The long, absurd saga of an Idaho sex offender who wants gender reassignment surgery took another disappointing turn this week when a federal court ruled the state must pay for it.
However, Idaho’s GOP governor says he’s not going down without a fight and has vowed to take the case to the U.S. Supreme Court.
The case of Adree Edmo has been winding its way through the courts for quite some time now. Edmo is serving a 10-year sentence after being convicted in 2012 for sexually abusing a 15-year-old. The transgender inmate, who is biologically male, is scheduled for release in 2021.
Edmo is currently suing the state of Idaho to pay for gender reassignment surgery.
The suit claims Edmo “lived full-time as a woman, dressing in women’s clothes and wearing women’s cosmetics” before being sent to prison. Edmo has twice attempted “self-castration” with a razor.
That isn’t enough for Edmo’s doctors to recommend gender reassignment surgery, however, and they’ve decided on a different course of treatment.
The suit claims that Edmo’s gender dysphoria is so crippling that not providing surgery would be tantamount to a violation of the Eighth Amendment, which prohibits “cruel and unusual punishment.” Last week, the 9th Circuit Court of Appeals became the latest judicial body to agree with that line of thinking.
According to Boise State Public Radio, the court found that Edmo’s argument was “logical and well-supported” and “responsible prison officials were deliberately indifferent to Edmo’s gender dysphoria, in violation of the Eighth Amendment.”
“It is enough that [Edmo’s doctor] knew of and disregarded an excessive risk to Edmo’s health by rejecting her request for [gender confirmation surgery] and then never re-evaluating his decision despite ongoing harm to Edmo,” the ruling reads, NPR reported.
This would make Edmo the first inmate to receive taxpayer-funded gender reassignment surgery while in prison — although it won’t happen if Idaho’s governor has anything to do with it.
“The court’s decision is extremely disappointing,” Gov. Brad Little said in a statement, according to The Washington Post.
“The hard-working taxpayers of Idaho should not be forced to pay for a convicted sex offender’s gender reassignment surgery when it is contrary to the medical opinion of the treating physician and multiple mental health professionals.”
“We cannot divert critical public dollars away from the higher priorities of keeping the public safe and rehabilitating offenders,” he added.
Edmo’s attorney, Lori Rifkin, said that an appeal would be “unfortunate” and “reprehensible.”
“She suffers every single day while they have denied this treatment to her for years and there can be no reason justifying Idaho’s continued refusal to provide her care except bias,” Rifkin said, according to NPR.
So, why is transphobia the only reason Idaho would refuse to perform this procedure? Rifkin says it’s because the state’s prison health care provider, Corizon Health, would cover the costs.
“The contract Idaho has with Corizon already covers necessary medical care,” Rifkin said.
“This is a false statement by the governor that this would cost the taxpayers any money.”
Of course, insurance for inmates costs taxpayers money — $46 million a year in Idaho, to be precise. And then there’s the fact that, according to the governor’s press secretary, gender reassignment surgery might not be covered after all.
“The contract also includes a provision under which Corizon can seek costs associated with treatments or procedures not reasonably foreseen at the time the contract was awarded in 2013,” Marissa Morrison Hyer said in a statement.
While Corizon hasn’t announced whether it will ask for taxpayer money to cover the procedure, it’s worth noting that there were 30 inmates in the Idaho prison system as of last December who had been diagnosed with gender dysphoria.
Consider those numbers and ask yourself whether that $46 million contract may be a bit more expensive next time around if the 9th Circuit Court’s ruling stands.
Beyond the straight numbers, there’s also the question as to whether or not the surgery is actually efficacious. For a dissenting opinion on the matter, I’ll turn to an organization not precisely known as a raging viper-pit of transphobia: the Obama-era Centers for Medicare and Medicaid Services, which was tasked with studying whether gender reassignment surgery should be covered under Medicare.
The 2016 decision, after an assessment of the evidence, was a decided no.
“Based on a thorough review of the clinical evidence available at this time, there is not enough evidence to determine whether gender reassignment surgery improves health outcomes for Medicare beneficiaries with gender dysphoria,” the centers concluded.
“There were conflicting (inconsistent) study results — of the best designed studies, some reported benefits while others reported harms. The quality and strength of evidence were low due to the mostly observational study designs with no comparison groups, potential confounding, and small sample sizes. Many studies that reported positive outcomes were exploratory type studies (case-series and case-control) with no confirmatory follow-up.”
What’s interesting is that two similar cases, tried before the 1st and 5th Circuit Courts, found that denying inmates gender reassignment surgery didn’t violate prisoners’ Eighth Amendment rights.
That’s not interesting in and of itself, until you look at how the 9th Circuit’s decision addressed those cases: The court said the rulings there rely “on an incorrect, or at best outdated, premise: that ‘[t]here is no medical consensus that [gender confirmation surgery] is a necessary or even effective treatment for gender dysphoria.’”
The Obama administration certainly feels like it happened ages ago, but it was recent enough that the Centers for Medicare and Medicaid Services’ decision that there wasn’t any medical consensus gender reassignment surgery was meliorative is only three years old.
The court also overruled the doctors and mental health professionals who attended to Edmo, given that their treatment plans didn’t involve gender reassignment surgery. The court ruled that that “general agreement in a medically unacceptable form of treatment does not somehow make it reasonable.”
I’ve heard people complain how judicial activism has usurped the role of the legislature. I’ve never heard it said that it’s usurped the role of doctors.
I guess we’ve broken new ground here, including ruling that someone who attempted to castrate himself with a razor is psychologically competent to decide on matters like gender reassignment surgery.
Little intends to appeal this to the Supreme Court, as well he should.
This is an absurd ruling, one which states that denying an inmate gender reassignment surgery that costs taxpayers money — either directly or indirectly — is somehow “cruel and unusual punishment” even though there’s no proof it improves outcomes.
This is opening a very expensive Pandora’s Box, all on scanty evidence that the convicted criminals who’ll receive the expensive treatment will actually live better lives because we opened that box.
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