in California prisons without approval<\/span><\/h1>\n\n\n<\/div>\n\n\n- \n
![\"\"](\"http:\/\/cironline.org\/sites\/default\/files\/styles\/person-thumb-small\/public\/20110117-staff_cw_corey_johnson-0069web_color_toned.jpg\")
<\/a>\u00a0 By\u00a0Corey G. Johnson<\/span><\/a><\/strong><\/span><\/div>\n<\/li>\n<\/ul>\n<\/div>\n\n\u00a0<\/span><\/p>\n\n\n![\"Sterilization](\"http:\/\/cironline.org\/sites\/default\/files\/styles\/inline-large\/public\/california-institution-for-women-3-664px.jpg\")
<\/span><\/div>\n<\/div>\nThe California Institution for Women in Corona was one of two state prisons where female inmates were sterilized without required state approvals. At least 148 women received tubal ligations in violation of prison rules from 2006 to 2010.<\/span><\/strong><\/em><\/span><\/div>\n\nCredit:\u00a0Courtesy of the California Department of Corrections and Rehabilitation<\/span><\/strong><\/em><\/span><\/p>\n<\/div>\n<\/div>\n\u00a0<\/span>\u00a0<\/span><\/p>\nDoctors under contract with the California Department of Corrections and Rehabilitation sterilized nearly 150 female inmates from 2006 to 2010 without required state approvals, The Center for Investigative Reporting has found.<\/span><\/p>\nAt least 148 women received tubal ligations in violation of prison rules during those five years \u2013 and there are perhaps 100 more dating back to the late 1990s, according to state documents and interviews.<\/span><\/p>\nFrom 1997 to 2010, the state paid doctors $147,460 to perform the procedure, according to a database of contracted medical services for state prisoners.<\/span><\/p>\nThe women were signed up for the surgery while they were pregnant and housed at either the California Institution for Women in Corona or Valley State Prison for Women in Chowchilla, which is now a men\u2019s prison.<\/span><\/p>\nFormer inmates and prisoner advocates maintain that prison medical staff coerced the women, targeting those deemed likely to return to prison in the future.<\/span><\/p>\n![\"Crystal](\"http:\/\/kalamu.com\/neogriot\/wp-content\/uploads\/2013\/07\/female-inmate-01.jpg\")
<\/a>Crystal Nguyen, with her 6-year-old son, Neiko, in Pittsburg, Calif., is a former Valley State Prison for Women inmate. She worked in the prison’s infirmary in 2007 and says she often overheard medical staff asking inmates who had served multiple prison terms to agree to be sterilized.<\/strong><\/em><\/span>
Credit: Noah Berger\/For The Center for Investigative Reporting<\/strong><\/em><\/span><\/p><\/div>\n\u00a0<\/span><\/p>\nCrystal Nguyen, a former Valley State Prison inmate who worked in the prison\u2019s infirmary during 2007, said she often overheard medical staff asking inmates who had served multiple prison terms to agree to be sterilized.<\/span><\/p>\n\u201cI was like, \u2018Oh my God, that\u2019s not right,\u2019 \u201d Nguyen, 28, said. \u201cDo they think they\u2019re animals, and they don\u2019t want them to breed anymore?\u201d<\/span><\/p>\nOne former Valley State inmate who gave birth to a son in October 2006 said the institution\u2019s OB-GYN, Dr. James Heinrich, repeatedly pressured her to agree to a tubal ligation.<\/span><\/p>\n\u201cAs soon as he found out that I had five kids, he suggested that I look into getting it done. The closer I got to my due date, the more he talked about it,\u201d said Christina Cordero, 34, who spent two years in prison for auto theft. \u201cHe made me feel like a bad mother if I didn\u2019t do it.\u201d<\/span><\/p>\nCordero, released in 2008 and now living in Upland, Calif., agreed, but she says, \u201ctoday, I wish I would have never had it done.\u201d\u00a0<\/span><\/p>\nThe allegations echo those made nearly a half-century ago, when forced sterilizations of prisoners, the mentally ill and the poor were commonplace in California. State lawmakers officially banned such practices in 1979.<\/span><\/p>\nDuring an interview with CIR, Heinrich said he provided an important service to poor women who faced health risks in future pregnancies because of past cesarean sections. The 69-year-old Bay Area physician denied pressuring anyone and expressed surprise that local contract doctors had charged for the surgeries. He described the $147,460 total as minimal.\u00a0\u00a0<\/span><\/p>\n\u201cOver a 10-year period, that isn\u2019t a huge amount of money,\u201d Heinrich said, \u201ccompared to what you save in welfare paying for these unwanted children \u2013 as they procreated more.