A federal judge on Thursday ordered California's corrections department to provide a transgender inmate with sex reassignment surgery, the first time such an operation has been ordered in the state.
U.S. District Judge Jon Tigar in San Francisco ruled that denying the surgery to 51-year-old Michelle-Lael Norsworthy violates her constitutional rights. Her birth name is Jeffrey Bryan Norsworthy.
The ruling marks just the second time nationwide that a judge has issued an injunction directing a state prison system to provide the surgery, said Ilona Turner, legal director at the Transgender Law Center in Oakland, which helped represent Norsworthy.
The previous order in a Massachusetts case was overturned last year and is being appealed to the U.S. Supreme Court.
In his ruling in California, Tigar cited testimony that the surgery has actually been performed just once on an inmate, an apparent reference to a person who castrated himself in Texas then was given the surgery out of necessity.
Norsworthy, who was convicted of murder, has lived as a woman since the 1990s and has what Tigar termed severe gender dysphoria - a condition that occurs when people's gender at birth is contrary to the way they identify themselves.
"The weight of the evidence demonstrates that for Norsworthy, the only adequate medical treatment for her gender dysphoria is SRS," Tigar wrote, referring to sex reassignment surgery.
California Department of Corrections and Rehabilitation officials said they were considering whether to appeal the ruling.
"This decision confirms that it is unlawful to deny essential treatment to transgender people" in or out of prison, said Kris Hayashi, executive director of the Transgender Law Center. "The bottom line is no one should be denied the medical care they need."
If the order stands, Norsworthy would be the first inmate to receive such surgery in California, said Joyce Hayhoe, a spokeswoman for the federal receiver who controls California prison medical care.
Hayhoe said it's not known how much the surgery would cost, but it could run as high as $100,000 depending on the circumstances. The Transgender Law Center called the estimate "a gross exaggeration" and said Medi-Cal, California's health care program for low-income residents, has covered the procedure for years.
Corrections officials, in previous court filings, argued that Norsworthy has received proper medical and mental health care for more than 15 years and is in no immediate medical danger if the surgery is not performed.
Her care has included counseling, mental health treatment and hormone therapy that the department said "has changed her physical appearance and voice to that of a woman" while helping her find her gender identity.
That care is consistent with what other judges nationwide have found to be appropriate for transgender inmates, the department said.
Norsworthy has been in prison since 1987, serving a life sentence for second-degree murder. She has twice delayed her scheduled parole hearings in recent months.
She currently is housed at Mule Creek State Prison, an all-male prison in Ione, 40 miles southeast of Sacramento.
The sex change surgery would prompt practical problems, the department said.
It said keeping Norsworthy in a men's prison could invite violence, including possible assault and rape.
But she could also face danger at a women's prison - or pose a threat herself - because she had a history of domestic violence before her murder conviction, the department said.
Last month, attorneys for the transgender inmate convicted of murder in Massachusetts asked the U.S. Supreme Court to overturn a ruling denying her request for sex reassignment surgery.
A federal judge in 2012 ordered the Massachusetts Department of Correction to grant the surgery to Michelle Kosilek, but the ruling was overturned in December by the 1st U.S. Circuit Court of Appeals.
As in California, the appeal in Massachusetts cited security concerns about protecting the inmate.
Courts in other states have ordered hormone treatments, psychotherapy and other treatments but not surgery.