Michelle Teasdale, DNP, APRN, FNP-C
Hello everyone,
I recently attended the National Commission on Correctional Health Care (NCCHC) conference in Las Vegas. One topic of discussion was transgender healthcare and housing recommendations in corrections. After the conference, I talked with medical providers and correctional employees about a few discussion points covered during the presentation. I received a variety of opinions on the topic. I have listed some of those discussion points and would like to know your thoughts.
1- Transgender individuals should be addressed by their chosen names (not their legal names) and correct pronouns. Should staff at the correctional facility be subject to legal or institutional repercussions if they do not comply with the inmate’s request? Why or why not?
2- Transgender inmates should be housed in areas of the same gender they identify without segregation or isolation from other inmates. Do you agree?
3- Suppose an inmate is incarcerated for a long period of time and during the incarceration, now identifies as transgender. Do you believe it should be the correctional facility’s responsibility to diagnose the individual with gender dysphoria, if it applies, and begin treatment? Do you foresee any legal challenges associated with such a change?
4- There have been some correctional facilities that have paid for gender reassignment surgery. Should this treatment be an option for all transgender individuals who meet surgical requirements while incarcerated? Should federal/community funding be used to directly pay for such services?
Tough questions! I imagine one could be fired or reprimanded just for answering them honestly.
1. No
2. No
3. No, Yes
4. No, No
Given that correction facilities are based upon the law suggest that the applicable laws of the county, state and federal jurisdiction apply – regarding names & pronouns. A caveat – unless names are legally changed then the legal name is in force.
Housing – post conforming surgery maybe with gender assigned. Before that – no way; too much risk of being victimized.
Treatment – several facets (and how long is long): if the individual has begun treatment there is some obligation to continue the course – at least for medications. Conforming Surgery is elective and should only be approved after careful / extensive evaluation and validation of the individuals prior history and current situation. Medications in jail – maybe Surgery – not. Medications in prison – probably Surgery – case by case and with a ton of clinical validation.
It may be reasonable to consider conforming surgery when there is clear psychologic / psychiatric affirmation of dysphoria causing severe symptoms and there is no other viable option.
Correction facilities are not expansively funded and a fiscal triage is very appropriate, as in, the costly confirmation surgery may drain the budget.
Legal aspects – there will most likely be claims by offenders. Yet, imagine the offender that is intent on ‘twisting the tail’ of the facility and its staff; who strongly lobbies for confirmation surgery (to include complaints to any organization / agency they can think of – not to mention the press) and then: files a claim (post surgery) indicating they were confused and traumatized and really didn’t want the surgery in fact.
Nope not jaded – experienced