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9th Circuit: Gender reassignment surgery must be granted to trans inmates

Court rules denying procedure violates 8th Amendment

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transgender health, gay news, Washington Blade
The Ninth Circuit affirmed an order granting gender reassignment surgery to trans inmate.

Denying gender reassignment surgery to transgender prison inmates is prohibited under the U.S. Constitution, a federal appeals court ruled Friday.

A three-judge panel on the U.S. Ninth Circuit Court of Appeals issued the per curiam decision on the basis that gender reassignment surgery is medically necessary, so denying the procedure to prison inmates violates the Eighth Amendment.

“We hold that where, as here, the record shows that the medically necessary treatment for a prisoner’s gender dysphoria is gender confirmation surgery, and responsible prison officials deny such treatment with full awareness of the prisoner’s suffering, those officials violate the Eighth Amendment’s prohibition on cruel and unusual punishment,” the decision says.

The three-judge panel that issued the ruling consists of U.S. Circuit Judge Mary Margaret McKeown, a Clinton appointee; U.S. Circuit Judge Ronald Gould, another Clinton appointee; and U.S. District Judge Robert Lasnik, another Clinton appointee sitting by designation on the Ninth Circuit.

The ruling affirms taxpayer funds will be used to provide gender reassignment surgery to Adree Edmo, who’s transgender and has been an inmate in the Idaho State Correctional Institution since 2012. Edmo has been ever since she pleaded guilty to sexual abuse of a 15-year-old male at a house party.

Edmo doesn’t have access to her personal funds while she’s incarcerated. The estimated cost of male-to-female gender reassignment surgery can be more than $100,000.

Medical providers have documented Edmo’s feminine presentation since 2012 and she has testified she “continues to actively think about self-castration” in prison, according to the Ninth Circuit decision.

“I am relieved and grateful the court recognized my right to necessary medical treatment, and that I will get the surgery I need,” Edmo said in a statement. “I hope my case helps the State of Idaho understand that they can’t deny medical care to transgender people.”

The case came to the Ninth Circuit upon appeal after U.S. Chief District Judge B. Lynn Winmil in Idaho issued a decision ordering the state to grant gender reassignment surgery to Edmo, who sued the state in 2017 after the Idaho Department of Corrections refused to great her the procedure.

“Although we addressed this appeal on an expedited basis, it has been more than a year since doctors concluded that GCS is medically necessary for Edmo,” the Ninth Circuit decision says. “We urge the state to move forward. We emphatically do not speak to other cases, but the facts of this case call for expeditious effectuation of the injunction.”

The Ninth Circuit affirmed Winmill’s order with respect to granting gender reassignment surgery to Edmo, but remanded to the trial court a separate with respect to whether Corizon, Inc., a private for-profit corporation that provides health care to inmates in Idaho prisons, should be included in the injunction.

The Ninth Circuit is now the only federal appeals court with a standing ruling ordering gender reassignment surgery. Although a three-judge panel on the U.S. First Circuit Court of Appeals ordered the procedure in 2014, the full court later reversed that decision.

Representing Edmo in the case was the National Center for Lesbian Rights, which noted the significance of the decision after it was handed down.

“One of the foundational principles of our Constitution is that the State cannot subject people in its custody to cruel and unusual punishment, including by failing to treat serious medical conditions,” NCLR Senior Staff Attorney Amy Whelan said in a statement. “This ruling is in line not only with long-standing medical evidence, but also with legal rulings across the country that it is dangerous and unconstitutional to deny transgender people access to medically necessary care in prison.”

The Washington Blade has placed a request in with the Boise-based law firm Moore Elia Kraft & Hall, LLP, which is representing the Idaho Department of Corrections, to seek comment on whether the state will seek an “en banc” rehearing before the Ninth Circuit or take up the matter before the U.S. Supreme Court.

The issue of whether transgender inmates are entitled to gender reassignment surgery has been percolating for some time and has dogged Democratic presidential candidate Kamala Harris, who as attorney general represented the California Department of Corrections in seeking to deny the procedure to two inmates.

As media scrutiny of the cases grew, Harris helped the California Department of Corrections reach an agreement in which to set up a process where transgender inmates could obtain transition-related care, including gender reassignment surgery. Both of the transgender inmates in those cases were able to obtain gender reassignment surgery, one through the state health care system after obtaining parole.

It should be noted Harris didn’t seek to the agreement to grant transgender inmates gender reassignment surgery until after a court already ordered one the transgender inmates be granted the procedure. At least one transgender advocate in California has also said the California Department of Correction has built a reputation for not fulfilling the agreement reached on behalf of transgender inmates.

