Qualitative Analysis of Transgender Inmates’ Correspondence

Abstract

Claims of inadequate health care and safety afforded to transgender inmates have become the subject of litigation. This article reviews 129 unsolicited letters from transgender inmates writing from 24 states and the Federal Bureau of Prisons to identify their concerns. Among the letters reviewed were reports from 10 inmates who had filed lawsuits naming departments of correction (DOCs) as defendants, claiming inadequate access to transgender health care. Five of these lawsuits have gone to trial. In all of those cases, the defendant settled the matter or was found liable as of the time of this report. Claims of inadequate care for transgendered patients that have sufficient merit to be fully litigated in U.S. courts appear likely to produce verdicts in favor of plaintiff inmates. The information gleaned from reviewing letters from transgendered inmates may alert staffs of DOCs to concerns worth addressing proactively to avoid the costs associated with transgender-related lawsuits.

Improving Transgender Healthcare in the New York City Correctional System

“…28 This is of special concern for transgender healthcare because when untreated in correction settings, GD has been associated with suicidality, depression, and autocastration. 22,27 The process of evaluation, training, policy revision, staff feedback, collaboration with a transgender healthcare expert, and continuous monitoring has led to substantial improvements in transgender healthcare in the NYC jail system. Six months after our interventions, a transgender healthcare grand rounds was organized and included a presentation by a community transgender healthcare expert.…”

“…In addition to improving the quality of care, there is some evidence that these types of efforts may address grievances that lead to litigation against correctional settings. 22 There are a couple of limitations that arose in the development of this program and should be acknowledged. First, as mentioned earlier, because we identified the population of transgender patients by reviewing the correctional pharmacy records of males on estrogen therapy and females on testosterone therapy, transgender patients who were not on hormone therapy were not represented in our collected survey data.…”

“…11,18,19 In the correctional setting, preoperative transgender individuals face improper housing and the burden of living as a member of the opposite gender in housing designated for the sex they were assigned at birth. 3,[20][21][22][23] Furthermore, incarcerated transgender individuals are at a higher risk of experiencing sexual abuse. 24,25 The New York City Department of Health and Mental Hygiene (DOHMH) oversees the delivery of medical, mental health, and dental care, as well as discharge planning services in the New York City (NYC) jail system, which has an average daily census of 11,000 inmates, over 70,000 annual admissions, and an average detainee stay of 30 days.…”

Narratives of Transgender People Detained in Prison: The Role Played by the Utterances “Not” (as a Feeling of Hetero- and Auto-rejection) and “Exist” (as a Feeling of Hetero- and Auto-acceptance) for the Construction of a Discursive Self. A Suggestion of Goals and Strategies for Psychological Counseling

“…Certainly, such negative representations of transgender people in culture and society are exacerbated in highly institutionalized environments like prison (Alexander and Meshelemiah, 2010; Sexton et al, 2010; Brown, 2014; Jenness, 2014). The penitentiary context itself was conceived to exclude, punish, and change a so-called deviant person's behavior (Foucault, 1995).…”

“…As shown by several studies focused on this topic (Brown and McDuffie, 2009; Chianura et al, 2010; Brown, 2014), transgender people in prison request special needs, whether compared to other typologies of prisoners. Transgender inmates, indeed, are generally more exposed to processes of violence and exclusion, and such a harsh existential condition exacerbates even more within highly institutionalized contexts, such as prisons.…”