California Transgender Inmate Loses Bid for Sex-Reassignment Surgery

A transgender California state prison inmate serving a 50-years-to-life sentence for murder has lost her appeal of a ruling denying her request for sex reassignment surgery and transfer to a women's prison.  The California 1st District Court of Appeal denied Lyralisa Stevens' appeal in a brief order on September 21, 2011, that gave no reasons for the decision, apart from commenting that she was receiving adequate security at the all-male California Medical Facility in Vacaville, where she stays in her single cell to avoid possible harm from other prisoners.

According to press reports about the ruling, Stevens began taking hormones to feminize her body in 1993, had her name legally changed to Lyralisa the next year, and had begun some surgical procedures to reshape her body prior to being incarcerated.  She was convicted of killing another woman with a shotgun during a dispute about some clothing.  When she was incarcerated in 2003, she had been living as a woman for a decade, but prison officials sent her to a male facility because she still had male genitals.  Her recent bid for surgical removal of her genitals and transfer to a female prison ran into the fact that to date no court has ever ordered a state prison system to provide gender reassignment surgery for an inmate.

Courts have ruled that under the 8th Amendment, which forbids cruel and unusual punishment, prison authorities are required to provide appropriate medical treatment for serious medical conditions of inmates.  Courts have come to recognize that "gender identity disorder" is a serious medical condition for which inmates are entitled to treatment.  Courts within the 9th federal circuit (including California) are bound by a decade-old precedent mandating that they make hormone treatments available in appropriate cases, and Stevens has been able to maintain her hormone treatments in prison, and to dress and groom herself as a woman.  However, due to threats of violence from male inmates, she stays in her cell, does not make use of time in the prison yard, and avoids showering when other inmates are using the facilities.  Her request to be transfered to a female prison has been denied, however, as prison authorities will not house an inmate with male genitalia in a female prison.

A similar lawsuit brought by an inmate seeking sex reassignment surgery is pending in Massachusetts.  Recently, the 7th Circuit Court of Appeals held unconstitutional a Wisconsin statute that prohibited the use of state funds to provide hormones or surgery for transgender inmates, finding that the state prohibition violated the constitutional obligation to provide appropriate medical treatment for serious conditions.  In its decision, the 7th Circuit at least theoretically rejected the argument that state payment for sex reassignment surgery for inmates could be categorically ruled out, but that case was brought by inmates seeking to maintain their hormone treatment, so the issue of surgery did not have to be decided.

Stevens is described in press reports as having a slight build and thus being quite vulnerable to physical attack.  The court of appeal indicated that if her living arrangements change or her safety is "otherwise compromised," she can reapply to the court for relief.  Otherwise, she continues to be sentenced to living in isolation for her own safety, and to be unable to complete her physical gender transition so long as her incarceration continues.  (Based in part on reports by the Associated Press, the Los Angeles Times, and the

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