Our Worst Fear

For many trans people one of our fears is being incarcerated in a prison of our birth gender and once we are in prison will we get proper medical treatment. There is a study that just has been released about healthcare in New York City Correctional System. “Improving Transgender Healthcare in the New York City Correctional System”

Introduction
In community healthcare settings, transgender individuals are more likely to be refused care than others. According to the National Transgender Discrimination Survey Report on Health and Healthcare, 19% of participants claimed that they were refused care because of their transgender identity. Even when care is provided, a healthcare provider's discomfort with or misinformation about transgender individuals' care needs can alienate patients, potentially affecting the quality and utilization of care by transgender patients.
In addition, transgender individuals in the community face inadequate medical care such as improper diagnosis and treatment and the onerous financial burdens of treatment. Many health insurance plans do not cover the cost of mental health services, cross-sex hormone therapy, or sex reassignment surgery. Consequently, some transgender individuals resort to illegal and dangerous self-administered injections to induce feminine or masculine physiological changes.
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The New York City Department of Health and Mental Hygiene (DOHMH) oversees the delivery of medical, mental health, and dental care, as well as discharge planning services in the New York City (NYC) jail system, which has an average daily census of 11,000 inmates, over 70,000 annual admissions, and an average detainee stay of 30 days. Our efforts to improve and standardize care for transgender patients in the NYC jail system were initiated after we received increasing complaints from transgender patients regarding clinical care.

In the NYC jail system, transgender individuals are assigned to housing according to their genitals or sex assigned at birth regardless of their gender expression. Upon intake into the NYC jail system, transgender patients are seen by a healthcare provider who is responsible for documentation of their community medication history before prescribing medications in the correctional setting. However, the process by which medical providers obtained these patients' community medication history was not uniform, which resulted in many patients not receiving their transgender therapy consistently. Furthermore, there was no existing written transgender medical care policy, which resulted in unstandardized and suboptimal care for this population.

Their findings were not unexpected…

Conclusion
Overall, our efforts to assess the quality of care provided to transgender patients in the NYC jail system have revealed significant areas for improvement. By taking a deliberative approach to formulating policies that are rooted in community standards and the express wishes of our patients, we have made significant gains in the acceptance of our new policies by patients and staff alike.

This survey didn’t look at whether inmates were housed in the facilities of their birth gender or a facilities of their gender identity (which is also area of concern) but only if they are getting proper medical care.