\u201d<\/span><\/p>\nThe top medical manager at Valley State Prison from 2005 to 2008 characterized the surgeries as an empowerment issue for female inmates, providing them the same options as women on the outside. Daun Martin, a licensed psychologist, also claimed that some pregnant women, particularly those on drugs or who were homeless, would commit crimes so they could return to prison for better health care.<\/span><\/p>\n\u201cDo I criticize those women for manipulating the system because they\u2019re pregnant? Absolutely not,\u201d Martin, 73, said. \u201cBut I don\u2019t think it should happen. And I\u2019d like to find ways to decrease that.\u201d<\/span><\/p>\nMartin denied approving the surgeries, but at least 60 tubal ligations were done at Valley State while Martin was in charge, according to the state contracts database.<\/span><\/p>\nMartin\u2019s counterpart at the California Institution for Women, Dr. Jacqueline Long, declined to discuss why inmates received unauthorized tubal ligations under her watch. But the Corona prison\u2019s former compliance officer, William Kelsey, said there was disagreement among staff members over the procedure.<\/span><\/p>\nDuring one meeting in late 2005, a few correctional officers differed with Long\u2019s medical team over adding tubal ligations to a local hospital\u2019s contract, Kelsey, 57, said. The officers viewed the surgeries as nonessential medical care and questioned whether the state should pay.<\/span><\/p>\n\u201cThey were just fed up,\u201d Kelsey said. \u201cThey didn\u2019t think criminals and inmates had a right to the care we were providing them and they let their personal opinions be heard.\u201d<\/span><\/p>\nThe service was included, however, and Kelsey said the grumbling subsided.<\/span><\/p>\nFederal and state\u00a0laws<\/span><\/a>\u00a0ban inmate sterilizations if federal funds are used, reflecting concerns that prisoners might feel pressured to comply. California used state funds instead, but since 1994, the procedure hasrequired approval<\/span><\/a>\u00a0<\/span><\/a>from top medical officials in Sacramento on a case-by-case basis.<\/span><\/p>\nYet no tubal ligation requests have come before the health care committee responsible for approving such restricted surgeries, said Dr. Ricki Barnett, who tracks medical services and costs for the California Prison Health Care Receivership Corp. Barnett, 65, has led the Health Care Review Committee since joining the prison receiver\u2019s office in 2008.<\/span><\/p>\n\u201cWhen we heard about the tubal ligations, it made us all feel slightly queasy,\u201d Barnett said. \u201cIt wasn\u2019t so much that people were conspiratorial or coercive or sloppy. It concerns me that people never took a step back to project what they would feel if they were in the inmate\u2019s shoes and what the inmate\u2019s future might hold should they do this.\u201d<\/span><\/p>\nJeffrey Callison, spokesman for the state corrections department, said the department couldn\u2019t comment because it no longer has access to inmate medical files.<\/span><\/p>\n\u201cAll medical care for inmates, and all medical files, past and present, are under the control of the Receiver\u2019s Office,\u201d Callison wrote in an email.<\/span><\/p>\nThe receiver has overseen medical care in all 33 of the state\u2019s prisons since 2006, when U.S. District Judge Thelton Henderson of the Northern District of California ruled that the system\u2019s health care was so poor that it violated the constitutional ban on cruel and unusual punishment.<\/span><\/p>\nThe receiver\u2019s office was aware that sterilizations were happening, records show.<\/span><\/p>\nIn September 2008, the prisoner rights group Justice Now received a written response to questions about the treatment of pregnant inmates from Tim Rougeux, then the receiver\u2019s chief operating officer.\u00a0The letter<\/span><\/a>acknowledged that the two prisons offered sterilization surgery to women.<\/span><\/p>\nBut nothing changed until 2010, after the Oakland-based organization filed a public records request and complained to the office of state Sen. Carol Liu, D-Glendale. Liu was the chairwoman of the Select Committee on Women and Children in the Criminal Justice System.