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.”