North Carolina Prison Has Ignored Woman’s Pleas for Gender-Affirming Surgery

It’s been nearly 10 years since Kanautica Zayre-Brown started taking estrogen. Her birth certificate and ID say “female.” She legally changed her name.

Her transition would be complete if she allowed it. Zayre Brownn, a North Carolina prisoner, is fighting for what experts consider a basic medical need for transgender people. This is gender-affirming healthcare. Her case highlights the tension between LGBTQ+ advocates, and the Biden administration, as trans people behind bars are denied medically necessary care.

Zayre-Brown has a diagnosis of gender dysphoria, when a person’s gender does not align with their sex assigned at birth. Two years ago — with orders from a doctor — she began petitioning Anson Correctional Institution to provide her surgery that would help complete her transition. Jaclyn Maffittore, an ACLU attorney, asserts that Anson has a legal duty to provide it.

“What the law requires is an individualized determination for each individual person for the medical care that they need,” Maffetore said. “The step that she’s seeking to take now is a step that has been in her plan of care for her gender dysphoria before she was incarcerated. And ways to treat her gender dysphoria [like hormone replacement therapy and affirming clothing] have just not been effective.”

“I just felt like they just didn’t care because they couldn’t understand me,” Zayre-Brown said. “When I take my clothes off, I don’t feel like the woman that I am.”

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Maffetore said she can’t get a clear answer from the state on why her client does not meet the criteria for gender-affirming surgery. She also said that her client had been misgendered in prison.

“She is a woman. She has been living as a woman for the majority of her life,” Maffetore said. “That obviously seems like a failure on the part of [the state Department of Public Safety] to ensure that their staff is adequately trained and following their policies.”

Maffetore claims that DPS has been slow in providing explanations for the delay. He blames procedural delays as well as the pandemic. Maffetore now says that the ACLU is ready to file suit.

“Kanautica is in mental anguish, dealing with her gender dysphoria that has not been released through any other means and feeling like DPS has forgotten about her,” she said.

John Bull, North Carolina DPS spokesperson provided the following: The 19thA copy with the department’s policyTransgender people must be cared for by a committee of prison administration and health officials.

He added that health privacy laws prevent the state from commenting on Zayre-Brown’s specific case.

It also requires staff members to use affirming names for transgender staff and pronouns. This is something many staff members have neglected, Zayre Brown claims. Although her name is legally changed, her “deadname,” a term trans people use to refer to a former name, still appears in searches on the state’s database of incarcerated people.

In recent years, intense scrutiny has been placed on the treatment of transgender prisoners in federal and state prisons. The candidate seeking the LGBTQ+ vote was Joe Biden promised that if elected president,He would support transgender prisoners behind bars by enhancing protections.

One of those promises was the implementation of the Prison Rape Elimination Act. This law, passed unanimously in Congress in 2003, was implemented in 2012. It required that prisons house transgender persons on a case by case basis, with a strong emphasis on where they would be most safe. An NBC News investigation in 2020 foundJust 15 transgender prisoners were housed according to their gender identity in just over 5,000 transgender prison cases.

On his campaign website, Biden also pledged to “ensure all transgender inmates in federal correctional facilities have access to appropriate doctors and medical care — including OBGYNs and hormone therapy.”

The Department of Justice enforces PREA in state prisons. It did not comment on the progress made by the administration in implementing policies toward these goals. In an email to The 19thThe department also mentioned its investigation into Georgia’s trans people.

The DOJ launched its April campaign filed a statement of interest in the case of Ashley DiamondA transgender female was held in Georgia, and she claimed that the state did not provide her with gender-affirming health care. This statement claims that it was cruel and unusual punishment, and that the Constitution obligates the U.S. government to protect against it.

“By taking action in this case, the Justice Department is reminding departments of corrections that prison officials have the obligation to assess and treat gender dysphoria just as they would any other medical or mental health condition,” said Associate Attorney General Vanita Gupta in a statement at the time.

LGBTQ+ advocates celebrated the Justice Department’s filing in the Georgia case as potentially landmark for the future of trans rights. The case is still pending.

Two years ago, U.S. 9th Circuit Court of Appeals ruled that Idaho must provide gender-affirming care. Circuit Court of Appeals ruled Idaho must provide gender-affirming health care. to Adree EdmoThe victim, who was serving a 10-year sentence for a sexual crime, was denied surgery multiple times.

Gov. Brad Little wrote in a statement at the time that “hardworking taxpayers of Idaho should not be forced to pay for a convicted sex offender’s gender reassignment surgeries.” Emdo’s attorneys countered that her right to care had nothing to do with her crime.

Trump’s administration didn’t enforce PREA’s section governing the placement transgender people in prison. Although PREA doesn’t directly mandate surgery access, they often go hand-in-hand. According to Project for Incarcerated Transgender Survivors at American University, many prisons won’t transfer transgender people who have not had surgery. Conversely, those who petition for surgery from men’s prisons are almost always denied, court records show.

A spokesperson for Justice Department stated that states must comply with PREA rules. Transgender people will be placed on a case-by–case basis and must certify they are in compliance. Otherwise, they could lose 5 percent of their funding.

LGBTQ+ advocates have been eager to see if the Biden administration might enforce health care protections for trans people behind bars in state and federal prisons and​​ revise changesmade to the federal Bureau of Prisons Manual of Trump’s Trump administration that removed transgender PREA Protections.

People like Zayre Brown are waiting in the interim. She doesn’t know how much longer she can hold out, she said. Her last emergency grievance in which she threatened self-mutilation was denied. She also offered to pay her own surgery and receive home monitoring.

“I really, really, really understand now how trans individuals, trans sisters, and brothers have passed away,” she said. “I totally understand how they feel from not having access to adequate care. It was something I never imagined I would be able to comprehend. I understand it now.”