A prison doctor investigated by the California medical board after ordering tubal ligations without state approval is responsible for hundreds of other inmate sterilizations, The Center for Investigative Reporting has found.
Dr. James Heinrich also has a history of medical controversies and expensive malpractice settlements both inside and outside prison walls. Female patients have accused him not just of trying to dictate their reproductive decisions, but also of unsanitary practices and botched surgeries that injured them and their infants.
Despite that history, Heinrich was not only hired by the prison system, but also kept on once a federal judge appointed a receiver to clean up the prison’s medical system.
Heinrich, 69, retired from Valley State Prison for Women in 2011 after six years, during which his total annual pay reached a high of nearly $237,000. Federal authorities rehired Heinrich as a contract physician, and he continued treating inmates at Valley State though December 2012. Since then, he has not worked at the prison. During a previous interview, Heinrich blamed a bad hip.
An earlier CIR investigation, published in July, found that more than 100 tubal ligation surgeries took place without the required state approval from 2006 to 2010. At the time, prison documents indicated there were 148 of those surgeries. Analysis of subsequent data and documentation provided under the state Public Records Act shows there were 132 because some were double counted.
The women were signed up for the surgery, also known as getting one’s tubes tied, while pregnant at the two women’s prisons that house pregnant inmates: the California Institution for Women in Corona or Valley State in Chowchilla. Valley State became a men’s prison in 2013.
Newly obtained state prison data indicates that more than half of those surgery referrals – 74 – were made at Valley State. None received signoff by a state-level committee of medical professionals, required since 1994 to prevent unnecessary surgeries and costs in prison. And more than two-thirds of those referrals came from Heinrich or a nurse on his staff, according to the prison’s medical service request records.
Heinrich previously told CIR that the money spent sterilizing inmates was minimal “compared to what you save in welfare paying for these unwanted children – as they procreated more.”
The fuller profile of Heinrich before and during his time at Valley State emerged from interviews with nine women and a review of hundreds of pages of court and medical records, confidential prison documents, and computerized contracting and cost data obtained under the California Public Records Act.
In addition to tubal ligations, Heinrich arranged other types of sterilizations 378 times at Valley State Prison from 2006 to 2012, according to the data. These included hysterectomies, removal of ovaries and a procedure called endometrial ablation, which destroys the uterus’s lining.
Although these sterilizations are not banned in California prisons, the quantity attributed to Heinrich ultimately caused federal administrators to take note, said Dr. Ricki Barnett, who oversees medical services and costs for the federal receivership.
The California Department of Corrections and Rehabilitation hired Heinrich in December 2005 to head obstetrics and gynecology at Valley State. A few months later, U.S. District Judge Thelton Henderson of the Northern District of California appointed a receiver to take over inmate health care after ruling that the state’s medical treatment of prisoners was so poor that it violated the constitutional ban on cruel and unusual punishment.
Overall, the number of sterilization surgeries sharply increased after Heinrich joined the prison system and the federal court began oversight.
One year after Heinrich’s hire, Valley State arranged for 23 inmates to have their tubes tied – the most ever for a California women’s prison in a single year since 1997, the earliest year for which prison sterilization statistics are available. From 2006 to 2008, Valley State averaged 150 sterilization surgeries of all types annually – six times that of the Central California Women’s Facility, the largest women’s prison in the state.
Heinrich would not talk to CIR for this story despite multiple requests by phone, email and in person at his home. His attorney, Ronald B. Bass of Walnut Creek, said he couldn’t comment on Heinrich’s role in the increased number of sterilizations because he hadn’t seen the data underlying CIR’s findings. However, Bass insisted that Heinrich followed proper medical procedures and standards. In a letter, he said the likely reason for the spike was that Heinrich “saw more patients in an effort by the State to provide better care.”
In response to CIR’s initial reporting, the federal receivership decided to bar Heinrich from future prison work, according to spokeswoman Joyce Hayhoe. State lawmakers held two hearings in August and ordered the Medical Board of California and California State Auditor to investigate the situation.
The medical board will not disclose the targets of its investigation or whether a review is ongoing. Bass said his client inquired in November and was told he was not under review.
Crystal Nguyen, a former Valley State inmate who worked in the prison infirmary, received a letter in August asking her to participate. “The Medical Board is currently examining Dr. Heinrich’s patient care,” it said.
When the investigator called in September, she said, he wanted to know what Heinrich said to inmates and his typical practices. He also asked her who else might have information to share, Nguyen said.
“He seemed very interested,” she said.
Nguyen had many names to offer, she said, because Heinrich’s habits, like eating while conducting vaginal exams, were well known not just by inmates, but also by staff, who she said felt powerless to force him to change. Nguyen said she experienced those habits firsthand during her pregnancy at Valley State.
“He would be eating popcorn all the time. Popcorn, cheese and crackers. And he would be examining while he would be eating,” she said. “And to me, that’s not hygienic. … It was gross. It just creeped me out.”
