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April 20, 2011

"Lawsuit asks state to pay for inmate's sex-change operation"

The title of this post is the headline of this article in today's Los Angeles Times.  Here is the start of the piece:

Lyralisa Stevens, who was born male but lives as a female, is serving 50 years to life in a California prison for killing a San Bernardino County woman with a shotgun in a dispute over clothes.

Stevens is one of more than 300 inmates in the state prison system diagnosed with Gender Identity Disorder, a psychiatric condition addressed in free society with hormone replacement therapy and, in some cases, sex reassignment surgery.  Prison officials have provided female hormones for Stevens since her incarceration in 2003.  But now she is asking the 1st District Court of Appeal in San Francisco to require the state to pay for a sex-change operation.

Stevens, 42, and her expert witnesses say that surgery is medically necessary, and that removal of her penis and testicles and transfer to a women's prison are the best way to protect her from rape and abuse by male inmates.

As prison officials have struggled to address chronic overcrowding, the constant threat of gang violence and a health system that federal judges have equated with "cruel and unusual" punishment, they have also gone to court multiple times to answer allegations that they failed to properly treat and protect transgender inmates.

Judges have sided with transgender prisoners — who according to a UC Irvine study are 13 times more likely to suffer sexual assault than other inmates — on some significant cases. In 2009, the California Supreme Court ruled that an inmate could sue guards for failing to protect her from repeated rapes and beatings by her cellmate.  In 1999, an appeals court ordered prison officials to provide hormone therapy to inmates who were already taking them when they arrived.  The treatments cost about $1,000 a year per prisoner.

A ruling in Stevens' favor would make California the first place in the country required to provide reassignment surgery for an inmate, according to lawyers for the receiver appointed to oversee California's troubled prison health system.  They argue that the state should be required to provide only "minimally adequate care," not sex-change operations that cost $15,000 to $50,000.

April 20, 2011 at 08:52 AM | Permalink


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no offense to the politically correct among us. BUT

it comitted it's crime as a male!

it was tried and convicted as a MALE!

IT can damn well serve it's sentence as a MALE!

once that's done if they wanna pay for it to change it's gender...have fun with your money not MINE!

Posted by: rodsmith | Apr 20, 2011 11:48:02 AM

Whether she should have the surgery or not, the state owes it to her to keep her safe. Solitary confinement due to victimization is unfair (and cruel, particularly if it is for a lengthy time) to the victim.

Posted by: Defense Lawyer | Apr 20, 2011 11:56:35 AM

Here's the problem, though, Rod...

Take an inmate who was in perfect health before being imprisoned. After being in prison, the inmate is diagnosed with high cholesterol. Does the prison have an obligation to provide lipitor to the prisoner, even though the prisoner offended as, was tried as, and was convicted as a perfectly healthy person?

Or use the same example, except instead of high cholesterol, the inmate begins suffering from mental health problems. Is the prison obligated to provide therapy and/or drugs to help the psychological illness?

I think the answer to both would be "yes." The real issue is not whether the prison has an obligation to provide care to an inmate in changed psychological circumstances, but rather whether gender identity disorder is the same type of problem as high cholesterol or some other psychological disease--if so, the game's up. As I'm not a pscyhologist, I can't opine either way.

Posted by: Res ipsa | Apr 20, 2011 12:48:28 PM

But Ipsa, the medications often used for gender reassignment cause metabolic and other disease. Presumably the state must pay for treatment of these as well. But, more importantly, the can cause mood disorders as well.

Posted by: Steve | Apr 20, 2011 1:33:26 PM

good point ipsa...but i would consider high cholesterol a medical necessity for correction with drugs. sorry i don't see gender change the same way. that's more of a cosmetic optional choice.

plus like steve said it's not a perfect surgary and tends to cause as many if not more health problems then mental problems it fixes.

Posted by: rodsmith | Apr 20, 2011 8:30:27 PM


Agreed on the possibility, but I'm not sure how far that gets you. When you listen to the commercials for lipitor, et al., side effects apparently can include internal bleeding, heart attack, stroke, diarrhea, nausea, vomiting, turning into Gollum from Lord of the Rings, etc., and should not be taken by women who are pregnant or may become pregnant. If a prisoner had a stroke as a result of a side effect of medication, the prison would still have to pay for it, right?

Organ transplants are also known to have a significant chance of rejection and infection--does that mean that a prisoner should never get an organ transplant because the state might have to pay for (possibly very expensive) follow-up treatment?

I'm just not sure that the potential expense of treating side effects is a justifiable reason to withhold a treatment. I think the issue still remains whether one considers sexual reassignment a medically necessary procedure.


Yep, that's my point--the real issue is whether reassignment is a medical necessity. I do know two people that have had sexual reassignment surgery--and it truly changed their lives for the better, as they were a lot more outgoing and happier than before the surgery. But I know that anecdotal evidence is just that, and my guess is you can find reasonable psychologists on both sides. I'm inclined to disagree with you on whether it can ever be medically necessary, but I think your position is nonetheless a reasonable one.

Posted by: Res ipsa | Apr 21, 2011 9:59:09 AM

Res ipsa --

There is, and should be, no legal obligation on the state to make convicts "a lot more outgoing and happier."

There has been a huge amount of discussion on this blog about the need to save dollars currently devoted to prison expenses. Providing operations of this sort is exotic, counter-intuitive (to say the least) to many taxpayers, and very costly, particularly when you include the years of aftercare.

In the age of cutbacks, the first thing to go will have to be the luxuries. This operation may well be, as you say, something that will put the sex changee in a happier frame of mind, but, given the fiscal realities of the justice system -- not to mention all government functioning at every level -- that cannot be regarded as anything but a luxury.

Posted by: Bill Otis | Apr 21, 2011 5:45:58 PM

If the inmate can't pay for it themselves, why should they get it from taxpayers. That's providing an incentive for those who can't pay for it to commit crimes and get imprisoned for 5-10 years. Absurd.

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Posted by: mariam | Jul 6, 2011 11:41:18 AM

Well, if the concern of Stevens is safety from being raped and molested by the male inmates, don’t you think that won’t also happen in the women’s prison? If they want to protect him, then security should be tightened and gender reassignment is not the answer. But if he really wants one, he can pay for it from his own pocket and not from the taxpayers. Speaking of lawsuits, a DePuy Pinnacle Hip Replacement lawsuit is filed by a lot of people because they had defective devices. Maybe you know some who are affected by this. It would be good news if they’ll be compensated from all their sufferings.

Posted by: Joan Davidson | Jul 8, 2011 4:15:05 PM

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