Between 2015 and 2018, transgender women incarcerated in New York City’s first-of-its-kind Transgender Housing Unit (THU) were deprived of access to lifesaving medication-assisted treatment (MAT) like methadone, buprenorphine and naltrexone. The three-year-long lapse in care was attributed by officials to the process of moving THU from Metropolitan Detention Complex (MDC) in Manhattan to the women’s jail, Rose M. Singer Center (RMSC), on Rikers Island.
THU was first opened in the North Infirmary Command on Rikers Island in April 2015, though it was shortly thereafter moved to MDC in Lower Manhattan. Women in the unit—66 percent of whom identified as Black—were “forced to make a choice: Either you go into a unit that you might feel more comfortable in, or go into a facility with all men to get your treatment,” said Kelsey De Avila, the program director for Brooklyn Defender Services’ Jail Service.
De Avila had a client who was subjected to detainment in a hostile space in order to access care. Housed with men in Anna M. Kross Center (AMKC), which has a Methadone Detoxification Unit, “It was a constant battle every day to protect herself,” described De Avila. The client was faced with a complex negotiation: She was in harm’s way in order to utilize lifesaving treatment, but by virtue of being there, she was risking her eligibility to eventually be transferred to the relatively-safer THU.
“Any kind of infraction could be used against her,” said De Avila. “We’ve had women denied THU because of their behavior awaiting transfer to THU. And some of that behavior could come from defending themselves against transphobic men. It was a struggle every day.”
The Legal Aid Society’s Criminal Defense services saw a transgender female client who was also held in men’s housing in order to access treatment. The anonymous client “went through detox at a male facility before she was moved to the THU,” described Legal Aid representatives. Additionally, Lisa Schreibersdorf, the executive director of Brooklyn Defender Services (BDS), described a client referred to as Ms. D who was required to be held in a men’s facility until she detoxed. According to Schreibersdorf, the Department of Corrections (DOC) “did not explain why Corrections and medical staff were unable to coordinate her treatment in a safer location where our client did not have to be house with incarcerated males.”
Cecilia Gentile, a trans activist who has been briefly detained at Rikers, experienced incarceration alongside men—but she wasn’t even able to access MAT. “I was dealing with a terrible addiction to heroin. Once sent to Rikers I was not provided with any medication to help my situation,” she testified before the City Council on May 1, 2019. “My stay there not only was terrible for the kind of harassment I experienced from…the male-identified individuals that I had to live with, but for the life-transitioning with drugs episodes that lasted five days without any treatment. Needless to say, I was not provided with any mental health support to help me adapt to such a shocking reality.”
In contrast, the Legal Aid representatives point out that “cisgender women would have done [treatment] in a female facility,” adding that “We are not aware of any transgender woman who has been allowed to be housed in mental health or infirmary housing at RMSC.”
According to lawyers and care providers who work with incarcerated trans people in the city, those with substance use disorders were faced with the impossible decision to choose between housing aligned with their gender, or treatment. Rye Blum, an adult nurse practitioner at Callen-Lorde Community Health Center, explained that their client’s “gendered self and exploration of self is a part of her fabric, and into that fabric is also woven the experiences that have shaped her PTSD and alcohol use disorder.” Because of that, “A person cannot heal and create their own idea of recovery without being allowed to bring their full self to the room.”
Schreibersdorf of BDS argued that “the extent that methadone maintenance is not available in the THU, this presents potential violations of our clients’ rights as they may be forced to decide between medically-necessary treatment (methadone maintenance) and safety and services offered in the THU.”
The Health and Hospital Corporation’s Correctional Health Services did not respond to Filter‘s request for comment by publication time.
It’s unclear how many transgender women were affected by DOC’s failure to provide care to all incarcerated people. Between September 2015 and July 2017, THU housed 130 individuals; 11 percent of the total 167 placements were transfers from AMKC, which offered a Methadone Detoxification Unit.
Since THU’s move to Rikers Island, people in the unit are supposed to be able to access treatment. “We’ve expanded access to MAT. Generally, we’ve moved away even from detox towards maintenance when appropriate for as many patients as possible and that’s available to anybody who is housed in Rosie’s,” said David Suarez, acting warden of Rikers’s women’s facility where THU is currently located.
At an April 24 City Council meeting, Department of Corrections Commissioner Cynthia Brann stated that transgender inmates have access to MAT. “Regardless of where they are housed within RMSC, transgender inmates have the same access to programs, education, and healthcare as the other women in RMSC.”
But City Council Member Diana Ayala wants to make sure this policy sticks. On April 18, she introduced a resolution that calls on Commissioner Brann to ensure that any housing unit where transgender, intersex, non-binary and gender non-conforming people are housed—and THU in particular—offers the same substance use disorder treatment available to other incarcerated people.
Additionally, the resolution requires that the DOC “provide for the continuance of such treatment by establishing parole procedures and after-care evaluation and implementation after the incarceration has terminated, during the period of parole.”
People recently released from incarceration are at increased risk for fatal overdose. Nationally, the CDC notes evidence that around 10 percent of opioid-involved overdose deaths are of people who were released from institutions in the month prior. Between 2011 and 2012, 37 percent of almost 60 people who died within six weeks of release from a NYC jail experienced an opioid-involved overdose.
The proposed City Council bill “would codify” transgender access to MAT “and make sure there is no gap in treatment in the future if there is a transfer in the future,” explained Bianca Almadina, chief of staff for the Council Member Ayala.
The resolution is especially timely, as the city prepares to close Rikers and move its population to borough-based jails. The City Council voted to pass the resolution on June 26.
Correction: Quotes from the Legal Aid Society had been previously been misattributed.
July 2, 2019 Update: Council Member Ayala’s resolution passed the City Council on June 26.
Image from Google Earth and edited by Sessi Kuwabara Blanchard