The Bureau of Prisons (BOP) of the United States Department of Justice (DOJ) stated in a federal court filing on January 31, 2022, that a transgender prisoner in Texas could be cleared for gender-conforming surgery (GCS) as early as March 2022. The prisoner in question is Cristian Noel “Cristina” Iglesias, 47; if the procedure is successful, she will become only the third prisoner in the United States to have undergone it—unless she is beaten by another prisoner who has been diagnosed with severe gender dysphoria in Wisconsin, whose Department of Corrections (DOC) was ordered to provide GCS by another federal court on December 8, 2020.

It was determined that she had a serious medical need for the surgery and, if she did, that the defendant Department of Corrections officials were deliberately indifferent to that need by repeatedly denying her requests for the procedure in March 2020 at the U.S. District Court for the Western District of Wisconsin.

A gender dysphoria consultant for the Department of Corrections (DOC), Cynthia Osborne, testified at the hearing that Campbell suffers from the most severe form of gender dysphoria, known as anatomic gender dysphoria, which means the presence of male genitalia causes her severe mental anguish and puts her at significant risk of self-mutilation or suicide.

Federal Court In Texas

Following a 2012 assessment, Campbell began undergoing mental health care as well as hormone medication, as recommended by Osborne. In 2014, Osborne conducted a second assessment and concluded that Campbell was a strong candidate for GCS, but that optimal hormone therapy should be done before GCS. Despite the fact that this was done, Campbell was still denied surgery two years later because it was against the Department of Health and Human Services policy.

Federal Court and the WPATH

The defendants argued that the World Professional Association of Transgender Health (WPATH) Standards of Care for the Health of Transsexual, Transgender, and Gender Nonconforming People (WPATH Standards) should be used to establish the medical necessity of GCS treatment.

However, the Court found that Osborne employs the criteria and that the Department of Defense (DOC) claims to adhere to them. According to the report, such guidelines “represented the consensus of qualified medical professionals regarding the appropriateness of various treatments for gender dysphoria, including sex reassignment surgery,” according to the report.

The central question addressed by the Department of Corrections was whether it was conceivable for a person to live one year in the gender role of a female while detained in a male prison, as required by the WPATH standard. Prison officials, on the other hand, expressed reservations about Campbell’s transfer to a female prison before the procedure, which prohibited her from doing so.

In order to get around that Catch-22, the Court used Osborne’s evidence that the requirement of a year of “real-life experience” was “a common-sense practice based more on tradition than on science,” according to the Court. Osborne argued in an academic study that it was conceivable for a transgender woman to live in a woman’s gender role while incarcerated in a male prison. The Court then ruled that neither of the issues barred the surgery from being performed.

It also discovered that GCS is the only effective treatment for Campbell’s severe, unrelenting anatomical gender dysphoria, which she has suffered from for years. Defendants were clearly aware of this, at least since Osborne’s 2014 assessment, and there was no debate about it. The Department of Health and Human Services, however, continued to decline Campbell’s petitions because “DOC policy categorically prohibited sex reassignment surgery.” Because of this, the Court determined the defendants were intentionally ignorant to Campbell’s critical medical needs, thereby violating her rights under the Eighth Amendment.

Because a previous appellate court decision in the case had already given the defendants qualified immunity, the issue of damages was not in question. The court stated that it would issue an injunction forcing defendants to have Campbell assessed for and administer GCS, but that it would not require Campbell to do breast augmentation, voice therapy, or electrolysis because Campbell did not provide expert testimony in those areas. Those representing Campbell included Hush Blackwell attorneys Iana Vladimirova, Joseph S. Dedrich, Natalia S. Kruse, and Thomas Patrick Heneghan, all of Madison. Case in point: Campbell v. Kallas, 2020 United States District Court, No. LEXIS 230117 (W.D. Wis.).

“The threat of self-castration or suicide is always present.”

Iglesias, the BOP prisoner, received a diagnosis of gender dysphoria that was even earlier than that, dating back to 1994. After bringing her claim pro se in the United States District Court for the Southern District of Illinois, the state where she was detained at the time, her complaint was found to be sufficient after undergoing a preliminary review. 403 F. Supp. 3d 680 (Iglesias v. True), for more information (S.D. Ill. 2019).

