When Kara Sternquist was arrested and jailed in MDC Brooklyn—a scandal-plagued federal detention center—she already had what a prosecutor described as “unique medical challenges.” After receiving surgery to address a spinal compression prior to her arrest, Sternquist was left with “very limited sensation in the bottom half of her body” and used devices like canes to walk, according to her attorney. She also was unable to use the toilet on her own and instead relied on a catheter, which needed to be replaced regularly.

Following her September 15 arrest, Sternquist initially did not see a doctor for 10 days, according to federal court transcripts reviewed by Mother Jones. That was merely the beginning of a series of medical failures, which ultimately resulted in her hospitalization with a life-threatening infection. While in custody, she faced issues accessing medications. And according to her lawyer, Sternquist—a transgender woman—was also repeatedly misgendered due to issues with how her identity was recorded in the jail’s IT systems, an apparent violation of federal prison rules.

“We are seriously concerned for Ms. Sternquist’s safety,” her lawyer, a federal public defender, wrote in a September 2022 court filing.

At one point, one of the numerous judges who has rotated through Sternquist’s case threatened to sanction the Department of Justice over the jail’s failure to obey a court order regarding her housing. In at least two other instances, judges issued orders regarding her medical care, but the jail failed to comply before the court-imposed deadlines had passed, according to court transcripts and documents.

Poor health care is not unusual for inmates at MDC Brooklyn, where one prisoner previously was left for two weeks with an untreated gunshot wound and others were denied access to medical equipment. A judge in Sternquist’s case even recalled releasing a potentially dangerous inmate because that inmate had received substandard care at the jail. One inmate died after being pepper sprayed by guards, and judges have expressed concern about the conditions of pregnant women held in the jail. In the winter of 2019, the jail went without heat and electricity for a week.

Sternquist has been charged with illegally possessing a firearm and fraudulent government ID badges. Mother Jones sent a detailed list of questions to the federal Bureau of Prisons, the agency within the Justice Department that oversees and operates MDC Brooklyn. A spokesperson declined to answer questions about the specific conditions of Sternquist’s incarceration but claimed that the bureau “provides essential medical, dental, and mental health services in a manner consistent with accepted community standards for a correctional environment.”

During her incarceration, two different judges ordered the jail to arrange for Sternquist to receive medical care, her lawyer told yet another judge in a September hearing. One of the orders, which is currently sealed, set a deadline mandating that Sternquist see a physician by September 23. But that medical appointment did not take place until September 26, three days after the deadline, her lawyer wrote in a legal filing. At that point, her lawyer said, Sternquist’s catheter was overdue to be replaced.

When Sternquist did receive medical care, her condition only worsened. The initial delay in replacing the catheter meant that when it was finally removed, Sternquist was left with what her lawyer described as an “abrasion” that made using the same type of catheter impossible. The jail then attempted to implant a different type of catheter. 

That attempt proved disastrous. The catheter’s “balloon was expanded at the wrong spot,” leaving Sternquist “in a tremendous amount of pain” and requiring her to be hospitalized in the emergency room with an infection, her lawyer said in a court hearing. On September 26, Sternquist was admitted to the hospital, where she was shackled to a bed. Although Sternquist’s mobility had been limited before her incarceration, she had still been able to walk using canes or other assistance, her lawyer wrote. But the infection left her unable to do that.

“My understanding is she cannot get out of her bed,” her lawyer said in a court hearing. “The records show that she is bedridden. I have visited her. She is in an extreme amount of pain. I don’t believe she can even sit up.” More than a month would pass before Sternquist, with the assistance of hospital staff, would be able to leave her bed and sit in a chair, her lawyer wrote in a later court document. 

The replacement of the catheter wasn’t the only instance in which the DOJ violated a court order related to Sternquist’s incarceration. On October 12, Sternquist’s lawyer wrote in a filing that Sternquist was unable to access three medications because the hospital did not have the medications in its pharmacy. Sternquist’s lawyer claimed that the hospital asked that either MDC staff or a friend or family member of Sternquist’s drop off the medications instead. However, the jail initially refused to provide the medications, according to Sternquist’s lawyer, and did not respond to a request to have Sternquist’s legal team or friends or family provide the medications.

Ultimately, on October 12, a judge issued an order directing MDC to provide the medications—which are used to treat depression—no later than the next day. Even so, as late as October 17, the jail had still not provided one of the three medications, according to a followup letter from Sternquist’s lawyer. The jail cited “logistical issues” in delivering medications to the hospital but eventually did provide all three drugs.

As a transgender woman, Sternquist was initially incarcerated in a men’s section of MDC. On September 22, a judge assigned to Sternquist’s case ordered that Sternquist be transferred to the women’s section of the jail by 4:00 pm that day. That order was initially disregarded by the government, which continued to house Sternquist in the men’s section, according to a later order issued by the judge.

That judge considered the jail’s inaction to be serious enough to warrant possible sanctions. The judge wrote that the government had proceeded “under the misapprehension that Court orders are advisory, treating them as if they are an opening motion to which they may respond and follow should they wish.” He threatened contempt sanctions against the DOJ. It was only after that threat that the jail assigned Sternquist to the women’s section of the facility, two days after the deadline in the initial order.

Transgender women housed in men’s prisons face a disproportionate risk of sexual assault. Transgender prisoners—including transgender men and nonbinary people—are also frequently subjected to abuses, such as the denial of medication, misgendering, and sexual assault, and have higher rates of solitary confinement than the general population. 