To protect against infections, state and federal safety rules ban health care professionals from having food and drink in areas where patients are treated.
In 2009, Heinrich admitted in a court deposition that he had eaten in the exam room while inmates were present. However, today, through attorney Bass, Heinrich denies that. Heinrich ate there between seeing patients, Bass said, and only because the prison didn’t provide an alternative space.
“If Dr. Heinrich skipped lunch, his performance could suffer in that skipping meals can lead to reduced concentration,” Bass said.
Nguyen said there was a break room used by the medical staff that was close to Heinrich’s desk. It was equipped with a sink and refrigerator that Nguyen said she sometimes helped clean.
Pushing procedures
Several former inmates told CIR that Heinrich pushed hysterectomies and other sterilizing surgeries during routine visits, often giving misleading information about the medical reasons.
Tamika Thomas, 36, of Stockton saw Heinrich in 2006, during a stint at Valley State for assault with a deadly weapon. Thomas said she wanted birth control to better regulate her menstrual cycle.
Heinrich refused, instead recommending surgery that would stop the bleeding entirely by heating the inside of her uterus. Thomas claims Heinrich never told her the surgery would sterilize her. Thomas agreed to the procedure and has regretted it since, she said.
Bass dismissed Thomas’ contention, saying she would have learned about the sterilizing effects of the procedure from at least one of the medical providers or from the consent forms.
“The private surgeon would not have operated unless he was convinced that the procedure was medically appropriate,” Bass said. “It would be incredible if two specialists both neglected to mention that endometrial ablation surgery led to sterilization.”
Reflecting back, Thomas said Heinrich’s comments during her initial visit should have raised alarms.
“I remember Heinrich asking me if I had children,” Thomas said. “When I told him I had two boys, his face changed. It got red, and he said to me, ‘That’s too many.’ ”
Former inmate Kimberly Jeffrey previously told CIR that she refused tubal ligation offers from Heinrich’s staff at Valley State and later at a local hospital while on the operating table for a C-section birth. But it was a run-in with Heinrich three years earlier that Jeffrey said toughened her resolve.
During a sentence at Valley State for petty theft that began in 2007, Jeffrey said she went to Heinrich for help with heavy menstrual bleeding. While there, Jeffrey said he recommended an immediate hysterectomy, saying she had tumors the size of grapefruits in her womb. Jeffrey was skeptical – and refused.
“He kept telling me that I had to do it now and why wait,” Jeffrey remembered. “I asked for other options, like shrinking them or getting surgery to remove them. He told me that it wasn’t an option.”
Medical notes written by Heinrich in September 2008 show that he concluded that a fibroid was the source of Jeffrey’s bleeding. An outside specialist’s report on Jeffrey’s Sept. 12, 2008, ultrasound, however, found “no definitive lesion such as fibroids.”
The report includes Heinrich’s initials and a Sept. 23 time stamp. Nevertheless, Heinrich and staff continued todiagnose Jeffrey as having fibroids during medical visits on Oct. 6 and Oct. 10.
“There were a lot of people (in prison) whispering that Heinrich was taking all the lifers’ uteruses,” Jeffrey said. “So when he tried to take mine, I was, like, ‘Whoa. He’s really spooky.’ ”
Bass said medical privacy laws prevent Heinrich from responding to Jeffrey’s allegations. However, Bass insisted that Jeffrey’s refusal of the hysterectomy proved Heinrich didn’t coerce her. He also said that Jeffrey saw an outside specialist because Heinrich recommended it.
Former inmate Cheryl Lee Ann Miller said she had a long and positive patient-doctor relationship with Heinrich that started in the 1980s, when he was in private practice in Fairfield. A mother of three, Miller had been in and out of prison while battling drug addiction. When she arrived at Valley State and saw Heinrich, he immediately remembered her and treated her kindly, Miller said. He readily supplied her with birth control, she said, and didn’t discuss or suggest sterilization.
“I never had a problem with him,” Miller said. “He never asked me to consider sterilization; that’s why I was surprised to hear that was happening.”
Official investigations
Federal officials took control of inmate health care at all 33 state prisons in 2006, then hired experts at UC San Diego to reassess and purge medical employees who didn’t measure up to high standards. Many prison doctors, nurses and assistants lost their jobs. Heinrich was not among them.
By late 2007, however, federal officials discovered problems with Heinrich’s care.
A team of federal examiners visited Valley State to investigate the death of two inmates’ babies during childbirth. They found one newborn died, in part, because Heinrich, staff and another prison doctor each gave the mother the wrong prenatal medicine. The other death, the team concluded, resulted from Heinrich failing to perform a routine prenatal test for bacteria, according to court documents.
Heinrich maintained in his written summary of the case and via his attorney, Bass, that the test was overlooked because the inmate had numerous unscheduled medical visits with emergencies that required immediate attention.
However, depositions of Heinrich and others on his staff, taken by lawyers for the child’s mother, established that the inmate wasn’t in critical condition during every visit. She also was given numerous other tests, the testimony revealed.
