Last Tuesday court-appointed receiver who has managed health care for California prisons under federal court order since the Scwarzenegger administration announced new guidelines which authorize surgical procedures for transgender inmates suffering from severe gender dysphoria who desire surgery.

The guidelines call for panels of state health professionals to review appeals for sex-reassignment surgery from inmates whose doctors say their patients are under significant distress because of a mental condition known as gender dysphoria. The inmate must have been taking hormones for at least a year and have consistently expressed a desire to change his or her biological gender before an operation can be approved.

Prison officials have estimated the cost of the state-funded operations as high as $100,000. But the Transgender Law Center in San Francisco, which has represented two inmates in suits against the state, says each operation would cost $15,000 to $30,000.

California's Department of Corrections and Rehabilitation says it has about 385 transgender inmates, most of them male-to-female, who are currently undergoing hormone therapy.

The new policy follows in the wake of the August settlement of a law suit by Shiloh Quine "for the first sex-reassignment surgery in any state prison system that was based on medical diagnoses."

Quine, 56 is serving a life sentence for murder. She was born male but has identified as female for most of her life, and has attempted suicide multiple times, according to a medical expert appointed by the state. She has been on hormone therapy since 2009. The state’s expert agreed with a mental health professional hired by the inmate’s lawyers that Quine needed surgery — a first for the prison system, which has opposed all previous surgery requests.

The settlement allows her to transfer to a women's prison after surgery.

The settlement also required the state to “review and revise its policies” for transgender inmates. The revisions allow transgender inmates to have access to clothing that reflects their identified gender and items like makeup as well as medical care.

The original case involved Michelle-Lael Norsworthy, ":whose doctors had recommended sex-reassignment surgery that was denied by prison officials, who said she was doing fine with hormones." US District Judge Jon Tigar determined that the department had chosen medical experts opposed to sex reassignment surgery and ordered the surgery for Norsworthy. That surgery was suspended when Norsworthy was unexpectedly released by the state parole board.

[T]he Transgender Law Center said Norsworthy, now living in a halfway house in San Francisco, is also eligible to have the surgery through Medi-Cal.

On Thursday Family Research Council president Tony Perkins criticized the new policy because it's his job to do so and he loves his job.

ON his Washington Watch radio show, Perkins described the policy as "rewarding people who don't just break the state's laws but nature's too."

He then stepped into mental free-fall:

I can assure you that [the number of incarcerated transgender people is] about to be more, once they know that they can get free surgery.

With a price tag of anywhere from $50,000 to $100,000 for these reassignment surgeries, I think there's no shortage of people that may want to sign up [to go to prison].

California, I don’t see how people live there.

--Perkins

Which explains the recent crime sprees by men in need of triple bypass surgery and women with metastacized breast cancer, I guess.

California has set a model for the country. This is care that, for too long, people have been denied simply because of who they are. It’s especially important because transgender people are incarcerated at six times the rate of the general population.

--Kris Hiyashi, Transgender Law Center

They’re pretty conservative criteria — the inmate doesn’t just request surgery and then get it.

--Joyce Hayhoe, California Correctional Health Care Services