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Friday, 3 June 2011

In the US, hormone therapy for transgender immigration detainees?

Monica Freas
Source: Orange County Register

By Cindy Carcamo

In the depths of depression, battling hot flashes and desperate about her situation, Monica Freas tried to throw herself from the second floor of the Santa Ana Jail before friends restrained her.

After two decades of taking hormone replacement therapy, the 35-year-old no longer had access to the drugs that made her feel comfortable in her own skin. She begged and pleaded with jailers for months to give her the medication that made her "feel normal" but they refused.
"I just can't even look at myself in the mirror anymore," Freas said in a recent interview while in detention on suspicion of being in the country illegally. She rubbed her face and pointed to the stubble on her cheeks. "For years I tried hard to get to that point and for it all to be taken away?"
Uriel Freas, who was born male in Mexico and is now known as Monica, is one of about 40 transgender immigration detainees at the Santa Ana Jail who have tried for months to get hormone replacement therapy.

She and others have shared their stories with the Heartland Alliance National Immigrant Justice Center, an advocacy group that has filed complaints with the Department of Homeland Security alleging that jailers nationwide have deprived detainees of "adequate health care" by denying them the therapy. Read about the complaints.

Immigrant rights groups, the American Medical Association and others in the medical community say hormone replacement therapy is not an elective or cosmetic treatment but necessary in cases of gender identity disorder. Those with the disorder feel a strong identification with the opposite sex, which causes intense emotional pain and suffering, according to the National Institutes of Health.

Others question whether taxpayers should fund the treatment for a certain population of immigration detainees. While immigration officials say they don't know the exact cost of providing hormone therapy to detainees, at least one physician puts the price tag at about $1,000 per person per year for treatment and monitoring.

It is unclear how many transgender detainees make up the estimated daily immigration detention population of more than 30,000 at nationwide facilities because Immigration and Customs Enforcement officials don't track such figures, said ICE spokeswoman Virginia Kice. Currently, the Santa Ana Jail houses about 40 transgender detainees as part of a contract with ICE.

Over the last few months, Santa Ana Jail has become the primary host for vulnerable and special needs ICE detainees - including transgender detainees - for the Los Angeles area, ICE officials said.

Mark Krikorian, executive director of the Center for Immigration Studies, an anti-illegal immigration think-tank, said taxpayers shouldn't have to pay for the treatment.
"It's one thing if you have a medication that is necessary for you to continue breathing," Krikorian said. "It's not what this is. As important as it may be for the people undergoing the process, it's not the government's responsibility to provide them with it."
Eric Berndt, an attorney with the Heartland Alliance, said the detainees have the right to the medication.
"The U.S. government has a fundamental responsibility to provide for the healthcare needs and dignity of anyone that they take off the streets and put in jail. If we're going to lock someone up, we need to provide for their basic needs," he said.
Freas said she's taken hormone replacement therapy since she was 15 because it transformed her into a woman – something she'd wanted since she was a youngster.

She bought the drugs from friends, on the black market and at a Mexican specialty shop in Pomona before she became incarcerated.

However, six months ago, Freas landed in immigration custody after police gave her a ticket for loitering – her seventh criminal conviction in 14 years, immigration officials said.

She was taken to Santa Ana Jail, where she said she was cut off from hormone therapy even after multiple requests. After that she spiraled into depression and attempted to kill herself in February, she said.

Immigration officials acknowledge that Freas climbed over a railing into a platform at the Santa Ana Jail but said there was no indication she was going to jump.

Freas told Santa Ana jailers she wasn't serious about committing suicide and instead wanted attention because she'd been disciplined earlier in the day for starting rumors about other detainees, according to immigration officials. She met with a counselor, had a psychiatric evaluation and was given depression medication as a precaution, officials said.

ICE officials said hormone therapy is provided to transgender detainees on a case-by-case basis when health care professionals have determined it to be medically necessary at detention facilities staffed by ICE Health Service Corps personnel.

However, Santa Ana Jail does not have this service. The decision to provide hormone therapy at the Santa Ana Jail is made by the facility's on-site health care provider.

Santa Ana Jail officials began to give hormone replacement therapy in March at the request of ICE officials, Santa Ana Police Cpl. Anthony Bertagna said in a written statement.

In an April interview, Freas said only one transgender detainee had received hormone treatment. She said she and others still had been denied, despite numerous requests.

Kice said they have no record of Freas requesting hormone therapy until late April. Freas is scheduled for a medical consultation to determine whether hormone therapy is medically necessary, Kice said.

ICE is working on a policy to ensure consistent treatment at all facilities that house ICE detainees, officials said. The policy would likely mirror the practice that is followed at facilities staffed by ICE Health Service Corps personnel.

Krikorian called the government's response to the hormone therapy issue a "parody."
"Hormone therapy for illegal aliens?'' he said. "It's almost like a parody that someone at Saturday Night Live would think of."
Experts say that denying hormone replacement therapy to someone with gender identity disorder can have medical implications ranging from depression to near death.