<\/span><\/p>\nPrompted by a phone call from Liu\u2019s staff, Barnett said the receiver\u2019s top medical officer asked her to research the matter. After analyzing medical and cost records, Barnett met in 2010 with officials at both women\u2019s prisons and contract health professionals affiliated with nearby hospitals.<\/span><\/p>\nDuring those meetings, Barnett told them to halt inmate sterilizations. In response, she said, she got an earful.<\/span><\/p>\nThe 16-year-old restriction on tubal ligations seemed to be news to prison health administrators, doctors, nurses and the contracting physicians, Barnett recalled. And, she said, none of the doctors thought they needed permission to perform the surgery on inmates.<\/span><\/p>\n\u201cEverybody was operating on the fact that this was a perfectly reasonable thing to do,\u201d she said.<\/span><\/p>\nRisk factors<\/strong><\/span><\/p>\n\u00a0<\/span><\/p>\n\n![\"Sterilization](\"http:\/\/cironline.org\/sites\/default\/files\/styles\/inline-medium\/public\/valley-state-prison-for-women-664px.jpg\")
<\/span><\/div>\nAt Valley State Prison for Women in Chowchilla, Calif., the top medical manager from 2005 to 2008, Daun Martin, characterized tubal ligations as an empowerment issue for female inmates, providing them the same options as women on the outside.<\/span><\/span><\/div>\n\nCredit:<\/strong>\u00a0Courtesy of the California Department of Corrections and Rehabilitation<\/span><\/p>\n<\/div>\n<\/div>\n\u00a0<\/span><\/p>\nMartin, the Valley State Prison medical manager, said she and her staff had discovered the procedure was restricted five years earlier. Someone had complained about the sterilization of an inmate who had at least six children, Martin recalled. That prompted Martin to research the prison\u2019s medical rules.<\/span><\/p>\nAfter learning of the restrictions, Martin told CIR that she and Heinrich began to look for ways around them. Both believed the rules were unfair to women, she said.<\/span><\/p>\n\u201cI\u2019m sure that on a couple of occasions, (Heinrich) brought an issue to me saying, \u2018Mary Smith is having a medical emergency\u2019 kind of thing, \u2018and we ought to have a tubal ligation. She\u2019s got six kids. Can we do it?\u2019 \u201d Martin said. \u201cAnd I said, \u2018Well, if you document it as a medical emergency, perhaps.\u2019 \u201d<\/span><\/p>\nHeinrich said he offered tubal ligations only to pregnant inmates with a history of at least three C-sections. Additional pregnancies would be dangerous for these women, Heinrich said, because scar tissue inside the uterus could tear, resulting in massive blood loss and possible death.<\/span><\/p>\n\u201cIt was a medical problem that we had to make them aware of,\u201d Heinrich said. \u201cIt\u2019s up to the doctor who\u2019s delivering (your baby) \u2026 to make you aware of what\u2019s going on. We\u2019re at risk for not telling them.\u201d<\/span><\/p>\nFormer inmates tell a different story.<\/span><\/p>\nMichelle Anderson, who gave birth in December 2006 while at Valley State, said she\u2019d had one prior C-section. Anderson, 44, repeatedly was asked to agree to be sterilized, she said, and was not told what risk factors led to the requests. She refused.<\/span><\/p>\nNikki Montano also had had one C-section before she landed at Valley State in 2008, pregnant and battling drug addiction.\u00a0<\/span><\/p>\nMontano, 42, was serving time after pleading guilty to burglary, forgery and receiving stolen property. The mother of seven children, she said neither Heinrich nor the medical staff told her why she needed a tubal ligation.<\/span><\/p>\n\u201cI figured that\u2019s just what happens in prison \u2013 that that\u2019s the best kind of doctor you\u2019re going get,\u201d Montano said. \u201cHe never told me nothing about nothing.\u201d<\/span><\/p>\nMontano eagerly agreed to the surgery and said she still considers it a positive in her life.<\/span><\/p>\nDr. Carolyn Sufrin, an OB-GYN at San Francisco General Hospital who teaches at UC San Francisco, said it is not common practice to offer tubal ligations to women who\u2019ve had one C-section. She confirmed that having multiple C-sections increases the risk of complications, but even then, she said, it\u2019s more appropriate to offer women reversible means of birth control, like intrauterine devices or implants.