SHOULD TAX DOLLARS FUND INMATE SEX CHANGE MEDICAL COSTS?

Should Tax Dollars Fund Inmate Sex Change Medical Costs?

Ronald Edwards

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Prison staff members arguably have the most difficult jobs in public service today. They must be flexible in their attempt to properly house, treat, and rehabilitate inmates in an effort to produce productive tax paying citizens upon release. The roles of prison staff fundamentally focus on society’s interest to advance retribution, incapacitation, rehabilitation, and restoration of society. Most inmates will re-enter society, hopefully, better prepared to successfully integrate into a community near you.

However, it is thought that in many cases it is futile to attempt to try to rehabilitate those that have never been habilitated to begin with. Prisons house some of society’s most incorrigible people. Additionally, prisons are home to the most socially and morally deficient persons in the populace. Society bears the expense for the care and treatment of over 2 million prisoners incarcerated in the nation.

This extraordinary chronicle will provide you an unusual and in-depth look into some of the serious challenges that prison staff are obliged to contend with, as they strive to advance the goals of the criminal justice system. Please keep an open mind as you consider the needs of the individual offender and the needs of society.

Persons who contravene the traditional ideologies of gender and sex through transgender sex reassignment surgery are now confronted with unexpected issues and consequences when they step into prison. Transgender is defined as a person who alters their biological birth sex through surgery or pharmaceutical enhancements. Those persons who chose to identify themselves as a member of the opposite sex, such as male to female (MtF) and female to male (FtM), are finding that many prison facilities are not prepared to accommodate the many treatment issues that the transgender inmate present. For instance, the transgender inmate in prison is at a potentially higher risk of assault or even self-injury than typically found in the prison general population. Prison can be a very dangerous environment for a transgender inmate. Such inmates are in need of special policies that will protect them from predatory inmates in the general prison population. Multiple legal and ethical issues confront correctional administrators in their duties to provide appropriate healthcare services to transgender inmates.

The decision for a person to change their sexual gender is a serious personal choice that involves a significant health risk. It is a personal decision that requires extensive pre and post psychological and medical treatment plans. People who elect to proceed with the transgender transformation processes are cognizant that they will need substantial monetary resources to completely finance such an expensive elective procedure. These “life-changing decisions” are extremely serious and may even present life-threatening ramifications if the proper pre and post psychological treatment and post medical care plan is not implemented prior to the initial surgery. In most cases multiple surgeries and extended post surgery hospitalization are required to complete the process. The expense of transgender reassignment surgery can cost anywhere from $6,000 to $8,000 overseas (Thailand and Europe) while the same surgery would cost $10,000 to $20,000 in the United States.

At any given time a transgender person enter the criminal justice system, be adjudicated, and sentenced to prison. Once processed and received at a prison reception facility, correctional healthcare administrators are confronted with the initial legal and ethical aspects of how to address these medical issues. Most correctional agencies mandate that a prison inmate’s current state of health will be maintained as assessed at the initial reception center’s medical diagnosis. Prison medical staff are obliged to determine if a transgender inmate has serious medical needs and if so, to provide at least some treatment. In the United States, unlike Canada, transgender inmates will be maintained only at the level of change which existed when entered the reception facility. The policy for the Federal Bureau of Prisons is to provide hormone therapy at the level that was maintained prior to being incarcerated.

Several States are embroiled in litigation by inmates who are striving to gain taxpayer funded sex change surgery while incarcerated. Wisconsin currently has a law that specifically prohibits the use of government funds to provide hormone therapy or sex reassignment surgery for inmates. Most correctional jurisdictions do not have policies or laws in place to address these cases, or if so, as interpreted, are limited in scope or are too ambiguous in content to cover the complicated issues that exist. Some states allow transgender inmates to receive hormone therapy while in custody. In 1994 alone, there were seventy inmates receiving hormone therapy treatments in New York State prisons and seventeen in the New York City jail system.

The general public is not aware of such legal, ethical, and controversial dilemmas involved in this public conflict unless the media happens to report a particular case. Here are the most perplexing questions:

What is enough standard of care?
What is appropriate gender care?
What care options should be continued?
How do you educate staff against transgender prejudice?
Is lack of treatment “deliberate indifference”?
Is it discrimination?
How should this be explained to the public?
Should taxpayers pay for psychological and medical maintenance of transgender inmates’ healthcare?

However the case, when correctional administrators and healthcare staff identify transgender inmates at reception medical staff should concur if the transgender crossover progression has surgically altered the inmate’s biological birth gender as MtF or FtM. If the medical determination is made that an inmate is surgically rendered MtF or FtM, the inmate will be transferred and housed in a facility consistent with their current gender identity. If the circumstances exist that the inmate is still considered to be his/her biological birth gender, the inmate would be sent to a facility consistent with that gender. Once the assessment is concluded, a collaborative treatment plan should be initiated involving both mental health and medical staff.

