Providing prison inmates with adequate care for severe illnesses seems, if not commonsensical, than minimally humane; it is also mandated by 8th Amendment prohibitions on cruel and unusual punishment. If Kosilek were suffering from cancer, or from schizophrenia or another "major mental illness," even Scott Brown might not be offended by her request for treatment, and Kosilek would probably not have had to file a federal lawsuit to obtain it. Some may consider basic medical care for prisoners a form of coddling, but constitutional provisions requiring it are well established. Kosilek's case is controversial because of public skepticism about her illness and the extent of her suffering.
In fact, Judge Wolf found that state officials acted in bad faith to deny Koselik treatment for political, not penological, reasons. The judge found and stressed repeatedly that former Corrections Commissioner Kathleen Dennehy "engaged in a pattern of pretext, pretense, and prevarication" because she feared that providing sex change surgery to an inmate (particularly a convicted murderer) would "provoke public and political controversy, criticism, scorn, and ridicule."
She fabricated security concerns, "falsely claimed" not to know whether doctors "viewed sex reassignment surgery as medically necessary," and coordinated comments to the media with a state senator who sponsored legislation barring the use of tax dollars to provide sex reassignment surgery to inmates. In other words, she lied, shamelessly and repeatedly: "Dennehy testified untruthfully on many matters."
This is, after all, a shocking (if not surprising) case involving "an outrageous abuse of taxpayer dollars," but not for the reasons cited by Senator Brown. It's a shocking example of a morally corrupt official willing to waste a great deal of public money disingenuously litigating a legitimate demand for necessary medical treatment, in service to her political agenda.
But it's worth stressing that Dennehy was not alone in defying the state's obligation to provide inmate medical care. As the First Circuit Court of Appeals observed in Battista v Clarke, the Massachusetts Corrections Department had a habit of wrongly denying treatment to inmates with gender identity disorder. After prolonged litigation, convicted rapist Sandy Battista (who also tried to castrate himself) won a federal injunction requiring that she be treated with female hormones and given access to women's clothes, after the trial judge found that he could not trust state officials, perceiving in their behavior "a pattern of delays, new objections substituted for old ones, misinformation and other negatives."
Official resistance to treating transsexual prisoners may or may not lessen in the aftermath of the Kosilek case. Public opposition to Wolf's ruling is easily provoked. It's easy to sensationalize and misrepresent. Critics claim that it will lead to a rash of false gender identity disorder claims or frivolous lawsuits demanding other presumptively frivolous treatments, like cosmetic eyelid surgery.