<\/span><\/p>\n\u201cEvery C-section, every situation is different,\u201d Sufrin said. \u201cSome people with more prior C-sections have absolutely no problems and no risks.\u201d<\/span><\/p>\nHistory in eugenics<\/strong><\/span><\/p>\nTo be sure, tubal ligations represented a small portion of the medical care provided to pregnant inmates. Statistics and a report from the prison receiver\u2019s office show that from 2000 to 2010, 2,423 women gave birth while imprisoned in California, costing the state $2.7 million. Fewer than 1 in 10 were surgically sterilized.<\/span><\/p>\nBut the numbers don\u2019t tell the full story. California still grapples with an ugly past: Under compulsory sterilization laws here and in 31 other states, minority groups, the poor, the disabled, the mentally ill and criminals were singled out as inferior and sterilized to prevent them from spreading their genes.<\/span><\/p>\nIt was known as eugenics.<\/span><\/p>\nBetween 1909 and 1964, about 20,000 women and men in California were stripped of the ability to reproduce \u2013 making the state the nation\u2019s most prolific sterilizer. Historians say Nazi Germany sought the advice of the state\u2019s eugenics leaders in the 1930s.<\/span><\/p>\nIn 2003, the state Senate held two hearings to expose this history, featuring testimony from researchers, academics and state officials. In response, then-Attorney General Bill Lockyer and Gov. Gray Davis issuedformal apologies.<\/span><\/a><\/span><\/p>\n\u201cOur hearts are heavy for the pain caused by eugenics. It was a sad and regrettable chapter in the state’s history, and it is one that must never be repeated again,\u201d Davis said in a statement.<\/span><\/p>\nMissing from the hearings was the perspective of state prison officials. Then-Corrections Director Edward Alameida Jr. had informed the Senate committee that the prison system lacked records about sterilizations.<\/span><\/p>\n\u201cWhile obviously this was a dark chapter in our State\u2019s history, the CDC (California Department of Corrections and Rehabilitation) played a minuscule role,\u201d Alameida wrote in a\u00a0June 2003 letter<\/span><\/a>. \u201cThus our participation in your hearing would provide no substantial information on that role and I do not believe our presence would contribute in any way toward your objectives.\u201d<\/span><\/p>\nHowever, Alexandra Minna Stern, a professor at the University of Michigan and leading expert on California sterilization, cited state prison activity among the lingering questions from that era.\u00a0Stern testified<\/span><\/a>\u00a0during the hearings that she found in private hands and university archives evidence of 600 sterilizations at San Quentin State Prison prior to 1941 that were not included in official numbers.<\/span><\/p>\nCalifornia sterilizers, Stern told the committee, consistently viewed their work as humane and cost saving.<\/span><\/p>\n\u201cOne of the goals \u2026 and this is critical to understanding the history of eugenics in California \u2013 was to save money: how to limit welfare and relief,\u201d Stern told them, according to a transcript of her presentation. \u201cAnd sterilization is very much tied up in this.\u201d<\/span><\/p>\nSeeking patient consent<\/strong><\/span><\/p>\n <\/p>\n
![\"Former](\"http:\/\/kalamu.com\/neogriot\/wp-content\/uploads\/2013\/07\/female-02.jpg\")
<\/a>Former Valley State Prison for Women inmate Kimberly Jeffrey spends time with her son Noel, 3, at their San Francisco home. During her imprisonment in 2010, Jeffrey says a doctor pressured her to agree to be sterilized while she was sedated and strapped to a surgical table for a C-section. She refused.<\/strong><\/em><\/span>
Credit: Noah Berger\/For The Center for Investigative Reporting<\/strong><\/em><\/span><\/p><\/div>\n\u00a0<\/span>\u00a0<\/span><\/p>\nLawsuits, a U.S. Supreme Court ruling and public outrage over eugenics and similar sterilization abuses in Alabama and New York spawned new requirements in the 1970s for doctors to fully inform patients.<\/span><\/p>\nSince then, it\u2019s been illegal to pressure anyone to be sterilized or ask for consent during labor or childbirth.<\/span><\/p>\nYet, Kimberly Jeffrey says she was pressured by a doctor while sedated and strapped to a surgical table for a C-section in 2010, during a stint at Valley State for a parole violation. Jeffrey, 43, was horrified, she said, and resisted.<\/span><\/p>\n\u201cHe said, \u2018So we\u2019re going to be doing this tubal ligation, right?\u2019 \u201d Jeffrey said. \u201cI\u2019m like, \u2018Tubal ligation? What are you talking about? I don\u2019t want any procedure. I just want to have my baby.\u2019 I went into a straight panic.\u201d<\/span><\/p>\n