Appointment of counsel in federal court

Transgender Pride

Iglesias was then appointed as counsel, and he filed an updated complaint that was also accepted by the Court after it passed through its preliminary screening process. The case of Iglesias v. Federal Bureau of Prisons (2020 U.S. Dist. LEXIS 201281) is an example of this (S.D. Ill.).

In the following year, on April 19, 2021, Iglesias filed a preliminary injunction (PI) against the Bureau of Prisons (BOP), requesting that the agency provide her with GCS and transfer her to a women’s prison, where she would be safe from the repeated attacks she had endured during her two decades of intermittent incarceration in BOP facilities for men. The Bureau of Prisons transported her to the Federal Medical Center at Carswell, Texas, on May 2, 2021, which is a female-only facility, thirteen days after she was arrested.

Regarding the PI motion, the Court noted that the Bureau of Prisons based its position heavily on Campbell v. Kallas, 936 F.3d 536 (7th Cir. 2019), which held that there was no deliberate indifference to a prisoner’s medical needs so long as some treatment was provided, as in Iglesias’ case, with hormone therapy being the treatment in question. Nonetheless, the Seventh Circuit found in the same opinion, as the Court emphasized, that “[d]enying a specific therapy in a specific case may constitute a constitutional violation.”

Furthermore, the Court found that the Bureau of Prisons had been delaying Iglesias’ requests for surgery, hormone therapy, and even reassignment to a women’s jail for years, during which time the prisoner had attempted 12 times to commit suicide. Iglesias herself testified that, in the event that GCS does not take place, “self-castration or suicide is always an option.” Dr. Randi Ettner, the immediate past president of WPATH, testified on behalf of Iglesias, stating that Iglesias had met the organization’s standards for recommending surgery by doing so in the following ways:

• being diagnosed with gender dysphoria and having a well-documented diagnosis;

• being on hormones for a long period of time;

• have more than 12 months of experience in her current position and being over the age of majority; and

• maintain good control over any physical or mental health difficulties that may arise.

As a result, the Court determined that Iglesias’ complaint had a good chance of succeeding on the merits, removing the obstacle to obtaining a PI. The court ordered the Bureau of Prisons to show cause by January 24, 2022, as to why it should deny Iglesias’ plea for surgery. The case of Iglesias v. Federal Bureau of Prisons, 2021 United States District LEXIS 245517, provides an example (S.D. Ill.).

Iglesias and her attorneys, including Josh Blecher-Cohen with the ACLU of Illinois, Angela M. Povolish with Feirich Mager Green Ryan and Taylor Brown with the ACLU, as well as Katherine D. Hundt, Courtney Block, Frank Battaglia, and Kevin Warner with the Chicago firm of Winston & Strawn LLP, came to the conclusion that the BOP was going to deny their request. The deadline came and went without any word from BOP, leading Igle

Winston &Amp; Strawn Llp

BOP presents proposal to TEC

When the BOP presented the proposal of its Transgender Executive Council (TEC) that Iglesias receives GCS before her projected release at the end of 2022, it came as a surprise. Federal prosecutors representing the agency stated that “assuming [Iglesias] does not engage in behavior that would prevent her from continuing to be placed in a female facility and assuming further that no other reasons develop that would make gender confirmation surgery inappropriate,” the TEC “does anticipate that plaintiff will be referred to a surgeon at the appropriate time.”

In an unexpected turn of events, the use of public funds to fund gender transition surgery has provided fodder for some conservative news outlets, particularly in the case of Campbell, who is serving a 34-year sentence for a First Degree Sexual Assault charge involving her 10-year-old daughter, which was handed down in 2007. According to reports, it could take up to a year for her to be evaluated for surgery because Wisconsin has only one surgeon who specializes in the operation at this time.

GCS has previously been granted to two other prisoners: Shiloh Heavenly Quine in California in 2017 and Adree Elmo in Idaho in July 2020, both of whom were sentenced to death.

Source : PLN