California prison officials have set the first standards in the nation for determining when transgender inmates should receive state-funded sex-reassignment surgery — a move that came after it spent years in court fighting to block the operations.
Under the policy that took effect Tuesday, prison mental health professionals would refer inmates for the surgery.
To qualify, prisoners must be diagnosed with what is formally known as gender dysphoria; lived as a member of the preferred gender for at least 12 months; and expressed a desire for sex-reassignment surgery for at least two years.
The announcement came after California became the first state to agree to pay for surgery for one inmate and refused to provide the procedure to another inmate who has since been paroled.
The requirements were developed in cooperation with the California Department of Corrections and Rehabilitation, which oversees inmates' mental health care, and are similar to those used by medical providers outside the prison system, said Joyce Hayhoe, a spokeswoman for the federal court-appointed official who controls California's prison medical care.
"It's a great victory for transgender people across the country, and I think it's a model that other jurisdictions can follow," said Flor Bermudez, detention project director at the Oakland-based Transgender Law Center that represented two inmates seeking the surgery.
The eight-page policy document calls for inmates who request the surgery and meet the criteria to be referred for evaluation to a committee of two doctors, two psychiatrists and two psychologists that would make a recommendation to a higher-level panel of medical professionals.
The policy prohibits procedures that are considered merely cosmetic, including hair removal, facelifts, breast augmentations or other implants.
Hayhoe said those prohibitions will help hold down the cost to taxpayers. She previously estimated the cost of full transgender procedures could approach $100,000, though the Transgender Law Center said that is exaggerated.
"I don't think it's a proper use of taxpayer money," said Kent Scheidegger, legal director at the Sacramento-based Criminal Justice Legal Foundation that represents crime victims. "This is basically an elective procedure. I mean, you're surgically altering body parts which have nothing wrong with them because the person has a psychological issue."
California could have kept fighting the court battle, as Massachusetts did after a judge ordered the state to provide the surgery, he said. That lower-court decision was overturned on appeal last year.
Bermudez noted that the U.S. Justice Department intervened in a lawsuit filed in April by a transgender inmate in Georgia. Federal lawyers said state officials must treat the plaintiff's gender identity condition just as they would any other condition. However, inmate Ashley Diamond was paroled last month before any surgery was done.
There are currently 375 males and 26 females in California's prison system receiving hormone therapy. They are housed in prisons based on their gender at girth unless they have had surgery. Many are in special protective housing or mental health facilities.
Hayhoe said she does not expect a flood of applications or approvals for the surgery because many people won't qualify under the guidelines that she described as conservative.
One new guideline requires an inmate to have at least two years left in prison, which Bermudez said should not matter if the inmate needs the surgery.
That became a factor in the case of Michelle-Lael Norsworthy, who was released from prison in August just one day before a federal appeals court was to hear her request for the state prison system to pay for her sex reassignment surgery.
The corrections department also announced in August that it would pay for the surgery for Shiloh Heavenly Quine, who is serving a life sentence for a Los Angeles County murder. She has not yet had the surgery.
A federal judge in Sacramento is considering the case of inmate Mia Rosati, after the 9th U.S. Circuit Court of Appeals ruled in June that the state may be violating her rights by denying her sex reassignment surgery. She also is serving a life sentence for a murder in Los Angeles County.
