AMANDA PEACHER, BYLINE: One late afternoon in September 2015, a transgender inmate named Adree Edmo left a note in her prison cell in Idaho. The note read, I do not want to die, but I am a woman, and women do not have these. Then she attempted to castrate herself.
LORI RIFKIN: Because she isn't receiving adequate treatment...
PEACHER: That's Lori Rifkin, Edmo's lead attorney.
RIFKIN: ...This distress has led her, twice now, to attempt to castrate herself to stop the testosterone from circulating in her body.
PEACHER: Edmo is a member of the Shosone-Bannock Tribes and identifies as two-spirit, which is a Native American term for people who don't conform to one gender. She's serving time for sexually abusing a 15-year-old boy when she was 22. Prison providers diagnosed her with gender dysphoria in 2012. Rifkin says Edmo is not being adequately treated.
RIFKIN: What Ms. Edmo requires is gender confirmation surgery, and that's what she needs to receive.
PEACHER: That need for surgery is at the heart of this case. Amy Penkin manages the Transgender Health Program at Oregon Health and Science University.
AMY PENKIN: Gender dysphoria is used as a clinical diagnosis of the experience of someone whose gender experience is not in alignment with the gender or sex they were assigned at birth.
PEACHER: Not every transgender person experiences gender dysphoria, but for those who do, there's a spectrum of treatment options, from changing their hair and clothing, to hormone treatment. And in persistent, well-documented cases, gender confirmation surgery might be medically necessary, also known as sex reassignment surgery. When Edmo's requests for surgery were denied by the prison, she sued. At the district court level, the judge ruled in her favor. Governor Brad Little of Idaho appealed.
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BRAD LITTLE: Allowing this case to sit there, I was afraid that it would lower the bar as to what we had - what the state of Idaho had to pay for.
PEACHER: And the state argues there's disagreement among medical professionals about whether the surgery is necessary. Idaho Department of Correction's Chief Psychologist Wally Campbell says he can't comment on Edmo's case because it's pending litigation. But more generally, Campbell says the bar for surgery is high. An inmate would need to be experiencing significant distress from gender dysphoria.
WALLY CAMPBELL: In my mind, doing a irreversible medical procedure would require a higher level of distress than hormone replacement therapy.
PEACHER: Edmo's lawyers say she's on hormones and still tried to castrate herself, which is a clear sign of distress. Lori Rifkin says denying Edmo the surgery constitutes cruel and unusual punishment.
RIFKIN: When government entities hold people in prisons or jails, they're required to provide adequate and necessary medical care because their freedom has been taken away, and they can't seek such care for themselves.
PEACHER: And Rifkin says Edmo's need is as clear as treating a cancer patient.
RIFKIN: If somebody requires surgery, or chemotherapy or radiation to shrink their tumor, that is what we give them.
PEACHER: If the 9th Circuit agrees, Adree Edmo will be the first inmate to get gender confirmation surgery through the courts and could make it easier for other inmates with gender dysphoria to do so. It also means Edmo would be transferred to an Idaho women's prison after her surgery. She's scheduled to be released in 2021. For NPR News, I'm Amanda Peacher in Boise, Idaho.
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And Amanda's story came to us from the Mountain West News Bureau, a public media collaboration.
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