Heinrich and his office created a correction plan pledging to change in January 2008.
In 2010, the attorney general’s office and the state prison system filed documents acknowledging that Heinrich had been negligent. The state paid the woman $150,000 to settle the claims against Heinrich, documents show.
State law requires malpractice settlements of $30,000 or more to be reported to the state medical board, so officials can review the medical care and decide whether the doctor involved is competent to practice.
However, the receivership didn’t report the settlement to the medical board until questioned recently by CIR. In an emailed statement, Liz Gransee, spokeswoman for the receivership, said the office should have told the medical board, but prior to 2011, no one was assigned to do so.
If penalized, the maximum penalty the receivership could face for failing to report settlements is a $5,000 fine.
Prison officials also investigated Heinrich in 2008 after then-inmate Michelle Diaz accused him of unprofessional and unsanitary behavior during a Pap smear.
According to Diaz, it happened during a visit to get treatment for irritation near her genitals. Diaz, 36, told Heinrich the discomfort was outside her vagina, but Heinrich inserted his fingers inside her. Diaz noticed Heinrich wasn’t wearing a glove and exploded in anger. Then without warning, Heinrich applied a burning chemical to her vaginal area.
Diaz filed a complaint against Heinrich on March 28, 2008, which prompted prison officials to question the medical staff. One of Heinrich’s regular nurses confirmed that Heinrich didn’t warn Diaz before treating her, according to confidential notes of the interview that became public as part of a federal lawsuit.
The nurse also said it was Heinrich’s practice to use one glove, not two, when doing vaginal exams. Using one glove is not considered a standard practice. After treating Diaz, Heinrich took off the one glove, looked at some medical records, then ate food – without washing his hands or using hand sanitizer, the nurse said.
State and federal safety rules require hand-washing immediately or as soon as possible after the removal of gloves or following contact with body areas with blood or potentially infectious materials.
Those rules, which are designed to stop infections and the spread of disease, also mandate that health care workers wear gloves when it is “reasonably anticipated” the hand may come in contact with blood, other potentially infectious materials, nonintact skin and mucus membranes. The rules don’t specify one or two gloves.
However, Dr. Carolyn Sufrin, an OB-GYN at San Francisco General Hospital who teaches at UC San Francisco, said it is not common to perform a Pap smear with one glove.
“I don’t do it,” Sufrin said. “I don’t know any colleagues that do it.”
Prison officials concluded that Heinrich violated policy and that he should have warned Diaz about the chemical procedure, a May 2008 memo filed in court records shows.
Dr. Pal Virk, Valley State Prison’s chief medical officer at the time, met with Heinrich and reminded him about “appropriate hygiene issues” and the need to communicate with inmates, the memo stated. But no further action was recommended against Heinrich, and he was allowed to continue to see patients.
He was not disciplined by federal officials, Bass said. And one day after his 2011 retirement, Heinrich returned to the prison as a contractor, court records show. Upon his return, Heinrich continued to order sterilizations, records show, and was responsible for training his replacement physician at the prison.
Lawsuits in private practice
Other controversies dogged Heinrich in the years prior to joining the state prison.
From the mid-1990s to 2004, Heinrich paid $342,000 in legal settlements related to claims of negligence and incompetence during surgeries and deliveries at NorthBay Medical Center in Fairfield. One payout of $55,000 occurred when a former patient accused Heinrich of severing her bowels during a hysterectomy.
Lawsuits are common among OB-GYNs because of the sensitive nature of their work. Numerous studies show they have the highest litigation rates among all medical professionals.
Bass said those settlements don’t adequately represent the quality of Heinrich’s care. He said he believed that Heinrich was responsible for about 8,000 procedures over his career, which meant “99.875 percent” of his work didn’t lead to lawsuits. Bass added that Heinrich never had his hospital privileges revoked and that he was a well-regarded physician who always passed his specialty exams.
“My conclusion is that Dr. Heinrich had an approximately average claims experience compared to other competent insured OB-GYN’s,” Bass said in a written statement. “Dr. Heinrich is a very competent doctor and surgeon who has earned the respect of his peers over a long career caring for expectant mothers and other women, including many of them in need.”
Still, inmate advocates question whether Heinrich’s history should have given prison officials pause before they hired him.
Settlements of $225,000 and $62,000 went to two families after Heinrich failed to show up during births. Both children experienced dangerous complications during delivery and were born with permanent nerve damage and loss of movement in their arms.
Suzzanne Black, who received the $225,000 settlement, said Heinrich rarely had time to see her in 1995 because he was shuttling so many people in and out. She compared his private practice to an assembly line.
“I came from the very, very best care in Anchorage (Alaska) to the very, very worst in California,” Black said. “He treated me like a cow.”
CIR asked the state prison system whether officials were aware of Heinrich’s past medical settlements before he was hired. State officials declined to comment, citing personnel privacy laws.
Chavala Madlena contributed to this story. It was edited by Amy Pyle and copy edited by Nikki Frick and Christine Lee.
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