California will become the first state to cover the cost of a transgender inmate’s gender-affirming surgery after the state Department of Corrections reached a settlement on Friday agreeing to pay for the care.

Shiloh Quine, a transgender woman who started her sentence in a men’s prison in 1980, has been living openly as a woman since 2008 and began hormone therapy a year later. In the 35 years Quine has been incarcerated, she has attempted suicide multiple times, most recently in 2014 after prison officials denied her request for surgery.

“I’m in severe pain,” Quine wrote in an appeal, according to the Los Angeles Times. “I feel tortured.”

Multiple medical and mental health professionals argued that surgery was medically necessary for Quine, and a way to treat gender dysphoria and relieve her depression.

“After years of unnecessary suffering, Shiloh will finally get the care she desperately needs—and transgender people nationwide will hear a state government affirm that our identities and medical needs are as valid as anyone else’s,” said Kris Hayashi, executive director of the Transgender Law Center, which represented Quine.

The settlement on Friday was preceded by a court decision earlier this year, in which the same district court judge who presided over Quine’s case ruled that a different transgender woman in prison, Michelle Norsworthy, should have her gender alignment surgery covered by the state.

But Gov. Jerry Brown’s office announced on Friday that Norsworthy will be paroled, likely meaning she will not have the surgery covered and making Quine the first to receive such care.

The state’s settlement says that Quine will be referred to a surgeon “as promptly as possible,” and that she will be transferred to a women’s prison once the surgery is complete.

Of the 400 transgender inmates currently receiving hormone therapy in California, only one transgender woman is incarcerated in a women’s prison, according to the Los Angeles Times.