Stengah wrote:Well, the state is not responsible for providing medical care to its poor citizens, but the state is responsible for providing medical care to its prisoners, so treating prisoners like any other poor person is unconstitutional.
Well, that's about what the judge says. We'll see if his reasoning holds up on appeal, assuming the state appeals. Which it might not do.
Department of Correction spokeswoman Diane Wiffin said the state agency has received Wolf’s ruling.“We are reviewing the decision and exploring our appellate options,’’ Wiffin said today.
I wouldn't be surprised if they did, as they've been fighting against it since 2000.
It depends on why they were fighting it. If they were worried about public outrage if they approved the surgery, then they can point to the court order if somebody screams about this in Mass and just pay for the treatment. If they're worried about setting a precedent, then they're more likely to appeal.
momgamer wrote:Insurance companies and Medicaid deciding what is medically necessary and what is not is a whole 'nother can of worms.
Gah, I'm not talking about them. I'm talking about the actual medical community. i.e. letting doctors handle medicine and keeping insurance, medicaid, the courts, etc out. All I meant is that for now, the specialist doctor handling the case made a call, and it's appropriate for the judge to support it. If there's a debate to happen, it should happen amongst the medical community.
But there are plenty of others here who have been blatantly suggesting that we should limit what is done to prisoners to what we do for people on Medicaid. That was the point I was making.
It depends on why they were fighting it. If they were worried about public outrage if they approved the surgery, then they can point to the court order if somebody screams about this in Mass and just pay for the treatment. If they're worried about setting a precedent, then they're more likely to appeal.
"Denying adequate medical care because of a fear of controversy or criticism from politicians, the press, and the public serves no legitimate penological purpose,” Wolf wrote. “It is precisely the type of conduct the Eight Amendment prohibits.”Wolf also concluded that if he does not explicitly order the DOC to provide the surgery, leaders of the DOC will never do it on their own.
“The DOC, through several commissioners, has continued, without proper justification, to refuse to discharge its constitutional duty to provide Kosilek the adequate care required for his serious condition,’’ Wolf wrote. “It is evident that the defendant will continue to violate Kosileks’ Eight Amendment rights if a court order is not issued.”
If they were only concerned about public outrage, they could have accepted the first court's decision instead of fighting it all the way to a federal court. There's already a precedent set that the state is required to provide medically necessary procedures for inmates, so the only precedent they could be fighting against was that SRS surgery was medically necessary. And as Farscry already said, that's a decision best left to the medical community, not the corrections community. In this case, the state's own doctors are telling them it's medically necessary, so the best the state can say is that they disagree with their own professional's findings.
Just wanted to go back to this one more time: Free people always have options.
Only if they have wealth. A poor free person doesn't have more options than a prisoner with a fancy lawyer and a million dollar defense fund.
I submit that the only reasonable argument against providing SRS is that it's an optional non-necessary procedure, and that the only reasonable people to make that decision are doctors.
It's an optional, non-necessary medical procedure. Would someone die because they don't get the treatment? The answer is no. Ergo, they don't need the procedure.
It would only be considered a medical necessity if doctors could definitively show that the patient would die without receiving the sexual reassignment surgery during the sentence.
It's an optional, non-necessary medical procedure. Would someone die because they don't get the treatment? The answer is no. Ergo, they don't need the procedure.
It would only be considered a medical necessity if doctors could definitively show that the patient would die without receiving the sexual reassignment surgery during the sentence.
The prison's doctors have already stated that they found it to be medically necessary, so why argue that point?
Edit - using danger of imminent death as your basis for whether something is medically necessary is going to classify a lot of things as "optional." Broken legs? Meh, they can just sit in their cell, they don't need to walk to live. Chronic physical pain? No need for treatment, they can't die from it directly. Cancer? Well, sometimes is goes away for no reason we can find, and many people have cancer but die from something else unrelated, so we can't definitively say it would kill them if we don't treat it.
And repeated nearly successful attempts to commit suicide don't qualify, apparently? Even if it costs more to deal with them than to provide the surgery?