Harris, in a statement provided to the Washington Blade from her presidential campaign, said she supports the Ninth Circuit decision in the Edmo case.

“This ruling rightly reaffirms the right to adequate and comprehensive health care, including transition-related care for those at correctional facilities,” Harris said. “Everyone deserves access to compassionate and comprehensive care.”

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Puerto Rico

The ‘X’ returns to court

1st Circuit hears case over legal recognition of nonbinary Puerto Ricans

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(Photo by Sergei Gnatuk via Bigstock)

Eight months ago, I wrote about this issue at a time when it had not yet reached the judicial level it faces today. Back then, the conversation moved through administrative decisions, public debate, and political resistance. It was unresolved, but it had not yet reached this point.

That has now changed.

Lambda Legal appeared before the 1st U.S. Court of Appeals in Boston, urging the court to uphold a lower court ruling that requires the government of Puerto Rico to issue birth certificates that accurately reflect the identities of nonbinary individuals. The appeal follows a district court decision that found the denial of such recognition to be a violation of the U.S. Constitution.

This marks a turning point. The issue is no longer theoretical. A court has already determined that unequal treatment exists.

The argument presented by the plaintiffs is grounded in Puerto Rico’s own legal framework. Identity birth certificates are not static historical records. They are functional documents used in everyday life. They are required to access employment, education, and essential services. Their purpose is practical, not symbolic.

Within that framework, the exclusion of nonbinary individuals does not stem from a legal limitation. Puerto Rico already allows gender marker corrections on birth certificates for transgender individuals under the precedent established in Arroyo Gonzalez v. Rosselló Nevares. In addition, the current Civil Code recognizes the existence of identity documents that reflect a person’s lived identity beyond the original birth record.

The issue lies in how the law is applied.

Recognition is granted within specific categories, while those who do not identify within that binary structure remain excluded. That exclusion is now at the center of this case.

Lambda Legal’s position is straightforward. Requiring individuals to carry documents that do not reflect who they are forces them into misrepresentation in essential aspects of daily life. This creates practical barriers, exposes them to scrutiny, and places them in a constant state of vulnerability.

The plaintiffs, who were born in Puerto Rico, have made clear that access to accurate identification is not symbolic. It is a basic condition for moving through the world without contradiction imposed by the state.

The fact that this case is now being addressed in the federal court system adds another layer of significance. This is not a pending policy discussion or a legislative proposal. It is a constitutional question. The analysis is not about political preference, but about rights and equal protection under the law.

This case does not exist in isolation.

It unfolds within a broader context in which debates over identity and rights have increasingly been shaped by the growing influence of conservative perspectives in public policy, both in the United States and in Puerto Rico. At the local level, this influence has been reflected in legislative discussions where religious arguments have begun to intersect with decisions that should be grounded in constitutional principles. That intersection creates tension around the separation of church and state and has direct consequences for access to rights.

Recognizing this context is not an attack on faith or religious practice. It is an acknowledgment that when certain perspectives move into the realm of public authority, they can shape outcomes that affect specific communities.

From within Puerto Rico, this is not a distant debate. It is a lived reality. It is present in the difficulty of presenting identification that does not match one’s identity, and in the consequences that follow in workplaces, schools, and government spaces.

The progression of this case introduces the possibility of change within the applicable legal framework. Not because it resolves every tension surrounding the issue, but because it establishes a legal examination of a practice that has long operated under exclusion.

Eight months ago, the conversation centered on ongoing developments. Today, there is already a judicial finding that identifies a violation of rights. What remains is whether that finding will be upheld on appeal.

That process does not guarantee an immediate outcome, but it shifts the ground.

The debate is no longer theoretical.

It is now before the courts.

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National

LGBTQ community explores arming up during heated political times

Interest in gun ownership has increased since Donald Trump returned to office

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Gun rights organizations and advocates say interest in gun ownership seems to have increased in the LGBTQIA+ community since President Donald Trump returned to the White House last year. (Photo by Kaitlin Newman for the Baltimore Banner)

By JOHN-JOHN WILLIAMS IV | As the child of a father who hunted, Vera Snively shied away from firearms, influenced by her mother’s aversion to guns.

Now, the 18-year-old Westminster electrician goes to the shooting range at least once a month. She owns a rifle and a shotgun, and plans to get a handgun when she turns 21.

