New Legislation

[sarah_ab]

saw the following article on my associated press app under health

Feds revise medical rules for transgender inmates

LISA LEFF

Published: Oct 3, 2011 2:22 PM

SAN FRANCISCO (AP) - 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.

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Online: http://bit.ly/pAnaog

[baby_snow_white]

How is that going to work if let's say you are in a women's prison and you are going from female to male? Would they be transferred to another person?

[Guest Baby Rina]

i still think the moral of the story should be... don't wind up in prison in the first place... Yea i'm all for trans folk getting the help they need and stuff but... if i gotta out of pocket my hormones why should my tax dollars be paying for someone elses ... not fair

[pullupsboy89]

Ok, look....Im all for gay (please understand Gay to mean gay, lesbian, transgender, ect) rights. But this is rediculous. You are in PRISON. You committed a CRIME. I, as a responsible taxpayer, should not have to pay for your hormone treatment. I can barely stand to pay for prisoner's cable TV, let alone something like this. If youre a man who wants to be a woman, more power to you. But you sure as hell should have to wait until you have paid your debt to society.

[Bettypooh]

Rina, why should any person with a recognized medical condition not be given continuing treatment if they are incarcerated? Would you take this further to say that anti-depression meds are not necessary for those with CD who are not suicidal when they were arrested? This matter is much the same. I agree on avoiding the place when you can, but I've been falsely convicted twice so far- that alters one's perspective on matters quite a lot. IMHO treatment there would be adequate for those with all the previous required diagnoses to begin or continue on 'mones at an adequate level; surgeries can wait as for most TG's the emotional settlement is enough treatment temporarily. I see no need to do any more than to preserve the persons being incarcerated at the point they were at on arrest, or with additional treatment as needed for worsening conditions only.

The question of where to house TG's is still a problem here though it is my understanding that other nations are beginning to have TG-only buildings or areas implemented in their penal systems. Luckily my local PD has TG training so the last time it was an issue for me, so I was allowed the option of disposing of my underwear before being placed in a male cellblock since I am surgically unaltered and there was no "apparent reason" to do anything else with me. Had I been further along I would have been been placed in a separate cell locally and temporarily- I am unsure what they do with longer-term folk here after their convictions. There is a separate section for those who are Gay here, but that wouldn't be proper for TG's that are not Gay. In fact, it may even be less safe than an improper-gender area for a TG. I felt I was treated fairly and didn't request that my 'mones be continued since I wasn't going to be there very long.

The idea of there being no more than two genders, and that sexual orientation goes with gender, is obviously wrong, and in this situation needs to be addressed far better than we're doing now for the safety of the inmates. The law has already held that it is illegal to knowingly endanger inmates by placing them in improper populations so it becomes obvious that the matter needs to be addressed before we end up paying out tax dollars in settlement of suits brought over that matter. It's already happening- I know of at least three settlements in the last year nation-wide including one small PD who had to cut their budget afterward to cover that. That is obviously a waste, so let's fix the system right to save money and do the right thing for all involved.

Let's place inmates properly and give all needed medical treatments it will take for them to maintain as healthy a life as one should give someone in this situation temporarily. That money could be taken from what is currently being spent on people with life sentences and no more available appeals; as I see it prolonging their lives is of less importance than this though if we can cover both, we should. YMMV.

Bettypooh

[Guest Baby Rina]

Actually betty if i didn't make that post when i should have been sleeping a more coherent version of my argument might have been closer to...

