The New York Times editorial board on Wednesday called the Army's stated refusal to provide Chelsea Manning hormone therapy while she is incarcerated "callous and out of step with medical protocol, stated policies for transgender people in civilian federal prisons and existing court rulings."
In addition to the Army's official statement on the matter, a spokesperson at the military prison where Manning will be incarcerated was uncertain whether she would be permitted to begin hormone therapy while incarcerated, even if she is able to finance the treatment herself.
Both the Army's position and the lack of clarity about available medical care at Fort Leavenworth violate Manning's constitutional right to appropriate medical care, as the Times notes.
But Manning's access to care also illuminates the larger issue of the rights of transgender people in prison when it comes to medical care, housing and personal safety:
Several federal courts of appeal have said that a state’s deliberate failure to provide individualized assessments of whether a transgender prisoner needs access to specialized medical treatment, like hormone therapy or surgery, violates the Eighth Amendment’s prohibition against cruel and unusual punishment. As part of a lawsuit settlement in 2011, the federal Bureau of Prisons began making medically necessary hormone therapy available to all transgender inmates, including those who had not received a diagnosis and begun the therapy before incarceration. Although transgender people continue to be barred from service in the military, the Department of Veterans Affairs offers a range of services for transgender veterans, including hormone therapy.
Of course, the Manning case presents other issues as well, starting with whether the all-male prison at Fort Leavenworth is the right institution for Private Manning. Transgender inmates are especially vulnerable to sexual assaults, and special care must be taken to ensure their safety with accommodations like private showering. The nature of Private Manning’s offense could make for added safety worries. Prodded by lawsuits and strong Justice Department regulations issued last year to implement the Prison Rape Elimination Act of 2003, civilian jails and prisons around the country are developing ways to address the particular needs of transgender inmates.
Private Manning’s lawyer, David Coombs, said last week that he hoped military prison officials would voluntarily provide hormone treatment, without a lawsuit. It should not take a court order to get officials — including Defense Secretary Chuck Hagel — to do the right thing. They should give Private Manning appropriate medical care and safe but not unduly isolated housing, which should be available for all transgender prisoners.