If an inmate who self reports gender identity disorder and taking hormones prior to being incarcerated, is now demanding the same; how does one handle it?
Interesting dilemma: Do inmates have this right?
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I have worked in the prisons before. If I came upon this situation, I would do a psychiatric evaluation. If I thought that hormone treatment was psychiatrically appropriate, I would refer to primary care/endocrinology for hormone treatment. I doubt that this would be carried out in Alabama (I did some locum tenens prison psych there a few years ago)
Btw, it is now known as gender dysphoria, significantly.
If you can confirm that the patient was being prescribed hormones, and that a letter of support from mental health clinician was provided at that time (which is required in CT but I'm not sure about other states), then the patient should have his treatment continued.
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I'm not sure I understand the confusion here. Why is this different than any other medication?
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It's being given for a non-FDA approved indication for a disorder that is not recognized in all states/prison systems.
It isn't - but just like if a patient told you they were taking 200 units of insulin, you would want to confirm that this was in fact prescribed, as the adverse consequences could be significant.
Well many medications are given for non-FDA approved indications. I'm not sure what it means that gender dysphoria is "not recognized" in all states - do states have a list of diagnosis they acknowledge, and does this matter for anything?
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http://www.uiowa.edu/~ilr/issues/ILR_97-4_True.pdf This is a little outdated, but some states did have constraints on tx for gender dysphoria
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Medicare now pays for this, so the federal government at least is seeing this as a legitimate treatment for gender dysphoria, which is listed in the DSM. To say that it is just giving in to some kind of lifestyle choice, etc., and not a treatment of a real disorder, is probably going to be viewed by many as homophobia.
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One tells him/her to shut his trap or face cosequenes(isolation or whatever)....pretty sure that is how the prison would and should handle it.
Being a prisoner doesn't given one a right to any and all treatments one could possibly get on the outside.
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It's been a while since you've made me want to go beat my head against the wall until I knocked myself out.
Well we will just have to disagree on that issue.....there are about 2 million more important things(many of which funds are already scarce for) than making sure prisoners have access to such treatments. In the real world some things have to be prioritized over others.
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There's no disagreement, in that I'm not convinced that you have enough of a clue about trans issues to have any sort of educated opinion. Based on your prior posts from quite awhile ago, this isn't a conjecture. You simply don't have a clue.
And there's no issues of priority here. We mistreat prisoners, especially sexual minorities. We shouldn't, period.
That may be the way the prison system will deal with the situation, but to pretend that is somehow a legitimate position is just seriously ****ed up.
And there's no issues of priority here. We mistreat prisoners, especially sexual minorities. We shouldn't, period.
That may be the way the prison system will deal with the situation, but to pretend that is somehow a legitimate position is just seriously ****ed up.
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Of course there are issues of priority. Resources are not infinite. I simply don't believe that providing medical gender identity services or whatever you want to call them are as important as providing some other services. I don't believe a lot of things are as important as a lot of other things.
I work 1.5 days per week in a prison system now doing lt work, so I'm familiar with how we treat prisoners. It's certainly not the way I would want to live, but I wouldn't call it mistreatment.
Of course there are issues of priority. Resources are not infinite. I simply don't believe that providing medical gender identity services or whatever you want to call them are as important as providing some other services. I don't believe a lot of things are as important as a lot of other things.
I work 1.5 days per week in a prison system now doing lt work, so I'm familiar with how we treat prisoners. It's certainly not the way I would want to live, but I wouldn't call it mistreatment.
I've enjoyed your posts recently, mostly because its nice to have a gadfly to keep debate lively. But squelching free speech and personal advocacy with the threat of torture is a little dark even for me.
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Okay, let's break this down into the three issues that came up because of your response.
This is not a matter of disagreement. This is you being a terrible, ignorant human being. This is the sort of fascist bull **** that your grandchildren will hear about and be embarrassed to talk about their grandfather.
Probably. Because our prison system is really screwed up.
Whereas there could be room to debate this in a reasonable way, your initial statement makes it pretty clear that you are so inept at evaluating trans-related priorities that you lost your vote in anything resembling a reasonable conversation. It's not a matter of "priority" because our prison system is so underfunded that basic human dignities are violated all over the place. It's a matter of pure lack of will to respect people's basic humanity, and THEN wondering why, after they leave, they continue to struggle to respect others' basic humanity. It's effective punishment, but it's not very effective deterrence, it's not very effective against recidivism, and it's entirely ineffective at rehabilitation.
