Bigger Than Just 1 Person: Care for Transgender Individuals in Prison

Two transgender women in North Carolina are facing struggles in getting prisons to acknowledge their gender identity. What does this say about care for incarcerated transgender individuals in general?

“Unfortunately, many prison officials are transparently hostile to the rights of transgender people,” said Elizabeth Simpson, an attorney and the associate director of Emancipate North Carolina.1

Two different transgender women in North Carolina are feeling the effects of this hostility. Ashlee Inscoe and Kanautica Zayre-Brown face difficulties in recognition and treatment.

Inscoe, aged 40, is an intersex transgender woman who currently resides in an all-men’s facility, Avery-Mitchell Correctional Institution in Spruce Pine, North Carolina. She has been there since early 2018. Previously, she was housed in another all-men’s facility, Craven Correctional Institution. Her requests to be treated in alignment with her gender identity—and her requests to transfer to a women’s facility—have been denied.

In a letter to a group of advocates, Inscoe explained she’s in abdominal pain and needs surgery to remove residual gonad material, and fears for her safety: “Department of Public Safety (DPS) need not wait for a tragedy to respond to the dire needs of intersex and transgender persons in its care. I am facing escalating distress and growing fears for my safety. I have filed grievances within the DPS system and have exhausted those remedies with nothing in return but denials, heartache, and fear of retaliation by officials.”1

In the summer of 2021, a group of organizations wrote a letter to North Carolina DPS prison commissioner Ishee and his counsel, advocating for Iscoe’s rights and requests. They stated DPS is violating Inscoe’s Eighth and Fourteenth Amendment rights, and are even violating their own policies, as under the federal Prison Rape Elimination Act (PREA), prison officials are obligated to protect all incarcerated individuals and assess their risk of sexual abuse. They must, by federal law, take steps to protect these individuals.

In response, DPS Deputy General Counsel Jodi Harrison wrote a letter of her own, in which she concluded that DPS is providing Inscoe with constitutionally adequate care.

“Despite PREA’s mandate and DPS’s formal implementation of it, however, my case and situation demonstrates that intersex and transgender prisoners are being subjected to blanket rules with regard to placement,” said Inscoe.1

Zayre-Brown faced similar problems; however, in 2019, she became the first incarcerated transgender individual in North Carolina to move from an institution for one gender to one designated for another. Unfortunately, the situation has not improved much despite the transfer.

“I thought it would be so much better,” Zayre-Brown said. “The staff is not willing to adapt.”2

While Zayre-Bown is now less afraid of beatings or rape, the staff consistently misgender her, refuse to recognize her as a woman, and use the name she was given at birth rather than the female name to which she legally changed it years ago. This has isolated from the other women at her facility and exacerbated the gender dysphoria she and many transgender people feel.

“Gender dysphoria is very serious,” said Jaclyn Maffetore, the American Civil Liberties Union (ACLU) staff attorney handling Zayre-Brown’s case. “Among other things, it’s responsible for the high suicide rate among trans folks.”2

In 2019, the 9th US Circuit Court of Appeals upheld a trial court opinion, ruling that it was cruel and unusual punishment to not provide adequate care to a transgender inmate, which includes gender confirmation surgery when necessary.3 “We apply the dictates of the Eighth Amendment today in an area of increased social awareness: transgender health care,” they wrote. “We are not the first to speak on the subject, nor will we be the last.”

The ruling in Admo v Idaho Department of Correction, et al, used an amicus brief filed by the American Medical Association, American Medical Student Association, the Endocrine Society, GLMA: Health Professionals Advancing LGBTQ Equality, and the World Professional Association for Transgender Health (WPATH) that noted, “if untreated, gender dysphoria can contribute to debilitating distress, depression, impairment of function, substance use, self-mutilation to alter one’s genitals or secondary sex characteristics, other self-injurious behaviors, and suicide.”

In its ruling, the court noted, “Ms Edmo has twice attempted self-castration resulting in significant pain and suffering,” and that it was persuaded “that without surgery, Ms Edmo is at serious risk of life-threatening self-harm.”

Zayre-Brown is currently fighting to have a gender-affirming surgery. Zayre-Brown began transitioning to female in 2010, and has had previous gender affirmation surgery. She feels 90% of the way to the transition she was working toward before her arrest. Although her doctors and specialists at the UNC Transgender Health Program have deemed further gender-affirming surgery medically necessary, Zayre-Brown said the state will not approve the procedure.

“When you choose to incarcerate somebody, you become responsible for their medical care and for any medical care that is deemed necessary. That applies to gender-affirming care, of course,” said Maffetore.2

Maffetore continued by stating that transgender individuals deserve to have a clear and transparent process where medical professionals make these decisions in consultation with their patients. “This is much bigger than just 1 person.”2

References

1. Wilson J. An intersex, transgender woman incarcerated at a men’s prison wants to transfer to a women’s facility for her safety. Indy Week. October 6, 2021. Accessed December 8, 2021. https://indyweek.com/news/northcarolina/intersex-transgender-prisoner-ashlee-inscoe-is-requesting-transfer-to-a-womens-facility/

2. Killian J. Transgender prisoner fighting for gender-affirming surgery. NC Policy Watch. November 5, 2021. Accessed December 8, 2021. https://ncpolicywatch.com/2021/11/05/transgender-prisoner-fighting-for-gender-affirming-surgery/

3. Transgender prisoners have fundamental right to appropriate care. American Medical Association. May 17, 2019. Accessed December 8, 2021. https://www.ama-assn.org/delivering-care/population-care/transgender-prisoners-have-fundamental-right-appropriate-care