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Trump Ninth Circuit judges Collins, Bumatay, Bade, Nelson, VanDyke, Hunsaker and Bress dissented from a vote to deny an en banc rehearing of a three-judge panel decision that ruled that the state of Idaho must provide gender confirmation surgery to a transgender woman in prison with gender dysphoria. The February 2020 case is Edmo v. Corizon.
Adree Edmo, a transgender woman, has been incarcerated at an Idaho men’s prison since 2012. (Idaho houses incarcerated people based on their sex assigned at birth.) Two months after arriving, a prison psychiatrist diagnosed Edmo with gender dysphoria based on several factors: She had been experienced a significant amount of trauma, including sexual abuse, drug and alcohol addition and mental illness. After the diagnosis, Edmo started hormone therapy, and changed her name and sex on her birth certificate.
Edmo spent four years undergoing hormone therapy. During that time, she tried to castrate herself with a razor blade twice. When Edmo requested gender confirmation surgery to treat her persistent gender dysphoria, her prison doctor denied her request, instead recommending that she remain on hormone treatment.
A year later, Edmo sued the state of Idaho and the prison healthcare provider in district court, arguing that their failure to accommodate her medical condition with gender confirmation surgery violated the Eighth Amendment. The district court sided with Edmo, concluding that Edmo had a serious and legitimate medical need. The state appealed.
The majority affirmed the district court ruling in favor of Edmo, explaining that she had established that she would suffer ongoing mental anguish and irreparable harm if she continued to be denied gender confirmation surgery. Not allowing her to receive the vital and potentially life-saving medical treatment for her gender dysphoria amounted to deliberate indifference and cruel and unusual punishment in violation of the Eighth Amendment.
A petition was filed for a full panel Ninth Circuit review of the case. The full court was advised of the petition for rehearing en banc and a vote on rehearing was held. The matter failed to receive a majority of votes from the Ninth Circuit judges in favor of a rehearing.
Trump judges Daniel Bress, Patrick Bumatay, Briget Bade, Ryan Nelson, Danielle Hunsaker, Lawrence VanDyke and Daniel Collins strongly dissented from the rehearing denial. They argued that the majority relied on a “mere professional association” to define what is considered constitutionally acceptable treatment of people in prison with gender dysphoria and “invent a constitutional right to state-funded sex reassignment surgery.” The Ninth Circuit, they continued, now is alone in finding that denying this debated area of medical treatment amounts to cruel and unusual punishment under the Constitution.
The three-judge panel rejected this argument. Experts for both Edmo and the state of Idaho relied on the same internationally-recognized guidelines for gender dysphoria, the judges said, and agreed that those guidelines provided “the best guidance” and “were the best standards out there.” Furthermore, the panel continued, there were “no other competing, evidence-based standards that are accepted by any nationally or internationally recognized medical professional groups. The weight of opinion in the medical and mental health communities agrees that sex-reassignment surgery is safe, effective and medically necessary in appropriate circumstances.” Similarly, Edmo’s experts established that the procedure was medically necessary to treat Edmo’s gender dysphoria.
Indeed, gender dysphoria is a legitimate medical condition that requires medical treatment. Regardless of the condition and the treatment, denying an individual the medically necessary care they need is unconstitutional. Thankfully, Adree Edmo will face no such roadblock to that treatment, despite Trump Ninth Circuit appointees’ dissent.