A Prison Used Solitary Confinement to Force a Trans Man to Undergo a Genital Exam, Lawsuit Alleges

This article was published in partnership with The Appeal.

FOR MONTHS AFTER a New York judge sentenced him to prison in late 2019, John Smith, a transgender man, tried to ward off attempts by jail and prison officials to touch his genitals, he says. (“John Smith” is a pseudonym being used in court filings and this article to protect his privacy.)

At a women’s facility at New York City’s Rikers Island jail complex, where he stayed for three months before being sent to state prison, corrections officers tried to subject Smith to a genital examination, according to a federal lawsuit filed Monday. He refused it. Before his incarceration, Smith had worked at an LGBTQ services organization, he told New York Focus and The Appeal, where he learned that the federal Prison Rape Elimination Act, or PREA, prohibits jails and prisons from conducting exams solely to determine someone’s genital status.

The doctor at Rikers honored Smith’s objection to a genital exam. But state prison officials were more insistent. In January 2020, Smith was transferred to Bedford Hills Correctional Facility, a women’s prison in the Hudson Valley. When he arrived, staff subjected him to a standard intake strip search, then a secondary strip frisk, during which a female officer ordered Smith to manipulate his genitals, leaning in to closely inspect them. Officials then sent him to the prison medical ward, where, as part of an examination, a doctor lifted his waistband to view his private parts.

After the examination, Smith was sent to a waiting room. Minutes later, he was brought back into the exam room, where the doctor and a nurse told him that, even though prison staff had already looked at his genitals three times, the prison superintendent had ordered an additional exam to see what his genitals looked like, according to the lawsuit. The doctor again looked inside his pants, the lawsuit alleges, and the nurse attempted to pull them down without asking. Smith refused further examination.

Instead of finishing the intake process, prison officials then placed Smith in “medical lock,” a solitary cell in the medical reception area where people — typically those with contagious illnesses — are confined for 23 hours a day.

In addition to the well documented mental anguish that solitary confinement places on people, the heat in the medical lock cell made it unbearable, Smith said. There was poor ventilation, and the location of the room’s window made airflow impossible. Even though it was January, it felt like “sitting in a sauna in the middle of summertime,” he said. When Smith tried to remove some clothes to cool down, prison officials ordered him to put them back on. Officials only gave him ice and water during meal times, despite his requests for water throughout the day. For several days, they denied him the proper dosage for his hormone treatments, which made the heat sickness worse, and they frequently misgendered him, the lawsuit alleges.

According to Smith, several prison officials — including the sergeant in charge of administering PREA regulations — told him that they placed him in medical lock because he had refused the superintendent’s orders for a full genital exam. Smith repeatedly reasserted his rights, but the prison continued to insist that he undergo the exam, he said. At one point, a case worker threatened to place him in a long-term solitary confinement unit if he continued to object, and told him that he wouldn’t be able to participate in a prison program that could reduce his sentence.

Smith held out for more than a week, including three days during which officers denied him his one hour outside of the cell, according to the lawsuit. But after eight days in medical lock, officials took an emotionally and physically drained Smith to see another doctor, who convinced him to undergo a final, formal genital exam — which, she assured, would only be visual, according to the lawsuit. With Smith’s legs in stirrups, the doctor allegedly touched his genitals with her finger, causing him to jump off the exam table. She then proceeded to penetrate Smith with a cotton swab. After the exam was finished, officers finally released Smith from medical lock.

[Prison officials] feel like they can do or get away with pretty much anything that they want to.

The doctor took detailed notes on Smith’s anatomy and the apparent progress of his genital transition, but the records don’t provide a medical reason for the exam, nor do they mention that he consented to being touched, according to the lawsuit.

“The horrific mistreatment suffered by our client … is an example of the all too common abuse that transgender people face in the carceral system,” said Erin Beth Harrist, director of the LGBTQ+ law and policy unit at the Legal Aid Society, which filed the suit in partnership with the law firm Paul Hastings. The suit names a number of Bedford Hills officials, including the doctor who allegedly performed the exam, the case worker who allegedly threatened to punish him for not acquiescing to it, the PREA sergeant, and the superintendent.

“Officials’ complete disregard for established laws and rules, and use of solitary confinement to force Mr. Smith to commit to an unnecessary, prohibited, and degrading search, speaks volumes about the transphobia that persists in New York state prisons and jails,” said Harrist.

