Attorney: Manning not receiving hormone therapy

[DonViejo]

Source: ASSOCIATED PRESS

KANSAS CITY, Mo. (AP) — The American Civil Liberties Union and an attorney say convicted national security leaker Chelsea Manning isn’t receiving medical treatment for her gender identity condition as previously approved by Defense Secretary Chuck Hagel.

The ACLU and Manning’s civilian attorney sent a letter Tuesday to the U.S. Department of Defense and the federal military prison in Fort Leavenworth, Kansas threatening to sue if Manning does not receive treatment for gender dysphoria, the sense of being a woman in a man’s body.

Manning, who changed her name from Bradley after her conviction, is serving a 35-year sentence at Fort Leavenworth for giving WikiLeaks classified documents. She has asked for hormone therapy and to be able to live as a woman.

Messages seeking comment were left Tuesday for the U.S. Army and the prison.

###

Read more: http://www.salon.com/2014/08/12/attorney_manning_not_receiving_hormone_therapy/

[hlthe2b]

1. Seems pretty cut and dry--the treatment has been pre-approved.

[IronGate]

2. If it's been approved by SecDef Hagel,

then why is she not receiving the therapy?

[MADem]

6. I think I know why, but this is just a guess.

People who receive that kind of therapy are routinely transferred to federal prison, as Leavenworth doesn't house prisoners who are undergoing gender reassignment. Federal prisons, OTOH, do have facilities for people who are in a transitional therapy program.

Manning has indicated that she does not desire to be transferred to federal prison, she wants to stay at Leavenworth. Leavenworth, though, cannot accommodate housing patients undergoing this therapy.

That could be the Catch-22.

[msanthrope]

32. I predicted she'd have to move earlier in the year...like Butner or another

federal facility. Military prison is a cakewalk compared to the federal system.

[MADem]

36. It's closer to "restriction" that never ends, as opposed to

prison (for those military personnel who know what that means).

People at Leavenworth can have visitors every day, too, as opposed to the federal system which doesn't have such a liberal policy. The food is good, too, so I have heard--none of that green bolgna. Plus, the prisoners are incentivized to behave, to keep it mellow, to not be jerks to one another. There's lots of stuff to keep people busy, to work on an education, etc. There is a pecking order, and it goes by seniority, so I've been given to understand--but that seniority is more about time in the pen than paygrade!

Martha did OK in that prison they put her in--maybe somewhere like that would work. I think Chelsea could use a few mentors, though, so it would be preferable if the place she goes to has some transgender women who can help her adjust.

[msanthrope]

38. I dated enough military to know what that means. LOL

Butner has excellent medical facilities. Manning's crimes would not get him placed in a minimum security prison, however...I'd be surprised if BOP considered putting him anywhere but maximum, given his sentence.

[FarPoint]

3. Maybe Manning wants to refuse....

Its a huge choice to make...I understand.

[Yo_Mama]

4. Manning was supposed to be transferred to a civilian prison for the treatment

http://bigstory.ap.org/article/pentagon-oks-manning-transfer-gender-treatment

[MADem]

7. See upthread--Manning doesn't want a transfer, is what I read.

I think the bottom line is the Leavenworth just isn't going to oversee the treatment. If she wants the treatment, she's got to migrate to the federal prison system. I do not blame her for NOT wanting to do this--Leavenworth is PARADISE by comparison--one can have visitors every day, the food is good, the environment is pleasant, one can go to school, it's not overcrowded, it's clean and airy...who would want to swap that out for a federal prison?

Her lawyer is trying to insist that Leavenworth do this, but that's rather like insisting that a junior high nurse's office do open heart surgery. They don't have the expertise. There are facilities that can oversee the treatment in a professional way, they are appropriate for federal prisoners, to include military ones, and I don't think trying to push Leavenworth into doing this will succeed. It's a stand-off. Chelsea will either have to forgo treatment, or transfer to an appropriate facility to get it.

http://time.com/99591/chelsea-manning-doesnt-want-move-to-civilian-prison/

Chelsea Manning, the transgender soldier serving a 35-year sentence for leaking state secrets to WikiLeaks, has rejected a Pentagon plan to move her to a civilian facility in order to receive the hormone therapy she requested 10 months ago.