No, repeated, nearly successful attempts to commit suicide shouldn't matter for sh*t during sentencing. Allowing it to matter would mean that anyone could get a massively reduced sentence by merely threatening to do damage to themselves: "Yes, I killed five people during that bank robbery, but if you make me serve more than a day in jail I'll totally hurt myself..."
Also: Thank you for your understanding. I'll make sure to remember if my gender dysphoria ever reaches such an extreme point that I don't [em]really[/em] need SRS.
Edit:
Sorry, that last was a bit snarky. But seriously: I don't feel a pressing need right now to have my boy bits off. I don't know if I ever will. But, I am looking at spending $20k-$50k on procedures that I [em]do[/em] feel that I need, and which involve going through a great deal of pain and social stigma. And I experience a tremendous amount of regret that I didn't have the resources to do this in the past, because it's going to be much much harder now than it was then. I also know that my feelings are pretty mild compared to some peoples'--we're talking kids who take out a pair of scissors at age 6 because they know their body is wrong and they have to do something about it.
This stuff is not something you can brush off, and the attitude that it is is infuriating precisely because that's the sort of argument that's made to keep it from being covered by many insurance plans. It's no more valid in this case than it is in numerous other cases of people who aren't in prison, and it should absolutely be covered by insurance and by public health care for those in need.
Just so we're entirely clear on this, we were talking about making taxpayers pay for SRS for prisoners, people who have violated the law. You're asking that they get an optional medical treatment before law-abiding citizens get treatment they need to stay alive. You're essentially saying that a shaved trachea and a vaginoplasty takes precedence over a prisoner getting chemotherapy for a cancer that will kill them during their sentence. It doesn't.
If you want to have a discussion about why those procedures aren't covered by private insurance, I'd be more than happy to join, but basing the conversation on the principle that prisoners should get SRS on demand isn't legitimate.
before law-abiding citizens get treatment they need to stay alive
If they're under detention, we have to treat them. That's just morally required. If you don't want to spend that money, then don't lock people up. If you think it's okay to leave people untreated simply because they're imprisoned, then I hope you never get the finger pointed at you. We imprison more of our population than any other nation by a huge margin, so it's very, very easy to be put in jail here. If you're willing to turn off your empathy as soon as someone is called a criminal, well, consider that that horrible criminal might someday be you.
Criminals are still human, and they are still citizens, and there is just a minimum standard level of care. Procedures prescribed by a doctor are included.
You're essentially saying that a shaved trachea and a vaginoplasty takes precedence over a prisoner getting chemotherapy for a cancer that will kill them during their sentence. It doesn't.
You're right. They both should be treated, if it's medically necessary. If there's not enough money to treat both, then you need to come up with the money from somewhere else, and stop locking up so many people.
I think this thread is an interesting contract with Norway's treatment of their prisoners: they're actually hiring friends for the biggest mass murderer in their history.
No, repeated, nearly successful attempts to commit suicide shouldn't matter for sh*t during sentencing. Allowing it to matter would mean that anyone could get a massively reduced sentence by merely threatening to do damage to themselves: "Yes, I killed five people during that bank robbery, but if you make me serve more than a day in jail I'll totally hurt myself..."
...
Just so we're entirely clear on this, we were talking about making taxpayers pay for SRS for prisoners, people who have violated the law. You're asking that they get an optional medical treatment before law-abiding citizens get treatment they need to stay alive. You're essentially saying that a shaved trachea and a vaginoplasty takes precedence over a prisoner getting chemotherapy for a cancer that will kill them during their sentence. It doesn't.If you want to have a discussion about why those procedures aren't covered by private insurance, I'd be more than happy to join, but basing the conversation on the principle that prisoners should get SRS on demand isn't legitimate.
Dude, the prison's doctors flat out said it was the only treatment for a serious medical issue.
He wrote that prison officials were being “deliberately indifferent” to Kosilek’s medical needs and violating her Eight Amendment rights against cruel punishment, noting that prison doctors recommended the surgery as the only treatment for a serious medical issue.
She's not just making this up to have some fun, and she's still going to be in jail.