“I want to be able to defend my community, especially being in political spaces and queer spaces,” said Snively, a trans woman. “It’s just having that extra line of safety, having that extra peace of mind would be important to me.”

Snively is among what some say is a growing number of LGBTQ gun owners across the United States. Gun rights organizations and advocates say interest in gun ownership appears to have increased in that community since President Donald Trump returned to the White House last year.

The rest of this article can be read on the Baltimore Banner’s website.

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Tennessee

Tenn. lawmakers pass transgender “watch list” bill

State Senate to consider measure on Wednesday

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Tennessee, gay news, Washington Blade
Image of the transgender flag with the Tennessee flag in the shape of the state over it. (Image public domain)

The Tennessee House of Representatives passed a bill last week to create a transgender “watch list” that also pushes detransition medical treatment. The state Senate will consider it on Wednesday.

House Bill 754/State Bill 676 has been deemed “ugly” by LGBTQ advocates and criticized by healthcare information litigators as a major privacy concern.

The bill would require “gender clinics accepting funds from this state to perform gender transition procedures to also perform detransition procedures; requires insurance entities providing coverage of gender transition procedures to also cover detransition procedures; requires certain gender clinics and insurance entities to report information regarding detransition procedures to the department of health.”

It would require that any gender-affirming care-providing clinics share the date, age, and sex of patients; any drugs prescribed (dosage, frequency, duration, and method administered); the state and county; the name, contact information, and medical specialty of the healthcare professional who prescribed the treatment; and any past medical history related to “neurological, behavioral, or mental health conditions.” It would also mandate additional information if surgical intervention is prescribed, including details on which healthcare professional made a referral and when.

HB 0754 would also require the state to produce a “comprehensive annual statistical report,” with all collected data shared with the heads of the legislature and the legislative librarian, and eventually published online for public access.

The bill also reframes detransitioning as a major focus of gender-affirming healthcare — despite studies showing that the number of trans people who detransition is statistically quite low, around 13 percent, and is often the result of external pressures (such as discrimination or family) rather than an issue with their gender identity.

This legislation stands in sharp contrast to federal protections restricting what healthcare information can be shared. In 1996, Congress passed the Health Insurance Portability and Accountability Act, or HIPAA, requiring protections for all “individually identifiable health information,” including medical records, conversations, billing information, and other patient data.

Margaret Riley, professor of law, public health sciences, and public policy at the University of Virginia, has written about similar efforts at the federal level, noting the Trump-Vance administration’s push to subpoena multiple hospitals’ records of gender-affirming care for trans patients despite no claims — or proof — that a crime was committed.

It has “sown fear and concern, both among people whose information is sought and among the doctors and other providers who offer such care. Some health providers have reportedly decided to no longer provide gender-affirming care to minors as a result of the inquiries, even in states where that care is legal.” She wrote in an article on the Conversation, where she goes further, pointing out that the push, mostly from conservative members of the government, are pushing extracting this private information “while giving no inkling of any alleged crimes that may have been committed.”

State Rep. Jeremy Faison (R-Cosby), the bill’s sponsor, said in a press conference two weeks ago that he has met dozens of individuals who sought to transition genders and ultimately detransitioned. In committee, an individual testified in support of the bill, claiming that while insurance paid for gender-affirming care, detransition care was not covered.

“I believe that we as a society are going to look back on this time that really burst out in 2014 and think, ‘Dear God, What were we thinking? This was as dumb as frontal lobotomies,’” Faison said of gender-affirming care. “I think we’re going to look back on society one day and think that.”

Jennifer Levi, GLAD Law’s senior director of Transgender and Queer Rights, shared with PBS last year that legislation like this changes the entire concept of HIPAA rights for trans Americans in ways that are invasive and unnecessary.

“It turns doctor-patient confidentiality into government surveillance,” Levi said, later emphasizing this will cause fewer people to seek out the care that they need. “It’s chilling.”

The Washington Blade reached out to the American Civil Liberties Union of Tennessee, which shared this statement from Executive Director Miriam Nemeth:

“HB 754/SB 676 continues the ugly legacy of Tennessee legislators’ attacks on the lives of transgender Tennesseans. Most Tennesseans, regardless of political views, oppose government databases tracking medical decisions made between patients and their doctors. The same should be true here. The state does not threaten to end the livelihood of doctors and fine them $150,000 for safeguarding the sensitive information of people with diabetes, depression, cancer, or other conditions. Trans people and intersex people deserve the same safety, privacy, and equal treatment under the law as everyone else.”

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