[Unvanguard]

9. It's just hormone therapy. Nothing like open heart surgery.

You don't need special facilities, you just need a doctor who knows what he or she is doing to prescribe a course of treatment. There's no reason it couldn't happen in a military prison. I think Manning's lawyer (quoted in the article) is right, it sounds like an attempt to pressure her to drop her demand.

[MADem]

10. That's not accurate. There's psychological counseling and medical issues that arise from the

hormone therapy.

Military doctors don't specialize in that kind of stuff. Leavenworth doesn't offer that therapy and they don't intend to start. Nor should they be required to offer it, for a single patient who can be treated elsewhere.

Bottom line--she can have the therapy. She has to transfer--as many military prisoners do, for other reasons--to a federal facility.

She doesn't want to do that. The only one stopping Manning from getting the therapy is Manning.

This isn't a surprise, either, before the therapy was approved, the word was put forth that it would entail a transfer.

[Unvanguard]

11. Still nothing like open-heart surgery. And still nothing that couldn't be done in a military prison.

You don't have to have a doctor on staff who specifically specializes in a kind of medical treatment to offer that medical treatment to prisoners; prisoners can be treated by non-prison doctors. I don't see any reason to think that a civilian prison is especially better suited to do this; they may have offered hormone therapy before (they have more prisoners so the probability it's an issue they would have faced is higher), but I doubt they have specialists in it either. On the other hand, given the widespread reluctance many officials have to give adequate medical care to trans people, and given the fact that I'm sure the Pentagon has no fondness for Chelsea Manning, it makes complete sense that they would use the threat of transfer (which is a dangerous threat, having to do with more than comfort or convenience--you're aware of the dangers facing trans women in prisons, right?) to deny her such adequate medical care.

[MADem]

14. And still nothing that military medicine is prepared to handle with the professionalism of those

who treat the condition regularly--and military practitioners treat the condition, well, NEVER.

The bottom line is the bottom line, here. Leavenworth is not the Hilton. It's a prison. The treatment is available at another federal prison if she wants it. She won't be the first, or only, prisoner at Leavenworth who is transferred to a federal prison. It happens frequently.

It's not a "threat" of transfer, it's a move to facilitate the treatment that Chelsea specifically requested.

Perhaps you do not realize that, right now, anyway, the military doesn't recruit or enlist trangender personnel? That should change, and it may well happen one day, but I'll wager Chelsea Manning will be a good way through her sentence before it does.

Final point--there are NO trans women in Leavenworth. None. There ARE trans women in federal prison, and that's where she would go, to a place that has the ability to administer the medications that she requires and that is alert to any problems resulting from the administration of those medications. Being treated at Leavenworth would likely leave her isolated, because I will bet the military would refuse to integrate her with female prisoners.

If the Pentagon wasn't accommodating her, her request would still be "under review." Instead, it was expedited. I think Chuck Hagel is doing the right thing, here, but it's not reasonable to demand that the Pentagon gin up a treatment protocol for a single, solitary prisoner when their counterparts in other federal prisons can provide a better, more experienced quality of treatment.

[MillennialDem]

24. As someone who is transgender and is on hormones, you are overcomplicating this

It's not rocket science. In fact, there are many people who in fact do "DIY hormones". I started mine with a doctor but since then I've done DIY. Though granted I'm only on a maintenance dose.

The only thing they really need to watch for is her getting a blood clot but that is not specific to hormones (many get them and they are treated the same way).

Other than that the only thing to mess around with is to start with a smaller dose and then increase it if results are not gained fast enough - but even a conservative dose is going to do something.

