California has instituted a new review process for transgender inmates seeking gender reassignment surgery that advocates are hailing as “historic” and a potential model for the nation.
The policy, established this week by the California Correctional Health Care Services, sets a formal process for transgender people seeking taxpayer-funded gender reassignment surgery — a procedure endorsed by major medical and psychological organizations.
Kris Hayashi, executive director of Transgender Law Center, commended the change in a statement and said other states should look to the policy for guidance.
“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,” Hayashi said.
The change was enacted after lawsuits filed by the Oakland-based Transgender Law Center on behalf of Michelle Norsworthy, a transgender inmate who’s on parole and was incarcerated for second-degree murder at Mule Creek State Prison in Ione, Calif., and Shiloh Quine, another transgender inmate serving time at the same facility for first-degree murder, kidnapping and robbery.
Norsworthy, who was initially granted gender reassignment surgery as a result of court order, but later denied the procedure after the state appealed the decision, was among those commending the change in a statement.
“I suffered for decades as my identity, my medical needs, and my very humanity were denied by the people and system responsible for my care,” Norsworthy said. “I am beyond proud to have been part of the movement to make this policy happen, and I know it will change and save the lives of so many women still fighting for survival in men’s prisons.”
Flor Bermudez, the Transgender Law Center’s detention project director, credited her organization’s lawsuit with bringing the change into effect.
“We are thrilled that our work with Michelle and Shiloh brought about this historic change in California prison policy, and Transgender Law Center looks forward to working with the California Department of Corrections and Rehabilitation to ensure transgender people in prison aren’t denied medical care, commissary items, or safe housing just because of who they are,” Bermudez said.
But Bermudez added more work is needed to ensure humane treatment of transgender prisoners within the California corrections system.
“There are absolutely some details, such as compliance with the Prison Rape Elimination Act and the qualifications of the experts making the assessment, which require more work and consideration, and we hope to continue that discussion with CDCR,” she said.
The eight-page guidance details the process by which transgender patients meeting basic criteria can request gender reassignment surgery. Institution providers must refer the request to the Headquarters Utilization Management Committee for evaluation.
A six-member subcommittee consisting of physicians and psychologists will then determine any medical consideration that would preclude surgery, the current treatment offered to the inmate to alleviate gender dysphoria and whether the procedure is appropriate from a medical and mental health perspective.
Criteria the subcommittee will consider include whether the inmates have sought to make their body congruent with their preferred gender for at least two years, have lived in the desired gender role for at least 12 months; and have at least two years before an anticipated parole or release date.
Consideration will also be given to whether an inmate can transfer safely and adjust medically and psychologically to confinement post-operatively with other inmates with the same gender identity and whether “there are no penological contraindications for placement in the prison housing the inmate’s professed gender.”
The Headquarters Utilization Management Committee decision is the final step in the process. If a request for gender reassignment surgery is denied, an inmate can renew the request no sooner than one year afterward.
California makes the policy change as the issue of affording taxpayer-funded gender reassignment surgery to inmates has emerged at the forefront of the transgender rights movement.
Harper Jean Tobin, policy director for the National Center for Transgender Equality, said the new California policy is a “positive development,” but isn’t perfect.
“It’s unfortunate that any state has to go through multiple lawsuits and make a special policy for one type of medical service just to do what the Constitution requires: Provide health care for everyone based on medical decisions by medical professionals,” Tobin said.
Tobin also objected to a portion of the policy linking gender reassignment surgery for inmates to housing placements.
“We are deeply concerned, though, that CDCR’s policy links prisoner housing placements with surgery, in violation of the Prison Rape Elimination Act,” Tobin said. “This means that many transgender prisoners will continue to be housed in extremely unsafe settings.”