1. SEX CHANGE OPERATIONS IN PRISON Thomas Gilevich, JD, LLM

2. CONSTITUTIONAL STANDARDS FOR ADEQUATE PRISON HEALTH CARE The Eighth Amendment: Excessive bail shall not be required, nor excessive fines imposed, nor cruel and unusual punishments inflicted. Estelle v. Gamble 429 U.S. 97 (1976): deliberate indifference to serious medical needs of prisoners constitutes the "unnecessary and wanton infliction of pain,".... Farmer v. Brennan 511 U.S. 825 (1994): if prison officials were "reckless in a criminal sense," meaning that they had "actual knowledge" of a potential danger. Wilson v. Seiter 501 U.S. 294 (1991): Whether prison officials, acting with deliberate indifference, exposed a prisoner to a sufficiently substantial "risk of serious damage to his future health”

3. SEXUAL ABUSE IN PRISON Prison Rape Elimination Act of 2003 (PREA) – Codified at Title 42, United States Code, section 15601, et seq. California Sexual Abuse in Detention Elimination Act of 2005 (SADEA) – Codified at Cal. Penal Code, sections 2635 – 2643. CDCR Department Operations Manual (DOM) – DOM, Chapter 5, Article 44, sections 54040.1 – 54040.17.

4. DEMOGRAPHICS TRANSGENDER POPULATION CHARACTERISTICS CIVILIAN POPULATION INCARCERATED POPULATION

5. STANDARDS AND GUIDELINES DSM V (2013) The Sexual and Gender Identity Disorders Work Group Gender identity disorder vs. Gender incongruence Removal of transvestic disorder WPATH Standards of Care

6. GENDER IDENTITY EVALUATIONS Criteria – Meets criteria for GID per DSM-IV-TR – Assess for co-occurring disorders Competency – Capable of giving informed consent Compliance – Agrees to comply with all medical & mental health protocols

7. WHERE ARE WE? Gender vs. SexHOUSING GID Assessment and DiagnosisHEALTH CARE AccommodationsTHREATS & RISKS TreatmentMENTAL HEALTH HORMONES

8. WHERE ARE WE GOING? Gender vs. SexHOUSING - FEMALE GID Assessment and DiagnosisINTERDISCIPLINARY Accommodations“HUB” SYSTEM CLOTHING & PROPERTY TreatmentMENTAL HEALTH HORMONES SURGERY

9. HOW DID THAT HAPPEN? WHERE WILL IT STOP? INSTITUTIONAL RELUCTANCE POLITICAL INERTIA CULTURAL & LEGAL CHANGES CASE STUDIES – PRESERVE THE STATUS QUO (CALIFORNIA) – EXCLUDED SERVICES (WISCONSIN) – IGNORE IT AND IT WILL GO AWAY (IDAHO) – KOSILEK (MASSACHUSETTS) – THE ENGLISH WAY

10. SEXUAL REASSIGNMENT SURGERY ETHICS MENTALLY NECESSARY MEDICAL CARE EFFICACY AND OUTCOMES COMMUNITY STANDARDS OTHER ALTERNATIVE TREATMENTS

11. References American Psychiatric Association. (2000). Diagnostic and Statistical Manual of Mental Disorders (4 th ed,. text rev.) Washington D.C. American Psychological Association. (2008) Resolution on transgender, gender identity, and gender expression non-discrimination. Association of Lesbian, Gay, Bisexual, and Transgender Issues in Counseling. (2009). Competencies for counseling transgender clients. Alexandria, VA: Author. Meyer, W. (Chairperson), Bockting, W., Cohen-Kettenis P., Coleman, E., DiCeglie, D., Devor, H., Gooren, L., Joris Hage, J., Kirk, S., Kuiper, B., Laub, D., Lawrence, A., Menard, Y., Patton, Y., Schaefer, L., Webb, A., Wheeler, C.. (2001) The Standards of Care for Gender Identity Disorders – Sixth Version, International Journal of Transgenderism. www.symposion.com/ijt/

12. References (cont’d) Brown, G. and McDuffie, E. (Oct. 2009) Health Care Policies Addressing Transgender Inmates in Prison Systems in the United States. J. Correctional Health Care 15:4 World Professional Association for Transgender Health (WPATH) www.wpath.org