I could simply have 'liked' this post but that would have lacked the desired impact. Really well said!
Your statements regarding what is and isn't a 'priority' are nonsensical. The fact that the prison system may be underfunded doesn't change the fact that priorities are still in place. Despite being underfunded, prisoners do still have access to insulin, blood pressure meds, basic nutritional needs, etc.....so there are priorities. That's just common sense....sheeesh.
Your last points go to a much larger discussion(the role of the prison system in general), of which I'm sure we also disagree but is beyond the scope of this.
this is a pretty whacked out statement- the idea that because someone doesn't think such prisoners should get the treatment in question that they are a 'terrible, ignorant human being'. Now perhaps I am a terrible human being, but trust me if that is the case there are numerous other reasons for that
but really you don't have any idea how I feel about gay people, trans people, all 'sexual minorities' as you call them......you clearly think you have an idea what I think about this population, but I can assure you that it is not accurate.
ummm these are prisoners. You do realize you give up some rights when you go to prison right?
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I think what posters are objecting to is the implication that you personally, rather than "the system"/warden/etc, "tells him/her to shut his trap or face cosequences(isolation or whatever)". I interpreted your post as that being the response of the system, and am giving you the benefit of the doubt for the time being.
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this is a pretty whacked out statement- the idea that because someone doesn't think such prisoners should get the treatment in question that they are a 'terrible, ignorant human being'. Now perhaps I am a terrible human being, but trust me if that is the case there are numerous other reasons for that
but really you don't have any idea how I feel about gay people, trans people, all 'sexual minorities' as you call them......you clearly think you have an idea what I think about this population, but I can assure you that it is not accurate.
I broke it down very clearly in the second post which part of your post was worthy of the "terrible, ignorant human being" moniker. MichaelRack's above point reinforces this, though he is giving you benefit of the doubt, where I'm not (based on exactly what you said). If you use language like that loosely, you're going to get torn apart. If that's not what you think, okay. Don't say that unless you're okay with other people thinking you're worthy of being called terrible or ignorant.
Your language and your past posts suggest your personal opinions, mainly that you "don't have a problem" with sexual minorities (it's not my term, it's a well established term), but that you also don't believe they deserve any "special treatment" (which I imagine you would define as nearly anything that recognizes or accommodates their status, and which I would define as the bare minimum accomodations necessary for humane and safe treatment).
You're suggesting in your post that hormone replacement for a trans person who is already transitioning/transitioned isn't that big a deal. It's a huge deal. Trans folks are particularly vulnerable in prison, psychiatrically, risk for violence, etc. You might disagree, but I would hope that someday "being your gender" would be a fundamental and inalienable right recognized in courts. Personally, any opinion less than this I would label transphobic and not blink about it, because any less opinion shows a pretty fundamental lack of understanding of the trans community (says the cis-hetero white guy)
I would say the same thing to other inmates regardless of race/gender/orientation if they made a fuss over accomodations/treatment not granted. This is a prison people- you give up some rights when you enter. That's the way it is.
the issue here is that you interpreted my language(I'm assuming the shut your trap part) to mean something that it doesn't mean. As I said earlier, I would use the same language to describe any number of groups in that situation....
Regarding your last paragraph, you are correct that I don't think treating this population with hormone therapy(or surgery or whatever) is as big a priority as giving a type 1 diabetic insulin or something. Hence my point about priorities.....every single issue/need/want a prisoner has falls somewhere on a priorities continuum. The fact that I think insulin for a type 1 diabetic > hormone therapy for this population on this continuum doesn't mean I think it's "not a big deal" as you say. That's your mind running with all these preconcieved ideas about what you would imagine my thoughts on sexual minorities to be.
There are numerous issues at play here which blur this issue and make it difficult to tease out the motivations behind a singular statement. There are issues of an active govt vs a limited govt, the role of prisons, and the rights of alternative lifestyle individuals.
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I have heard of this dilemma before, but I don’t think it is a very wide spread problem. If our prison system decided to provide hormone treatments for gender dysphonia it probably will not become a prisoner fad or kick.
“Hey Joe, I’m bored. What do you say you and I go and try and get on female hormones just to see what it is like?”
“Hey Joe, I’m bored. What do you say you and I go and try and get on female hormones just to see what it is like?”
