A transgender woman serving time in federal prison could become the first inmate to undergo gender-affirming surgery under a recent federal judge’s ruling.
The judge ordered the US Bureau of Prisons this week to provide a detailed timeline showing how he will ensure that Cristina Nichole Iglesias receives by the end of the year the gender-affirming surgery she has requested for several years of litigation.
“This is something that is long overdue,” said Alexis Rangel, policy advisor for the Washington, D.C.-based National Center for Transgender Equality. “We recognize that trans people who are incarcerated have a fundamental right to care. appropriate, and they should not have to jump through hoops to access this care while they are inside.
Gender-affirming care, particularly as it relates to young people, has come under increasing attack from lawmakers, fearing young people are making life-altering decisions they may regret. Federal prisons are required to cover the costs of all necessary health care for inmates under the US Constitution.
Joshua Blecher-Cohen, an attorney for the ACLU of Illinois who represents Iglesias, said the directive represents “a real first step” toward Iglesias finally getting gender-affirming surgery.
“This case has been fraught with delays and denials, as this notice acknowledges,” Blecher-Cohen said. “We are delighted, but there is still work to be done to make this happen.”
In her order, U.S. District Judge Nancy Rosenstengel of the Southern District of Illinois ordered the Bureau of Prisons to conduct an immediate nationwide search for a qualified surgeon while providing detailed evidence of her efforts.
The judge also asked the bureau to demonstrate why it should not be disciplined or held in contempt for past delays and violations of court orders that have repeatedly postponed proceedings. She ordered senior officials and staff representing the bureau and the U.S. Department of Justice to appear at a future hearing to justify the misconduct.
For example, in December, the court ordered the Bureau of Prisons’ Transgender Executive Council to assess Iglesias’ readiness for gender-affirming surgery, the first time the bureau had been mandated to do so. by court order. The council is a group of high-level administrators that includes two psychiatrists, a psychologist and a pharmacist, according to court records.
For weeks, the council said it would set up a surgical consultation, but eventually referred Iglesias to a surgeon unable to perform the necessary vaginoplasty, a surgical procedure in which a vagina is constructed. Subsequent consultations with other surgeons then failed.
The judge’s latest order, issued Monday, directs the bureau to file weekly reports detailing its search for a qualified physician who can conduct the proceedings before Iglesias’ scheduled release from federal custody in December 2022.
A spokeswoman for the Bureau of Prisons said the office “does not comment on ongoing litigation or matters that are the subject of legal proceedings, nor do we comment on the conditions of detention of any individual or a group of inmates”.
In a statement released by the ACLU, Iglesias, 47, said she hoped the order meant she would “finally get the care I need to fully live my life as the woman I am.” “.
“(The office) has denied me gender affirmation surgery for years and continues to bring up new excuses and put new obstacles in my way,” she said. “I am grateful that the court recognized the urgency of my case.”
A story of resistance
Gabriel Arkles, senior counsel for the Transgender Legal Defense and Education Fund, said the federal government, as well as many states, have long resisted providing necessary surgical care to transgender inmates.
“Anyone in custody has the right to the health care they need,” Arkles said. “It is unconstitutional and immoral to deny health care because of a person’s gender or because the care they need is stigmatized.”
An estimated 1,200 transgender people are in the federal prison system, or about 0.7% of the total prison population of approximately 156,000 people.
Iglesias, previously held in a federal women’s prison in Fort Worth, Texas, is now being held in a residential rehabilitation facility in Miami. She pleaded guilty in 2005 to sending an envelope to British officials that she falsely claimed contained anthrax.
At the time, she was in federal prison and listed the detention center as her return address.
“No threat has been carried out in any way,” wrote his public defender, Kathleen Williams, asking for a more lenient sentence. She noted Iglesias’ history of bipolar disorder and the consistency of the crime with Iglesias’ history of a decade of sending such letters.
Iglesias was eventually sentenced to 20 years in prison. She has been in the federal prison system since 1994, where until recently she was primarily held in men’s facilities, subject to physical and sexual abuse. According to court documents, she experienced gender dysphoria so extreme that she considered self-castration and was placed on suicide watch on multiple occasions.
“She is at risk of committing suicide and her psychological state will continue to deteriorate,” the judge wrote in her order.
Gender dysphoria is a medical condition marked by mental distress caused by an incongruity between a person’s gender identity and their sex assigned at birth, which can cause anxiety and depression if left unchecked. is not processed. Not all transgender people have gender dysphoria, and for those who do, surgery isn’t always necessary.
Advocates note that treatment options are developed over a years-long process involving patients, parents, doctors and mental health professionals.
Transgender care protocols have been established by the World Professional Association for Transgender Health (WPATH) and endorsed by groups such as the American Medical Association, American Psychiatric Association, American Academy of Family Physicians, and the World Organization of health.
These guidelines call for individuals to live in their identified gender role for at least one continuous year before proceeding with surgery, a procedure that should be supported by their primary care provider with referrals from two mental health professionals.
‘We still have a long way to go’
Iglesias didn’t receive hormone therapy until 2015, and the following year she told prison health officials she wanted sex-confirmation surgery, according to court documents. She requested that she be transferred to a women’s correctional facility, both to match her identity and due to harassment from male prisoners.
Eventually, the ACLU took up her case, and in May 2021, she became one of the few transgender inmates ever to have been transferred to a federal prison aligned to their gender identity.
Blecher-Cohen said he hopes the judge’s order will finally compel the Bureau of Prisons to provide Iglesias with the care she needs.
“The court order makes it clear that she needs gender-affirming surgery now and that BOP cannot justify her inability to provide this medically necessary care,” he said. “We hope this historic decision will help secure long overdue health care for Cristina – and the many other transgender people in federal custody.”
Rangel, of the National Center for Transgender Equality, noted that the Bureau of Prisons recently updated guidelines governing the management of transgender inmates to streamline the identification, tracking and placement of such individuals.
“We are now in a situation where the federal government is catching up,” Rangel said. “There is movement, but we still have a long way to go to make sure trans people get the care they need.”