[MADem]

25. You seriously think the Army is going to permit "DIY" treatment of Ms. Manning?

Come on. There is what's called a "standard of care" and she deserves to have it.

If she died from one of those blood clots, the outrage would be extreme. They'd be accused of killing her and the conspiracy theorists would have a field day.

She deserves to have treatment from doctors who are experienced in delivering this kind of treatment, not "DIY" or "earn as you learn." And the military doesn't offer it, so her only recourse--and she's known about this for a half year, at least--is to go to a federal facility to get the treatment.

[MillennialDem]

27. I'm not saying they should allow DIY. I'm just saying that because of how simple it is

they can call in one outside endocrinologist to visit her once a year to prescribe a dose.

[MADem]

29. To visit her in her isolation cell?

They aren't going to let a pre-operative woman live with men, and they aren't going to let her live with the women, either.

If she gets treated there, she'll be stuck in solitary.

[MillennialDem]

30. Are you saying

It would be cruel to put her in solitary confinement because of hormones so they can't do it?

Or are you saying a doctor can't treat a prisoner in solitary?

[MADem]

33. I am saying that she isn't suicidal, she's not being segregated for her

protection (Leavenworth is a No-Drama correctional facility; it's a very different vibe from "pre-trial confinement" where people will act out, once they've been sentenced they know that they start to accrue a "report card" and it's in their interest to not get demerits), and she wouldn't be separated from the rest for misconduct--she would be segregated because the military would regard her as a male, because that is what the paperwork says, and once she starts the hormone therapy, that could be problematic for the other males in the dorm--that's why they won't leave her there. Because she's still a male on paper, she's not going in the female dorms. It's just not going to happen. She's stuck between two genders, for purposes of the military, anyway.

So, she will be placed, cruelly, with no medical reason such as suicidal ideation, into an environment where she has limited exposure to other people--unless a boatload of prisoners who are in her same situation suddenly appear at the facility. How likely is that, though?

Her lawyer should be pushing for a minimum security facility, something like the place where Martha Stewart did her time. That would probably work out well all around.

[MillennialDem]

35. Your last paragraph would be of course ideal. Comment on your other two paragraphs

Again as I said I'm trans - but I've been on hormones for a decade and have had breast implants and what is called facial feminization surgery. I made a personal decision to have a penis though, so I would be kept in a male prison if I were ever able to get into trouble. Of course I'm generally law abiding anyway other than having a lead foot so my criminal record consists of minor traffic violations. Anyway, having said all that - guilty of a felony or framed for one I didn't commit, I'd rather go into solitary than be forced to live as a man again. Just my perspective on it - I don't know if Ms. Manning feels the same way or not, but it's very possible she does.

[MADem]

37. Well, I understand that they've given her some female undergarments, but

that's about it. I think beyond that, they'd have to move her.

I think she's adjusted fairly well to the routine because you know that if she hadn't, we'd be hearing about it--there's no way that kind of word wouldn't get out.

I don't think she'd like solitary, though--she was segregated when she vocalized suicidal ideation during pretrial confinement, and they had to put her in the isolation unit with one of those packing blanket outfits (it's an all in one outfit that is your clothing AND your bedding, made out of that awful material that they use to wrap up your furniture when you move--it's impossible to tear so ya can't hang yourself with it). She didn't do very well in there at all and she was on the fifteen minute check routine. It's a catch 22--they have to insure the safety of the person, but the person gets no rest, and is exhausted, and more upset...a real mess of a circle.

I think her lawyer should bargain for the best federal facility that can be gotten, one with a good standard of living, because I don't think they are prepared to treat her at Leavenworth (for reasons of military regs as much as anything else) and they certainly don't want to leave her in the male dorm and they won't put her in the female one.