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I think it would also come down to experience in training, seeing as its not-FDA approved and isn't particularly common in most physicians training, I think a lot of physicians wouldn't be comfortable writing a prescription for a treatment they have almost no experience with.
Which then makes the question, "Does every prisoner with a rare illness have a right to get care from a physician utilizing the most cutting edge treatments for that given condition?"
I'm not sure what the answer is to that question
Which then makes the question, "Does every prisoner with a rare illness have a right to get care from a physician utilizing the most cutting edge treatments for that given condition?"
I'm not sure what the answer is to that question
I'm not sure I agree with that - I often continue medications that are complicated for patients on the inpatient unit with medical problems. If this was started by their cardiologist or internist I am happy to continue the current regimen. It shouldn't be any different here.
Of course it should be because the payer is different....if someone's rheumatologist starts them on a 45k a year infusion that works 20 percent better for their RA than a drug 20x cheaper, then that is between the pt, physician, and payer(likely an insurer).....expensive treatments just don't materialize out of thin air.
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Hormonal tx is complicated and I don't think a psychiatrist is qualified to prescribe it (even continuation of treatment) without special training/experience in the area.
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you'd be surprised
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I disagree with you- I don't think transgender tx (hormones/surgery) should be provided in prisons for a pre-op person- but this is my own personal opinion and I treat all my patients with respect (and I have had transgender pts in the past, although I wasn't treating that) and I recognize that it's not my job to decide what treatments the government covers. Telling a patient to shut his trap his inexcusable
Look at the word used to describe the prisoners request in my original reply- demanding. This implies a more assertive stance on his part for a request that has already been denied. When prisoners take such an approach, the best response is not a passive or weak denial. Words mean things. And again, if a prisoner DEMANDS oxycodone and it's not going to happen I would take the exact same approach. This is a prison, not a g8 summit.
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Yeah but an inpatient psych unit is quite a bit different, you can either easily have consultants come evaluate the patient or have patients followup with specialists right after discharge. I don't think prison really works like that and I doubt most physicians covering prisons have much experience with prescribing/monitoring these therapies. (For example I don't think I ever saw a patient on it for the entirety of medschool and never was taught it in any respect except for saying it exists)
I see what you are saying - and the prison context may be pretty specific, but even if I didn't think I could have consultants come over easily, I'd just take a few minutes to call the endocrinologist or whoever is prescribing, and make sure I had the dose correct and that there weren't significant monitoring requirements?
For starters a lot of these people are ordering their hormones online through international pharmacies....for the prison population, it's even higher I'm sure. So good luck with that.
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Let's answer the question.
Do inmates have the right? This implies the law, not ethics.
Legally, prisoners have very little rights when it comes to medical treatment.
http://en.wikipedia.org/wiki/Estelle_v._Gamble
Estelle v Gamble established a minimum level of treatment for prisoners. Unfortunately that level of treatment is quite low. "Deliberate indifference" is the standard a health care provider must be above...that's it.
In this case, Gamble was treated by a prison doctor who wasn't even a doctor, didn't even have training or credentials. The guy gave him a clean bill of health despite that Gamble was in pain and had an arrhythmia that was later proven because a weekend doctor on duty actually checked Gamble out for real. Because Gamble was not able to do manual labor, the prison management put him in a heat box and solitary confinement when he "refused" to work.
The court acknowledged that Gamble suffered from care below the standard but also argued that if all prisoners received the standard of care, malingering would overtake the prison system. A prisoner could easily fake chest pain, be brought to an ER where it's easier to escape, or simply do this because hospitals usually have nicer amenities such as cable TV, air conditioning and females.
Now the Supreme Court established a minimum. That doesn't mean a state has to follow the bare minimum. A doctor, could for example, still actually give some decent care if he/she chose to do so, it just means the prison can allow for bad care so long as it's not "deliberate indifference."
(I'm not saying I agree with the Court, we're talking about their ruling, not my own opinion).
Some states do enforce higher standards of care. The problem now becomes that most, well virtually all prisons, do not have the capability of providing everything that a community level of care can. They have their own formularies, their own hierarchies and approaches to care (or lack thereof....).
To answer the question, can an inmate get hormonal treatment? It depends on the state. It's not something that the federal government mandated as needed, and echoing some of the statements above 1) It's not a common problem among inmates so it'll likely be ignored 2) The treatment is often times considered unnecessary-so prisons will likely not advocate for inmates to get it 3) the public doesn't exactly have sympathy for inmates so don't expect a public response.
