that there was a continuous price to be paid to protect our democracy, to protect our freedoms. To be able to play a small part in defending those freedoms was incredibly important to me — to be part of something larger than myself.”

(Photo courtesy of Bree Fram)

Commissioned through the U.S. Air Force Officer Training School in 2003, Fram served as an astronautical engineer and rose to the rank of colonel in the U.S. Air Force before later serving in the U.S. Space Force. She remained on active duty until 2025, when she was forced out following the Trump-Vance administration’s reinstated ban on trans military service.

Fram has been married for 20 years to her spouse, Peg Fram, and they have two children.

Beyond her military service, Fram has long been involved in advocacy and leadership. She has been a member of SPARTA, a trans military advocacy organization, since 2014, served on its board of directors beginning in 2018, and was president of the organization from 2021-2023.

Most recently, Fram served as chief of the Requirements Integration Division at Headquarters, Space Force, and as co-lead of the Joint Space Requirements Integration Cell in collaboration with the Joint Staff. Previously, she was chief of the Acquisition Policies and Processes Division for the assistant secretary of the Air Force for space acquisition and integration.

Earlier in her career, Fram served as a materiel leader at the Air Force Research Laboratory, overseeing the development of counter-small unmanned aerial systems and offensive cyberspace technologies in support of Pentagon and intelligence community priorities, managing an annual budget exceeding $100 million.

Her previous assignments also included oversight of Air Force security cooperation in four strategically significant Middle Eastern countries and 258 foreign military sales cases valued at $15.79 billion; serving as executive officer to the Air Force director of strategic plans, where she helped integrate the 30-year, $3.6 trillion Air Force Plan; a legislative fellowship on Capitol Hill with then-U.S. Del. Madeleine Bordallo (D-Guam), handling military, veterans, and foreign affairs issues; and a program management role at the National Reconnaissance Office, where she led a $700 million multi-agency engineering and IT contract overseeing more than 500 personnel and supporting $40 billion in assets.

Fram also directed 24/7 worldwide operations and maintenance of mission data processing for space-based and airborne national intelligence assets and co-led the Department of the Air Force’s LGBTQ+ Initiatives Team and Barrier Analysis Working Group from 2023-2025.

She holds a master’s degree from the Air Force Institute of Technology and is a distinguished graduate of the Naval War College. Fram deployed in support of Operation Iraqi Freedom, where she worked on airborne counter-improvised explosive device technologies.

In January, Fram, alongside four other trans military officers, was given a special retirement ceremony by the Human Rights Campaign — a direct result of President Donald Trump’s 2025 Executive Order 14183, titled “Prioritizing Military Excellence and Readiness.” The policy directed the Pentagon to adopt measures prohibiting trans, nonbinary, and gender-nonconforming people from serving in the military.

Under Virginia’s current congressional maps, Fram would challenge Congressman James Walkinshaw in a Democratic primary in the 11th Congressional District, which includes the city of Fairfax and most of Fairfax County. However, the district’s boundaries could change pending ongoing redistricting discussions in the state.

Fram emphasized that her decades working within the executive branch shaped her understanding of what it means to take — and uphold — an oath to the Constitution, even when those in power later forced her out of service solely because of her identity, not her performance.

“Through 23 years of service, I learned what it meant to fulfill that oath to the Constitution, and I wanted to continue serving,” she said. “But when this administration came in and labeled me and others like me ‘dishonorable’ and ‘disciplined liars who lack the humility required for military service,’ it hit hard. When the Supreme Court then agreed to let the administration fire all of us, I had to figure out what would allow me to continue my service in a way that was meaningful and lived up to that oath.”

After being told she would have to retire from a career she describes as her life’s calling, Fram said she began searching for another way to serve — a path that ultimately led her to run for Congress.

“I had done the work over the past couple of decades to understand the America that I believe in, that America I believe we all can be,” Fram said. “That’s where this decision came from. I believe I can fight back and fight forward for Virginians — with the knowledge I have and with a vision of the America we can be.”

That vision, she said, is one that has yet to be fully realized — despite decades of promises from Democratic leaders across all branches of government.

“This is about protecting our fundamental rights — freedom of speech, freedom to assemble, bodily autonomy, a woman’s right to choose, and the ability for queer people to live our best lives,” Fram said. “Right now, our government is throwing barriers up in front of many people. They’re strengthening them, building walls higher, and actively damaging lives.”

(Photo courtesy of Bree Fram)

Fram said her leadership philosophy was shaped by watching strong, effective leaders during her time in the Air Force and Space Force — leaders who reinforced her belief that true leadership means expanding opportunity, not restricting it.

“Leadership is about tearing barriers down — not climbing over them and forcing others to suffer through the same things,” she said. “It’s about making sure the people coming up behind us have even more opportunity to go further, faster. How do we be better tomorrow than we are today? How do we fulfill our founding promise of life, liberty, and the pursuit of happiness?”

One way Fram said Congress could help dismantle those barriers is by passing the Equal Rights Amendment, enshrining constitutional protections for all people — particularly LGBTQ Americans.

“Getting the Equal Rights Amendment into the Constitution is absolutely critical to the future of queer rights,” she said. “Voting rights must also be clearly protected.”

Protecting democracy itself is also among her top priorities, Fram said.

“We need to take control of the House so we can put real checks on this administration,” she said. “That allows the American people to see how this administration is actively making their lives worse and less affordable — and it’s how we ultimately throw them out and get back to making life better.”

Fram said her experience working under four presidents — including during Trump’s first term — reinforced her belief that opposition to efforts curtailing civil liberties is essential.

“The primary thing we can do to protect democracy is to get rid of this administration,” she said. “Taking control of the House gives us true investigative power. Under every rock, there is likely an impeachable offense because they are failing to faithfully execute the laws of the United States.”

For her, the message Trump is sending is clear — he and others close-minded to the LGBTQ community are threatened by the possibility of what someone truly dedicated to service can become.

“One of the reasons this administration had to throw us out and silence us was because we were an example of what was possible. We shined so brightly by meeting or exceeding every standard that they couldn’t hide us away by any other means except kicking us out.”

Fram acknowledged that her identity has been a political target since 2016, but said those attacks have never been grounded in her ability to lead or accomplish complex missions over more than two decades of service.

“If others want to attack me on my identity, I welcome it,” she said. “I’m focused on whether people can afford groceries or feel safe in their communities.”

“I’m happy to be a lightning rod for those kinds of attacks,” she added. “If it allows Democrats to advance an agenda that makes life better for Americans, they can come after me all day long. They attacked me while I was in the military, before I was ever running for office.”

On policy, Fram said affordability, health care, and safety are at the center of her agenda.

“No one should be afraid to go to the doctor or fear surprise medical bills that put them into debt,” she said. “Every American deserves access to affordable, high-quality health care.”

She also emphasized a willingness to work across party lines — even with those who previously politicized her identity — if it means delivering results for constituents.

“If someone wants to work together to make people’s lives better, I’ll work with them,” she said. “If they want to come after me based on who I am, they can waste their energy on that.”

Asked how she defines hope in the current political moment, Fram rejected the idea of passive optimism.

“Hope isn’t naive optimism,” she said. “Hope is doing the work — engaging people and bending the moral arc of the universe toward justice.”

She added that representation itself can be transformative.

“Just being in Congress changes the narrative,” Fram said. “It lets a kid say, ‘Oh my God — I could do that too.’”

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