Should State Pay for Convict's Sex Change?

But advocates, like John Knight, a staff attorney for the ACLU's Lesbian, Gay, Bisexual, Transgender and AIDS Project, argued that while the individual cost of treatment may seem high, the cost of denying the treatment could turn out to be even more expensive.

"If inmates are denied treatment, they can become depressed and suicidal. They can even engage in self-castration. ... those kinds of issues will end up costing the state a lot more in the long run," said Knight.

Knight argues the state is simply not allowed to deny "medically necessary" treatment to inmates. He says the need for that treatment must be determined by a medical professional, not by state legislators.

Edward Harrison, president of the National Commission on Correctional Health Care, agreed: "The dynamic that we struggle with on a daily basis is that the Constitution, the Supreme Court and many, many lawsuits say that we must provide adequate health care to inmates, and when we don't, there are bad outcomes. It can wind up in a lawsuit that can end up being tremendously expensive."

Of course, one person's "adequate health care" is another's "inappropriate expenditure" -- particularly when, says Tarr, many states "are struggling to balance the most basic elements of their budgets."

In just a few weeks, Kosilek will again be in court to make his latest bid for the state of Massachusetts to pay for his sex-change operation.

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