Colorado legal settlement would up care and housing standards for trans women inmates

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Talia Murphy received a letter in early 2018 about a soon-to-be-filed class-action lawsuit on behalf of transgender women like her in a men’s prison in Colorado. It gave her hope.

Murphy and other trans women in Colorado had been sexually harassed for years and often faced violence from staff and fellow inmates. They were denied safe housing options and requests for treatment, including surgery, for gender dysphoria, the emotional distress some trans people experience because there is a discrepancy between the sex they were assigned at birth and their gender identity, according to the lawsuit.

“We were targets of victimization, whether it was sexual assault, extortion, you name it,” said Murphy, who will be released from prison in 2020.

A consent decree called a historic legal settlement, which is expected to be finalized in early March, will establish two new voluntary housing units for incarcerated trans women, making Colorado the first state to offer a separate unit, according to attorneys in the case. A federal law says such units are prohibited unless ordered by a court. The plan outlined in the agreement, which received preliminary approval last fall, would oblige the Colorado Department of Corrections to pay $2.15 million in settlements to trans women who were harmed; update its protocols and staff training; improving medical and mental health services; limit cross-gender searches from correctional officers; and requiring corrections staff to use proper names and pronouns for trans female inmates.

A state judge held a hearing on the consent decree in January. 4 and is expected to finalize it by early March, when he granted an extension to allow more incarcerated women to be notified of the disposition. Approximately 400 currently or formerly incarcerated trans women are eligible to be beneficiaries.

Housing assignments in U.S. prisons are based almost exclusively on a person’s anatomy, despite a federal law outlining that the safety concerns of trans people should be taken into account during placement. Because they are significantly more likely than inmates who are not to be sexually or physically abused while incarcerated.

“It’s worth watching their backs,” said Paula Greisen, a civil rights lawyer with the California-based Transgender Law Center who filed the class-action suit in 2019.

The US Department of Justice found in 2014 that incarcerated trans people were much more likely to experience sexual violence behind bars from staff members and other inmates, with 35% of trans inmates surveyed having been assaulted in the previous 12 months. A 2007 study of trans women in California prisons found that 59% had been sexually assaulted while incarcerated, 13 times more than others incarcerated.

The Colorado case comes among a growing number of lawsuits across the country aimed at improving access to gender-affirming care and protections for incarcerated trans people. In a landmark 1994 case, the US Supreme Court ruled that prison officials’ “deliberate indifference” to an inmate’s safety violated the Eighth Amendment’s “cruel and unusual punishment” clause. Since then, incarcerated trans people have won legal cases against prison administrators in Washington, Georgia, California and Idaho.

And while a handful of states, including Colorado, have written policies on gender-affirming care and surgery, barriers to access to care are often insurmountable — a problem the consent decree hopes to address. California was the first state to institute gender-affirming medical care policies in prisons, offering gender-affirming surgeries beginning in 2017. In 2019, a three-judge panel ruled that the state of Idaho needed to perform a surgery officials had previously denied. . An incarcerated man in Colorado has undergone gender-affirming surgery, according to a Department of Corrections spokeswoman.

Matthew Murphy, assistant professor of medicine and behavioral sciences at Brown University and a physician who oversees gender-affirming clinical care for the Rhode Island Department of Corrections, said the constitution requires jails and prisons to provide the same standard of care available in the community. . (Matthew and Talia are not related.)

“Medicaid and private insurance increasingly cover gender-specific care,” she said, adding that “there is a growing precedent.”

There were 148 trans women incarcerated in Colorado prisons as of December, according to a Department of Corrections spokeswoman, with nine trans women living in women’s facilities. Before 2018, trans women were housed exclusively with men. The class-action lawsuits relate only to trans women and do not include trans men, nonbinary people, or intersex people.

The lawsuit was filed after a young trans woman who was previously housed with girls in a juvenile facility was transferred to an adult men’s prison, where she was brutally raped. Her numerous requests to stay with other women were denied, citing safety concerns. After taking on the woman’s case, Greisen quickly stumbled upon many other trans women who had experienced similar violence. He contacted the Colorado attorney general’s office and the governor’s office, but little changed, prompting him to file a class action.

“The Department of Corrections in every state — it’s like trying to turn the Titanic around. There’s a lot of bureaucracy,” Greisen said. “You often have to sue to get their attention.”

The World Professional Association for Transgender Health, a leading professional organization that sets standards for the treatment of people with gender dysphoria, recommends an “informed consent model” that allows patients to receive gender-affirming care, including surgery, without extensive treatment. Psychological counseling.

But Colorado’s prison system, like many across the country, doesn’t adhere to those standards. Current corrections department policies require trans women to receive multiple referrals from medical and mental health providers to be considered for transition-related surgery. According to Matthew Murphy, often, prisons provide gender-affirming care “on paper” but lack qualified providers, making access to care impossible.

This was the case for Taliah Murphy, who underwent gender-affirming surgery twice during her incarceration. Murphy went to prison in 2009, according to the lawsuit, after being convicted in a fight with her abusive boyfriend. His sentence was commuted in 2013, he said.

In 2019, she finally received a recommendation from a Department of Corrections psychiatrist for surgery to treat her gender dysphoria. But she was told her other medical providers didn’t have the necessary training to evaluate her, according to the lawsuit, which halted the process. He received surgical treatment only after his release from prison in 2020, he said.

Gender dysphoria, if left untreated, can lead to depression, anxiety, thoughts of self-harm, and suicide—all of which already disproportionately affect trans people due to discrimination, stigma, and other social pressures. “Those things are usually addressed, or improved, through gender-affirming clinical care — whether medical, procedural, or surgical,” says Matthew Murphy.

But prison systems are dragging their feet in providing treatment, she said, and a national shortage of gender-affirming care providers and surgeons makes matters worse.

“And so, people are then forced to go to court,” he said.

The consent decree would create two new voluntary housing options for incarcerated trans women in Colorado to better meet their specific needs and improve their safety.

A voluntary 100-bed transgender unit, already under development, will be based at the Men’s Stirling Correctional Facility. For those approved to go to the women’s prison, they will spend several months in the 44-bed integration unit described in the consent decree.

That adjustment period will be important for both cisgender women already incarcerated in women’s prisons and trans women leaving men’s prisons under traumatic circumstances, said Shawn Meerkamper, a senior staff attorney at the Transgender Law Center who worked on the case. .

“We’ve seen in other places when people are just dropped into a new environment, it can be a sink-or-swim situation,” Mirkamper added.

According to the settlement, eligibility for the units will be determined on a case-by-case basis by a committee including medical and psychiatric experts trained in gender-affirming care, as well as prison officials. But regardless of location, Colorado’s Department of Corrections will still be legally required to provide adequate mental and physical health care to trans women.

“Trans women should not be forced to go to trans units or women’s prisons if they don’t want to,” Meerkamper said. “And they cannot be punished or retaliated against for refusing to go.”

In response to the lawsuit, the Department of Corrections hired an independent medical expert from Denver Health, as well as a gender-affirmative care specialist to help oversee requests for housing assignments and surgical referrals.

Taliah Murphy hopes that new housing units and improved access to gender-affirming care will allow incarcerated trans women to focus less on safety and survival and more on their rehabilitation and planning outside of prison walls.

“We want them to leave better than they came and get the care they need,” said Murphy, who is now a small-business owner in Colorado Springs and pursuing her bachelor’s degree in finance and accounting. “What is this all about.”

Kaiser Health NewsReprinted from this article khn.orgA national newsroom that produces in-depth journalism about health issues and is one of KFF’s core operating programs – the independent source for health policy research, polling and journalism.

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