CHICAGO – For the first time ever, a federal court has ordered the federal Bureau of Prisons (BOP) to evaluate a transgender woman for gender-affirming surgery. This care would end the years of suffering Cristina Nichole Iglesias has experienced from being denied adequate medical care while in federal custody.
The Court’s order follows a November hearing in which U.S. District Court Chief Judge Nancy Rosenstengel heard from Ms. Iglesias and an expert psychologist who testified to the harm caused by Ms. Iglesias’s lack of treatment, as well as a representative for the BOP.
“For years, Cristina has suffered greatly from the denial of appropriate healthcare and the constant threats to her life while in BOP detention,” said John Knight of the ACLU of Illinois who represents Ms. Iglesias. “Cristina has fought for years to get the treatment the Constitution requires. The Court’s order removes the unnecessary hurdles and delays BOP has repeatedly constructed to prevent her from getting the care that she urgently needs.”
Even though about 1,200 transgender prisoners are currently in federal custody, no prisoner—past or present—has ever yet received gender-affirming surgery from BOP. The Court’s order that BOP must evaluate Ms. Iglesias for gender-affirming surgery marks the first time the federal Government has been ordered to make this decision for a transgender prisoner.
Ms. Iglesias has been in BOP custody for more than 27 years and currently lives in a federal prison in Texas. BOP has known that Ms. Iglesias is transgender since she first arrived in prison in 1994 and identified as a woman. Since then, she has been denied basic medical care to treat her gender dysphoria and was housed in men’s prisons for more than two decades, where she experienced severe physical and sexual violence. (Previously, in May 2021, this lawsuit resulted in Ms. Iglesias being one of the few transgender prisoners ever moved to a federal prison that aligns with her gender.) Ms. Iglesias has been seeking gender-affirming surgery to treat her gender dysphoria since at least January 2016.
Under the Court’s order, BOP must decide by January 24, 2022, whether to recommend Ms. Iglesias for gender-affirming surgery. If BOP’s Transgender Executive Council (TEC) recommends Ms. Iglesias for surgery, BOP’s medical director must assess Ms. Iglesias within 30 days and report to the Court about progress on locating a surgeon to perform the procedure. If the TEC does not recommend Ms. Iglesias for surgery, a detailed explanation must be filed with the Court.
The Court found that Ms. Iglesias “suffers daily and is at risk of self-mutilation and suicide” because of her inadequately treated gender dysphoria and that she is “running out of time.” Rejecting the Government’s arguments that the Court should defer to BOP’s judgment, the Court held that “the public has the ‘highest’ interest in ensuring that Iglesias’s constitutional rights are not violated by Defendants.” The Court also found that BOP’s unwritten criteria used to justify Ms. Iglesias’s delay in transfer to a female facility and its ongoing denial of surgery—including alleged concerns about security classifications and hormone levels—were “forbidden post hoc justification[s] created in response to litigation.” None of the reasons BOP offered were sufficient to justify its refusal to evaluate Ms. Iglesias for surgery.
“We hope that the order directing BOP to move forward will result in medically necessary and long overdue healthcare for Cristina—and, in time, for the many other transgender people in BOP’s custody who have also been denied surgery and other much-needed gender-affirming care,” added Knight.
Ms. Iglesias is represented by a legal team that includes counsel from the ACLU of Illinois, the American Civil Liberties Union, Winston & Strawn LLP, and Feirich/Mager/Green/Ryan.
**The full order from the Court can be found here.**
