Feds Revise Medical Rules for Transgender Inmates

Transgender inmates who did not begin treatment prior to entering federal custody can now receive hormones, specialized mental health counseling and possibly gender reassignment surgery while they are in prison, according to new rules adopted by the U.S. Bureau of Prisons as part of a court settlement.

A May 31 memo issued to wardens at the nation's 116 federal prisons and made public by gay rights groups in announcing the settlement Friday states, "current, accepted standards of care" will be applied to inmates who believe they are the wrong gender.

Under the bureau's previous policy, issued in 2005, only federal inmates with a preexisting diagnosis were eligible for transgender-related care, which was limited to treatments that would maintain them "only at the level of change which existed when they were incarcerated."

The new guidelines mean prisoners who were previously disqualified from treatment because they had not received any on the outside will now be eligible to begin hormone therapy to feminize or masculinize their features and to dress and live accordingly as part of individualized treatment plans.

"The treatment plan may include elements or services that were, or were not, provided prior to incarceration, including, but not limited to: those elements of real life experience consistent with the prison environment, hormone therapy and counseling," the memo from bureau medical director Newton Kendig states.

The policy memo does not mention surgical intervention, but National Center for Lesbian Rights Legal Director Shannon Minter said the agreement would permit surgery as a treatment option if prison doctors agree it is necessary for individual inmates.

The May guidance specifically advises wardens that "treatment options will not be precluded solely due to level of services received, or lack of services, prior to incarceration."

That language, as well as the reference to accepted standards of care is significant since the World Professional Association for Transgender Health, the professional organization that issues guidelines for treating gender identity disorders, considers genital reconstruction surgery "essential and medically necessary" for some patients suffering from "gender dysphoria."

Jennifer Levi, director of the Transgender Rights Project at Gay & Lesbian Advocates and Defenders, said that because the memo does not prohibit surgery, 'It leaves open the possibility that the full range of appropriate medical care must be considered in adopting an individual treatment plan."

"There is no reason why an incarcerated person should be excluded from receiving surgery if it turned out to be medically necessary for that individual," Levi said.

Bureau spokesman Ed Ross said there are currently 48 federal inmates who have been diagnosed with gender identity disorders. Ross did not respond to attempts by The Associated Press on Friday and Monday to clarify other aspects of the policy, including confirmation that inmates could be eligible for sex reassignment surgery that would necessitate their move to a new prison. All state and federal prisons in the United States assign inmates to men's or women's prisons based on their genitalia.

The policy shift resulted from a two-and-a-half-year-old lawsuit seeking hormone therapy for Vanessa Adams, who began serving a 20-year sentence as Nicholas Adams and was diagnosed with gender identity disorder in 2005 by doctors at the U.S. Medical Center for Federal Prisoners in Springfield, Mo.

After she was denied treatment because of the rule requiring previous care for gender identity disorder, Adams, 41, tried to castrate herself with a razor and attempted to and ultimately succeeded in amputating her penis, according to court papers.

Prison officials agreed to put Adams on a course of hormones in August 2009 after a federal judge in Massachusetts, where Adams briefly was imprisoned and her lawsuit was filed, agreed that her lawyers could retain an independent expert to evaluate her. The same judge refused almost a year later to dismiss Adams' claim that the Bureau of Prisons' policy on transgender health care constituted cruel and unusual punishment, a decision that paved the way for the settlement.

The agreement also calls for transgender inmates to be notified of the new policies and for prison doctors to be trained to identify and treat gender identity disorders.

Levi said prison officials have typically been hostile to transgender inmates and that she anticipates more legal action to ensure the bureau's policy is put into practice.

"This should have a very significant effect on the lives of trans inmates. It means people will be receiving appropriate medical care," Levi said.