- \n
- \n<\/a>\u00a0 By\u00a0Corey G. Johnson<\/span><\/a><\/strong><\/span><\/div>\n<\/li>\n<\/ul>\n<\/div>\n\n
\u00a0<\/span><\/p>\n
\n\n<\/span><\/div>\n<\/div>\nThe California Institution for Women in Corona was one of two state prisons where female inmates were sterilized without required state approvals. At least 148 women received tubal ligations in violation of prison rules from 2006 to 2010.<\/span><\/strong><\/em><\/span><\/div>\n\nCredit:\u00a0Courtesy of the California Department of Corrections and Rehabilitation<\/span><\/strong><\/em><\/span><\/p>\n<\/div>\n<\/div>\n
\u00a0<\/span>\u00a0<\/span><\/p>\n
Doctors under contract with the California Department of Corrections and Rehabilitation sterilized nearly 150 female inmates from 2006 to 2010 without required state approvals, The Center for Investigative Reporting has found.<\/span><\/p>\n
At least 148 women received tubal ligations in violation of prison rules during those five years \u2013 and there are perhaps 100 more dating back to the late 1990s, according to state documents and interviews.<\/span><\/p>\n
From 1997 to 2010, the state paid doctors $147,460 to perform the procedure, according to a database of contracted medical services for state prisoners.<\/span><\/p>\n
The women were signed up for the surgery while they were pregnant and housed at either the California Institution for Women in Corona or Valley State Prison for Women in Chowchilla, which is now a men\u2019s prison.<\/span><\/p>\n
Former inmates and prisoner advocates maintain that prison medical staff coerced the women, targeting those deemed likely to return to prison in the future.<\/span><\/p>\n
<\/a>Crystal Nguyen, with her 6-year-old son, Neiko, in Pittsburg, Calif., is a former Valley State Prison for Women inmate. She worked in the prison’s infirmary in 2007 and says she often overheard medical staff asking inmates who had served multiple prison terms to agree to be sterilized.<\/strong><\/em><\/span>
Credit: Noah Berger\/For The Center for Investigative Reporting<\/strong><\/em><\/span><\/p><\/div>\n\u00a0<\/span><\/p>\n
Crystal Nguyen, a former Valley State Prison inmate who worked in the prison\u2019s infirmary during 2007, said she often overheard medical staff asking inmates who had served multiple prison terms to agree to be sterilized.<\/span><\/p>\n
\u201cI was like, \u2018Oh my God, that\u2019s not right,\u2019 \u201d Nguyen, 28, said. \u201cDo they think they\u2019re animals, and they don\u2019t want them to breed anymore?\u201d<\/span><\/p>\n
One former Valley State inmate who gave birth to a son in October 2006 said the institution\u2019s OB-GYN, Dr. James Heinrich, repeatedly pressured her to agree to a tubal ligation.<\/span><\/p>\n
\u201cAs soon as he found out that I had five kids, he suggested that I look into getting it done. The closer I got to my due date, the more he talked about it,\u201d said Christina Cordero, 34, who spent two years in prison for auto theft. \u201cHe made me feel like a bad mother if I didn\u2019t do it.\u201d<\/span><\/p>\n
Cordero, released in 2008 and now living in Upland, Calif., agreed, but she says, \u201ctoday, I wish I would have never had it done.\u201d\u00a0<\/span><\/p>\n
The allegations echo those made nearly a half-century ago, when forced sterilizations of prisoners, the mentally ill and the poor were commonplace in California. State lawmakers officially banned such practices in 1979.<\/span><\/p>\n
During an interview with CIR, Heinrich said he provided an important service to poor women who faced health risks in future pregnancies because of past cesarean sections. The 69-year-old Bay Area physician denied pressuring anyone and expressed surprise that local contract doctors had charged for the surgeries. He described the $147,460 total as minimal.\u00a0\u00a0<\/span><\/p>\n
\u201cOver a 10-year period, that isn\u2019t a huge amount of money,\u201d Heinrich said, \u201ccompared to what you save in welfare paying for these unwanted children \u2013 as they procreated more.\u201d<\/span><\/p>\n
