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Idaho Provides Nation’s Second Gender Confirmation Surgery for Transgender Prisoner

by Mark Wilson

“I feel whole and connected in myself.”

That’s what transgender Idaho prisoner Adree Edmo had to say after receiving gender confirmation surgery (GCS) in July 2020, just under a year after a ruling by the U.S. Court of Appeals for the Ninth Circuit cleared the way. Edmo, who has since been released, was the second U.S. prisoner provided GCS, which courts have subsequently ordered for two more prisoners suffering gender dysphoria. [See: PLN, Mar. 2022, p.30.]

The condition results from a discrepancy between gender identity and assigned sex, causing severe emotional distress, debilitating depression, impairment of life functions, substance abuse, self-surgery/castration to alter genitals, other self-harm, and even suicide.

Edmo, who was born male, has viewed herself as female since age five or six. After struggling with gender identity as a teen, she was living full time as a woman by 21. That same year she sexually abused a 15-year-old boy, pleading guilty in 2012. She was sentenced to the custody of the Idaho Department of Corrections (DOC), which contracts with Corizon, Inc., to provide prisoner healthcare.

While incarcerated, Edmo was diagnosed with gender dysphoria. She changed her name and legal sex designation. She has consistently presented herself as a female, wearing feminine hairstyles and makeup, despite incurring numerous disciplinary violations for doing so. Corizon staff also documented Edmo’s feminine presentation since 2012.

Despite gaining the maximum physical changes provided by hormone therapy, Edmo continued to suffer significant distress due to her male genitalia. She tried to hide her “disgusting penis,” a complaint she later filed recalled. Her first attempt to castrate herself in September 2015 was unsuccessful.

DOC policy prohibited GCS unless the treating physician determined it was “medically necessary.” On April 20, 2016, a Corizon psychiatrist evaluated Edmo for GCS, listing three “bizarre” criteria that he “invented out of whole cloth,” the complaint added, noting that none of the criteria complied with accepted standards of transgender care and that courts later found them medically unacceptable.

Relying on those “criteria,” however, the psychiatrist concluded that GCS was not “medically necessary” for Edmo. She was never re-evaluated for the surgery.

Edmo attempted a second castration in December 2016. This attempt was much more successful than the first. Edmo managed to remove one testicle before excessive blood loss forced her to abandon the operation. She also “self-medicated” by cutting her arms, claiming the physical pain helped ease her “emotional torment” and anguish.

Edmo brought suit in federal court for the District of Idaho against DOC and Corizon officials, alleging they were deliberately indifferent to her serious medical needs. She sought a preliminary injunction to require Defendants to refer her to a qualified surgeon and provide GCS, along with other relief.

After a three-day evidentiary hearing, the district court issued a 45-page opinion that found the testimony of Edmo’s experts credible while rejecting the contrary opinions of defense experts, who did not have “any direct experience with patients receiving gender confirmation surgery,” or with “assessing patients for the medical necessity of gender confirmation surgery,” or even any “experience treating patients with gender dysphoria other than assessing them for the existence of the condition.”

The district court also found that defense experts misinterpreted the World Professional Association of Transgender Health Standards of Care (WPATH SOC) for transsexual, transgender, and gender-nonconforming people, which are “the internationally recognized guidelines for the treatment of individuals with gender dysphoria” and “the best standards out there” as recognized by many major American mental health groups, the ruling noted.

In granting Edmo’s requested preliminary injunction, the district court found that “Corizon and [DOC] have a de facto policy or practice of refusing” GCS to transgender prisoners, which amounts to deliberate indifference. It ordered prison officials to provide Edmo GCS within six months. See: Edmo v. Idaho Dep’t of Corr., 358 F.Supp.3d 1103 (D. Id. 2018).

Defendants appealed to the Ninth Circuit, and the Court affirmed on August 23, 2019, holding that Edmo established her Eighth Amendment claim and that “she will suffer irreparable harm — in the form of ongoing mental anguish and possible physical harm — if GCS is not provided.” In doing so, the Court rejected Defendants’ argument that the dispute involved a mere difference of opinion.

“This is not a case of dueling experts, as the State paints it,” the Court explained. Edmo’s “experts are well-qualified. … On the other side of the coin, the district court permissibly discredited the contrary opinions of the State’s treating physician and medical experts,” who “lacked expertise and incredibly applied (or did not apply, in the case of the State’s treating physician) the WPATH [SOC].”

The Court also rejected Defendants’ argument that the injunction was overly broad, but it agreed that Corizon and several individual doctors should be excluded from the order.

“It has been more than a year since doctors concluded that GCS is medically necessary for Edmo,” the Court noted. “We urge the State to move forward.”

Edmo was represented in her appeal by attorney Lori Rifkin of Hadsell Stormer & Renick LLP in Emeryville, along with Dan Stormer and Shaleen Shanbhag of the firm’s Pasadena office, as well as Craig Durham and Deborah Ferguson of Ferguson Durham PLLC in Boise and Amy Whelan and Julie Wilensky of the National Center for Lesbian Rights in San Francisco. See: Edmo v. Corizon, Inc., 935 F.3d 757 (9th Cir. 2019).

Defendants’ request for a rehearing en banc before the full Ninth Circuit was denied on February 10, 2020, as was a subsequent petition for a writ of certiorari by the U.S. Supreme Court, with Justices Samuel Alito and Clarence Thomas dissenting, on October 13, 2020. See: Edmo v. Corizon, Inc., 949 F.3d 489 (9th Cir. 2020); and Idaho Dep’t of Corr. v. Edmo, 141 S. Ct. 610 (2020).  

Additional Source: National Center for Lesbian Rights

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Idaho Dep’t of Corr. v. Edmo

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Edmo v. Idaho Dep’t of Corr.