The 9th Circuit Court of Appeals upheld U.S. District Judge B. Lynn Winmill's ruling that the state of Idaho had to provide Adree Edmo’s confirmation surgery. The panel of judges maintained that Winmill’s findings were "logical and well-supported," adding that "responsible prison officials were deliberately indifferent to Edmo's gender dysphoria, in violation of the Eighth Amendment."
Edmo was sentenced to a 10-year mandatory term with no possibility of parole for sexually abusing a 15-year-old boy. She was 22 at the time. According to the Idaho Department of Correction policy, Edmo will be transferred to a state women's prison after the surgery.
Idaho has 90 days to appeal the ruling.
Governor Brad Little released a statement, writing: "We cannot divert critical public dollars away from the higher priorities of keeping the public safe and rehabilitating offenders. The hardworking taxpayers of Idaho should not be forced to pay for a convicted sex offender's gender reassignment surgery when it is contrary to the medical opinions of the treating physician and multiple mental health professionals."
In the 85-page opinion provided by the 9th Circuit, the judges wrote: "It is enough that [her doctor] knew of and disregarded an excessive risk to Edmo's health by rejecting her request for [gender confirmation surgery] and then never re-evaluating his decision despite ongoing harm to Edmo.”
Referring to the decision by two other physicians to continue with Edmo’s original treatment plan, the judges wrote: "general agreement in a medically unacceptable form of treatment does not somehow make it reasonable."
Lori Rifkin, Edmo's lead attorney, stated that the appeal was "unfortunate" and "reprehensible."
"She suffers every single day while they have denied this treatment to her for years and there can be no reason justifying Idaho's continued refusal to provide her care except bias," she said.
Edmo suffers from a severe form of gender dysphoria, and has twice attempted to self-castrate while in prison.
"[P]rison authorities have not provided that treatment despite full knowledge of Edmo's ongoing and extreme suffering and medical needs," the judges wrote.
Winmill’s ruling was made in December 2018, but the appeal halted any arrangements for Edmo’s surgery. The 9th Circuit ruling means that the state and its contracted prison health care provider, Corizon, have to start making the necessary arrangements. The procedure can cost between $20,000 and $30,000.
The ruling doesn’t mean that all prisoners suffering from gender dysphoria will be allowed to have the surgical procedure. It does, however, set a standard for providing the procedure for certain inmates who suffer from severe gender dysphoria, and for whom surgery is determined to be a medical necessity.