Sidestepping broader constitutional questions, the California Department of Corrections and Rehabilitation (CDCR) has agreed to pay for a transgender inmate’s sex reassignment surgery — the first in the nation.
The decision, announced on Friday, settles a lawsuit brought by 56-year-old Shiloh Quine, who argued that California’s refusal to provide medically necessary treatment for her gender dysphoria violated the Eighth Amendment’s protection against cruel and unusual punishment. If she goes through with it, Quine – who is serving life without parole for murder – will be the first inmate in the country to receive sex reassignment surgery while incarcerated.
“After so many years of almost giving up on myself, I will finally be liberated from the prison within a prison I felt trapped in, and feel whole, both as a woman and as a human being,” said Quine in a statement released by the Transgender Law Center, which has been representing her. “I’m just overwhelmed, especially knowing that this will help so many other people. I know I can never truly make amends for what I’ve done in the past, but I am committed to making myself a better person, and to helping others so they don’t have to struggle the way I have.”
The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) defines gender dysphoria as “clinically significant distress” arising in people whose gender assigned at birth differs from the one with which they identify. As treatment, the DSM-5 recommends a broad set of options including counseling, cross-sex hormones, social and legal transition to the desired gender, and sex reassignment surgery.
But for transgender inmates, options are limited. In 2009, Quine, formerly known Rodney James Quine, was diagnosed with gender dysphoria and began taking feminizing hormone treatment. The prison system, however, would not allow her to legally change her name or transfer her from Mule Creek State Prison, a male facility where California sends transgender women. According to legal filings, Quine has repeatedly attempted suicide and reported once instance of attempted self-castration.
“Based on my examination of Ms. Quine’s medical and mental health records and my clinical interview, I have determined that genital sex-reassignment surgery is appropriate and medically necessary treatment for Ms. Quine,” concluded Dr. Richard Carroll, a clinical psychologist hired by the CDCR in June. “Sex-reassignment surgery is medically necessary to prevent Ms. Quine from suffering significant illness or disability, and to alleviate severe pain caused by her gender dysphoria. In addition, sex-reassignment surgery is likely to significantly reduce Ms. Quine’s other mental-health conditions, which include depression, anxiety, and risk of suicide attempts.”
Under the 1994 Supreme Court case of Farmer v. Brennan, prisoners can hold prison officials accountable for “deliberate indifference” to their safety. Though Friday’s settlement means that the federal judiciary won’t be using Quine’s case to settle the question of whether denying access to sex reassignment surgery constitutes “deliberate indifference” to an inmate’s medical needs, her attorneys believe the decision will still have a broad impact on the national stage.
“While this isn’t ‘precedent-setting’ in the general sense, other jurisdictions can look to California and, in particular, to this case to develop policies that are compliant with the constitutional requirement to provide medical care to inmates,” Flor Bermudez, detention project director at the Transgender Law Center, told msnbc. “The settlement agreement itself is a public document that can be cited by other inmates seeking redress from the courts.”
“In other words,” she added, “by settling this case, the state of California is acknowledging that this is what they have to do.”