The Federal Bureau of Prisons is Still Delaying My Health Care, Despite a Court Order
In December, the federal Bureau of Prisons was court ordered to provide ACLU client Cristina Iglesias with gender-affirming surgery following a filed in September 2020. The Bureau of Prisons failed to approve surgery by the court ordered deadline of January 26.
I’m an outgoing person, which makes me want to meet new people and learn about them. I’m a caring person, too, which means I often want to find a way to make things better for others, if I can. I’m also a transgender woman. And as someone who is different, it’s easy for me to be patient with other people who are having problems and to sympathize with what they are going through.
For more than 27 years, I’ve lived in federal prisons across the country. The Bureau of Prisons has known that I am a woman since 1994, though they housed me in men’s prisons for decades. I have also had to spend years fighting to get the health care I need for my gender dysphoria.
Being denied the gender-affirming care I need has had a huge impact on me, because I’m unable to complete myself. Not having a body that matches who I know myself to be affects me every moment of every day. It is very difficult and hard to keep hope.
Last month, a federal court ordered the Bureau of Prisons — for the first time ever — to finally evaluate me for gender-affirming surgery. When I heard about the ruling from my lawyers, I went back to my cell to process just how huge this is. After being denied for so long, I cried — but it was tears of relief. This week, however, I found out that the Bureau of Prisons has decided to recommend me for surgery on paper but delay actually referring me to a surgeon until mid-April 2022.
Getting medical care is necessary to allow me to finally live my life fully as the woman I am. Living with gender dysphoria — and being denied the treatment I need — has caused me torture every day. Gender-affirming surgery would help end that torture and remove one of the biggest obstacles facing me for decades. Putting this barrier behind me would let me devote my time to living a productive life and advocating for others when I leave prison later this year.
Preparing for my lawsuit has been a long and difficult journey, but it has taught me how to advocate for myself. I am fighting not just for me, but for other people like me, too. I am fighting to make sure that transgender people in prison get the care we urgently need, just as other trans people have done before me.
Working with my legal team has also reminded me that there are people who care about transgender people and are willing to help us fight for what we need. My message to people who want to do something to help is that you can be an advocate by encouraging your friends and family members to be more accepting of transgender people. Everyone needs to understand that being trans is real and that our medical needs are real and serious.
I wish that prison officials and other people understood how hard it is to be transgender in prison because we have to fight not just for our basic rights, like medical care, but also for our safety. I have faced violence and discrimination from staff and other prisoners just for being who I am, and it has not been easy.
I want the Bureau of Prisons to do the right thing and give me the surgery I need. It shouldn’t take a court order for me and other transgender people to get adequate health care, as has happened in the past. A federal judge has already ordered the Bureau of Prisons to evaluate me for surgery, but they are still dragging their feet. I want them to stop creating barriers — and to understand that we are human, too.
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Press ReleaseDec 2024
LGBTQ Rights
President Biden Must Veto Defense Bill Attacking Military Families with Transgender YouthPresident Biden Must Veto Defense Bill Attacking Military Families with Transgender Youth
WASHINGTON — The U.S. Senate today passed a version of the National Defense Authorization Act that would ban coverage for gender-affirming care for transgender youth whose parents are active-duty military personnel. The American Civil Liberties Union is opposing final passage of the defense bill over the inclusion of this health care ban and calling on President Joe Biden to veto the bill. Section 708 of the NDAA would prohibit insurance coverage for “medical interventions for the treatment of gender dysphoria” such as hormone therapy and puberty-suppressant medications, which Speaker Mike Johnson says would “permanently ban transgender medical treatment for minors.” The same treatments would be covered by TRICARE for any medical purpose other than treating gender dysphoria, the clinical diagnosis for the psychological distress experienced by transgender people related to their gender identity. “By passing this bill, the House and Senate are forcing thousands of active-duty service members to choose between their careers in the military and the future of their transgender children,” said Mike Zamore, national director of policy & government affairs at the ACLU. “This unconscionable and unjustifiable attack on those families stands in direct contrast to President Joe Biden’s legacy of defending the civil rights of transgender Americans — including when few in his own party showed the courage to do so. President Biden should cement his legacy by vetoing this bill and sending it back to Congress to pass without Speaker Johnson’s last minute health care ban for servicemembers’ kids.” If signed by President Biden, this health care ban would be the first new anti-LGBTQ provision enacted by Congress and signed into law by the president since the enactment of the military’s since-repealed “Don’t