FORT WORTH, Texas — A judge has ordered the Bureau of Prisons to schedule gender-affirmation surgery for a transgender woman who has experienced repeated delays in receiving treatment, including when she was housed at a Fort Worth women’s prison.

On April 18, an Illinois judge ordered the BOP to provide a detailed timeline for gender-affirming surgery for Cristina Iglesias, including undertaking a nationwide search to identify a qualified surgeon. Iglesias was incarcerated at FMC Carswell, a women’s medical prison in Fort Worth, beginning in May 2021. She was transferred to a BOP residential reentry center in Florida in March and is scheduled to be released in December.

Iglesias has been incarcerated since 1994 and fighting for appropriate treatment for years, according to the ACLU of Illinois. She would become the first transgender person to receive gender-affirming surgery while in federal custody, according to the ACLU and statements made by the BOP in court proceedings.

“I am hopeful that I will finally get the care I need to live my life fully as the woman I am,” Iglesias said in a statement provided by the ACLU. “BOP has denied me gender-affirming surgery for years — and keeps raising new excuses and putting new obstacles in my way. I am grateful that the court recognized the urgency of my case and ordered BOP to act.”

Iglesias filed a lawsuit against the BOP in 2020, saying she had been denied medically necessary treatment and the BOP had failed to protect her by refusing to move her to a women’s facility.

“Under the Constitution, prisons cannot be deliberately indifferent to the serious medical needs of those in their custody,” said Joshua Blecher-Cohen, Iglesias’ primary legal representative with the ACLU. “And we are excited that Ms. Iglesias, after years of fighting, is one step closer to getting the care she needs.”

The BOP does not comment on litigation or individual conditions of people who are incarcerated. In court documents, the BOP said it has been working to schedule treatment for Iglesias. The head of the Transgender Executive Council within the BOP wrote in court documents that her “priority has been on getting Ms. Iglesias in front of the surgeon and making clear the scope of things that we want to secure.”

In her court order Monday, Illinois judge Nancy Rosentengel admonished the BOP over the repeated delays in Iglesias’ treatment, writing in her order on Monday that the agency’s “tactics are turning into a game of ‘whack-a-mole.'” She threatened the Department of Justice and the BOP with sanctions if the agencies cannot fully explain why they violated court orders related to Iglesias’ gender-affirmation surgery.

For example, in December, the judge ordered the BOP to have Iglesias evaluated for gender-affirming surgery and, if approved, find her an appropriate surgeon immediately. Iglesias was evaluated and, after a seven-week search, the BOP said it had found a surgeon for her. However, the surgeon does not actually perform the type of gender-affirming surgery that Iglesias needs.

Iglesias met with the surgeon on April 7, where she “allowed herself to be hopeful that she was finally going to see a surgeon… who could help provide her gender-affirming surgery,” according to a statement from Iglesias quoted in the court order. Instead, she was left feeling “humiliated, angry and scared.”

While in custody, she has been diagnosed with severe gender dysphoria, a condition in which someone has extreme mental distress stemming from strong feelings of incongruity between one’s anatomy and one’s gender. She has attempted to die by suicide and made references to self-castration, according to court documents.

Over the years, Iglesias has requested various treatments dozens of times, according to court documents. She has been repeatedly denied “medically necessary care as required by the Constitution,” Blecher-Cohen said, including when she was incarcerated at Carswell.

According to court documents, Iglesias said staff at Carswell told her she was going to be moved back to a men’s prison, even though this was not the case.

Under federal law, the BOP is supposed to make decisions about where a transgender person should be incarcerated based on where they would feel safest. Yet Iglesias, who was taken into custody in 1994, remained in a male facility until 2021 despite repeated requests to be moved because of sexual harassment.

For Iglesias, who has been on hormone therapy since 2015, her gender dysphoria causes severe anxiety and psychological harm. Dr. Randi Ettner, a clinical and forensic psychologist with a specialty in gender dysphoria, assessed Iglesias in 2021 and determined Iglesias had the most severe form of gender dysphoria. Iglesias has shown signs of gender dysphoria since she was a child, and is at risk of attempting suicide or self-castration if she does not receive treatment. Her psychological condition deteriorates the longer she goes without treatment.

State and federal prisons are required by federal law to provide adequate medical care.

About 1,200 transgender people are in the custody of the Federal Bureau of Prisons, according to court documents. Their treatment must be vetted and approved by the Transgender Executive Council. In her court statement, Ettner commented that those members are not specialists in gender dysphoria or transgender health, and “they lack the competency to make those individualized decisions.”

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