ISSUANCE DATE

EFFECTIVE DATE

NO.

21 MAR 11

64.5.43.0

COOK COUNTY, ILLINOIS

INTERAGENCY DIRECTIVE
SUBJECT

07 MAR 11
DISTRIBUTION

MANAGEMENT OF INMATES WITH
GENDER IDENTITY DISORDER

G

RELATED DIRECTIVES

I.

RESCINDS

AMENDS

PURPOSE
This Interagency Directive establishes guidelines and procedures for housing, clothing,
commissary, showering, grooming, recreation, programming, escort, transportation,
searches and other matters involving the custody and the safety and security of inmates
with gender identity disorder.

II.

POLICY
It is the policy of the Cook County Department of Corrections (CCDOC) to provide a
safe and secure environment for all inmates who identify themselves as transgender or
who are identified by Cermak Health Services of Cook County (Cermak) as having
gender identity disorder, and to uphold the respect and dignity of these, and all, inmates
at the CCDOC. This policy is a component of the CCDOC Prison Rape Elimination
(PREA) Policy and thereby requires zero tolerance for discrimination on the basis of
sexual orientation, including verbal or physical harassment or abuse of transgender
inmates by other inmates or by CCDOC employees.

III.

AUTHORITY
A.

United States Constitution, Eighth Amendment

B.

United States Constitution, Fourteenth Amendment

C.

Illinois Human Rights Act, 775 ILCS 5/1-102

D.

Prison Rape Elimination Act (PREA) of 2003

E.

Title 20, Section 701.70 Administrative Code, Classification and Separation

F.

American Psychiatric Association Diagnostic and Statistical Manual, Fourth
edition

G.

Health Insurance Portability and Accountability Act (HIPAA) of 1996

INTERAGENCY 64.5.43.0
IV.

AMERICAN CORRECTIONAL ASSOCIATION REFERENCE
4-ALDF-2A-25, 29, 30, 31, 32, 34
4-ALDF-6B-02

V.

DEFINITIONS
A.

Accommodation Plan – A plan constructed by the Gender Identity Committee
for an individual inmate with gender identity disorder that shall include
instructions regarding issues including, but not limited to housing, clothing,
showering, grooming, recreation, programming, escort, transportation, and
searches.

B.

Gender Identity or Gender-Related Identity – Gender identity is a person’s
internal sense of being male or female. It is not necessarily based on the
individual’s anatomical sex at birth or on the individual’s sexual orientation. An
individual’s gender identity is the result of genetics and environmental
influences. It may be manifested in appearance, behavior, or other aspects of the
person’s life.

C.

Gender Identity Disorder (also termed transsexualism) – Gender Identity
Disorder is a specific mental disorder, in which a person evidences all of the
diagnostic criteria for this condition, as listed in the Diagnostic and Statistical
Manual of Mental Disorders (DSM-IV):
1.

Strong and persistent desire to be a member of the opposite sex;

2.

Persistent discomfort with his/her sex or sense of inappropriateness in the
gender role of that sex;

3.

Clinically significant distress or impairment in social, occupational, or
other important areas of functioning;

4.

Absence of evidence for intersex.

D.

Intersex (also termed Disorder of Sexual Development or DSD and also,
in the past, hermaphroditism) - Intersex is a congenital condition in
which development of chromosomal, gonadal, or anatomical sex is
atypical. Gender identity disorder and intersex are separate and
distinct clinical entities. However, some individuals with gender
identity disorder may incorrectly represent themselves as intersex and
vice versa.

E.

Sexual Orientation – Sexual orientation is a pattern of sexual attraction to males,
females, both, or neither. Sexual orientation and gender identity are separate and
distinct concepts.

2

INTERAGENCY 64.5.43.0

F.

VI.

Transgender person – A transgender person is an individual whose gender
identity and outward gender expression differ from the physical characteristics of
his/her birth gender. A person can be transgender without meeting the criteria
and definition of gender identity disorder.

PROCEDURE
A.

Identification of Inmates with Gender Identity Disorder
If during the initial screening process, an inmate’s gender identity is in question
via verbal or written notification from the inmate or the arresting police agency,
or upon reasonable suspicion that the inmate has gender identity disorder or is a
transgender person; the following procedures are followed prior to the housing
assignment:

B.

1.

The inmate shall be separated and secured in a designated area from the
general population.

2.

The classification officer shall notify his/her supervisor.

3.

The classification officer or his/her supervisor shall present the inmate to
Cermak for evaluation by health staff.

4.

Cermak health staff shall proceed according to Cermak’s policy and
procedures (Cermak Policy G-02.9) for clinical verification of gender
identity, genital anatomy, and the status of any hormonal and/or surgical
interventions that may be underway as part of a gender transition.

5.

In any case where the inmate’s gender identity and genital anatomy are
clinically verified to be different than that reported by the arresting police
agency, the CCDOC shall notify the arresting police authority of any
misidentification of the individual immediately after the clinical
verification.

Gender Identity Committee
1.

The purpose of the Gender Identity Committee shall be to consider the
case of each inmate who is clinically verified as having gender identity
disorder and to recommend appropriate accommodations that shall be
made for the inmate with regard to housing, clothing, commissary,
showering, grooming, recreation, programming, escort, transportation,
searches and other matters. The Committee shall be composed of a
medical representative and a mental health representative, appointed by
the Cermak Chief Medical Officer, together with a member of the
CCDOC executive staff, appointed by executive director, the Sheriff’s

3

INTERAGENCY 64.5.43.0
Medical Advocate/designee, and the Superintendent of
Classification/designee.
2.

If members of the committee do not agree regarding recommendations to
be made for a particular inmate, the opinion of the majority shall be the
deciding opinion.

3.