It's a difficult situation--refusing to provide the treatment is cruel, and solitary is cruel. For awhile there, the federal prison system was saying they didn't want her, too, so there was that to overcome. Of course, Obama could overcome many objections with a wave of his hand (but not the living situation--I don't think he'd go anywhere near that) but being alone for years at a time, with only visitors, sucks. I think she could probably do well at a women's federal facility if the right one could be found for her.

[LeftyMom]

52. It's not rocket surgery. The Planned Parenthood clinics here do it.

They can handle it as they would any other specialized medical need: learn, contract it out or bring somebody in to consult. Manning will not be their last trans charge, that she is the only one now is no excuse for ignorance of trans health care.

Transfering a high visibility inmate, whose notoriety and trans identity both place her at great risk, to a less secure facility out of a squeamishness about her gender is an irrational and needlessly dangerous option.

[MADem]

55. I don't see it happening. The standard of care would not be met.

The first time military medicine does anything, they tend to overdo it. I've seen this happen--they don't fart around, they go overboard on the protocols and pare it down after they've got some experience.

Leavenworth is not an overcrowded prison. I rather doubt that a crew of incarcerated people are going to step forward and demand to be screened for gender reassignment. They won't step forward from the non-incarcerated ranks because, if they did, they would be discharged as transgenders are currently "incompatible with military service." That's not me talking, them's the regs.

It has nothing to do with "squeamishness." It's culture, and while we may not like it, it moves at the speed of a mellow tortoise. Look how long it took to go from DADT to full repeal? When I warned that the DADT business would be a long road, many years ago, I got HAMMERED for my opinion, but I was right.

I know how that joint runs, from the field to the Pentagon and the Hill, the wheels grind slowly and fine.

The first time they take this medical procedure on--if they ever do (some procedures the military just doesn't do, they get farmed out, but we're not talking about prisoners, we're talking about service and family members)--they will do it "super right." They will be careful and they'll be overly concerned about T crossing and I dotting. But there has to be a place for transgender service personnel first, and there isn't at the present time.

I'm quite certain, too, that the "no trans" rule in the military will 'enjoy' the full scrutiny of the HASC as well, which is right now a GOP-run show. That will slow things down for a time, too. I can just see a few of the fundies on one of the subcommittees putting forth a "no funding for THAT procedure" caveat and attaching it to some Need-It-Now legislation.

I don't think Chelsea Manning is a flight risk (she's not in a high security section at Leavenworth, after all, she has a typewriter in her room, she works in the kitchen, and she spends a lot of time in the library) and the Martha Stewart prison, or one like it, is probably a good enough fit. No one beat up Martha, who was the ULTIMATE high viz inmate, and once she got to know the culture she thrived--as much as anyone could "thrive" in prison--there. She might not get her own typewriter in that place, though, or get a "good" job like the kitchen (access to the food, first).

[LeftyMom]

57. Look, this is your discomfort talking.

Yur post reeks of it. The problek isn't dispensing two common pills and running the occassional lab, the problem is the squeamishness of people like you.

[Yo_Mama]

51. That was my understanding - that the Pentagon would authorize the transfer

so that Manning could get treatment. The linked article doesn't say why, so thanks for your link!!!

But does Leavenworth have anyone really qualified? I would think the psych part is much more important for a prisoner. The situation has to be stranger and more stressful than for the average transgender.

[MADem]

53. I am not a medical professional, but I know that with the understanding of

PTSD and the push that the Services have towards enhanced mental health, that any military psychiatrist/psychologist would probably INSIST upon some kind of counseling. This is likely a hard enough evolution for a person to go through, even if they are motivated towards it, but to do it while berthed within a culture that has no experience, nor, at present, tolerance (at least in terms of recruitment) for transgender people (mainly due to lack of exposure, I suspect) would probably be difficult in the extreme. Add to that there's nowhere to put her, she's classified MALE for so long as she's in military custody, and her presence under hormone treatment would be disruptive in a male dormitory environment. She'd be isolated, alone. It would suck for her.

