First State-Funded Transgender Surgery for California Inmate

First State-Funded Transgender Surgery for California Inmate

On January 6th, 2017, California became the first state to fund gender reassignment surgery due to an inmate’s gender dysphoria, an “incongruence between one’s experienced/expressed gender and assigned at birth”.1

Shiloh Quine has identified as a woman since 2008 and has been treated with both hormones and psychotherapy since 2009. At this point she is considered “hormonally reassigned” in that her circulating hormones are at the level of an adult female. Despite these treatments, Miss Quine is still exhibiting signs of severe psychological distress.1

She has unsuccessfully attempted to change her name, unsuccessfully advocated for the usage of “female” accessories such as razors and panties, and has known herself for 8 years as a woman living in a prison inhabited by men.2  Quine has attempted suicide and castration on separate occasions.1 In court document, one of Quine’s several Doctors testified,

“Having a female appearance and male genitalia is the source of profound distress. Her inability to reduce or modulate this internal anguish is likely to result in emotional decompensation and may result in further self-harm”1

Quine has reported increasing harassment by staff and inmates who, among numerous abuses, call her “dude” and pretend to vomit in her presence every day. When a person undergoes such stigmatized humiliation and hatred, along with the unrelenting pain of gender dysphoria, serious physical and mental consequences may occur.1

It appears that the threat of potential self-harm was enough for the state of California to settle the case and agree to pay for surgical treatment. This cost was estimated by her lawyers to be between $15,000 and 25,0003, but estimated by the California Correctional Health Department to be upwards of $100,000.4

Miss Quine was sentenced to life in prison without parole for and drug and alcohol induced first-degree murder. The victim’s daughter attempted to block the court ruling saying, “My dad begged for his life. It just made me dizzy and sick. I’m helping pay for his surgery; I live in California, it is kind of a slap in the face”.3 The victim’s family is not the only Californian distressed by this settlement. Kenneth Hannagan, an openly gay Californian who supports sex changes, finds himself in a conundrum that many Californians (even liberal ones) are finding themselves in. Hannagan writes in The Modesto Bee: Letter to the Editor,  “Prisoners deserve to be fed and clothed and kept warm, but I think we are going too far when the prisoners are given opportunities non-prisoners have a difficult time getting”.5

Both the 8th amendment, banning cruel and unusual punishment, and the Equal Protection Clause are generally invoked during legal proceedings regarding treatment of transsexuals in prison2. Transgender inmates face unique challenges. Most report they are not placed according to their self-identifying gender, which incites harassment and violence.6 An astonishing report from the Federal Bureau of Justice Statistics states, “more than 3,200 transgender people were incarcerated in 2011-12 and that 39.9% of them had reported sexual abuse that year”.7

Transgender Law Center Director Kris Hayashi told reports of the historic significance of this settlement, "For too long, institutions have ignored doctors and casually dismissed medically necessary and life-saving care for transgender people just because of who we are – with devastating consequences for our community".3

This case was settlement and was not a court ruling and therefore evades the question of precedent. The question remains- does the withholding reassignment surgeries qualify under the 8th amendment as, “cruel and unusual punishment”? For now, this settlement sets an esoteric precedent, but it is not a constitutional ruling and so there is nothing that legally binds the next judge to rule one way or another.

There are two significant provisions in this settlement. First, the California Department of Corrections must now allow inmates to have clothes and toiletries in accordance with their stated gender.2

Second, Quine will be placed in a women’s prison after the surgery is completed.


  1. United States. District Court. San Francisco Divison.Shiloh Quine v Beard Settlement. By Randi D. Ettner. San Francisco, CA, 2017. 8-30.

  2. "Quine v. Beard." Transgender Law Center. January 4, 2017. Accessed January 11, 2017.

  3. St. John, Paige. "In a first, California agrees to pay for transgender inmate's sex reassignment."Los Angeles Times, August 15, 2015. Accessed January 10, 2017.

  4. Guerra, Kristine. " A convicted killer became the first U.S. inmate to get state-funded gender-reassignment surgery."The Washington Post, January 10, 2017. Accessed January 10, 2017.

  5. Hanigan, Kenneth. "State went too far in giving sex-change operation to prisoner."The Modesto Bee, January 9, 2017. Accessed January 11, 2017.

  6. "Jails and Prisons." Lambda Legal. 2016.

  7. United States. US Department of Justice. Office of Justice Programs Bureau of Justice Statistics. By Allen J. Beck. December 2014. Accessed January 10, 2017.

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