The Committee shall retain summary notes of each meeting to document
persons attending the meeting and conclusions that have been reached.
One copy of these notes shall be maintained by the Committee and one
copy shall be placed in the inmate’s classification file in accordance with
(HIPAA) regulations.

4.

If and when persons are brought to the attention of the Gender Identity
Committee who do not meet clinical criteria for gender identity disorder,
the Committee shall proceed as follows:

5.

C.

a.

In the case of other clinical disorders relating to gender identity,
such as intersex, the Committee may opt to formulate
recommendations for an Accommodation Plan.

b.

In the case of non-clinical conditions relating to gender identity
and/or sexual orientation, such as homosexuality, the Committee
recognizes it has the same obligation to maintain the safety and
security of the inmates as it does all inmates at CCDOC.
Accommodations of such persons, if any, shall be under the sole
purview of CCDOC and its existing classification system.

In the event that the clinical definition and criteria for gender identity
disorder are changed by the American Psychiatric Association in its
Diagnostic and Statistical Manual of Mental Disorders, the Gender
Identity Committee shall recommend appropriate changes to this
Interagency Directive.

Accommodation Plan for an Inmate with Gender Identity Disorder
1.

The Gender Identity Committee shall meet within 72 hours of the clinical
verification that an inmate meets clinical criteria for the diagnosis of
gender identity disorder. In preparation for this meeting, the Sheriff’s
Medical Advocate shall meet with the inmate to solicit his/her
preferences and requests with regard to housing, clothing, commissary,
showering, grooming, recreation, programming, escort, transportation,
searches and other matters. The inmate’s preferences and requests shall
be considered but are not determinative.

4

INTERAGENCY 64.5.43.0
2.

At the meeting of the Gender Identity Committee, Cermak’s
representatives shall present clinical information pertinent to the
Committee’s charge. The Sheriff’s Medical Advocate shall present the
inmate’s stated preferences and requests with regard to the
Accommodation Plan. At the Committee’s discretion, this meeting may
also include direct conversations with the inmate and/or with treating
clinicians.

3.

The Gender Identity Committee shall then construct an Accommodation
Plan for each individual inmate with gender identity disorder based on
the physical and psychological findings on examination of that
individual, and based on safety and security issues relating both to that
individual inmate and to the inmate population at the CCDOC.

4.

The Accommodation Plan constructed by the Gender Identity Committee
for the individual inmate with gender identity disorder shall include
instructions regarding issues including, but not limited to, housing,
clothing, showering, grooming, recreation, programming, escort,
transportation, and searches.

5.

In its deliberations, the Gender Identity Committee must ensure that the
dignity and respect of the inmate with gender identity disorder are always
taken into consideration.

6.

The Gender Identity Committee shall notify the Assistant Executive
Director (or, outside of regular duty hours, the administrative duty
officer) in writing of its recommendations. The Assistant Executive
Director (or, outside of regular duty hours, the administrative duty
officer) shall in turn notify appropriate personnel at CCDOC. Cermak’s
representatives on the Gender Identity Committee shall notify appropriate
personnel at Cermak.

7.

The Gender Identity Committee shall meet to review the Accommodation
Plan as needed and at intervals of not more than every 3 months. More
frequent meetings may be mandated by individual inmate medical
concerns, inmate request, or any other concerns related to
Accommodation Plans. In preparation for this meeting, the Sheriff’s
Medical Advocate shall meet with the inmate to solicit his/her
preferences and requests with regard to housing, clothing, commissary,
showering, grooming, recreation, programming, escort, transportation,
searches and other matters. The Sheriff’s Medical Advocate shall then
present to the Committee a summary of the inmate’s expressed
satisfaction regarding the Accommodation Plan that has been in place.
Cermak’s representatives shall then present any follow-up clinical
information pertinent to the Committee’s charge. At the Committee’s

5

INTERAGENCY 64.5.43.0
discretion, this meeting may also include direct conversations with the
inmate and/or with treating clinicians.
D.

CCDOC Procedures For Following Recommendations of the Gender Identity
Committee
1.

The Assistant Executive Director (or, outside of regular duty hours, the
administrative duty officer) shall notify the superintendent of the division
where the inmate is to be housed of the recommendations made by the
Gender Identity Committee and the superintendent in turn shall notify
line staff.

2.

CCDOC personnel shall follow the recommendations outlined in the
inmate’s individual Accommodation Plan written by the Gender Identity
Committee for the housing, clothing, commissary, showering, grooming,
recreation, programming, escort, transportation, searches, and other
matters involving the custody and the safety and security of inmates with
gender identity disorder.

3.

If a CCDOC employee identifies a safety or security risk posed by the
Accommodation Plan recommended by the Gender Identity Committee,
he or she must inform the Gender Identity Committee directly, or must
notify his/her supervisor, and that supervisor must notify the Gender
Identity Committee, that the Accommodation Plan poses a safety or
security risk. The Gender Identity Committee shall review the case, and
shall make adjustments to the Accommodation Plan, if necessary. In the
case of an immediate threat to the safety or security of the inmate the
CCDOC employee or supervisor should notify the Assistant Executive
Director or designee for approval to make temporary change to
Accommodation Plan. The Gender Identity Committee must approve a
permanent change to the Accommodation Plan.

4.

An inmate with gender identity disorder shall be called by his/her last
name, consistent with CCDOC policy regarding inmates in general.

5.

An inmate with gender identity disorder shall be allowed to possess those
hygiene and personal items that may be purchased through commissary
that are consistent with the recommendations of the Gender Identity
Committee.

6.

To the extent that strip and pat-down searches are permitted for security
purposes, said searches of an inmate with gender identity disorder shall
only be made by correctional officers of the gender recommended by the
Gender Identity Committee.

6