A transgender inmate who goes by the name Cristina Iglesias has not spent a day outside of federal prison as an adult. Iglesias was locked up in 1994 for sending death threats to federal judges and then pleaded guilty in 2005 to mailing fake anthrax to U.S. allies in the earliest days of the War on Terror. Now, thanks to a judge's ruling, Iglesias is set to become the first transgender inmate to undergo sex-reassignment surgery—on the taxpayer dime.
Iglesias in 2020 became the poster child of the American Civil Liberties Union's quest to ensure even the most hardened criminals enjoy transgender rights, and the civil rights group that once focused its energies on free speech sued the government, arguing that denying the costly surgery is a violation of Iglesias's constitutional rights. U.S. District Judge Nancy J. Rosenstengel agreed, writing in an opinion issued last month that "Iglesias suffers daily and is at risk of self-mutilation and suicide."
Iglesias, 47, is set for release on Christmas Day, but wants the surgery before that time—and Rosentengel is ordering the Bureau of Prisons to find a surgeon to carry out the sex change. Cost estimates for the surgery itself vary widely. Some hospital estimates reach six figures, while the Philadelphia Center for Transgender Surgery pegs the figure at about $25,000. Pricey quality-of-life care is required for years after the surgery, running about $40,000 annually in the first five years, according to a 2015 study from the Johns Hopkins Bloomberg School of Public Health. The cost falls to $10,000 per year after a decade. The Bureau of Prisons declined to say whether taxpayers will provide that support.
New Biden administration policy requires prison officials to use a transgender inmate's preferred name and pronouns and consider housing transgender inmates in prisons matching their "lived gender." Federal policy doesn't require surgery in every case, but left-wing groups like the ACLU are now using cases like Iglesias's to make sure it is widely available for inmates. There are about 1,300 transgender inmates in federal jails, according to a Bureau of Prison spokeswoman.
Iglesias, who according to prison records is white but has used Hispanic names since 2004, is nearing the end of a 20-year bid for mailing white powder—from prison—to the British Commonwealth and Foreign Office in 2002, which prompted evacuations and street closures around London.
"I hope to see to it you people die a slow and painful death!!!" Iglesias wrote in a letter containing faux-anthrax. "This anthrax is very lethal and deadly!!!!"
Iglesias's defense lawyers attributed those crimes to a long and clinically documented history of mental illness, which includes a pattern of compulsive and self-destructive behavior that is difficult to control.
"The subject's history and the results of this evaluation suggest that his behavior is influenced by the existence of severe psychological deficits that are of long-standing duration," Dr. Jethro Toomer wrote in the 2005 assessment. Defense filings from that case indicate Iglesias has from a young age been diagnosed or treated for bipolar disorder, schizophrenia, borderline personality disorder, and alcohol addiction.
The Federal Bureau of Prisons in 2015 allowed Iglesias to begin hormone therapy. Iglesias went on to request facial laser hair removal, a transfer to a female facility, and "gender confirmation surgery."
Iglesias in 2019 sued the Bureau of Prisons without counsel. A year and a half later, the ACLU showed up on the scene, took over the case, and filed a new complaint on Iglesias's behalf. The Chicago legal powerhouse Winston & Strawn LLP also lent firepower to the cause. They argued, among other things, that the bureau's "deliberate indifference" to Iglesias's medical needs violates the Eighth Amendment, which bans cruel and unusual punishments.
"To Ms. Iglesias, her genitalia feel like an abnormal and life-threatening growth on her body, like a malignant tumor from cancer that needs to be removed," the lawsuit reads.
The Bureau of Prisons emphasized in court filings that it has never opposed those steps. It was willing, for example, to transfer Iglesias to a female prison provided that Iglesias sustained hormone levels that would make it impossible to maintain an erection—a condition essential for the safety of female inmates, according to prison authorities. And while the bureau has never categorically denied Iglesias's requests for sex-reassignment surgery, the bureau maintained Iglesias should spend 12 months living as a woman in a female prison before undergoing the procedure.
Rosenstengel said the Bureau of Prisons violated Iglesias's constitutional rights. Rosenstengel accused the bureau of manufacturing its prison rape rationale in response to the ACLU lawsuit. And she faulted authorities for holding Iglesias to "categorical" pre-surgery requirements, rather than individualizing medical decisions with input from LGBT medical experts.
The judge added urgency to her decision, writing that Iglesias requires the surgery but is "running out of time," apparently referencing a government-funded sex change.
The ACLU says that Iglesias will be the first federal inmate to undergo a sex-reassignment procedure and on June 2 celebrated its victory as a legal landmark.
It's not clear when the procedure will happen. Iglesias over the course of the case posed other problems for the bureau. Iglesias in 2021 leveled "unsubstantiated" allegations of violence and forced prostitution against another inmate, according to an affidavit from a corrections captain. And Iglesias had to be transferred to a different prison after authorities discovered Iglesias incurred "substantial debts to multiple inmates" to buy drugs. Court records are sparse on details about treatment the inmate needs ahead of release at the end of this year.
The Bureau of Prisons said it would not comment on matters subject to ongoing legal proceedings. The ACLU did not respond to a request for comment.