Transgender inmate celebrates historic ruling mandating gender-affirming surgery: ‘I am hopeful’

(Photo Illustration: Yahoo News; photos: Getty Images (2))
(Photo Illustration: Yahoo News; photos: Getty Images (2))

After an intense three-year legal battle, Cristina Nichole Iglesias, a transgender female inmate, is now set to become the first federal prisoner in U.S. history to receive gender-affirming surgery, after a federal judge in Illinois last month ruled that the U.S. Bureau of Prisons (BOP) had to find a qualified surgeon immediately to perform the procedure.

“The court’s order [last] month captures the urgency of Ms. Iglesias’ situation,” Joshua Blecher-Cohen, a staff attorney with ACLU of Illinois who represents Iglesias, told Yahoo News of the April 18 decision. “I’m hopeful that this court order reflects a growing recognition that transgender people are entitled to the same protections as all other people.”

Two inmates in state prisons, in California and Idaho, have already received the surgery.

Last spring, a district court ruled the BOP needed to evaluate Iglesias for the surgery, according to Blecher-Cohen, but the BOP repeatedly postponed referrals to a surgeon, court documents show. The BOP declined to comment to Yahoo News on this story, stating that it does "not comment on pending litigation or matters subject to legal proceedings.”

A sign saying Federal Correctional Complex, United States Department of Justice, Federal Bureau of Prisons, stands in front of trees, with a fence protected by voluminous coils of barbed wire in the background.
The Federal Bureau of Prisons Correctional Complex in Butner, N.C. (Photo by Sara D. Davis/Getty Images)

With this latest ruling, the agency has been ordered to provide a detailed timeline of Iglesias’s surgery, along with a list of qualified surgeons for the procedure, to be completed before Iglasias’s sentence ends in December.

In 2005, Iglesias pleaded guilty to mailing a letter from prison containing a powdery substance purporting to be anthrax to the Foreign and Commonwealth Office in London. For Iglesias, who’s been in federal custody for 28 years, this landmark decision has been decades in the making.

“I am hopeful that I will finally get the care I need to live my life fully as the woman I am,” Iglesias, 47, said in a statement to Yahoo News provided by the ACLU. “BOP has denied me gender-affirming surgery for years — and keeps raising new excuses and putting new obstacles in my way. I am grateful that the court recognized the urgency of my case and ordered BOP to act.”

Iglesias and her legal team first filed a lawsuit in 2019 against the BOP, challenging the persistent delays she had faced in scheduling the surgery. Until then, Iglesias had spent more than two decades in a men’s prison with male genitalia that she said felt like a “malignant tumor” that needed to be removed, according to the Chicago Sun-Times.

A federal prison cell with bunk bed, toilet, chair and lockers.
The 8-foot by 13-foot dimensions of a federal prison cell in Coleman, Fla. (Photo by Nikki Kahn/The Washington Post via Getty Images)

In the suit, Iglesias said that at 12 years old, she told her mother she wanted to be a woman and that in 2009, she tried to castrate herself.

While incarcerated, Iglesias went through numerous medical evaluations. Members of her legal team provided medical research that they argued proved that she suffered from gender dysphoria, the clinical distress that accompanies the strong desire to be of another gender.

The BOP, for its part, refused to provide Iglesias with the medical care requested, questioning its necessity, according to the ACLU, and refused to move her to a woman’s facility until last spring. Court documents show the BOP recently apologized for stalling on the procedure without merit.

In April’s ruling, Chief Judge Nancy Rosenstengel of the Southern District of Illinois compared the back-and-forth to a game of “whack-a-mole,” according to CNN, and said the BOP had "employed tactics similar to the game of Plinko on 'The Price is Right.'”

Nancy Rosenstengel, seated at a hearing.
Nancy Rosenstengel, then clerk of the court for the U.S. District Court for the Southern District of Illinois, testifies at her confirmation hearing before the Senate Judiciary Committee Jan. 8, 2014, on Capitol Hill in Washington, D.C. (Photo by Alex Wong/Getty Images)

Amy Whelan, a senior staff attorney at the National Center for Lesbian Rights (NCLR), told Yahoo News that while this decision calls for celebration, she hopes it’s more than a single victory.

“It's really important that other prison systems understand that this is a medical standard of care and that people are suffering in prisons and jails without this care, which jeopardizes the safety and security of the institution and puts their staff members in untenable positions,” she said.

Whelan is familiar with the legal fight for gender-affirming surgery for inmates. She represented Adree Edmo, a transgender woman housed in the Idaho Department of Corrections, who in July 2020, became the second person in the U.S. to receive court-ordered surgery in prison. (In 2017, a California inmate became the first.) Edmo initially won her case in 2018, but appeals slowed down the process for almost two years.

Whelan sees similarities in the ways that Iglesias and her client were denied care.

“One of the most glaring similarities is the amount of suffering that they both were forced to endure,” she said, adding that Edmo tried to castrate herself twice. On the second occasion, she was taken to the emergency room with severe bleeding.

“Ms. Iglesias has been put through the same kind of torture, and there's really no reason for it,” she added. “And the prison officials now know that it puts people at risk of harm if they deny this care.”

Demonstrator waving the trans flag at a protest.
A demonstrator waving the trans flag at a protest where the transgender community was demanding a state law to guarantee gender self-determination. (Photo by Marcos del Mazo/LightRocket via Getty Images)

More than 1,200 transgender people are incarcerated in BOP custody, according to the ACLU. Blecher-Cohen hopes this latest ruling will set an example.

“We are hopeful that this landmark decision will result in care, not just for Ms. Iglesias, but also make the more than a thousand other transgender people in BOP custody realize that it is possible to get the gender-affirming care that is medically necessary for them,” he said. “We hope that this represents an inflection point in BOP’s recognition that gender dysphoria is a serious condition that needs appropriate treatment.”


Cover thumbnail photo illustration: Yahoo News; photos: Getty Images (2)