The Wisconsin law, named the Inmate Sex Change Prevention Act, was passed in 2005, and was challenged in 2006 by three transgender inmates, with the help of the American Civil Liberties Union and Lambda Legal.
The court’s decision was based upon the 8th Amendment of the U.S. Constitution and its guarantee of freedom from cruel and unusual punishment.
In its decision, the Court looked at the science behind what is known as “gender identity disorder” (GID), a medical term used to describe the condition where ones physical gender does not match ones gender identity.
In its ruling, the Court determined that by refusing the inmates access to hormone treatments, the state was increasing the psychological stress and harm that may come to those inmates that have GID. To the Court, this meant that the state was deliberately inflicting a cruel and unusual punishment on its transgender inmates.
Wisconsin, in its defense of the law, did not disagree that gender identity disorder was a medical condition that needed to be treated. Instead, they asserted that the law was constitutional because hormone treatments were not the only way that GID could be dealt with.
Wisconsin‘s basis for this logic was two court cases, from 1987 and 1997 respectively which stated that the State does not need to provide hormone treatments to inmates because of the prohibitive cost of the drugs and the other treatment options available to transgender individuals.
In the judges decision, they rejected this prior precedent and asserted that not only has the cost of hormone treatments for transgender inmates become significantly less expensive, but that the long term costs to the system (such as increased security, psychological expenses, etc.) far outweigh the costs of the hormone treatments. A portion of the court’s decision reads:
At trial, defendants stipulated that the cost of providing hormone therapy is between $300 and $1,000 per inmate per year. The district court compared this cost to the cost of a common antipsychotic drug used to treat many DOC inmates.
In 2004, DOC paid a total of $2,300 for hormones for two inmates. That same year, DOC paid $2.5 million to provide inmates with quetiapine, an antipsychotic drug which costs more than $2,500 per inmate per year. Sex reassignment surgery is significantly more expensive, costing approximately $20,000. However, other significant surgeries may be more expensive.
In 2005, DOC paid $37,244 for one coronary bypass surgery and $32,897 for one kidney transplant surgery. The district court concluded that DOC might actually incur greater costs by refusing to provide hormones, since inmates with GID might require other expensive treatments or enhanced monitoring by prison security.
ACLU attorney John Knight, hailed the ruling as a significant victory:
“This was a discriminatory law that cruelly singled out transgender people by denying them — and only them — the medical care they need … too often the medical needs of transgender persons are not treated as the serious health issues that they are.
“We are glad that the appeals court has found that medical professionals, not the Wisconsin legislature, should make medical decisions for inmates.”