Adree Edmo jail portrait

Idaho inmate Adree Edmo is at the center of controversy after a judge ruled the state must pay for Edmo’s requested gender confirmation surgery.

Since a judge in December ruled Idaho officials must provide a transgender inmate with gender confirmation surgery, Gov. Brad Little has often cited the potential cost of the procedure to taxpayers as a reason he opposes the decision. In a three-minute interview with Fox News’ Laura Ingraham Tuesday, he again mentioned the cost factor multiple times.

But the state’s contract with its prison health care provider, Corizon Health, includes the cost of appropriate treatment for gender dysphoria, meaning the cost for the inmate’s surgery could be covered by the existing contract.

The inmate in the case, Adree Edmo, was born male but identifies as a woman, and has been housed in a men’s prison since 2012. She is serving a 10-year sentence for sexually abusing a 15-year-old boy in Bannock County when she was 21. Edmo is scheduled for release in 2021, and is not eligible for parole.

Edmo has gender dysphoria, a condition in which the difference between a person’s birth gender and their chosen gender is distressing, severe and detrimental to their quality of life. She is suing the state of Idaho and Corizon because doctors have not provided gender confirmation surgery, therefore violating her protection against cruel and unusual punishment, according to her attorneys.

The surgery could be an additional cost to taxpayers if Corizon sought extra payment; a provision in the contract allows the company to do so if it provides “treatments or procedures not reasonably foreseen at the time the contract was awarded in 2013, potentially including Edmo’s desired procedure,” governor’s office spokesman Marissa Morrison told the Idaho Press on Friday.

In December, a federal judge ruled officials had to provide the surgery. Then, on Aug. 23rd, the 9th Circuit Court of Appeals made the same finding. Little has vowed to take the case to the U.S. Supreme Court.

IN THE CONTRACT

In April, with Edmo’s case preparing to go before the 9th Circuit Court of Appeals, Jody Herman, a scholar of public policy at the UCLA School of Law, penned an amicus brief in support of Edmo. Amicus briefs are considered by judges in appellate cases, and can be used by the judges to inform their decisions. Much of Herman’s work, according to the brief, examines discrimination against transgender people.

In the brief, she argued taxpayers would not have to pay more for the surgery.

“The cost of providing treatment for gender dysphoria to (Edmo) and to similarly situated transgender prisoners in Idaho is already covered under the existing healthcare plan with Corizon,” Herman wrote.

“Idaho taxpayers do not pay for prisoners’ needs a la carte,” she wrote. “Corizon agreed to provide treatment for gender dysphoria … as part of its contract with IDOC.”

The Idaho Board of Correction approved the five-year contract with Corizon, effective Jan. 1, 2014, according to the contract purchase order award. In December, board members opted to extend the contract through 2020. The contract is worth about $48 million per year.

In the state’s request for a proposal for that contract, officials listed “gender identity disorder,” an older term for gender dysphoria, as a “chronic disease” the contractor would have to provide care for.

When it came to providing treatment for chronic disease, according to the request for proposal, the prospective caregiver “shall follow the most current national guidelines for testing and treatment as applicable for patients in any of the above categories. ... The contractor shall be responsible for payment of all medical claims for offenders.”

Scott Eliason, the regional psychiatric director for Corizon, testified in an Oct. 12 court hearing in the case that the surgery is available through Corizon, according to a transcript of that hearing. When an attorney asked him “what treatment options are available for treating gender dysphoria through Corizon,” he responded “all treatment options that are seen as medically necessary.”

“So it would include — I mean it’s not limited to this, but it would include psychotherapy, hormone treatment, surgical procedures,” he said.

In her brief, Herman argues the cost of the surgery would be negligible.

“The available cost data collected online indicates that these surgeries for male-to-female transgender individuals usually falls within a range of $10,000 to $30,000, and the cost for female-to-male transgender individuals is similar — approximately $12,000 to $25,000,” she wrote.

Paying for surgery for an inmate who has severe gender dysphoria might actually save money, she argued, because in some cases inmates’ mental health might improve in general, and that would mean they would need less mental health treatment.

Of the more than 9,000 inmates in Idaho Department of Correction facilities, court documents in Edmo’s case indicate only 30 have been diagnosed with gender dysphoria. Not every person who lives with gender dysphoria requires surgery.

‘GOING TO BE EXPENSIVE’

On Ingraham’s show Tuesday night, Little said the 9th Circuit Court’s ruling would be expensive.

“It’s a bad precedent, it’s going to be expensive, and it’s contrary to the health professionals that we have reviewing inmate Edmo’s records,” Little said.

Morrison agreed taxpayers would ultimately foot the bill for the surgery.

“Taxpayers would pay for the procedure,” she told the Idaho Press in an email Friday. “Idaho’s contract with Corizon Health is funded by taxpayer dollars. Governor Little has stated that Idaho taxpayers should not cover procedures not approved by medical professionals.”

While Corizon’s medical professionals did not approve the surgery, two doctors who specialize in treating gender dysphoria interviewed Edmo and recommended she receive the surgery, according to the 9th Circuit Court’s opinion. One of those doctors had treated hundreds of patients with the condition. The other, Randi Ettner, “has evaluated, diagnosed, and treated between 2,500 and 3,000 individuals with gender dysphoria,” according to the court’s opinion.

“She has referred about 300 people,” for gender confirmation surgery and also “refused to recommend surgery for some patients who have requested it,” the opinion reads.

LAWSUIT COSTS

Since April 2017, when Edmo filed her lawsuit, the state has paid $325,269.46 expenses related to the case, according to Keith Reynolds, the deputy director and chief financial officer of the Idaho Department of Administration.

At an October court hearing in the Edmo case, one of the expert witnesses who testified for the defense was Keelin Garvey, a former chief psychiatrist for the Massachusetts Department of Correction. Garvey testified that, as of Oct. 12, she’d been paid $60,000 for her expertise, according to a transcript from the hearing.

Another expert witness for the defense, Joel Andrade, testified in his deposition by lawyers that he charges $250 an hour for his services, according to a transcript. During the deposition in September 2018, said he’d been paid for 70 hours worth of work, or $17,500.

Because both witnesses are testifying for the state and Corizon, it is unclear how their compensation was divided up between the two parties.

In a release from Little on Friday, he said he is committed to appealing the case to the U.S. Supreme Court. Two other circuit courts have heard similar cases and ruled differently, Little pointed out on Tuesday night. The U.S. Supreme Court often hears cases in which circuit courts are split.

“We must remain focused on reducing our prison population, not incentivizing people to get in prison and stay in prison,” Little said in the release. “We should not divert critical public dollars away from the priorities of keeping the public safe and rehabilitating offenders.”