A transgender inmate at Lackawanna County Prison says she suffered physical and psychological harm because prison medical staff halted hormone medications needed to help her transition from a biological male to a female.
Steven Fritz, 44, of Scranton, received hormone medications while incarcerated at the State Correctional Institution at Houtzdale. She expected to continue the medications when she was incarcerated at the county jail on new theft charges, but the medical staff abruptly stopped the drugs after just three days, she said.
Joseph D’Arienzo, spokesman for the county, declined to discuss the case, citing medical privacy laws. He confirmed the county has no policy regarding hormone treatment for transgenders.
The prison’s denial of treatment is at odds with the state Department of Corrections’ policy regarding hormone treatment for transgenders and likely violates Fritz’s constitutional rights, which could lead to a lawsuit, attorneys for a transgender advocacy group and prisoners rights group said.
“In the last few years, courts have increasingly recognized that providing adequate medical care to transgenders is constitutionally required,” said Flor Bermudez, an attorney with the Transgender Law Center in Oakland, California. “If prisons are not doing that, they are violating Eighth Amendment rights against cruel and unusual punishment.”
Medical treatment for transgender inmates is a growing controversy nationwide as states grapple with what type of treatment they must provide.
Advocates for transgenders argue hormone therapy is an essential treatment for people who suffer from gender dysphoria, which the American Psychiatric Association defines as a conflict between a person’s physical or assigned gender and the gender with which he or she identifies.
Prison officials generally acknowledge the disorder, but disagreement remains over what steps they are required to take to treat it. Multiple lawsuits have been filed across the country, which has led some states to enact policies, Bermudez said.
At least 28 states, including Pennsylvania, provide hormone treatment at the state prison level, according to a survey conducted by the Transgender Law Center. The other 22 states either have no policy on the matter or did not respond to the center’s request for information, Bermudez said.
As of May, there were 140 transgender inmates incarcerated in the Pennsylvania state prison system, said Amy Worden, a spokeswoman for the department. Of those, 136 are transgender women and four are transgender men.
The state DOC has a team of medical and psychiatric professionals who decide what treatment to provide, which can include hormone therapy. County jails are not required to follow DOC standards.
Lackawanna County has a policy that protects lesbian, gay, bisexual, transgender and intersex inmates from sexual abuse and harassment. The policy does not address the evaluation and treatment of inmates with gender dysphoria. That decision is left up to the jail’s medical provider, Correctional Care Inc.
Edward Zaloga, M.D., owner of Correctional Care Inc., did not respond to a detailed letter seeking comment on Fritz’s case.
A prison official at SCI Houtzdale confirmed Fritz was diagnosed with gender dysphoria in January 2016 and began receiving hormone therapy involving two forms of estrogen.
Taken by a male, estrogen blocks the release of the hormone testosterone, said Bonnie Shanis, M.D., an endocrinologist in Ambler who treats transgenders but did not treat Fritz. The drug halts hair growth and causes a slight increase in breast size and other body changes that “feminize” the person.
In a recent phone interview, Fritz, who calls herself “Sparkles Wilson,” said she hopes to undergo gender reassignment surgery.
Fritz has a long criminal history, mostly on theft-related charges. She was paroled from SCI Houtzdale in November 2016 and lived at a Scranton halfway house, where she said she continued to receive hormone treatment.
Her troubles began in January, when she was jailed at Lackawanna County Prison after she was arrested for using a stolen credit card. Unable to post bail, she remains incarcerated awaiting trial on several charges, including receiving stolen property and access device fraud.
Fritz said she provided county prison officials documentation showing she was legally prescribed estrogen. Initially medical staff gave her the drugs but then stopped treatment “cold turkey” without consultation or evaluation.
Speaking generally, Shanis said there is no physical harm in stopping the drugs cold turkey, but there could be psychological issues for transgenders.
Fritz said she has known for more than a decade that she wants to be a woman and the hormone therapy helps in that transition. The lack of treatment caused her facial hair to grow back. Her breasts, which enlarged, reverted to their previous state.
“I’m mentally distraught from all of this,” she said.
Fritz said she was not told why the medications were stopped. A handwritten note at the top of one of the grievances she filed says Lackawanna County Prison will not provide her hormone pills because “the risk of serious side effects outweighs any benefits.”
Shanis said there is some risk associated with estrogen, including an increased risk of blood clots. It is up to the patient to decide whether to take that risk, she said.
Fritz said she has no medical issues that would increase her risk of an adverse reaction to the hormones. She suspects the decision was based on the cost of the drugs.
Records show Fritz was prescribed Premarin and Estrace, two forms of estrogen, at SCI Houtzdale. The average retail price for Premarin is $202.87 for 30 tablets, according to the website, GoodRX, while the average cost of Estrace is $17.39.
Su Ming Yeh, an attorney with the Pennsylvania Institutional Law Project, said Lackawanna County Prison is opening itself up to a potential lawsuit by denying Fritz her hormone treatment, especially since she was receiving it in the state prison system.
“If medical treatment has already been prescribed and you are withholding that treatment, and that withholding causes harm, that is a constitutional violation,” Yeh said.
Yeh said to prevail in a lawsuit, an inmate must prove he or she suffers from a serious medical condition and that prison officials showed “deliberate indifference” in failing to treat them. Courts nationwide consistently viewed transexualism as a serious medical condition. That means prisons are obligated to treat is just as they would other serious medical conditions.
“Look at someone who has diabetes,” Yeh said. “You are not allowed, all of a sudden, to withhold insulin.”
Fritz has not filed a lawsuit but said she may.
It is not clear how much longer she will be in Lackawanna County Prison. She is scheduled to plead guilty today to theft charges before Lackawanna County Judge Michael Barrasse.
She may be sentenced to time served, which means she could be released as soon as she gets a home plan completed. It also is possible she will be sent back to state prison, however, because the new charges violated her parole on her previous conviction.
Whatever happens, Fritz said she wants to get out of Lackawanna County Prison so she can restart the hormone therapy that will eventually lead to her gender reassignment surgery.
“I’ve known since 2000 that I wanted to be a woman,” she said. “I want to do what I have to do to make myself happy.”
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