California sets policy for inmate sex reassignment

Guidelines to decide whether transgender prison inmates in California can undergo sex reassignment surgery took effect Tuesday, making it the first U.S. state to offer a regular path to such treatment.

California last summer agreed to regularly provide and pay for treatments including hormones as well as surgery to alter the biological sex of its prisoners.

The guidelines are believed to be the first in the nation by a prison system, said Joyce Hayhoe, a spokeswoman for the federal court-appointed official who controls California’s prison medical care. They were developed in cooperation with the California Department of Corrections and Rehabilitation, which oversees inmates’ mental health care.

"California has set a model for the rest of the country and ensured transgender people in prison can access life-saving care when they need it,” said Kris Hayashi, executive director of Transgender Law Center in Oakland, which represents two inmates who sued the state after being denied the surgery.

The eight-page document (PDF) calls for inmates who request the surgery and meet the basic criteria to be referred for evaluation to a committee of two medical doctors, two psychiatrists and two psychologists, which would make a recommendation to another higher-level committee of medical professionals.

The policy prohibits procedures which are considered merely cosmetic, including hair removal, face lifts, breast augmentations or other implants, which Hayhoe said will help hold down the cost to taxpayers. She previously estimated the cost could near $100,000, though the Transgender Law Center, which has represented several inmates, said that is exaggerated.

There are currently 375 men and 26 women in the prison system receiving hormone therapy that gives them the characteristics of the opposite sex. They are housed in prisons based on their birth gender unless they have surgery. Many are in special protective housing units or in mental health facilities.

Hayhoe said she does not expect a flood of applications or approvals for the surgery because many won’t seek it or won’t qualify under guidelines that she described as conservative.

Jody L. Herman, a scholar of public policy who focuses on gender identity and transgender people at The Williams Institute, a think-tank on LGBT issues at the University of California, Los Angeles, said the best national survey found that about 42 percent of respondents had any surgery, including some of the procedures the department defines as cosmetic.

One of the new guidelines is that the inmate must have at least two years left in prison.

That became a factor in the case of Michelle-Lael Norsworthy, who was released from prison one day before a federal appeals court was to hear her request in August for the state prison system to pay for her sex reassignment surgery.

But the same month, the corrections department announced 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 third case, that of 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 murder from Los Angeles County.

“I am beyond proud to have been part of the movement to make this policy happen," said Norsworthy felt distress and anxiety since adolescence of as a result of gender dysphoria but only realized she needed sex reassignment surgery while she was in prison. "I suffered for decades as my identity, my medical needs and my very humanity were denied by the people and the system responsible for my care."

She began asking the corrections department for the surgery in 2012 after learning a judge for the first time had ordered Massachusetts to provide an inmate with the procedure. However, that decision was overturned on appeal in December, and the U.S. Supreme Court declined to intervene.

Wire services