A transgender woman incarcerated in Utah faced a deepening mental health crisis as she was discriminated against in a state correctional facility, the U.S. Department of Justice found in a new report.
After being denied gender-affirming care and other accommodations for her identity, the woman’s gender dysphoria worsened to the point that “she performed dangerous self-surgery and removed her own testicles” nearly two years after entering custody, the department wrote on Tuesday.
During their investigation, federal officials interviewed Utah Department of Corrections’ medical director and Americans with Disabilities Act coordinator, as well as other staff and contractors. They also requested and reviewed policies provided by the department.
The Utah Department of Corrections said Tuesday afternoon that it disagreed with the Justice Department’s finding and had been “blindsided” by the report.
“We have been working to address this complex issue, and were blindsided by today’s public announcement from the Department of Justice. We have also taken steps on our own, and as a state, to address the needs of inmates while maintaining the highest safety standards,” executive director Brian Redd said in a statement. “We fundamentally disagree with the DOJ on key issues, and are disappointed with their approach.”
A spokesperson for Utah Department of Health and Human Services — which is in the process of taking over health care in correctional facilities following past scrutiny — told The Salt Lake Tribune Wednesday morning that it stands by Redd’s statement.
Gender dysphoria is a condition that is covered under the ADA. While being transgender is not considered a disability, some trans people experience the medical condition which causes severe mental and emotional distress when a person’s assigned sex at birth and their gender identity don’t align.
“By not allowing me this opportunity to live my life as a woman, who I believe I am and have lived life for many years, the prison is causing me such mental stress in the form of anxiety, depression ... ,” the incarcerated woman wrote in ADA requests and grievances, according to the Justice Department.
As the woman sought gender-affirming care, such treatment had to be approved by a committee, the report found. That process “unnecessarily delayed and restricted” her access to care as members of the committee reportedly “expressed bias against individuals who are transgender and reluctance to prescribe medically appropriate treatment for gender dysphoria.”
Once the woman did receive access to care, her physician at the prison reportedly tried to talk her out of the hormone therapy she had been asking for over the previous 15 months. When that therapy started being administered, her physician “failed to take basic steps to ensure that it was provided safely and effectively,” according to the Justice Department.
She also asked for makeup and female clothing, including bras and women’s underwear, from the commissary. Except for one sports bra, investigators found, her requests were denied.
In its denial, Utah corrections officials wrote, “female underwear and cosmetics are approved for incarcerated persons assigned to female housing units.” After the woman appealed, the department issued a second denial, writing, “prison incarcerated persons shall be dressed in the approved clothing for the incarcerated persons designated housing classification.”
The incarcerated woman has been assigned to male housing since she entered the Utah correctional system.
“Despite its policy to ensure appropriate and safe housing, UDOC assigns incarcerated persons, including those with gender dysphoria, to either male or female housing based solely on sex at ‘commitment,’ as determined by staff conducting a visual search of genitals,” the Justice Department wrote in its report.
In the ADA requests and grievances she filed, the woman also complained about being subjected to cross-gender pat and visual searches. To avoid being pat down by male correctional officers, which is required every time incarcerated people exit the dining hall, the woman eats alone in her cell, according to the report.
The Justice Department urged the Utah Department of Corrections to “remedy these violations, and to protect the civil rights of other individuals with gender dysphoria” by revising policies to allow incarcerated people with gender dysphoria an equal opportunity to participate in and benefit from ... services, programs, and activities.” Those policies should also outline providing health care for gender dysphoria “consistent with UDOC’s treatment of other medical conditions.”
It is also requesting that all correctional employees be trained on ADA requirements. Federal officials are asking that the department allow it to access its facilities and files, as well as provide reports “delineating all steps taken to comply with these requirements, including the dates on which each step was taken, and, where applicable, information sufficient to demonstrate compliance.”
An attorney overseeing the Disability Rights Section of the Justice Department’s Civil Rights Division in wrote in a letter to Redd and the Utah attorney general’s office that the state should also pay compensatory damages to the woman.
The Justice Department aims to work with the Utah Department of Corrections to draw up a “court- enforceable consent decree.”
“If we are unable to reach such a resolution, the Attorney General may initiate a lawsuit,” the letter says.
The crackdown on ADA compliance in this case is part of a broader effort by President Joe Biden’s Justice Department to address discrimination against trans people in correctional settings, the statement said. It pointed to a statement of interest the department filed in a case in Georgia in which a trans woman incarcerated there is seeking gender-affirming care that the state has so far denied.
Could recently passed laws lead to more federal scrutiny?
Multiple bills passed in Utah’s most recent legislative session could get in the way of the Utah Department of Corrections meeting the Justice Department’s demands.
One already signed by Gov. Spencer Cox, “Sex-based Designations for Privacy, Anti-bullying and Women’s Opportunities,” more widely known as HB257, changes the legal definitions of “female” and “male” to categorize Utahns by the reproductive organs of their birth.
It’s criminal for anyone who doesn’t meet those definitions to use locker rooms, showers or dressing rooms in government-owned or -controlled buildings. There are limited exceptions for transgender people who have amended their birth certificates and had invasive and costly gender-affirming surgeries.
Another bill that awaits the governor’s signature would provide additional guidance to the Utah Department of Corrections when incarcerated transgender people request housing and accommodations that align with their gender identity.
That bill, “Inmate Assignment Amendments,” would require trans people to undergo an “individualized security analysis” to assess a number of factors — including their physical characteristics, whether they are sincere in expressing their identity, social behavior and “any other factor determined to be relevant” — before being moved to spaces that align with their identity.
Editor’s note • This article discusses a mental health crisis. If you or people you know are at risk of self-harm, call or text 988 to reach the Suicide & Crisis Lifeline for 24-hour support.
This story is developing and may be updated.
Follow @emilyreanderson