Idaho and Indiana Challenge Federal Ruling on Prison Sex Reassignment Surgery

Idaho and Indiana have filed an amicus brief challenging a federal ruling that requires Alaska to provide sex reassignment surgery for prison inmates, in a case that could have far-reaching implications for correctional facilities nationwide.

Alaska is appealing to the Ninth Circuit Court to overturn a ruling that found denying sex reassignment surgery to a transgender inmate violated the Eighth Amendment’s protection against cruel and unusual punishment. The case has drawn significant attention, with 24 states now warning that if upheld, the decision could force prison systems across the country to provide transgender medical procedures.

“A federal court ordered Alaska to refer a prisoner for sex-change surgery consultation, which threatens to set a precedent that forces other states to provide these procedures using taxpayer dollars,” said Idaho Attorney General Raúl Labrador. “The Eighth Amendment ensures basic medical care for prisoners, but it doesn’t require states to provide experimental gender transition surgeries.”

The case centers around prisoner Emalee Wagoner, who was diagnosed with gender dysphoria and is currently serving a 40-year sentence for sexual abuse of minors. Magistrate Judge Matthew Scoble had ruled that Alaska acted with “deliberate indifference” when Wagoner was denied the requested surgery.

In their 32-page brief, Idaho and Indiana officials rejected the judge’s Eighth Amendment argument, asserting that sex reassignment surgery is not a “minimal civilized measure of life’s necessities” because the procedure “is not available to free citizens in half of the Nation.”

Indiana Attorney General Todd Rokita emphasized this position, stating, “The Eighth Amendment stops cruel and unusual punishment. It doesn’t give prisoners the right to demand risky, optional surgeries when doctors and scientists still strongly disagree about whether they’re safe or even helpful.”

The brief also raised concerns about the financial implications of the ruling. “If courts force states to provide these expensive, controversial procedures in one prison, it will open the floodgates everywhere—putting Hoosier taxpayers and families across the country on the hook for hundreds of thousands of dollars per surgery in virtually every state,” Rokita added.

The state officials pointed to what they describe as a lack of scientific consensus on the effectiveness of reassignment surgery for treating gender dysphoria. They cited a 2016 Centers for Medicare and Medicaid Services review which concluded that selected studies “did not demonstrate clinically significant changes or differences in psychometric test results after” surgery.

The amicus brief also expressed skepticism toward the World Professional Association for Transgender Health (WPATH), claiming the organization “has changed its medical guidance to accommodate external political pressure.”

“Despite WPATH’s insistence on surgeries, nothing in the Eighth Amendment’s text or history allows prisoners to demand whatever medical interventions they desire,” the brief stated. “Nor does anything in its text or history require States to provide risky, controversial medical procedures of uncertain benefit to prisoners.”

Following Judge Scoble’s ruling last October, Wagoner’s attorney Richard Saenz had praised the decision, telling the Alaska Beacon that his client “should not have to continue to wait for the care that the court and her treating doctor and experts have said is medically necessary for her to receive.”

Saenz noted that while the ruling would likely affect a relatively small number of transgender people, it would be significant for them. “Gender dysphoria, which is a medical condition that the department itself recognizes needs treatment, should not be treated in an exceptional way. It should be treated like other medical conditions,” he said.

The case highlights the ongoing tension between state authorities concerned about precedent and costs, and advocates who argue that denying appropriate medical care to transgender inmates constitutes cruel and unusual punishment. The Ninth Circuit’s eventual ruling could reshape prison healthcare policies across the United States, especially regarding treatment for transgender inmates.