US Bureau of Prisons recommends inmate receive historic gender-affirming surgery

The U.S. Bureau of Prisons could still approve a Texas inmate’s request to become the first to undergo a gender-affirming surgery while in federal custody, according to documents obtained by The Hill.

The Bureau’s Transgender Executive Council (TEC) recommended 47-year-old Cristina Iglesias receive the sex reassignment surgery, according to documents submitted on Monday in the U.S. District Court for the Southern District of Illinois. The Department of Justice and U.S. attorneys further wrote that if certain conditions are met, including good behavior, it would refer Iglesias to a surgeon one month after the inmate transitions to another facility in March.

“Thus, assuming she does not engage in behavior that would prevent her from continued placement in a female facility and assuming further that no other reasons develop that would make gender confirmation surgery inappropriate, the TEC does expect plaintiff to be referred to a surgeon at the appropriate time,” the documents read.

The move comes as a surprise given that last week, the TEC failed to meet a court deadline requiring notice of approval, leading Iglesias and her legal team to assume it was denying the surgery.

But the recommendation does come with conditions. The Bureau will only approve the surgery after Iglesias transitions to a halfway house in Florida in the spring. Court documents also argue Iglesias should continue to be monitored before approval, citing that the inmate has “demonstrated significant difficulty adjusting to living with women in a correctional setting.”

Edwin Yohnka, the director of communications and public policy at the American Civil Liberties Union (ACLU) of Illinois, which is representing Iglesias, said the team will be meeting with their client in the coming days to discuss the TEC’s conditions.

“I think it’s important that they recognized the need for Cristina to have surgery,” he said. “But continued, additional delay, I think, raises concerns.”

Iglesias was assigned male at birth and has been held in prison since 1994 on terrorism charges. In May, Iglesias was transferred to the Federal Medical Center Carswell in Fort Worth, Texas, a women’s facility, as one of the first federal inmates to be reassigned to another facility based on gender identity.

Iglesias has been suing the Bureau of Prisons since 2016, arguing the surgery is as pertinent as any other medical procedure a federal prisoner would receive while in custody. 

Yohnka said although Iglesias’s sentence concludes at the end of the year, it was important she receive the surgery while in federal custody.

“The idea that the clock would run out just doesn’t seem satisfactory,” he said. “We wouldn’t do that with any other health care, we wouldn’t say ‘Don’t get X procedure,’ even though it was necessary and needed, simply because you are going to be out in a year.”