Transgender inmates can attract unneeded attention in general prison populations. The attention can actually disrupt the harmony of an institution. The presence of a MtF inmate in a male facility can pose serious security concerns, especially when their appearance, through hormone therapy or surgical alterations, render their appearance to be more feminine. Some MtFs welcome this attention. Most transgender inmates chose to lead open homosexual lifestyles and therefore increase the probability of becoming prey for inmates who engage in homosexual sex, whether consensual or not.

Healthcare administrators, nurses, mental healthcare staff, and correctional officers collectively have a legal and ethical responsibility in providing adequate care and the appropriate level of security to protect the inmate. If a transgender inmate is assaulted while incarcerated, legal claims could be brought against the correctional agency for “failure to protect.” “Failure to protect” suits are serious and have proven difficult to defend, often ending in costly settlements.

Many transgender inmates are classified and initially placed in “special housing” or protective custody status. Protective custody status placement is to protect both inmate and staff from incorrigible inmates who prey on vulnerable transgender subjects. However the isolation of transgender inmates has occasionally resulted in suicides, which indicates that psychological and psychiatric intervention may be necessary. Self-esteem is a serious and complex psychological issue for transgender inmates, thus monitoring for mental instability is essential. Additionally, separate toilet and private showering facilities are necessary.

The transgender inmate is provided continuous psychological counseling and medical examinations to further determine what “special needs” are applicable. Controversy erupts between staff and inmates when transgender prisoners begin to receive non-conventional care. In many cases transgender prisoners are prescribed brasseries to be worn as undergarments to support hormone altered breast tissue in an attempt to “to maintain and sustain the health” of the MtF inmate. Some cases require that the inmate be prescribed hormone therapy to stabilize the medically altered process of the transformation. In many cases, prison medical staff prescribes the same hormone therapy that the prisoner received prior to their incarceration. Hormonal treatments maintain the MtF inmate’s breast size, impedes the growth of facial hair, and other hormonal effects that are intended to promote a feminine appearance. FtM hormone therapy may achieve the opposite effects of MtF, i.e. growing chest hair, facial hair, voice change, attenuation of the testicles and other internal medicinal modifications. Only Wisconsin has legislated that no government funds will be used for transgender inmate hormone therapy. Medical staff are conscious that any cessation of a prior prescribed hormonal therapy plan (from the transgender’s physician prior to incarceration), could prove to be ethically, morally, legally, and mortally damaging. Termination of the transgender inmate’s treatment can cause them to develop more serious gender identity issues and could lead to suicide.

Is it morally, ethically, and legally proper for taxpayer funds to pay for the transgender inmate’s psychological and medical maintenance programs during their incarceration years? Unequivocally yes.

There has not been any substantial media coverage or public attention that has generated significant debate for such cases because of the “out of sight, out of mind” philosophy. But, if it is ever revealed that hundreds of thousands of dollars per year are spend individually on these type situations, the public outcry may be certain to reach political attention.

The transgender inmate will require special needs from prison healthcare staff. Prison populations are a realistic reflection of society; prisons are in fact a microcosm of our communities and culture. As in most correctional systems in this country, legislatures establish laws that mandate that all inmates must be treated fairly despite the crime they committed. A popular correctional cliché is that “inmates are sent to prison as punishment, not for punishment.” That cliché’ can easily be interpreted to reflect the civilized manner of treatment in which prison inmates have grown accustomed to in the United States. This has not always been society’s stance. Our modern point of view is the result of years of moral and ethical evolution created by litigious prison inmates through their near effortless access to the courts.

American prison ideology is distributed throughout undeveloped and developed nations of the world. That ideology includes how prisoners are to be treated and afforded basic privileges. Our government in its noble efforts promotes an ideology that says that basic rights should be afforded to each and every detainee. People in society are divided on this issue of providing services to the transgender inmate.

A prison population is reflective of our society in that it too has become a very litigious environment. Legally transgender issues are recognized as medical and psychological disorders. All professionals involved need be cognizant that failure to provide appropriate care and treatment to transgender inmates may lead to malpractice or human rights abuse claims.

The conclusion is that there is no way out of providing medical and psychological maintenance programs for transgender inmates. It’s simply a legal necessity regardless of the extraordinary expensive. I am not saying that taxpayer funds should be used for transgender surgeries nor for other such controversial elective procedures. What I am saying is that we cannot in good conscious avoid spending money on the maintenance of procedures that were implemented prior to incarceration.

Our society strives to advance civilized philosophies. Having worked a year as the former U.S. corrections advisor to the Republic of Haiti I observed first hand that the prison conditions there lack many of the things that we take for granted in the United States. To quote yet another cliché “you can tell the advancement of a society, by the operations of its prisons”. Our highly cultured American society will continue to preserve its worldly and sophisticated way of life and culture. The majority of our people are a caring and giving culture and even in this eccentric correctional issue there is some redemption for doing the right thing.


Reference:

“Transgender Inmates” No. 168 by Jake Blight; Trends and Issues: In Crime and Criminal Justice, Australian Institute of Criminology, September 2000