Sen. Hannah-Beth Jackson photo

California Sen. Hannah-Beth Jackson, D-Santa Barbara, is one of the legislators who requested the state audit of female inmate sterilizations.Rich Pedroncelli/Associated Press

UPDATE, June 19, 2014: This story updates throughout with more details about the audit.

The California state auditor today blasted federal and state oversight of sterilization surgeries for female prison inmates, finding numerous illegal surgeries and violations of the state’s informed-consent law.

Of the 144 tubal ligations performed on inmates from fiscal years 2005-06 to 2012-13, auditors found, more than a quarter – 39 – were done without lawful consent, according to the report by State Auditor Elaine Howle. The “true number” of illegal procedures might be higher, the audit said, because auditors found seven cases at one hospital for which health records were lost in a routine purging.

The findings “made me sick to my stomach,” said state Sen. Ted Lieu, D-Redondo Beach, who was the first to call for the Medical Board of California to investigate the surgeries after The Center for Investigative Reporting broke the story nearly a year ago. That probe has not been completed.

Former inmates and prisoner advocates have claimed that prison medical staffers coerced the women, targeting those deemed likely to return to prison after they were released. The new audit notes that all women receiving tubal ligations in state prisons from 2005 to 2013 had been incarcerated at least once before. However, prison medical officials have denied any ill intent.

In addition, the audit found:

  • Inmates receiving tubal ligations typically were between 26 and 40 and had been pregnant five or more times before being sterilized. Fifty white women, 53 Latino women, 35 black women and six women classified as “other” received the procedure.
  • Most of the women tested at less than a high school level of reading proficiency, the report stated, with about one-third of the inmates who received the surgery reading below the sixth-grade level.
  • In 27 cases, the inmate’s physician – the person who would perform the procedure in a hospital or an alternate physician – did not sign the required consent form asserting that the patient appeared to be mentally competent and understood the lasting effects of the procedure and that the required waiting period had been satisfied.
  • There were 18 cases with potential violations of the required waiting period between when the inmate consented and when the surgery actually took place. State law mandates a 30-day wait to ensure patients aren’t pressured or rushed. The audit also found that some doctors falsified the consent forms, indicating the proper waiting period had passed when it clearly had not.  

The audit noted that the federal receiver’s office, which took over medical care in the state’s prisons in 2006, maintains that it has no legal duty to make sure prison employees comply with the consent procedures, which Lieu called “ludicrous.”

Liz Gransee, spokeswoman for the federal prison receiver, confirmed that the office’s lawyers disagree with the audit’s conclusions. Nonetheless, Gransee said the office will implement the audit’s recommendations. In the audit, the office says it has initiated staff training, among other measures.

Assemblywoman Bonnie Lowenthal, D-Long Beach, and Sen. Hannah-Beth Jackson, D-Santa Barbara, of the California Legislative Women’s Caucus had requested the state audit in August in response to CIR’s investigation.

Today, Jackson described the results as shocking.

“Based upon the auditor’s report, the problem is far more systemic,” she said. “We now have clear proof that the prison environment is an environment where consent simply cannot be obtained in a responsible, reliable manner for these procedures.”

Cynthia Chandler, an adjunct professor at the Golden Gate University School of Law and co-founder of the Oakland-based prisoner rights group Justice Now, called the report a good first step. She also called for state reparation for the women who were sterilized.

Justice Now has been raising questions about prison sterilizations since the early 2000s, after receiving medical reports and allegations of abuse from incarcerated women. 

“We were dismissed as heretics despite having evidence abuse and illegal sterilizations were occurring,” Chandler said. “This report feels like an incredible step and vindication for people who work toward challenging human rights abuses.”

The state auditor urged federal officials to forward the names of physicians involved in the illegal surgeries to the Medical Board and the state Department of Public Health for further investigation and disciplinary action. That would include 39 cases, 17 doctors and eight hospitals.

Lieu said he wants more action. He said he will ask the Medical Board to investigate nearly all of the sterilization cases on the basis that they were done without required state approvals. He also demanded a formal apology from the federal receiver’s office.

“The federal judiciary took over our state prison system, and they are responsible,” Lieu said. “These gross failures demonstrate again why the judicial branch is ill-equipped to run a large, complex prison system.” 

CIR’s investigation, published in July, found that 132 women received tubal ligations in violation of prison rules from 2006 to 2010. As many as 100 more women may have undergone questionable operations since the late 1990s.

CIR found that inmates were signed up for the surgery while pregnant at two women’s prisons that housed pregnant inmates: the California Institution for Women in Corona or Valley State Prison for Women in Chowchilla. Valley State became a men’s prison in 2013.

Federal officials have said none of the tubal ligations performed since 2006 received the required signoff by a state-level committee of medical professionals.

State prison data indicate that more than half the surgeries from 2006 to 2010 – 74 – were requested by Valley State. More than two-thirds of those requests came from Dr. James Heinrich, Valley State’s OB-GYN, 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.”

In response to the CIR’s investigation, Jackson introduced a bill that would ban all inmate sterilizations for birth control purposes. Under SB1135, such surgeries would be performed only during life-threatening emergencies and to cure physical illness.

Prisons performing sterilizations would be required to report annually the number of surgeries by race, age, reason and surgical method. The bill also provides legal protections for any personnel who report abuses.

The Senate approved the measure last month. It is now before the Assembly.

This story was edited by Amy Pyle and copy edited by Nikki Frick.

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Corey G. Johnson is a reporter on the government oversight team at The Center for Investigative Reporting. A native of Atlanta, Corey has exposed secrecy, mismanagement, corruption and abuse of power inside governmental, educational and police organizations. He was the lead reporter on CIR's On Shaky Ground series, which uncovered systemic weaknesses in earthquake protections at California public schools. That work was a finalist for a 2012 Pulitzer Prize and won the IRE Medal from Investigative Reporters and Editors, the Scripps Howard Award for public service reporting and the Gannett Foundation Award for Innovation in Watchdog Journalism. Before joining CIR, Corey covered higher education at The Fayetteville Observer in North Carolina. He is a graduate of Florida A&M University.