Cristina Nichole Iglesias will become the first person to receive gender-affirming surgery while in federal custody under a landmark settlement agreement approved on Tuesday by a federal court in Illinois. The settlement between Ms. Iglesias and the Federal Bureau of Prisons (BOP) successfully ends a years-long battle for Ms. Iglesias, a transgender woman who filed suit in 2019 after BOP repeatedly denied her requests for medically necessary gender-affirming healthcare.
“I feel so relieved,” said Ms. Iglesias after the settlement was approved. “I fought for so long to get the healthcare I need, but wasn’t sure this day would ever come. Now, the federal government has finally agreed to provide me with gender-affirming surgery. This will change my life and allow me to live as the woman I am. Gender-affirming care is necessary, lifesaving, and—for me and so many others—long overdue.”
Under the order—stipulated to by the parties and entered by Chief Judge Nancy Rosenstengel in the Southern District of Illinois—BOP will provide Ms. Iglesias with vaginoplasty, a gender-affirming surgery she has sought since at least January 2016. In the agreement, BOP also agreed to provide Ms. Iglesias with other medically necessary gender-affirming procedures, including permanent facial hair removal, facial-feminization surgery, and breast augmentation. Because of BOP’s long delays in providing Ms. Iglesias’s care, any surgeries that occur after Ms. Iglesias is released from BOP custody will be paid for from an escrow fund administered by a retired federal judge.
“This is a landmark win for Cristina,” said Joshua Blecher-Cohen, an ACLU of Illinois staff attorney who represents Ms. Iglesias. “Under the agreement entered by the court, Cristina will be the first person to receive gender-affirming surgery from BOP. We hope this victory will pave the way for other transgender people in federal custody to get the care they need.”
In the settlement agreement, BOP confirmed that it has never before provided any gender-affirming surgery to an individual in federal custody. There are currently more than 1,200 transgender people in federal custody, as the court noted in its December 2021 ruling ordering BOP to evaluate Ms. Iglesias for gender-affirming surgery.
The settlement also includes several new commitments from BOP to Ms. Iglesias to improve the overall experience of transgender people in federal custody. In a document given to Ms. Iglesias, BOP promises to draft a mission statement for its Transgender Executive Council, an internal committee that oversees care for transgender prisoners. This statement will, for the first time, set out target timelines for considering requests for gender-affirming treatment. BOP also commits to recognizing permanent hair removal and gender-affirming surgery as medically necessary treatments for gender dysphoria and to updating resources and training for BOP employees. Per the document, these policy commitments should be executed within two months of Tuesday’s settlement.
“I am not the only transgender person in federal custody who needs care,” Ms. Iglesias added. “BOP’s Transgender Executive Council denied and delayed my requests for years. I hope that new procedures and timelines will make gender-affirming care more accessible to those who desperately need it.”
“Cristina has broken new ground for transgender rights,” added Mr. Blecher-Cohen. “We are hopeful that Cristina’s case and this settlement will lead to change for the many other transgender people in BOP custody.”
Ms. Iglesias has been in federal custody for 28 years and lives in a BOP residential reentry center in Florida. BOP has known that Ms. Iglesias is transgender since she first arrived in federal custody 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 facilities for over two decades, where she experienced severe physical and sexual violence. In May 2021, this lawsuit resulted in Ms. Iglesias being one of the few transgender people ever moved to a federal prison that aligns with her gender. In December 2021, Ms. Iglesias won her motion for preliminary injunction, with the court issuing the first-ever order for BOP to evaluate an individual for gender-affirming surgery. In February 2022 and again in April 2022, the court issued an order contemplating sanctions against BOP and the U.S. Department of Justice for misconduct in this case.
As part of Tuesday’s settlement agreement, BOP will pay Ms. Iglesias’s attorney’s fees. 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.