A Look at Health Care Behind Bars

Guest blog by Sandy Getzky, associate editor at ProveMyMeds, a public health and education startup focused on producing helpful resources concerning the treatment of common ailments. 

The court trial involving Bradley Manning has captured the nation’s interest for a number of reasons. The former US soldier was convicted of passing classified information to the notorious WikiLeaks organization and sentenced to 35 years in prison, but the controversy around Manning goes beyond that. Manning identifies as female and has been diagnosed with gender dysphoria. She is asking to be referred to as Chelsea Manning and treated with hormone therapy while in prison. This has sparked a heated debate about the types of healthcare prisoners are entitled to.

 In Manning’s case, there is a lot of confusion over the exact nature of gender dysphoria, so many people believe that hormone therapy isn’t necessary and shouldn’t be done using taxpayer money. Psychologists disagree and have stated that this type of condition causes severe distress on a regular basis because the person who suffers from it feels as though they’re in the wrong type of body, biologically speaking. The military prison that Manning has been sent to has refused to provide hormone therapy, which could lead to a lawsuit.

 Although this case involves a military prison, it has led to discussions about access to hormone therapy and gender reassignment surgery in state prisons as well. Access to these kinds of treatments is very limited in state prisons, which has resulted in lawsuits being filed by or on behalf of transgender inmates. The Federal Bureau of Prisons did start allowing hormone therapy after reaching a settlement in 2011.

In broader terms, healthcare for prisoners is constitutionally required in order to prevent cruel and unusual punishment. This means that prisons are obligated to treat conditions like cancer, heart problems and mental disorders, while minor health issues, like stretch marks or toenail fungus, aren’t covered. This has raised the question of where gender dysphoria falls on this spectrum. It’s certainly not a minor issue, but how serious is it or how necessary is treatment? While inmates who have this disorder aren’t likely to be physically affected by it in the same way that an inmate with untreated diabetes would, mental health experts warn that the emotional and psychological distress it causes could fall under the “cruel and unusual” category.

 If Manning isn’t able to undergo hormone therapy while in prison, she’ll have to wait a minimum of eight years, which is when she’ll first be eligible for parole. Groups, such as the ACLU and the Human Rights Campaign, have filed statements in support of providing Manning with access to hormone therapy. If a lawsuit is filed on Manning’s behalf, it has the potential to change the way transgender individuals are treated in prison and possibly even lead to a better understanding of gender dysphoria.

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