Over a five-year period between 2006 and 2010, doctors under contract with the California Department of Corrections and Rehabilitation sterilized nearly 150 female inmates without the required state approval.

The series of tubal ligations over the five-year period compound some 250 surgeries dating back to the late 1990s, the Center for Investigative Reporting (CIR) has found. While doctors involved with the surgeries claim each patient was offered the choice to undergo the procedure, some inmates claim they were only asked while on the operating table and sedated, a behavior the CIR states has been illegal since the late 1970s.

One of the primary concerns falls on the issue of intent, according to Dr. Ricki Barnett, who tracks medical services and costs for the California Prison Health Care Receivership Corp. and has led the Health Care Review Committee since joining the prison receiver's office in 2008.

"When we heard about the tubal ligations, it made us all feel slightly queasy," Barnett said. "It wasn't 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's shoes and what the inmate's future might hold should they do this."

Dr. James Heinrich, an OB-GYN at California's Valley State Prison, has received considerable flak in the matter, as he believed the surgeries were products of emergency situations. The 69-year-old Bay Area physician denied pressuring anyone and expressed surprise that local contract doctors had charged for the surgeries, he told the CIR. The state paid doctors $147,460 to perform the surgeries over the 10 years. Heinrich described the $147,460 total as minimal.

"Over a 10-year period, that isn't a huge amount of money," Heinrich said, "compared to what you save in welfare paying for these unwanted children - as they procreated more."


Still, many women claim Heinrich coerced them into having the tubal ligation carried out.

Christine Cordero, 34, says the doctor pressured her into having the surgery following the 2006 birth of her son.

"As 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," said Cordero, who spent two years in prison for auto theft. "He made me feel like a bad mother if I didn't do it."

Cordero eventually agreed to the surgery, but admits that "today, I wish I would have never had it done."

Kimberly Jeffrey reports a similar story from 2010, when a doctor asked her while she was about to have a C-section whether she wanted a tubal ligation after the birth.

"He said, 'So we're going to be doing this tubal ligation, right?' " Jeffrey said. "I'm like, 'Tubal ligation? What are you talking about? I don't want any procedure. I just want to have my baby.' I went into a straight panic."

Jeffrey's records show she rejected a tubal ligation offer during a December 2009 prenatal checkup at Heinrich's office, and then a month later she refused a tubal ligation request made after she arrived at Madera Community Hospital.

University of Pennsylvania law professor and expert on sterilization, Dorothy Roberts says courts have deemed these sorts of requests illegal because they come at a time when a woman is experiencing discomfort and pain, and so she cannot make a reasonable decision.

"If this was happening in a federal prison, it would be illegal," Roberts said. "There are specific situations where you cannot say it's informed consent, and one of them is during childbirth or labor. No woman should give consent on the operating table."

Meanwhile, Heinrich maintains that his medical care was necessary and appreciated, and that those who criticized the sterilizations were unjustly dissatisfied later on.

"They all wanted it done," he said of the sterilizations. "If they come a year or two later saying, 'Somebody forced me to have this done,' that's a lie. That's somebody looking for the state to give them a handout.

"My guess is that the only reason you do that is not because you feel wronged, but that you want to stay on the state's dole somehow," he added.

Tubal ligations currently require state funds in order to be performed. Federal funds cannot be used toward the surgery. Since 1994, all tubal ligation requests have needed approval from top medical officials in Sacramento on a case-by-case basis. However, Barnett said no requests have come before the health care committee responsible for approving the procedure.


The first glimmers of foul play came in 2008, when the receiver's office for all 33 of California's prisons sent back a letter to the prison activist group Justice Now, which asked whether pregnant inmates were offered sterilization. The receiver's office said they did.

It wasn't until 2010 that Justice Now filed a public records request and complained to the office of state Sen. Carol Liu, D-Glendale, who, at the time, was the chairwoman of the Select Committee on Women and Children in the Criminal Justice System.

According to CIR, prompted by a phone call from Liu's staff, Barnett said the receiver's top medical officer asked her to research the matter. After analyzing medical and cost records, Barnett met in 2010 with officials at both women's prisons and contract health professionals affiliated with nearby hospitals.

Barnett told them to stop sterilization surgeries immediately.

According to her, the 16-year-old restriction on the procedure struck the doctors as news. None of them thought they needed permission in order to follow through with the tubal ligations.

"Everybody was operating on the fact that this was a perfectly reasonable thing to do," she said.

These assumptions characterize a long, unsightly history of unauthorized sterilization in California and around the country. Between 1909 and 1964, about 20,000 women and men in California were stripped of the ability to reproduce, making the state the nation's most prolific sterilizer. Historians say Nazi Germany sought the advice of the state's eugenics leaders in the 1930s.

As Heinrich noted above, the issue of sterilization often comes as one of health risks and future cost. Heinrich states that women who have had C-sections in the past face greater health risks later in life, and that minimizing the state's welfare cost can be accomplished through consensual sterilization.

"One of the goals ... and this is critical to understanding the history of eugenics in California - was to save money: how to limit welfare and relief," said Alexandra Minna Stern, a professor at the University of Michigan and leading expert on California sterilization, according to a transcript of her presentation at a 2003 Senate hearing on the state's spotty history. "And sterilization is very much tied up in this."

Barnett, for her part, does not hope to investigate prior cases of sterilization. Her greatest aim now is to prevent future surgeries from taking place, and to repair a system she believes has components that are seriously broken.

"Did Dr. Heinrich say improper things? I can't say. Is our process sufficiently draconian enough to weed out bad actors? We have a lot of civil service processes. Is it 100 percent effective? Is it the best process we can come up with?" she asked. "No, of course not."