The top medical manager at Valley State Prison from 2005 to 2008 characterized the surgeries as an empowerment issue for female inmates, providing them the same options as women on the outside. Daun Martin, a licensed psychologist, also claimed that some pregnant women, particularly those on drugs or who were homeless, would commit crimes so they could return to prison for better health care.<\/span><\/p>\n
\u201cDo I criticize those women for manipulating the system because they\u2019re pregnant? Absolutely not,\u201d Martin, 73, said. \u201cBut I don\u2019t think it should happen. And I\u2019d like to find ways to decrease that.\u201d<\/span><\/p>\n
Martin denied approving the surgeries, but at least 60 tubal ligations were done at Valley State while Martin was in charge, according to the state contracts database.<\/span><\/p>\n
Martin\u2019s counterpart at the California Institution for Women, Dr. Jacqueline Long, declined to discuss why inmates received unauthorized tubal ligations under her watch. But the Corona prison\u2019s former compliance officer, William Kelsey, said there was disagreement among staff members over the procedure.<\/span><\/p>\n
During one meeting in late 2005, a few correctional officers differed with Long\u2019s medical team over adding tubal ligations to a local hospital\u2019s contract, Kelsey, 57, said. The officers viewed the surgeries as nonessential medical care and questioned whether the state should pay.<\/span><\/p>\n
\u201cThey were just fed up,\u201d Kelsey said. \u201cThey didn\u2019t think criminals and inmates had a right to the care we were providing them and they let their personal opinions be heard.\u201d<\/span><\/p>\n
The service was included, however, and Kelsey said the grumbling subsided.<\/span><\/p>\n
Federal and state\u00a0laws<\/span><\/a>\u00a0ban inmate sterilizations if federal funds are used, reflecting concerns that prisoners might feel pressured to comply. California used state funds instead, but since 1994, the procedure hasrequired approval<\/span><\/a>\u00a0<\/span><\/a>from top medical officials in Sacramento on a case-by-case basis.<\/span><\/p>\n
Yet no tubal ligation requests have come before the health care committee responsible for approving such restricted surgeries, said Dr. Ricki Barnett, who tracks medical services and costs for the California Prison Health Care Receivership Corp. Barnett, 65, has led the Health Care Review Committee since joining the prison receiver\u2019s office in 2008.<\/span><\/p>\n
\u201cWhen we heard about the tubal ligations, it made us all feel slightly queasy,\u201d Barnett said. \u201cIt wasn\u2019t so much that people were conspiratorial or coercive or sloppy. It concerns me that people never took a step back to project what they would feel if they were in the inmate\u2019s shoes and what the inmate\u2019s future might hold should they do this.\u201d<\/span><\/p>\n
Jeffrey Callison, spokesman for the state corrections department, said the department couldn\u2019t comment because it no longer has access to inmate medical files.<\/span><\/p>\n
\u201cAll medical care for inmates, and all medical files, past and present, are under the control of the Receiver\u2019s Office,\u201d Callison wrote in an email.<\/span><\/p>\n
The receiver has overseen medical care in all 33 of the state\u2019s prisons since 2006, when U.S. District Judge Thelton Henderson of the Northern District of California ruled that the system\u2019s health care was so poor that it violated the constitutional ban on cruel and unusual punishment.<\/span><\/p>\n
The receiver\u2019s office was aware that sterilizations were happening, records show.<\/span><\/p>\n
In September 2008, the prisoner rights group Justice Now received a written response to questions about the treatment of pregnant inmates from Tim Rougeux, then the receiver\u2019s chief operating officer.\u00a0The letter<\/span><\/a>acknowledged that the two prisons offered sterilization surgery to women.<\/span><\/p>\n
But nothing changed until 2010, after the Oakland-based organization filed a public records request and complained to the office of state Sen. Carol Liu, D-Glendale. Liu was the chairwoman of the Select Committee on Women and Children in the Criminal Justice System.<\/span><\/p>\n
