More and more prisoners in California are requiring gender-affirming health care, including surgery

No trespassing signs outside Kern Valley State Prison on Nov. 15, 2022. (Larry Valenzuela, CalMatters/CatchLight Local)

By ANABEL SOSA | Cal Matters

The number of California prisoners requiring gender-affirming health care more than doubled last year, and the state correctional agency expects the trend to continue even as the state’s overall inmate population is projected to decline.

The estimate comes from budget documents detailing agency responsibilities for two groundbreaking policies the state has enacted over the past seven years.

One, in 2017, made California the first state to set standards that would allow gender-affirming surgery to state prison inmates. It followed state approval of surgery for a transgender woman serving a life sentence. She was subsequently transferred to a women’s prison.

The other, a 2021 law signed by Gov. Gavin Newsom, requires that every person entering prison be asked gender-specific questions to determine whether they should be housed in a facility for men or women.

Since the changes went into effect, the California Department of Correction and Rehabilitation has found that the number of transgender, intersex and nonbinary inmates has grown steadily each year, rising to 1,617 last year. That’s a 234% increase from 2017, according to the documents.

The vulnerable, transgender and transgender diverse population in the CDCR has grown and continues to grow, and there are enduring needs that need to be met, said Trisha Wallis, a senior psychologist in the department specializing in gender health care, at a committee hearing to budget in March.

The agency this year requested a small funding boost of $2.2 million to provide mandatory assistance. The agency’s request was not controversial and passed through the legislature this spring without pushbacks. Budget negotiations between Gov. Gavin Newsom and the lawmaker are expected to conclude this week.

Wallis at the hearing said the program was originally intended to address equitable access to safe and optimal gender-affirming care, but acknowledged that understaffing has led to treatment backlogs.

The backlog for gender-affirming care is growing

As of December, 20 inmates since 2017 had received gender affirming surgery. Another 150 surgeries had been approved, but not completed, according to the budget documents.

In the California government’s 2021-22 budget year, 270 inmates required gender affirming surgeries compared to 99 the previous year.

The state projects that 348 inmates will require gender-affirming treatment this year and 462 next year. The corrections agency says its staff can evaluate no more than three requests each week.

The agency has also received more than 364 housing relocation requests since 2021. Only 35 of those were approved and sent to the Central California Women’s Facility in Chowchilla.

Advocates for transgender and nonbinary inmates have urged the state to move faster in providing the surgeries and evaluate requests from other inmates to move to facilities that best fit their needs.

Some of them criticized the agency’s budget request, arguing that the $15 billion-a-year state prison system already had plenty of cash to implement the policies.

It’s ridiculous. $2 million for stuff they should already be doing? said Alex Binsfield, a policy analyst at the TGI Justice Project, a San Francisco nonprofit that advocates for incarcerated transgender people. I don’t think pumping any more money into the CDCR is going to fix health care there.

Transgender advocates are also on the lookout for signs that the state is withholding transfers for inmates who identify as transgender but have not received gender-affirming medical treatment.

Ultimately, the housing issue shouldn’t be a medical one, said Jen Orthwein, a psychologist who previously provided treatment to transgender inmates in jails across California.

Terri Hardy, a spokeswoman for the California Department of Corrections and Rehabilitation, said these fears were unfounded.

Incarcerated individuals are not required to undergo gender-affirming surgery to be transferred to an institution consistent with their gender identity, Hardy wrote in an email to CalMatters.

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