Answering the original question.....
No. They do not have a right. It's been established in Estelle v Gamble.
Do inmates have the right? This implies the law, not ethics.
Legally, prisoners have very little rights when it comes to medical treatment.
http://en.wikipedia.org/wiki/Estelle_v._Gamble
Estelle v Gamble established a minimum level of treatment for prisoners. Unfortunately that level of treatment is quite low. "Deliberate indifference" is the standard a health care provider must be above...that's it.
In this case, Gamble was treated by a prison doctor who wasn't even a doctor, didn't even have training or credentials. The guy gave him a clean bill of health despite that Gamble was in pain and had an arrhythmia that was later proven because a weekend doctor on duty actually checked Gamble out for real. Because Gamble was not able to do manual labor, the prison management put him in a heat box and solitary confinement when he "refused" to work.
The court acknowledged that Gamble suffered from care below the standard but also argued that if all prisoners received the standard of care, malingering would overtake the prison system. A prisoner could easily fake chest pain, be brought to an ER where it's easier to escape, or simply do this because hospitals usually have nicer amenities such as cable TV, air conditioning and females.
Now the Supreme Court established a minimum. That doesn't mean a state has to follow the bare minimum. A doctor, could for example, still actually give some decent care if he/she chose to do so, it just means the prison can allow for bad care so long as it's not "deliberate indifference."
(I'm not saying I agree with the Court, we're talking about their ruling, not my own opinion).
Some states do enforce higher standards of care. The problem now becomes that most, well virtually all prisons, do not have the capability of providing everything that a community level of care can. They have their own formularies, their own hierarchies and approaches to care (or lack thereof....).
To answer the question, can an inmate get hormonal treatment? It depends on the state. It's not something that the federal government mandated as needed, and echoing some of the statements above 1) It's not a common problem among inmates so it'll likely be ignored 2) The treatment is often times considered unnecessary-so prisons will likely not advocate for inmates to get it 3) the public doesn't exactly have sympathy for inmates so don't expect a public response.
Answering the original question.....
No. They do not have a right. It's been established in Estelle v Gamble.
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Says the forensic psychiatrist! And my lawyer wife. Y'all are so boring at cocktail parties. Srsly.
Exhibit A why y'all are nuts:
http://www.vox.com/xpress/2014/8/6/5975227/this-monkey-took-a-selfie-who-owns-the-copyright
"Rights" are often the subject of philosophical treatises and ethical discussions, and perfectly up for further debate, though you're not the first lawman to try to tell me otherwise. It's all brainwarshin'.
Even I would agree that these prisoners don't have a "legal right" to this treatment under current law. But I tend to hold my days to higher standards than, "Welp, good day. Didn't do anything illegal!" To me, and probably 4/9 current supreme court justices, "deliberate indifference" would apply in this case. But unless Kennedy has a trans kid I don't know about, I don't think our side would win. And I'm sure Roberts would write the opinion just to keep Scalia from doing so.
There's no "legal right" to healthcare in general, but that doesn't mean people can't discuss a "right" to healthcare depending on the context of the conversation.
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dp
Many would argue a right not to have ones money confiscated at the threat of force to pay for more than basic medical treatments for others.
I am a huge fan of people having the right to do whatever the heck they want.....as long as it doesn't infringe on my rights.
Reminds me of an old political cartoon. Some leftist feminist has a sign saying get out of my bedroom. In response a libertarian has a sign reading stay out of my wallet.
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http://www.amsa.org/AMSA/Homepage/About/Committees/GenderandSexuality/TransgenderHealthCare.aspx
Click on the link for "suggested hormone regimes" for an outline of hormone therapy. I wish there was a link to a more detailed article on the risks
Click on the link for "suggested hormone regimes" for an outline of hormone therapy. I wish there was a link to a more detailed article on the risks
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This was useless without a reference to the monkey selfie! Come on!
I wasn't bringing up health care as a right (today) so much as to say that it's okay to talk about rights independent of courts and constitutions. In conversations with lawyer friends (my wife's best friend and her boyfriend, pretty much the only folks we hang out with, are both public defenders), that's something I have to argue a lot!
Well yeah of course....but then those rights independent of laws are going to be opinions either way.