I'm sure she likes the facilities at Leavenworth and can't say I blame her, they are new, clean, lots to do, not brutally repressive, orderly but with opportunities for self-actualization, and low-key/no-drama. But it is "choice" time, I think--does she want to stay in the comfort of a known environment, or take the next step forward physically on her journey? Often rewards come with risks. She can get the therapy, but where she's at just ain't the place. At least that is how it's looking right now...

[Unvanguard]

5. It's well-established that denying hormone therapy to trans prisoners is unconstitutional.

If the military is stonewalling, that's contemptible.

[MADem]

8. She hasn't been denied. She just doesn't want to leave Leavenworth.

She could get the therapy immediately if she'd agree to a transfer to a place where they have doctors on staff to assist her appropriately. She doesn't want to leave Leavenworth.

[Adrahil]

12. Who's paying for this?

I mean, I'm all for Manning being able to live as she desires, but who's footing the bill for this? I have a friend undergoing gender reassignment right now, and I can tell you, it ain't cheap.

[Unvanguard]

13. If we don't want the government paying for the health care of people in prison

maybe we should imprison fewer people.

[Adrahil]

16. I won;t disagree with that, but....

... as far as I know, living as man wasn't causing Manning any serious issues. I certainly support her right to live as she wishes, but I think I might prefer that paying for elective treatment should maybe come from private funds.

[Unvanguard]

17. It's not an elective treatment. It's a medically necessary treatment.

And recommended as such by medical professionals, and understood as such by courts that have repeatedly rejected arguments like yours when employed to excuse governments from paying for hormone therapy. See, for example, this.

[Adrahil]

18. Why doesn't insurance cover it?

I'll tread lightly here, because I am a strong advocate of LBGT rights, and especially the rights of transgender people to live their lives as they choose, and the case you cite is certainly on-point.

But I do question the medical necessity of BEGINNING treatment in prison, rather than maintaining treatment for someone already under care.

[Unvanguard]

19. It's a complicated story. The short answer is that they're behind.

Medicare dropped coverage for transition-related care back in the 1970s and many private insurance companies followed their lead. The medical support for the treatment was less well-established then and simple anti-trans prejudice undoubtedly played a role. This has gradually been changing; Medicare just changed its policy with respect to surgery and some private insurers have been doing so too. And under laws that ban discrimination on the basis of gender identity, a few states have begun to require that insurance companies cover it. As you noted in your first post, the treatments are expensive, and it's not something most consumers will be concerned about, so it can be in the interest of insurance companies to deny coverage even if the medical case for coverage is strong.

As far as starting versus maintaining treatment, it can be medically necessary to start treatment if a person's untreated condition is sufficiently harmful, and it often is.

[Adrahil]

22. Has Manning had such a determination?

Has he had a doctor say, and a court accept that his treatment is medically necessary?

I mean, I know it can cause depression, but she is in prison.... she's bound to be a bit down in the dumps!

[Unvanguard]

34. You shouldn't have to file a federal lawsuit to get your legal rights respected.

But, yes, hormone therapy was medically recommended for her.

[Adrahil]

46. Elective treatment isn't an automatic right for Federal prisoners.

I personally think a lot of folks here are letting their personal sympathy for Manning cloud their judgment. I've been doing some research and their doesn't seem to be any consensus (at least yet) that such treatment is medically necessary.

Hmmm.... well, I hope she's able to get her treatment one way or another.

[Unvanguard]

47. Again, it's not elective treatment.

Personally, I feel much more strongly about the underlying issue (adequate health care for trans people, including incarcerated trans people) than I do one way or another about Manning. It doesn't matter how much sympathy you have for a prisoner; Manning aside, many people in prison have done horrible things and are not worthy of sympathy. But they are still entitled to their constitutional rights, and one of them is that prisons cannot simply ignore their serious medical issues and leave them untreated.

If you're interested in the facts about this particular case, see the ACLU's letter, which describes Manning's diagnosis, the treatment recommended for her, and the general medical standards for treatment.