Citing the pending litigation and medical privacy laws, the Department of Corrections and Community Supervision (DOCCS), which runs New York state prisons, declined to comment on Smith’s allegations.

A SEPTEMBER 2021 AUDIT of Bedford Hills by a US Department of Justice contractor concluded that relevant staff were aware that, in accordance with PREA, they’re prohibited from ordering a physical exam “for the sole purpose of determining [an] inmate’s genital status.” But Smith says that’s exactly what happened to him.

Smith’s case is just one of many allegations of abuse of transgender people in New York correctional facilities. The mistreatment likely illustrates a lack of policy framework and oversight, including surrounding issues of the most urgent concern to incarcerated trans people, such as housing placements. DOCCS only guarantees an “individualized assessment” based on no specific criteria when deciding whether to place someone in a men’s or women’s prison. While DOCCS officials are required to take an “inmate’s own views” into “serious consideration” when determining their placement, they frequently default to placing them in facilities that match their gender assigned at birth, rather than their gender identity.

The lack of guidance on housing affects local jails, too. In a report published this month, a task force convened by New York City asserted that city jails house gender non-conforming people in units inconsistent with their gender identity in a “vast majority” of cases.

But even in situations with robust legal or policy frameworks — like the administration of hormones and other gender-affirming health care, or the administration of strip-searches — the laws or policies dictating the proper treatment of gender non-conforming people in New York prisons and jails are often ignored.

In 2019, a trans woman sued the Steuben County jail for denying her access to her hormone therapy and failing to protect her from the predatory behavior of men she was locked up with. In 2021, a trans woman alleged that Jefferson County jail officials physically and sexually assaulted her, ripped off her hair piece, and subjected her to an unnecessary and aggressive cavity search by a male officer. And in March, a trans woman sued Broome County jail officials for refusing her hormone treatments and placing her in medical lock, where men could see her using the bathroom.

For DOCCS’s part, the Sylvia Rivera Law Project, a New York City-based organization dedicated to gender self-determination, has asserted based on interviews with incarcerated people that state prisons rarely follow department directives governing healthcare for trangender prisoners.

Making matters worse, oversight bodies have failed to provide guidance. The State Commission of Correction, the government agency that oversees jail and prison conditions across New York, has published no minimum standards related to the incarceration of transgender and other gender non-conforming people, despite years of urging by advocates. In 2019, the New York Civil Liberties Union sent a letter to the commission pointing to an email correspondence with a Rensselaer County jail official, who asserted that they would be “wasting [their] time dealing with transgender policy issues until the Commission [of] Correction begins requiring” them.

In response to a query from New York Focus and The Appeal, a State Commission of Correction spokesperson wrote in an email that “New York State is committed to equal treatment of transgender and non-conforming individuals,” and pointed to the commission’s two anti-discrimination regulations, which are each one sentence long.

State legislators are trying to make up for some of the lack of policy guidance. Senator Julia Salazar and Assemblymember Nily Rozic, both Democrats, introduced a bill in May 2021 that would, among other things, establish a presumption that people incarcerated in prisons and local jails should be placed in facilities that most closely align with their gender identities, unless they opt out of such a placement. The bill didn’t make it out of committee before the end of the current legislative session. Salazar told New York Focus and The Appeal that she plans to reintroduce it next session.

THE FORCED GENITAL EXAM has deeply affected Smith. After the incident, he transferred from Bedford Hills to a facility that administers the sentence reduction program that he’d nearly been banned from. Smith was eager to resume his life after his release in September 2020. But the trauma hasn’t been “that easy to shake off,” he said.

“It was heavy on my mind. I thought about it. I felt dirty,” Smith said. Post-traumatic stress from sexual abuse he experienced as a child — which he said he repeatedly told prison officials about — worsened, and his body image distorted. He developed trouble eating and sleeping and an aversion to physical touch. “At one point I just gave up on life,” he recalled. He lost weight and confined himself to his room, placing a portable toilet near his bed so he wouldn’t have to leave.

It was heavy on my mind. I thought about it. I felt dirty.

Today, Smith mostly interacts with his grandmother, whom he helps take care of, and a friend, whose child he babysits, but he is still struggling. He hopes his lawsuit will help other people avoid the distress he has gone through — especially those who, unlike him, may not be aware of their rights under PREA.

“[Officials] feel like they can do or get away with pretty much anything that they want to,” Smith said. “If it makes you feel bad as an individual, or makes you feel inhuman, you should not have to sit there and accept that.”