Besides all that, if the state's own doctors say that the only treatment for the actual, serious medical condition your hypothetical murderer has was a one-day sentence, then the state has to set that sentence at one day, or they'd be violating his 8th amendment rights. I'm not aware of anyone having a medically diagnosed fatal 24-hour limit on prison exposure, but it's your hypothetical.
My thinking basically goes like this:
People don't want to see prisoners being treated better than non-prisoners.
The State has a duty of care to prisoners in its charge.
The State does not have a duty of care as regards the health of its citizens to the same extent as they can purchase private health insurance.
If you want prisoners to be treated the same, then let them purchase private health insurance. Otherwise accept the State must follow through with its duty of care. If you think that's being treated better than non-prisoners then let prisoners earn money and pay for their food and accomodation as well. If the State mandates that their ability to meet the responsibility for their own well-being is taken away from then it has to meet them itself.
As for whether insurance funds - private or public - should be the arbiters of whether a procedure is medically necessary or not, I'm not sure why the argument is even on the table. If a policy holder is denied SRS and kills themselves, no-one is accountable. If a prisoner is denied SRS and kills themself, the State is accountable.
Minor point:
It was to emphasize the point that it is incorrect to call this "elective" care. It is contrary to the stated views of the AMA and the APA, and contrary to my own experience and that of many others.
Classification of surgeries in order of OR assignment priority are "elective," "urgent," and "emergent," if I recall the hierarchy correctly. It depends on how imminent death is. The point of the classification is to determine whether or not the patient's health can or cannot be optimized prior to the procedure. If he's dying of a heart attack, the broken leg can wait, really. Most cancers can wait, too, unless no optimization is possible while the tumor is active.
Such procedures could be classed, and are often referred to, as "elective" procedures on OR schedules for this reason. It's not the same as "unnecessary."
Unless you're dealing with the American insurance and Medicaid systems, which can arbitrarily decide what they call elective (which for them is a code-word for unnecessary) or not and just as arbitrarily decide whether or not to pay for them, completely independently of the medical profession's definitions/standards/opinions.
Unless you're dealing with the American insurance and Medicaid systems, which can arbitrarily decide what they call elective (which for them is a code-word for unnecessary) or not and just as arbitrarily decide whether or not to pay for them, completely independently of the medical profession's definitions/standards/opinions.
Honestly, I can't fathom how it's gotten to the point where insurance companies are dictating medical decisions - medical decisions that affect their bottom line, no less. It looks frickin' insane from the outside.
My point was that "elective" could be used in a manner that didn't mean "unnecessary," so it's sometimes correct to call it as it is.
It looks insane from the inside, too.
We already have death panels; they're called insurance companies. But, frequently, it's not even a panel, it's just an individual adjuster.
Just so we're entirely clear on this, we were talking about making taxpayers pay for SRS for prisoners, people who have violated the law. You're asking that they get an optional medical treatment before law-abiding citizens get treatment they need to stay alive. You're essentially saying that a shaved trachea and a vaginoplasty takes precedence over a prisoner getting chemotherapy for a cancer that will kill them during their sentence. It doesn't.
If you want to have a discussion about why those procedures aren't covered by private insurance, I'd be more than happy to join, but basing the conversation on the principle that prisoners should get SRS on demand isn't legitimate.
I am not sure I get your thoughts here, OG. The doctors have said it is a necessary procedure but you keep talking about how it is an "optional medical treatment"
So would it be correct to say that if this surgery was considered necessary for the patient's life you would be ok with the state paying? And in that case isn't your issue with the doctor who said it was necessary and not with the procedure itself?
Then for you the question, I think, would come down to who decides is a procedure is necessary, correct? And if that is correct, who in your opinion should decide if a procedure is necessary?
A doctor has said the SRS is required. Is there any sort of recognition for this on a national level (recommended best practices, published findings, etc.)? It seems a bit arbitrary to establish state-wide or nation-wide policy based on a single opinion.
Aside from the AMA, among other organizations? (That was just the first link that popped up when I searched for AMA transgender.)
Overall, the generally endorsed recommended best practices are the WPATH standards of care. Version 7 has just recently been published.
Thanks for the links. It is good to know that this is backed up by some level of professional consensus.
Pages