Prompted by a phone call from Liu\u2019s staff, Barnett said the receiver\u2019s top medical officer asked her to research the matter. After analyzing medical and cost records, Barnett met in 2010 with officials at both women\u2019s prisons and contract health professionals affiliated with nearby hospitals.<\/span><\/p>\n
During those meetings, Barnett told them to halt inmate sterilizations. In response, she said, she got an earful.<\/span><\/p>\n
The 16-year-old restriction on tubal ligations seemed to be news to prison health administrators, doctors, nurses and the contracting physicians, Barnett recalled. And, she said, none of the doctors thought they needed permission to perform the surgery on inmates.<\/span><\/p>\n
\u201cEverybody was operating on the fact that this was a perfectly reasonable thing to do,\u201d she said.<\/span><\/p>\n
Risk factors<\/strong><\/span><\/p>\n
\u00a0<\/span><\/p>\n
\n<\/span><\/div>\nAt Valley State Prison for Women in Chowchilla, Calif., the top medical manager from 2005 to 2008, Daun Martin, characterized tubal ligations as an empowerment issue for female inmates, providing them the same options as women on the outside.<\/span><\/span><\/div>\n\nCredit:<\/strong>\u00a0Courtesy of the California Department of Corrections and Rehabilitation<\/span><\/p>\n<\/div>\n<\/div>\n
\u00a0<\/span><\/p>\n
Martin, the Valley State Prison medical manager, said she and her staff had discovered the procedure was restricted five years earlier. Someone had complained about the sterilization of an inmate who had at least six children, Martin recalled. That prompted Martin to research the prison\u2019s medical rules.<\/span><\/p>\n
After learning of the restrictions, Martin told CIR that she and Heinrich began to look for ways around them. Both believed the rules were unfair to women, she said.<\/span><\/p>\n
\u201cI\u2019m sure that on a couple of occasions, (Heinrich) brought an issue to me saying, \u2018Mary Smith is having a medical emergency\u2019 kind of thing, \u2018and we ought to have a tubal ligation. She\u2019s got six kids. Can we do it?\u2019 \u201d Martin said. \u201cAnd I said, \u2018Well, if you document it as a medical emergency, perhaps.\u2019 \u201d<\/span><\/p>\n
Heinrich said he offered tubal ligations only to pregnant inmates with a history of at least three C-sections. Additional pregnancies would be dangerous for these women, Heinrich said, because scar tissue inside the uterus could tear, resulting in massive blood loss and possible death.<\/span><\/p>\n
\u201cIt was a medical problem that we had to make them aware of,\u201d Heinrich said. \u201cIt\u2019s up to the doctor who\u2019s delivering (your baby) \u2026 to make you aware of what\u2019s going on. We\u2019re at risk for not telling them.\u201d<\/span><\/p>\n
Former inmates tell a different story.<\/span><\/p>\n
Michelle Anderson, who gave birth in December 2006 while at Valley State, said she\u2019d had one prior C-section. Anderson, 44, repeatedly was asked to agree to be sterilized, she said, and was not told what risk factors led to the requests. She refused.<\/span><\/p>\n
Nikki Montano also had had one C-section before she landed at Valley State in 2008, pregnant and battling drug addiction.\u00a0<\/span><\/p>\n
Montano, 42, was serving time after pleading guilty to burglary, forgery and receiving stolen property. The mother of seven children, she said neither Heinrich nor the medical staff told her why she needed a tubal ligation.<\/span><\/p>\n
\u201cI figured that\u2019s just what happens in prison \u2013 that that\u2019s the best kind of doctor you\u2019re going get,\u201d Montano said. \u201cHe never told me nothing about nothing.\u201d<\/span><\/p>\n
Montano eagerly agreed to the surgery and said she still considers it a positive in her life.<\/span><\/p>\n
Dr. Carolyn Sufrin, an OB-GYN at San Francisco General Hospital who teaches at UC San Francisco, said it is not common practice to offer tubal ligations to women who\u2019ve had one C-section. She confirmed that having multiple C-sections increases the risk of complications, but even then, she said, it\u2019s more appropriate to offer women reversible means of birth control, like intrauterine devices or implants.<\/span><\/p>\n
\u201cEvery C-section, every situation is different,\u201d Sufrin said. \u201cSome people with more prior C-sections have absolutely no problems and no risks.\u201d<\/span><\/p>\n
History in eugenics<\/strong><\/span><\/p>\n