[Adrahil]

59. Yes, I've seen that...

... but I don't think it's at all clear that there is a medical consensus that beginning such hormone therapy is non-elective. If there is, then clearly such persons are entitled to care, but I don't there is. The ACLU's letter doesn't really clarify that point.

Anyway, I'm in deeper on this than I feel. I hope Manning gets the treatment, and if I'm paying for it, I'm paying a lot more for asshole tea-partiers in Congress, so I'll live.

[ga_girl]

54. Insurance does cover transgender medical care

If the employer hasn't specifically declined that coverage. Medicare was moving to cover transgender services, but I'm not familiar what the current status of that change is. I'm not familiar what restrictions are in place under the ACA, if any, but I'd assume that if Medicare starts to pay, ACA will follow.

http://www.foxnews.com/politics/2014/05/30/medicare-coverage-ban-lifted-on-transgender-sex-change-surgery/
http://www.washingtonpost.com/national/health-science/ban-lifted-on-medicare-coverage-for-sex-change-surgery/2014/05/30/28bcd122-e818-11e3-a86b-362fd5443d19_story.html

For someone to transition Male to Female (MTF), the expenses other than surgery aren't that high. Basic hormone replacement therapy (HRT) is relatively inexpensive, blood work only needs to be done quarterly at the onset of treatment. The blood tests are standard Estrogen / Testosterone and are easily interpreted even by a lay person. You don't need a full blown endocrinologist to guide hormone therapy, a physician assistant is often used to prescribe & monitor.

A major part of transition is social - how a person dresses and interacts with others. I'd assume that that's going to be a major problem for Manning. Many transitioners use the services of a gender counselor, but that would easily be accomplished via Skype with an authorized person monitoring the conversations.

The physical changes that accompany transition are probably the most troublesome. HRT will cause breasts to develop, and I'm going to guess that Manning's slim body will make those changes very apparent. Being a military prisoner, I'd assume that military grooming standards are in effect, so growing hair out is probably not going to happen. Other changes will also add up, but some things won't change. HRT doesn't eliminate a male beard, nor will it eliminate a male adam's apple. Electrolysis to remove a beard is horribly expensive and is considered elective, so insurance doesn't cover it.

As for "the surgery", my corporate health insurance covers it. More and more companies are finding that the overall expenses aren't really that large, and with pressure from HRC to get high ranking on their employer survey, more companies are quietly adding gender transition coverage.

[Reter]

20. What if they didn't start the process yet?

Say someone is there for a year and then decides he wants to be a woman. Then should it be covered in prison?

[MillennialDem]

26. Yes - what difference does that make?

Trans people (I am one) live under serious distress before treatment but often somehow we carry on and hide our condition for a long time. I didn't start hormone treatment until the end of college - many people start much older than that.

There's a lot of shame, self denial, fear of being discovered or picked on or marginalized for it etc. Just because someone went into prison without having been treated doesn't mean they were perfectly happy living as a man at age 28 when they were put in jail or prison and then went into agony at 29. In fact I can't even imagine the guts it would take to admit that you were trans while in there...

[Reter]

58. The only problem I would have is the cost

I support you 100% and the difficulties you must have went through. There is no shame whatsoever. For a prisoner, however, when do we draw the line (if ever)?

Now I know it's not the same at all, but what if a woman is totally ashamed of her A cups, and emotionally distressed by them? Should that be covered? Or nose jobs if it is not to his or her liking?

Perhaps it should depend on the crime? Like not even consider it if it's for a double murderer doing life? It's a very interesting debate, and I'd love to hear more from you.

[MillennialDem]

60. Some thoughts

Well if a person has severe psychological distress by small breasts or an ugly nose or something like that and it is a persistent thing that is not transient then I can see doing it yeah - because that's what trans is all about. It's not "my body is not to my liking" it causes severe depression, anxiety disorders, and other psychological problems.

