There are particular moments in the movement for transgender equality when we consider it a great victory when a court refuses to hear a case—and today is one of those moments. The U.S. Supreme Court refused to hear an appeal brought by the State of Wisconsin after Lambda Legal, the ACLU and the ACLU of Wisconsin successfully challenged a state law that prohibits medically necessary treatment for transgender people in prison.
In 2005, Wisconsin legislators passed a law—offensively coined the "Inmate Sex-Change Prevention Act"—that barred prison doctors from providing transgender prisoners medically necessary transition-related care such as hormone therapy or sex reassignment surgery while in state custody. Even though Wisconsin, to date, is the only state to pass such a repugnant law targeting an already marginalized, politically unpopular group of people, the law is symbolic of the widespread ignorance of transgender people's health care. Transition-related care is so often seen as cosmetic, experimental or simply unnecessary, even though the medical community for years has understood these treatments to be effective, medically necessary and often even life-saving.
In 2006, we filed Fields v. Smith, a lawsuit on behalf of several transgender women in prison who were experiencing severe physical and psychological harm after the medical treatment they had been receiving under prison doctors' care was abruptly cut off due to this new draconian law. During a four-day trial, our medical experts testified about the medical necessity of transition-related care and were joined by the medical director of the prison who testified in support of our case. The U.S. District Court for the Eastern District of Wisconsin then struck down the law as unconstitutional based on both the Eighth Amendment ( cruel and unusual punishment ) and on the Equal Protection Clause. Unfortunately, the State of Wisconsin didn't stop there. In 2010, they appealed the ruling. In August of last year, a unanimous three-judge panel of the U.S. District Court of Appeals for the Seventh Circuit upheld our victory, stating: "Refusing to provide effective treatment for a serious medical condition serves no valid penological purpose and amounts to torture."
After losing twice, in a last-breath attempt, the State of Wisconsin once again appealed the ruling, this time to the Supreme Court of the United States. Today, this seven-year battle has finally come to an end after the Supreme Court's rejection of the State of Wisconsin's appeal.
Although the Fields v. Smith case does not mean that all transgender people in prison now have full access to transition-related care, it does send a clear message that medical care should be left in the hand of doctors, not legislators who may be operating on bias and misinformation about the medical needs of a marginalized population. Access to discrimination-free health care is a constant challenge for transgender people and people in prison are particularly vulnerable to limited care. Legislators, politicians and policy makers should not be in the business of making medical decisions. We all lose when politicians get to decide what course of treatment our doctors prescribe for us.
The Fields v. Smith win is not the only recent significant victory for transgender people who are in the hands of the government for medical care. Last year, the Federal Bureau of Prisons ( BOP ) changed its policy for treatment of transgender individuals in federal prisons nationwide as part of a settlement in the Adams v. Federal Bureau of Prisons et al. case filed by National Center for Lesbian Rights and Gay and Lesbian Advocates and Defenders. The new BOP policy allows federal prisoners access to an evaluation by a doctor and treatment in accordance with the internationally accepted Standards of Care issued by the World Professional Association for Transgender Health. Like Fields, this case is groundbreaking because it established a new federal standard for transgender prisoners—one that states across the country will undoubtedly look to as guidance in forming their own policies.
We still have much work in front of us, but today's victory is just one more step along the road toward a more equitable future for transgender health care.
