Adree Edmo jail portrait

Adree Edmo

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When Idahoan Adree Edmo, 32, last month became the second transgender prison inmate in American history to receive gender confirmation surgery while incarcerated, the procedure cost roughly $75,000.

It’s likely it didn’t cost taxpayers anything extra — the Idaho Department of Correction contracts with prison health care company Corizon Health to provide services, such as surgeries, to those in Idaho prisons.

Meanwhile, even though Edmo received the surgery she took the state to court to receive, the case hasn't been resolved yet. It has risen to the U.S. Supreme Court, but justices there haven’t yet decided if they will hear it — although they didn’t move to block Edmo from receiving the surgery.

“The Idaho Department of Correction has an agreement with Corizon to provide health care to incarcerated persons in the department’s facilities,” according to an IDOC statement. “Corizon estimates the cost of the surgery was approximately $75,000. That cost does not include additional costs to the Department such as transportation.”

As of Wednesday, the state had spent $433,531.62 on “legal fees and associated costs,” according to Keith Reynolds, director of the Idaho Department of Administration.

The case has its origins in 2017. Edmo, who was diagnosed with gender dysphoria in 2012 while in prison, sued the state and Corizon Health after prison doctors did not prescribe gender confirmation surgery for her. Not all transgender people need or want gender confirmation surgery, but for some transgender people who have gender dysphoria — a condition in which there is a very painful separation between their birth gender and the gender with which they identify — gender confirmation surgery can be a treatment. Everyone involved in the case agreed Edmo had serious gender dysphoria — she’d tried to castrate herself twice while in prison — the question was whether the surgery was needed. Attorneys argued the state had violated Edmo's Eighth Amendment protection against cruel and unusual punishment by not providing her the treatment.

In December 2018, the U.S. District Court for the District of Idaho ruled Edmo must receive the surgery, and the 9th Circuit Court of Appeals agreed less than a year later, in the fall of 2019. The state appealed the case to the U.S. Supreme Court earlier this year, but the court declined to block Edmo from receiving the surgery, which took place, as ordered by the lower court, in July.

“We don’t think the (U.S. Supreme Court) will take the case or should take the case,” Lori Rifkin, one of Edmo’s attorneys, said in a phone interview earlier this week.

Rifkin said she felt the state should drop the case, since Edmo has had the surgery, especially in light of the fact that Idaho is facing an ongoing public health crisis in the new coronavirus. 

“This is something Idaho’s governor is continuing to prioritize even while there are people throughout Idaho in desperate need of resources right now, and I think that’s a shame,” Rifkin said.

Marissa Morrison, spokeswoman for Gov. Brad Little, wrote to the Idaho Press that, “the Governor’s Office is weighing available options in regard to the case.”

The U.S. Supreme Court hasn’t heard the case yet, Rifkin pointed out, so the highest court in the country hasn’t yet created precedent on the question of whether state prison systems must provide gender confirmation surgery as a treatment for gender dysphoria if needed. But if the U.S. Supreme Court doesn’t take the case, she said, the decisions made by the district court and the 9th Circuit Court of Appeals would still stand.

“And the precedent that this case would stand for is that prison administrators can’t treat medical conditions related to gender dysphoria or transgender people any differently than they treat any other medical condition under the Eighth Amendment,” she said. “…They don’t get to pick and choose which medical conditions to treat.”

It’s important to remember, she said, that the case doesn’t mean every transgender inmate in the Idaho prison system will now receive gender confirmation surgery.

“The standard of care is clear in that not every person with gender dysphoria requires surgery or wants surgery,” she said. “It’s based on the severity of someone’s condition and what they need just like any other serious medical condition.”

IDOC spokesman Jeff Ray confirmed Edmo had been transferred to Pocatello Women's Correctional Center on July 31.

Rifkin also shared a statement from Edmo.

“It’s just a great relief,” Rifkin read. “So much pressure and inner turmoil is gone. I feel whole and connected. The surgery itself was literally life-changing, and I feel whole and connected in myself."

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