Federal prisons have a set of policies regarding the treatment of transgender inmates, which are laid out in the Transgender Offender Manual. While that document does not guarantee that transgender prisoners will be housed according to their gender identity, it does claim to offer some protections, such as a prohibition on “deliberately and repeatedly mis-gendering an inmate.”

The manual says that the Bureau of Prisons keeps track of transgender inmates by designating them according to two codes: “TRN M2F” and “TRN F2M.” (M2F and F2M are abbreviations for male-to-female and female-to-male, terms that LGBTQ advocates describe as “outdated.”)

The jail initially listed Sternquist’s gender as “Male” but also classified her as “TRN M2F” in a separate field different from her “top-line” gender classification. The jail is the only government body to have classified Sternquist as male, Sternquist’s lawyer said. In court, the government referred to Sternquist as a woman, and Sternquist’s gender was listed as female on her passport, her drivers license, and her New York City ID card. 

The jail’s classification caused problems during Sternquist’s hospitalization, Sternquist’s lawyer said, as the hospital relied on the “Male” identifier rather than the additional “TRN M2F” notation. Sternquist’s lawyer said this led to hospital and correctional staff misgendering Sternquist.

Although the prosecutor claimed that “if there are correctional staff or even marshal staff that are misgendering the defendant, that is unacceptable and a violation of BOP’s policy,” one of the judges in the case expressed concern that Sternquist would not be gendered correctly unless her documentation was updated. “If they go and they look at the records and what they see is male, then that is what they are going by, regardless of what the inmate looks like,” the judge said, according to a court transcript. “That affects treatment that she gets.”

Ultimately, a judge ordered the jail to change Sternquist’s classification to female. This time, the government complied with the order on time.

Sternquist was initially arrested for possessing dozens of fake identification badges and credentials for government agencies like the EPA and the Coast Guard. A search of her apartment allegedly led to the discovery of “four fully assembled firearms,” two of which the government says were automatic, as well as what the prosecution described as “inoperable firearms in various stages of construction.” Due to two previous felony convictions related to fraudulent identification documents, it is illegal for Sternquist to possess guns. She was ultimately indicted on two counts related to the IDs and one count of possessing a firearm as a felon. She has pleaded not guilty.

Prosecutors argued that Sternquist should be denied bail because of the nature of the charges, which, they said, suggested she was a “danger to the community.” In a bond motion, Sternquist’s lawyer wrote that her prior criminal history had been nonviolent and that she “needs regular physical therapy with a professional” in order to “recover fuller mobility in her legs.” Although one judge initially approved a bail package for Sternquist, a different judge overruled that determination.

Sternquist has since left the hospital and is currently being detained at a nursing center, where she is receiving physical therapy. In the most recent court hearing in her case, her attorney raised yet another issue with her confinement: the metal shackles she wears “essentially 24 hours a day.” The shackles were causing “abrasions” on Sternquist’s ankles, the lawyer said, because “with shackles on your leg, when you are sleeping, if you move at all, they can get tangled and cut into your leg.” 

The use of metal shackles for prisoners who are in medical facilities is a common practice, despite concerns that shackling can lead to injuries or poor medical care. Sternquist’s lawyer suggested that the shackles could be removed while Sternquist is lying in bed, since she is under continuous surveillance by two guards and is “only able to move with the wheelchair,” which is not stored near the bed.

A prosecutor countered that “the ankle bracelets are loosely fitted to allow for proper circulation of blood and as much comfort as possible under the circumstances” and wrote that the shackles were attached to a six-foot chain, in anticipation that Sternquist’s mobility might improve in the future. “As the defendant starts to regain mobility, this chain will allow the defendant the ability to get out of bed, walk a short distance around her bed, and even to do light exercise,” the prosecutor wrote. A judge allowed the shackles to remain in place.

Throughout Sternquist’s legal saga, however, judges have criticized the government for broader issues at the jail. One judge, while discussing Sternquist’s gender classification, said that “we are in the year 2022 and they are still living with technology and classifications from the 20th century” and suggested that the BOP could develop a system that better took into account the needs of transgender inmates.

The same judge took MDC to task for inadequately implementing landmark criminal justice reform legislation passed during the Trump administration. “I have to wonder what was the whole point of the First Step Act in 2018 that put the burden on BOP to develop better medical services and better psychiatric services and better educational services to inmates,” the judge said. “Apparently, none of that has come to fruition.” (A spokesperson for the Bureau of Prisons said the agency “continues to make progress in fully implementing the historic First Step Act.”)

A different judge, after reviewing the docket from Sternquist’s case, asked an MDC representative a simple question: “Why does it take this much?” Listing the various jurists who had been involved in the case, Magistrate Judge Lois Bloom expressed concern that “it took Judge Bulsara, it took Judge Komitee, it took Judge Levy, Judge Mann, Judge Reyes and myself in order for Ms. Sternquist to get the medication that she should have been receiving.”

Bloom also described a previous case in which a different inmate hadn’t received access to various medications. Bloom said that as a result of MDC’s failures, she had reluctantly ordered the government to release that inmate from jail so they could receive better care at a VA facility—despite having safety concerns about doing so.

It shouldn’t “be a death sentence to be put into MDC’s care,” Bloom added. “That people are having to go to the hospital doesn’t surprise anyone.”

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