As an aside, I don't see how someone can go into law today....the good jobs for young attorneys that pay decent(Biglaw associate) are crappy hours, poor environment, unpleasant work, and the worst part is crappy longterm prospects. It doesn't take an actuary to figure out that thousands of biglaw associates all looking to lateral to gov work or midlaw after their time is up in 3-5 years means a glut of 30ish year old ex biglaw associates. Then pi work doesn't pay anything because it doesn't generate any money, and many law schools are even having to temporarily fund pi positions for its grads there is such a glut there. And then the other 80% of lawyers who don't get/want biglaw or pi do ####law, which is actually the hustling type of law I would prefer but sounds like hell for many.......basically, a field to stay away from
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Well sure, as that's exactly what they are when they are based on laws and courts.
My wife is doing child advocacy, and the two friends are doing public defending, all by their own choice. Their combined salary (all 3) is substantially lower than my academic psychiatry salary. I buy the whiskey rounds, usually.
yes but the choices for them weren't nearly as good as your choices. Even assuming all of them could have worked for biglaw out of the gate, that's a pretty crappy choice for a new lawyer in today's legal world.....get abused for 3-5 years in a job that pays pretty well but you likely hate and then get spit out and forced to compete with the other 5000 biglaw associates who are spit out at that stage for govt and other public jobs. no thanks.
otoh, i bet if those 3 had the option out of law school to take a job that pays what yours probably does(150-200k) and has good job security/a future and has a good work environment, they would have jumped on it regardless of whether it was PI or PD type work or not....they would be crazy not to. But those jobs(or anything close to them) just don't exist in law for young lawyers.
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My wife graduated cum laude from a top 10 law school. She could pretty much do whatever she wanted in the particular market we live in. She worked at the child advocacy organization before, did tons of child advocacy clinics in law school (in a different city), and had even submitted fellowship applications to fund particular probjects at this organization before she was even hired. We're a bunch of G-d- hippies, V. Haven't you picked up on that yet?!
I think we've officially de-railed this thread completely.
Yes, and my point was that ALL the choices for NEW law grads now are unappealing. So picking paid public interest work(which is extremely competitive to get paid legal positions for) isn't on its own some huge sacrifice. Yes, biglaw junior associates right out of law school start at 160k in the biggest 3-4markets(somewhat less in secondary markets), but this is a dead end career trajectory today with terrible prospects after 4 or so years. These people have a better chance of winning powerball than making partner. And the work is dreadful...two cousins both work for king and Spaulding in atlanta(though not related).....if they could lateral into a nice govt position paying 85-90k right now they would jump at it.
I guess what I'm trying to say is I wouldn't want to be a law student right now.....even one at HYS in the top fifth after 1st year because the career options out right now for new grads really are that bleak.
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The AMA does hold that prisons should strive to give care in a prison as good as that in the community. Heck the AMA says a lot of things about the way it should be. It doesn't mean it's a right in a legal sense.
This also doesn't mean a prisoner cannot get hormonal treatment under any circumstances. If he/she got the right doctor that gave a damn, that doctor could figure out a method to get the prisoner the treatment . They could complain through the prison system hoping someone would listen, etc. But do they have a right? No.
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No thanks, LOL!
Probably the first time that I agree with Vistaril. I did locums work in a prison about five years ago. It boils down to simple economics - the rationing of scarce resources. Money first goes to life saving treatments; all else takes a back seat. I did see a patient once who had been on hormonal treatment prior to incarceration, and was subsequently taken off of the medication while in prison. In my opinion, the medical director made the correct decision and I saw no protest from any of the other medical staff, psychiatrists and psychologists included. The core essential argument, in a prison population, is that hormone replacement is an elective treatment. If they approved it in prison, then one could make the argument that patients with low T should receive supplementation - this would create an even more serious problem.
Should a prisoner be told to shut his trap or suffer the consequences? Of course not, and you would be hard pressed to find a corrections officer that would talk that way outside the walls of a prison. Inside however, it happens - A corrections officer that is perceived as being weak, stands the risk of having a shank lodged in his neck even by a petite transgendered prisoner.
Should a prisoner be told to shut his trap or suffer the consequences? Of course not, and you would be hard pressed to find a corrections officer that would talk that way outside the walls of a prison. Inside however, it happens - A corrections officer that is perceived as being weak, stands the risk of having a shank lodged in his neck even by a petite transgendered prisoner.