While i appreciate the needs of those who have been incarcerated and am happy that they now have the chance to begin transitioning while inside a penal institution even if they had not previously started prior to beginning their stay. I wish there was a little bit more financial help for those who are not already incarcerated. Now i know this article takes place in California and everything in that state is a little off in the budget... On the other hand over here in PA i've sent several requests for help and advice, even just in picking out a therapist that i'm going to be paying for out of my own pocket to the nearest large transgender center and still in over 3 months have not gotten a single response from them other than an automated replay saying they got my message. Prison shouldn't offer more comprehensive treatment options than outside of prison. I

[Bettypooh]

Yes, Rina, it's a big problem that. (Which is why my last PM when I thought I could help out). In my past experiences in the TG world I found that until you showed up in person in that world, very few people would tell you diddly-squat about anything. You might seek out TG support groups near you and after learning a bit about the people ask those you think best to ask about the matters which concern you. I would be very surprised if you didn't get at least a dew answers or learn of where to go to get them. Especially among TS's, there's a tendency to keep such info private, giving it only to close friends. I can see some reasoning with that if someone is living stealth, or if you were in my situation where your Doctor told you they didn't want to help anyone else TG, just you. I have had to keep that mum so as to not risk the loss of my own treatment but luckily there is another Doc here that I can send people to. Especially among stealths, there is a risk when someone they deem as 'not passing' comes into their social circles. Once someone 'discovers' the non-passer, that person's mind may open up and find more TG's in that crowd than they had ever thought about before, which could have a negative impact on the life of the 'stealth TG' afterward should they too be 'discovered'. This is the main reason appearing personally can open previously closed doors for you.

When asking about Therapists and Shrinks, get the whole story ahead of time, confirming it as best you can. Many are just 'gatekeepers' who will hold you back as long as they can solely to make money off of you, while some are "too easy" and will send you out not really prepared for your journey- neither is good for you. Ditto for Doctors who administer 'mones willy-nilly; you need the careful monitoring proper care requires or you can die because of the improper treatment. It's a bitter pill to swallow knowing how much that costs but if you see yourself as worth it you'll do it properly. I think I mentioned my online source- if I didn't PM me and I'll send it. Top-quality 'mones are available there at prices that are realistic, and with a scrip it's totally legal to order them (even though they will ship without that). You seem to be well on your way to a happier life. Just remember to go slowly and carefully because you have the rest of your life to get there and decades from now that will be more important than rushing things today. You're worth that level of care and concern so give it to yourself- you're worth it.

As to the question of what is fair for the out-or-in situation, it's hard to say. Without being able to get GRS surgery quickly inside, I know of nobody who would choose that method over being free but poor an wanting outside. It must be kept that way or many of us would be willing to do a year or two to achieve dreams we otherwise will be waiting decades for. That too would be unfair, and is why I think limiting treatment to where I said is the proper approach. That free Americans are being scammed over Medical matters is a systemic problem and another topic altogether so I won't go into that here more than to say that there are a few insurance companies who will help TG's to varying degrees. If you can choose and afford one of those, maybe you can find life easier. There are also 'scrip-only' plans which may ease the financial burden if you go about it right. One non-op legally transitioned friend of mine gets her HRT partially covered because as far as the prescribing Doctor knows, she has always been a woman. Her primary care people know her past so she ha to keep the two separated. Usually it's all a compromise and still somewhat costly at best, but that's life in the USA when you have ongoing medical needs.

Being TG is one of the toughest things one can ever encounter in life, a curse as bad as it can get or a blessing that few are ever privileged enough to experience. Or maybe something in between. When you have to take that path just to survive life, it will be hard, but in the end as long as you do the journey right the reward is far more enriching than anything else any human can ever do or accomplish in this lifetime. Be well on your journey!

Bettypooh

[sarah_ab]

if someone goes to jail, and while there finds out they have cancer, should the treatment go to someone not in jail over the incarcerated person?

if someone goes to jail and has diabetes, should their insulin go to someone who is not in jail?

if a person goes to jail and has schizophrenia should their medication go to someone who is not in jail?

I cannot answer these questions, because it is an ethical and moral dilemma. I understand what you are saying, however if you are going to withhold medical treatment from one group of people, then it needs to be withheld from all prisons, and on the flip side, if you are going to treat medical conditions for prisoners, then ALL medical conditions need to be treated... and not just pick and chose.

At any rate, it does state in the article, that the AP attempted to find out if a person had gender reassignment surgery would they be sent to the appropriate facility...

It will be interesting to see how this plays out...