Michelle Really Needs This Surgery

Thanks to the prohibition of cruel and unusual punishment in our Constitution, we have some simple and basic legal rules when it comes to prison health care. Prisons must provide the people in their custody adequate health care. Prisons can’t ignore people’s serious health needs. Decisions about what treatments people need must be made by health care professionals with the necessary expertise, not prison bureaucrats. Prisons can’t have blanket policies that say no one can ever get a certain form of health care, even if doctors say they really, really need it.

Yesterday a federal court invoked these very uncontroversial legal principles to rule that California prison officials must provide Michelle-Lael Norsworthy, a transgender woman incarcerated at a men’s prison, with gender confirming surgery her doctors and medical experts say she desperately needs. Read more »

Doctor: Gender affirming surgery a necessity for Michelle

Michelle has for years suffered severe physical and mental distress because the prison flatly refused to provide her with surgical care she needs to treat her gender dysphoria. Her treating doctor determined that gender confirming surgery was “a clinical and medical necessity for her health and well-being.” Still the prison refused.

Some – though not all – transgender people need health care related to gender transition. According to the widely accepted Standards of Care for transgender healthcare, hormone therapy is often necessary to help align a person’s gender identity (the gender one knows themselves to be on the inside) and physical characteristics. However, for some people hormone therapy is insufficient or causes health risks. The Standards of Care state:

While many transsexual, transgender, and gender-nonconforming individuals find comfort with their gender identity, role, and expression without surgery, for many others surgery is essential and medically necessary to alleviate their gender dysphoria.

In Michelle’s case, her doctors and medical experts say she needs gender confirming surgery. The prison argued that giving her hormone therapy was all they had to do, even though hormones had not effectively resolved her distress and were risky for her to take because of other medical conditions. The court correctly ruled that constitutionally adequate health care is the treatment doctors say a prisoner actually needs, not treatment that isn’t working.

Thanks to the preliminary injunction granted yesterday, Michelle will now hopefully get gender confirming surgery. She told the court that she is “a woman trapped in a man’s body,” and that without the ability to conform her body to her gender identity, her spirit is “imprisoned in a way that causes excruciating pain and frustration,” and she can't “complete her existence or complete who she is.”

Everyone not only deserves adequate health care but also the ability to be themselves and to feel comfortable in their own skin.

We at the ACLU congratulate Michelle Norsworthy, and her lawyers at Transgender Law Center and Morgan Lewis & Bockius LLP, on this important victory.

Melissa Goodman is the Director, of the LGBTQ, Gender & Reproductive Justice Project at the ACLU of Southern California.