A major settlement over transgender prisoner health care in California was announced by the Transgender Law Center and we hope it spurs action in other states �" and that more trans prisoners here can benefit from it. Under the agreement, Shiloh Quine, a trans woman currently housed at the Mule Creek men's prison in Ione, will be able to receive gender-affirming surgery. Every medical doctor and mental health clinician who reviewed Quine's case determined that surgery is medically necessary, said a statement from California Department of Corrections and Rehabilitation spokesman Jeffrey Callison. Yet he also said that CDCR reviews situations like Quine's on a "case-by-case basis."
Flor Bermudez, TLC's detention project director, told us that while the state did consider individual cases, it had never referred any trans prisoner to surgery. "The practical reality was a blanket ban," Bermudez said, adding that testimony in the case involving trans prisoner Michelle-Lael Norsworthy revealed that advocates were told surgery was "off the radar."
The state's position, however, did not stand up to judicial scrutiny. In the Norsworthy case, federal Judge Jon Tigar found that the prison system had been "deliberately indifferent to her serious medical needs." Norsworthy was paroled this week, and media outlets reported that Medi-Cal will cover her surgery.
Bermudez said she didn't think CDCR changed its policy so much as realized it would lose in the Quine case. "Therefore, they wanted to settle," she said.
The terms of the settlement go beyond referrals for surgery, which was at issue in the Quine case. She had been referred for surgery by medical personnel, yet the state never approved it. According to TLC, the state has also agreed to change its policies so that trans prisoners can access clothing and commissary items consistent with their gender identity. This is a very important advancement that will make trans prisoners more comfortable.
This is not some politically correct move on the state's part. Trans people often experience harassment and ridicule, whether incarcerated or not. Being in prison is no picnic, and even small changes, like access to women's clothing for trans women, will help them emotionally and psychologically.
We've seen positive developments in the prison system's treatment of trans inmates. At the federal level, Chelsea Manning, who's incarcerated at a military prison, had to sue for access to hormone therapy. Earlier this year, for the first time, the Army approved the treatment.
Locally, San Francisco Sheriff Ross Mirkarimi has proposed a plan to stop classifying transgender inmates who have not had surgery according to their birth sex. This means that trans women would no longer be housed with men. (The jails see more trans women prisoners than trans men, although the policy would apply to them too, meaning they'd be housed in men's quarters.) One key part of getting the policy implemented is training the sheriff's staff, some of whose comments seem woefully ignorant of trans issues and consider surgery necessary to be a transgender person, which is not the case.
Bermudez said TLC hopes that one outcome from the CDCR settlement is that jurisdictions in other states follow the Quine case and begin providing medically necessary care to trans prisoners, including referrals for surgery.
"We want health care to be available and provided, whether by court order or policy change," Bermudez said.
Last week's settlement announcement is the beginning of that process, but it needs to be expanded well beyond the "case-by-case" basis used by the CDCR. Prison officials need to follow medical staff recommendations for surgery for trans prisoners.