Transgender inmates wage slow battle for necessary medical care in prison

Marius Mason, born a female, has asked the U.S. Bureau of Prisons for medical treatment to transition to a man. That approval was granted last week, his attorney said.
Marius Mason, born a female, has asked the U.S. Bureau of Prisons for medical treatment to transition to a man. That approval was granted last week, his attorney said.

Marius Mason is believed to be the first person approved to begin hormone therapy to transition from female to male in the federal prison system. Mason, 52, is serving a 22-year prison sentence for arson and will begin taking drugs to initiate the biological transition.

Mason’s lawyer, Moira Meltzer-Cohen, said he has been “waiting for this for a long time” in his Texas prison.

“He understands that his patience will benefit other transgender folks in custody,” Meltzer-Cohen said.

Mason is not the first transgender person to protest treatment in prison. Discrimination is common in prisons and jails across the country, with transgender inmates reporting sexual assaults, abuse and unsafe conditions as a result of their sexual orientation. States have varying policies when it comes to housing prisoners according to their birth gender or the gender with which they identify, with advocates saying placing an inmate in the wrong environment puts them at risk.

Mason is one of a recent few to get requested therapy approved while incarcerated.

Last year, California became the first state to provide sex-reassignment surgery to inmates. The state pays for mastectomies as well as removing and reconstructive reproductive organs after a review committee has examined a prisoner’s physical and mental state and approved the treatment. To undergo surgery, inmates must have at least two years left in their sentence before they are expected to be paroled and have been using hormone therapy for a year. They must also have shown a desire to live as a member of the opposite gender for at least two years.

According to California Correctional Health Care Services, an independent agency responsible for medical care in prisons, surgery and subsequent care could cost between $50,000 and $100,000. Hormone therapy alone costs between $500 and $3000.

The California ruling came in response to a lawsuit from Shiloh Quine, who had been denied surgery to complete her transition to a woman. Doctors and mental health clinicians ruled such surgery was medically necessary.

Mason’s lawyer said he does want full reassignment surgery, but he has to take hormones for at least a year before he will be reassessed.

The Justice Department has not explicitly said states must provide hormone therapy or surgery, but it came out in favor last year of a Georgia inmate who had been cut off from her drugs when imprisoned. Ashley Diamond, 36, sued the state department of corrections because they had identified her as male — her birth gender — on intake forms even though she had been taking hormone therapy for 17 years.

As a transgender woman in a male prison, Diamond is 13 times more likely to be sexually assaulted than the general prison population. She is serving a sentence for burglary and has been housed in several male prisons. According to a lawsuit she filed, she has been raped at least seven times.

Georgia allowed inmates to continue taking drugs they had been using before arrest but did not allow transgender prisoners to begin new treatment after being incarcerated. The Justice Department said that it was cruel and unusual punishment, a violation of the Eighth Amendment, for the state to cut off Diamond’s medication and each prisoner should be given appropriate medication based upon an independent review of their health.

Diamond had been diagnosed with gender dysphoria, meaning she identifies with the opposite gender of which she was born.

“Prison officials have the obligation to assess and treat gender dysphoria just as they would any other medical or mental health condition,” Vanita Gupta, head of the DOJ’s Civil Rights Division, told the New York Times.

The DOJ guidelines in response to Diamond’s case came after the Bureau of Prisons announced in 2011 they would require “individualized assessment and care” for transgender inmates.

In several other cases where a transgender person protested care in prison, the inmate was paroled before a court had ruled, making the case moot.

Although the DOJ came out in support of Diamond, there is no national law dictating what care a prison is required to provide and department guidlines are often ignored or implemented slowly. Prisoners are not entitled to medical care of their choosing, but that deemed medically necessary. The Supreme Court has not ruled on the constitutionality of requiring prisons across the country to provide hormone therapy or sex-reassignment surgery to inmates.

The scope of care legally required is also spurring new policy from other areas of the government: In announcing this year that transgender people can now serve openly in the U.S. military, the Department of Defense also said it would pay for reassignment surgery for soldiers who medically require the procedure.