Michelle-Lael Norsworthy is ready to go to the hospital.
She spends Thursday drinking clear fluids; no solid foods allowed. She downs a bottle of bowel prep like the doctor told her to, staying home in her tiny Bay Area apartment all day to deal with the results. She doesn't complain—she's effectively been waiting for Friday morning, when she will have gender confirmation surgery, for more than two decades.
"I gave and shed more blood on the journey to the table than I will shed or give during the surgery itself," Norsworthy tells VICE.
During the three decades she spent in the California prison system, she struggled to live as a transgender woman housed with men—men who attacked her, knocked out her teeth, and gang-raped her.
"There were no gray areas in prison," Norsworthy says. "You fuck up, you die. It was a constant walk on eggshells."
It was a fight that brought her to prison in the first place: In 1985, she shot an acquaintance during a spat in a bar parking lot after—she claims—he threatened her. He died six weeks later, and she was convicted of second-degree murder. His death, she insists, "haunts her to this day." At the time, Norsworthy still identified as Jeffrey; she transitioned while incarcerated and began presenting as a woman in the 1990s.
Transitioning as a California Department of Corrections and Rehabilitation (CDCR) inmate was a constant test of Norsworthy's ability to advocate for herself. In 1996, she says, she began requesting hormone therapy, but it wasn't until a prison therapist diagnosed Norsworthy with gender dysphoria that she began taking hormones, in 2000, and got on the road to feeling more like herself.
Her physical struggle ran parallel to her battle with the CDCR. Norsworthy began to spend hours in the law library, learning how to file grievances. That, she says, is how she got her first bra. If the prison rejected a grievance, she'd file again until she won. She started helping other inmates, too.
"It really has been trans women who have led the charge in the courts when it comes to healthcare for trans people in and out of prison," says Chase Strangio, an ACLU attorney and national expert on transgender rights who represents Chelsea Manning. "As advocates and trans people, we owe a lot to people who've been in the most vulnerable situations and who have put a lot on the line. Michelle is a part of that history."
Released on parole in August 2015, Norsworthy, now 52, is still learning to navigate life on the outside. Getting out after spending most of her adult life in prison was "more like time travel than culture shock," she says. She jokingly calls her cellphone her pocket phone, and when she grocery shops at Safeway, she finds it bizarre that human cashiers have been replaced by machines. "I was catapulted into a future world."
One of the toughest battles she's faced since her release, far more dizzying than high-tech supermarkets, has been navigating California's Medicaid system, Medi-Cal. Norsworthy spent months filling out paperwork and trying to find the right health insurance to continue her hormone treatment, she says, before identifying a surgeon who would take the insurance and perform her surgery.
This wasn't a bureaucratic hurdle she expected to face as a free woman. In April 2015, federal district judge Jon Tigar ordered the state to schedule, perform, and cover the expense of Norsworthy's operation. At the time, she was still incarcerated and had been refused parole five times. (She was serving a sentence of 17 years to life in prison.) California prison officials had repeatedly denied her appeals for surgery, in spite of her doctor deeming it medically necessary for her well-being. Tigar's order was a game changer, setting a precedent unseen in other states and forcing the CDCR to change its policy.
"Her case paved the way for medically necessary gender confirmation surgery in California prisons," said Penny Godbold, a disability and civil rights lawyer who began corresponding with Norsworthy while she was incarcerated.
Then, just a few months later and to her great surprise, the state released Norsworthy on parole. Though her case was to be heard by the Ninth Circuit Court of Appeals—the same body that just rebuked Donald Trump's immigration order—her release cut that process short. Still, the lower court's decision was a powerful, if not all-encompassing, win for trans prisoners.
"Even if there had been a great Ninth Circuit decision upholding the order, prison is terrible," says Strangio. "Our clients are dying in prison. I still consider it a win when you get someone out. It was still a net positive for trans people in custody."
Shiloh Quine, a transgender woman housed with men in California's Mule Creek State Prison, was the first to benefit from Norsworthy's case. Quine won a suit against the CDCR in 2015, the settlement of which included what the state calls "sex reassignment" surgery, which she underwent in January. As part of the deal, she was to be transferred to a women's prison to fulfill her life without parole sentence.
While Godbold celebrates Quine's settlement, she and other advocates are "not happy about the number of denials" being issued by the CDCR in response to requests for gender confirmation surgery. As of December 31, 2016, California Correctional Health Services, which handles all of CDCR's medical care, had received 64 requests from prisoners for the procedure, according to Joyce Hayhoe, the provider's communications director. Of those requests, 51 have been processed, and just four of those have been approved for surgery.
"There's a pretty strenuous process that we have to go through to make a determination," Hayhoe tells VICE. "That doesn't necessarily mean that [those who are denied] may not be considered in the future."
To be approved, Hayhoe says, applicants must have a diagnosis of gender dysphoria; must have undergone hormone therapy for at least a year; and must exhibit "mental health stability" for at least one year.
Check out Gaycation's interview with trans prison reform activist Ashley Diamond.
Though progress has been made for trans people in and out of prison, a lot of work lies ahead.
"I'm concerned that under the Trump administration things will get worse, but it's not like they were okay at all under the last administration," says Strangio. Citing an uptick in murders of trans women of color in recent years, and policing that he says disproportionately impacts the trans community, Strangio notes that "high-level legalistic change doesn't always trickle down."
Norsworthy is ready to keep pushing for the rights of trans women. After her surgery, she looks forward to opening Joan's House, a nonprofit she's working on to provide supportive housing for trans women in San Francisco, and plans to partner with Healthright 360, a network of medical clinics in California.
"I want to bring this fight to Trump," Norsworthy tells me. "If I could get five minutes with him, I bet he'd give me a donation."
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