Ask, Don’t Tell” policy for LGBTQ servicemembers and the since-repealed federal law barring recognition of same-sex marriages known as the Defense of Marriage Act. It is unknown how many transgender youth are currently enrolled in TRICARE or how many of those enrolled are currently receiving coverage for gender-affirming care. In one 2022 analysis, 2,500 minor patients sought care for gender dysphoria through TRICARE Prime insurance at military or civilian treatment facilities in 2017, and 900 received puberty suppressants or gender-affirming hormones. Earlier this month, the Supreme Court heard oral arguments in a landmark case brought by the ACLU, the ACLU of Tennessee, Lambda Legal, and Akin Gump on behalf of three families and a medical provider challenging a Tennessee ban on gender-affirming hormonal therapies for transgender youth on the grounds the ban violates the Equal Protection Clause of the U.S. Constitution. -
Press ReleaseDec 2024
LGBTQ Rights
Montana Court Blocks State From Refusing to Correct Sex Markers on Transgender People's Birth Certificates and Driver's LicensesMontana Court Blocks State From Refusing to Correct Sex Markers on Transgender People's Birth Certificates and Driver's Licenses
HELENA, Mont. – A Montana court has granted a preliminary injunction preventing the state of Montana from enforcing policies that bar transgender people from obtaining accurate sex designations on their birth certificates and driver’s licenses. After a prior restriction on amendments of birth certificates was struck down by the courts, in early 2024 the state of Montana enacted a new rule that categorically bars transgender Montanans from correcting the sex designation on their birth certificates. Around the same time, the Montana Department of Justice adopted a policy similarly restricting amendment of driver’s licenses. The plaintiffs challenged these policies in state district court, arguing that they violate various constitutional provisions, including the right to equal protection of the law. In a recent Montana Supreme Court decision, two justices concluded that discrimination on the basis of transgender status – as the state is engaging in here – is a form of sex discrimination that violates the Montana Constitution’s equal protection clause. The plaintiffs, two transgender women, are represented by the American Civil Liberties Union, the ACLU of Montana, and Nixon Peabody LLP. Plaintiff Jessica Kalarchik, a veteran who served in the United States Army for 31 years, said: “After finally being able to live my life openly as the woman I know myself to be, I am frustrated that my birth state, Montana, wants me to carry around a birth certificate that incorrectly lists my sex as male. I live my life openly as a woman, I am treated as a woman in my daily life, and there is no reason I should be forced to carry a birth certificate that incorrectly identifies me as male. Fortunately, the court agrees that this ridiculous policy should not be in effect.” “Once again the State of Montana chose to adopt a draconian policy that is clearly intended to marginalize transgender Montanans, only for that discriminatory action to be blocked by the courts,” said Akilah Deernose, executive director for the ACLU of Montana. “Here in Montana we treasure our right to privacy and to live our lives free from governmental intrusion. The State of Montana clearly has not learned any lessons from the past few years, where courts have repeatedly struck down unconstitutional laws targeting transgender Montanans.” “Forcing anyone to carry documents that contradict their identity unjustly violates their rights to privacy, equal treatment, and not being compelled to convey a government message about their sex that they disagree with,” said Malita Picasso, staff attorney for the ACLU’s LGBTQ & HIV Project. “Such a policy marks transgender people for further mistreatment and discrimination, essentially requiring them to carry papers that out them as transgender any time they need to provide identity documents. Fortunately, the court has refused to allow the state of Montana to subvert the freedom of transgender Montanans to control their own identity as this case goes forward.” In granting the plaintiffs’ motion for a preliminary injunction, the court held, “[i]f the challenged state actions discriminate against transgender individuals on the basis of their transgender status, they also necessarily discriminate the basis of sex.” The state has the option of appealing the district court’s ruling to the Montana Supreme Court, but the underlying case will proceed in district court. A trial has not yet been scheduled. -
FloridaDec 2024
LGBTQ Rights
Keohane v. DixonKeohane v. Dixon
On September 30, 2024, the Florida Department of Corrections rescinded its policy regarding treatment of gender dysphoria, which allowed for hormone therapy when deemed medically necessary, as well as access to clothing and grooming standards that accord with one’s gender identity. Under this new policy, grooming and clothing accommodations have been stripped away, and hormone therapy is not permitted unless an exception is deemed constitutionally required. The ACLU brought a class action challenging the policy. -
IdahoDec 2024
LGBTQ Rights
Robinson v. LabradorRobinson v. Labrador
Two incarcerated transgender women have sued the state of Idaho alleging that HB 688, a 2024 law barring state funding for gender-affirming medical care for transgender people, denies them access to the health care their doctors have prescribed for them and is a violation of their Eighth Amendment right to be free from cruel and unusual punishment. They represent a class of all incarcerated folks within the state of Idaho who face the loss of hormone therapy due to HB 668.