Judge orders feds to assess inmate for gender-confirmation surgery

Citing undue delays, a federal judge in Illinois last week ordered the federal Bureau of Prisons (BOP) to assess an inmate for gender-confirmation surgery. It’s believed to be the first order of its kind for the BOP. The judge also ordered a specific time frame for BOP to report progress on the inmate receiving the surgery. If BOP doesn’t approve the surgery, the judge ordered specific reasons for the denial, including a transcript of the meeting where a denial was determined.

U.S. District Judge Nancy J. Rosenstengel of the Southern District of Illinois issued her 61-page ruling on Dec. 27. No federal inmate has received gender-confirmation surgery in America, though the BOP has recommended one Trans inmate for such surgery. Several state inmates have received gender-confirmation surgery.

Cristina Nichole Iglesias, 47, is a Trans inmate at a federal prison in Ft. Worth, Texas. She’s been incarcerated since 1994 and has been diagnosed with gender dysphoria. She’s been requesting gender-confirmation surgery for about five years, but according to court records the BOP has failed to assess her for the surgery.

In the past, the BOP has given various reasons for not assessing Iglesias, including that she hasn’t lived long enough as a woman, she’s too high of a security risk and she hasn’t properly maintained her hormone levels. In her ruling, Rosenstengel questioned the validity of those reasons. Iglesias’ advocates say she’s been living as a woman for decades, she isn’t a security risk and she’s done her best to maintain hormone levels.

The judge gave BOP officials until Jan. 24 to assess Iglesias for the surgery. If surgery is approved, BOP officials must file a notice with Rosenstengel every seven days regarding progress they’re making to find a surgeon. If surgery is denied, the office must file a notice with the judge within seven days of that determination, explaining the medical reasons for the denial.

Iglesias filed suit in April 2019, seeking gender-confirmation surgery, permanent hair removal and housing in a female prison. She’s represented in the current litigation by the ACLU and several private attorneys. 

Iglesias issued this statement regarding Rosenstengel’s ruling: “I am very excited that the Court has intervened on my behalf. Without that happening, I would continue to fall through the cracks and BOP would ignore my need for gender-affirming surgery — which I’ve been fighting to get for decades. I am happy to have had the chance to tell my story and am hopeful that other transgender people will benefit from my case.”

A spokesperson for the BOP issued this statement: “For privacy, safety, and security reasons, the Bureau of Prisons does not comment on individual inmate’s conditions of confinement — to include medical information, or pending litigation or matters that are the subject of legal proceedings. However, we can provide the following response. The BOP’s team of subject-matter experts provide a wide range of gender-affirming accommodations based on comprehensive and individualized assessments. These accommodations can include gender affirming surgical referral when deemed appropriate.”

Iglesias endured multiple physical, sexual and verbal assaults in male

prisons. For example, inmates exposed themselves to her, groped her

and asked to see her breasts. In November 2019, Iglesias was raped by

another inmate. The following year, she was held hostage by a cellmate.

Authorities had to use force against the cellmate to secure Iglesias’ release,

according to court records.

Several months ago, after Iglesias filed suit, she was transferred to Carswell Medical Center, a federal prison for women in Ft. Worth. But some inmates at Carswell have protested her housing there, according to court records.

Prior to her transfer to Carswell, Iglesias was subjected to ongoing threats

and taunts by prison staff and other inmates. Her release date is Dec. 25, 2022, according to court records.

The defendants include various BOP officials. They’re being represented by the U.S. Department of Justice, which had no comment for this update.

Iglesias isn’t seeking any monetary damages. But her attorneys are asking for the BOP to pay for their reasonable court costs and fees, according to court papers.