Of course you also must be careful with what you are stating... "I'm concerned with the cost because ____" you've set up a slippery slope. Why should a prisoner be given ANY treatment that isn't for life saving purposes? A broken hand costs money too, it's not going to kill the prisoner, and they can just wrap their hand with a bandage.

Lastly, hormones are very very cheap if you are concerned with the cost. Surgeries and hair removal are what costs the big bucks.

[MADem]

15. We. the people, are. nt

[NobodyHere]

48. The military would probably pay for it.

Afaik Manning is still technically an Active Duty soldier thus the military is responsible for her healthcare.

Military members don't get discharged until they go through a couple appeals.

[Sunlei]

21. Leavenworth will have to bring in a Doctor to treat the prisoner, or train one of theirs!

Can't one of their Doctors consult with other Doctors? That's done ALL the time.

[Adrahil]

23. I wouldn't think it would be hard....

... to get a doctor to come in, set up a treatment plan, and then have an on-site doc monitor it. But what is the medical necessity here? Has such a determination been made?

[msanthrope]

31. And where will she live? Leavenworth has no space for her if she undergoes

treatment.

[Sunlei]

41. 34 year sentence? The Military and the Gov. can find some space. They will have to learn to

deal with this medical treatment.

[msanthrope]

43. Um...no. They don't accept trangender personnel in the regular

services. They have offered him what other prisoners who need certain medical treatments have been offered....transfer to an appropriate prison.

[NobodyHere]

49. The only female prison the military has is near San Diego

Otherwise she would have to be transferred to a federal facility and I don't think the federal facilities have any obligation to take her.

[msanthrope]

50. She can't go to a female military prison...she will still have her male

genitalia, and thus, will not be allowed. The feds take military prisoners from time to time when there is a medical or psychological issue, as their facilities are much better developed.

[Calista241]

39. I view it the way I view hospitals.

Some hospitals specialize in trauma, some specialize in cancer, some specialize in infectious diseases. To get the best care, you go to the correct hospital. Hospitals transfer patients around all the time for just this reason.

Leavenworth, for whatever reason, does not offer support for gender reassignment. Other prisons do. If Manning wants this treatment, she should go to the facility that's best suited to her needs.

The liability involved in making a prison that doesn't have this capability to do it anyway would be extreme.

[Sunlei]

42. Our Military spends 300? billion a year on Veterans medical treatments. They will have to learn.

[Calista241]

44. The entire military cost $672B in 2013

The VA spent $140b in 2013. Medicare, Medicaid and HHS spent nearly $1T in 2013.

I would think prison healthcare is under Medicare / Medicaid but I could be wrong.

And why should the Army change their policy for a single soldier, when there are other, equally effective means to treat this patient elsewhere? You're talking about hiring multiple people at this facility to treat 1 person, in addition to all other associated expenses.

Adding personnel and consultants requires budgeting and review. That shit doesn't happen at the drop of a hat, especially not for our government.

[Sunlei]

45. Because the Army will have to learn to change, to accommodate our Vets health care.

The Army is in charge of Mannings proper care for the next 34 years. Even if treatment takes a day trip a week to accommodate the Vets hormone treatment. Or additional training for one of our Military Doctors. Or consultation with an experienced Doctor specialist.

[MADem]

56. The funding stream supporting prisons is not the same as the funding stream supporting veterans or

active duty personnel.

It's a different pot. May sound like nitpicking, but it isn't.

And right now, the condition of being transgender is "incompatible with military service." So it's unlikely that they'll do any learning in the near term. I suspect they'll come around eventually, but not before a lot of arguing and drama and foot-stomping and "Think of the children..." speeches on the floor of Congress...look how long it took DADT to cycle through and out?

Manning won't be eligible for VA access when she finishes her sentence, so "veteran's" medical treatment really isn't at issue here. The quality of her discharge obviates that possibility. Her medical care is "prisoner's" medical care. It's very good care, but it is what it is.