Hormone replacement therapy decreases the effects of testosterone and increases feminization, experts say. It is usually administered by injection in prison settings, said Dr. George R. Brown, a professor of psychiatry at East Tennessee State University who has testified across the country on behalf of transgender inmates who have sued state prison systems to get access to healthcare, including hormone therapy.

Abrupt discontinuation of the therapy can have dire consequences for patients, Brown said. Physically, those cut off from the medication develop prominent facial hair, spontaneous erections and breast development reversal, he said.
"However, the greatest concern in terms of negative consequences is the psychological changes," Brown said. "There's depression, moodiness... possibility of suicide and auto castration.''
In extreme cases, transgender detainees deprived of estrogen have castrated themselves to get rid of the testosterone and have suffered extensive bleeding, Brown said. The cost of a hospital stay for auto castration could be anywhere from $10,000 to $20,000, he added.
"If you can get past all the stigma and look at it from a purely fiscal standpoint, it makes no sense," he said. "It'll ultimately cost the system more money to block them from having access."
Carolina, born Manuel, Zelaya-Ortega, said she endured sleepless nights, migraines and depression after she was deprived of hormone replacement therapy while she was in immigration detention at the Santa Ana Jail.
"It became a mental issue for me," said Zelaya-Ortega, who spent about 10 months in detention until January, when a judge granted her immigration relief. "It's a medical problem. I needed hormones."
The 50-year-old, who had taken hormone replacement therapy since she was a teenager in Honduras, said she and other transgender detainees petitioned the jailers numerous times for the therapy but to no avail.
"There was one gal who kept saying that she wanted to kill herself," Zelaya-Ortega said. "For me it wasn't that bad but for others it was a real emergency."
Most transgender individuals in detention are suspected of being in the country illegally. Others are legal immigrants who are suspected of committing a crime that has made them deportable.

However, many who came to the United States to escape persecution from their native countries are eligible for asylum as long as they apply during their first year, according to immigration law.

Freas fled her native Mexico at age 15 with an aunt, crossing into the United States illegally because both feared she'd be killed. She said her father beat her regularly because she was too feminine.

Whether transgender refugees crossed legally or illegally into the U.S. doesn't have much bearing in gaining immigration relief, said attorney Berndt. It becomes more complicated if the transgender individual fails to apply for asylum after they've been here longer than a year, he said.

That was the case for Zelaya-Ortega, who crossed illegally into Calexico in 1988 and attempted to apply for asylum that same year. But she said a notary scammed her out of hundreds of dollars and she missed the one-year window to make the petition.

Instead, Zelaya-Ortega avoided deportation and can stay in the United States legally after a judge determined that she would likely be persecuted and tortured if deported to Honduras. Her attorney submitted her story about rape, torture and abuse at the hands of her father, military and police officials, which helped to ultimately convince the judge to issue a "withholding of removal and relief under the convention against torture" – an international accord.

That essentially means that immigration officials are not allowed to deport Zelaya-Ortega because she'd likely face torture.

Freas has a story similar to Zelaya-Ortega's. Both say they tried to find regular jobs but ended up resorting to prostitution to make a living and to pay for the hormone therapy they bought in the black market. A good portion of transgender individuals resort to selling their bodies for money because they're unable to find work because of the way they look, transgender experts said.

The two also found it increasingly difficult to negotiate the trauma of life-long abuse and found solace in methamphetamine, which ultimately got them in trouble with the law and put them at risk for deportation.

Their stories aren't uncommon for transgender people, Berndt said.

As long as they have a good attorney, many transgender immigrants fleeing persecution and fighting deportation have a very good chance to stay because of the international convention against torture, he said.

Theo Lacy Facility in Orange, which formerly housed transgender detainees, had a policy of giving them hormone replacement therapy if their medical examiners determined they needed it for gender identity disorder, medical officials there said.

Like Theo Lacy, the California's prison system also administers hormone therapy to inmates with the disorder. Officials there take it a step further, giving the therapy to inmates with the disorder even if they hadn't taken it before their incarceration.
"California really does have the best policies that exist but that doesn't say there isn't room for improvement," Brown said.
Earlier this year, a California prison inmate born male but who lives as a female filed a lawsuit against the state seeking sex reassignment surgery so she can be assigned to a women's prison, according to news reports.
Prison officials had provided her with female hormones since her 2003 incarceration.

Freas doesn't want surgery, just hormone therapy. She said she'd be willing to pay for it herself if she had the money.
"But that's impossible because I'm detained," she added.
She said she was speaking out for herself and others in detention because she hopes to spark a change.
Krikorian, who heads the Washington, D.C.-group that believes in restricting legal and illegal immigration, said he hopes advocates push the issue into the spotlight.
"If anything is going to torpedo the efforts by the administration to weaken enforcement or change detention to make it more appealing to the detainee, this is the issue that will do it," he said.

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