JURIST - Paper Chase: Federal judge rules sex reassignment surgery medically necessary for inmate

[JURIST] The chief judge for the US District Court for the District of Massachusetts [official website] ruled [opinion, PDF] Tuesday that an inmate serving life without parole must be granted gender reassignment surgery as it is the only possible treatment for her gender identity disorder [NLM backgrounder]. Judge Mark Wolf contended that to do otherwise would constitute a violation of the Eighth Amendment [text] prohibition against cruel and unusual punishment, as the Massachusetts Department of Corrections [official website] would be denying a medically necessary procedure under the Harry Benjamin Standards of Care [text]:

The Eighth Amendment prohibits cruel and unusual punishment. The Supreme Court has explained that "[t]he Amendment embodies broad and idealistic concepts of dignity, civilized standards, humanity, and decency." Among other things, the Eighth Amendment does not permit the unnecessary infliction of pain on a prisoner, either intentionally or because of the deliberate indifference of the responsible prison official. Any such infliction of pain is deemed "wanton." The wanton infliction of pain on an inmate violates the Eighth Amendment. Prisoners have long been held to have a right to humane treatment, including a right to adequate care for their serious medical needs. It may seem strange that in the United States citizens do not generally have a constitutional right to adequate medical care, but the Eighth Amendment promises prisoners such care.

Wolf's opinion clarifies that gender reassignment does not fall under the standard of "adequate care" in all gender identity disorder cases, only the ones where the inmate has a diagnosis that proves so severe that only gender reassignment would alleviate suffering. The inmate in question, Mark Kosilek, has been under female hormone therapy treatment and anti-depressants for a number of years, but still remains at risk for self harm and suicide. Wolf found that Kosilek had proven gender reassignment was necessary for her adequate care as an inmate in Massachusetts: "Although female hormones have helped somewhat, he continues to suffer intense mental anguish because of his sincere and enduring belief that he is a female trapped in a male body. That anguish alone constitutes a serious medical need." Although an increasing number of prisons recognize gender identity disorder as a compelling medical ailment that requires treatment, most US health insurance policies do not cover [HRC backgrounder] gender reassignment surgery. Massachusetts passed a transgender anti-discrimination law [JURIST report] late last year.

Earlier this year, the US Supreme Court declined to rule [JURIST report] on a similar case, letting a lower court's decision that found hormone therapy for transgender inmates as medically necessary stand. The standing decision from the Seventh Circuit was analyzed [JURIST comment] by JURIST contributor John Knight [profile], who suggested that laws and regulations against transgender therapy are "blatantly discriminatory" due to "popular biases being put ahead of medical research, singling out a small group of inmates, and blocking medical treatments necessary only for them."