To be sure, tubal ligations represented a small portion of the medical care provided to pregnant inmates. Statistics and a report from the prison receiver\u2019s office show that from 2000 to 2010, 2,423 women gave birth while imprisoned in California, costing the state $2.7 million. Fewer than 1 in 10 were surgically sterilized.<\/span><\/p>\n
But the numbers don\u2019t tell the full story. California still grapples with an ugly past: Under compulsory sterilization laws here and in 31 other states, minority groups, the poor, the disabled, the mentally ill and criminals were singled out as inferior and sterilized to prevent them from spreading their genes.<\/span><\/p>\n
It was known as eugenics.<\/span><\/p>\n
Between 1909 and 1964, about 20,000 women and men in California were stripped of the ability to reproduce \u2013 making the state the nation\u2019s most prolific sterilizer. Historians say Nazi Germany sought the advice of the state\u2019s eugenics leaders in the 1930s.<\/span><\/p>\n
In 2003, the state Senate held two hearings to expose this history, featuring testimony from researchers, academics and state officials. In response, then-Attorney General Bill Lockyer and Gov. Gray Davis issuedformal apologies.<\/span><\/a><\/span><\/p>\n
\u201cOur hearts are heavy for the pain caused by eugenics. It was a sad and regrettable chapter in the state’s history, and it is one that must never be repeated again,\u201d Davis said in a statement.<\/span><\/p>\n
Missing from the hearings was the perspective of state prison officials. Then-Corrections Director Edward Alameida Jr. had informed the Senate committee that the prison system lacked records about sterilizations.<\/span><\/p>\n
\u201cWhile obviously this was a dark chapter in our State\u2019s history, the CDC (California Department of Corrections and Rehabilitation) played a minuscule role,\u201d Alameida wrote in a\u00a0June 2003 letter<\/span><\/a>. \u201cThus our participation in your hearing would provide no substantial information on that role and I do not believe our presence would contribute in any way toward your objectives.\u201d<\/span><\/p>\n
However, Alexandra Minna Stern, a professor at the University of Michigan and leading expert on California sterilization, cited state prison activity among the lingering questions from that era.\u00a0Stern testified<\/span><\/a>\u00a0during the hearings that she found in private hands and university archives evidence of 600 sterilizations at San Quentin State Prison prior to 1941 that were not included in official numbers.<\/span><\/p>\n
California sterilizers, Stern told the committee, consistently viewed their work as humane and cost saving.<\/span><\/p>\n
\u201cOne of the goals \u2026 and this is critical to understanding the history of eugenics in California \u2013 was to save money: how to limit welfare and relief,\u201d Stern told them, according to a transcript of her presentation. \u201cAnd sterilization is very much tied up in this.\u201d<\/span><\/p>\n
Seeking patient consent<\/strong><\/span><\/p>\n
<\/p>\n
<\/a>Former Valley State Prison for Women inmate Kimberly Jeffrey spends time with her son Noel, 3, at their San Francisco home. During her imprisonment in 2010, Jeffrey says a doctor pressured her to agree to be sterilized while she was sedated and strapped to a surgical table for a C-section. She refused.<\/strong><\/em><\/span>
Credit: Noah Berger\/For The Center for Investigative Reporting<\/strong><\/em><\/span><\/p><\/div>\n\u00a0<\/span>\u00a0<\/span><\/p>\n
Lawsuits, a U.S. Supreme Court ruling and public outrage over eugenics and similar sterilization abuses in Alabama and New York spawned new requirements in the 1970s for doctors to fully inform patients.<\/span><\/p>\n
Since then, it\u2019s been illegal to pressure anyone to be sterilized or ask for consent during labor or childbirth.<\/span><\/p>\n
Yet, Kimberly Jeffrey says she was pressured by a doctor while sedated and strapped to a surgical table for a C-section in 2010, during a stint at Valley State for a parole violation. Jeffrey, 43, was horrified, she said, and resisted.<\/span><\/p>\n
\u201cHe said, \u2018So we\u2019re going to be doing this tubal ligation, right?\u2019 \u201d Jeffrey said. \u201cI\u2019m like, \u2018Tubal ligation? What are you talking about? I don\u2019t want any procedure. I just want to have my baby.\u2019 I went into a straight panic.\u201d<\/span><\/p>\n