How Do You Put a Price on the Loss of Autonomy From Forced Sterilization?

How Do You Put a Price on the Loss of Autonomy From Forced Sterilization?

How Do You Put a Price on the Loss of Autonomy From Forced Sterilization?

California has created a compensation fund for victims of state-sponsored, non-consensual sterilization, which happened in prisons for decades. But as the deadline looms, many who lost organs aren’t qualifying.

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Leesha Gooseberry was ready to start over when she got out of prison at the Central California Women’s Facility in 2012. She had gone to prison at the age of 19 for killing her abuser, a drug dealer who had forced her into a relationship when she was 15. Gooseberry shot him after he raped her in front of their infant daughter. She spent 26 and a half years behind bars before the University of South California’s Post Conviction Project was able to get her released as a victim of domestic violence.

When she got out, Gooseberry scheduled a visit with a primary care doctor. He was doing a routine pap smear when he informed Gooseberry that she did not have a uterus or cervix. “He said, ‘You don’t have anything up there,’” Gooseberry told me.

In shock, Gooseberry got her medical records from the state. While incarcerated, she had undergone surgery that a doctor said was needed to treat fibroids. When she woke up from the surgery, doctors told her they had given her a partial hysterectomy. The records, when she got them, showed the doctors had performed a full hysterectomy, removing her uterus and cervix. “I was depressed about it, really, really sad, because I thought I could get out and have children,” Gooseberry said. “I don’t even know how to describe the feeling, but I guess I could say I felt lost, like something was dead inside. Heartbroken.”

“It was like I never had the opportunity, or the chance, to live,” she told me.

Gooseberry is one of more than 20,000 people who were sterilized without consent in California. Most of these sterilizations took place between 1909 and 1979, when the state sponsored an official eugenics program that targeted people in state institutions who were deemed “feeble-minded” and “unfit” to reproduce. A disproportionate number of those targeted were people of color and immigrants. California was a leading proponent of eugenic policies; a third of all people sterilized under US eugenics programs lived in California. A case file for a 16-year-old girl who was sent to the Sonoma State Home quoted by the Los Angeles Times shows the criteria used to justify sterilizations in this era: “One of the giggling dangerous type—a delinquent sexually, morally. Forged checks, remained away from home nights.”

In 1979, California repealed its eugenics laws, putting an end to the official program. But nonconsensual sterilizations continued in prisons. In 2013, the Center for Investigative Reporting reported that doctors under contract with the California Department of Corrections and Rehabilitation performed tubal ligations on at least 148 incarcerated people from 2006 to 2010 without state-required approvals, with perhaps 100 more cases dating back to the late 1990s. The ob-gyn for California’s Valley State Prison, Dr. James Heinrich, seemed to channel the logic of an earlier era when he told CIR that the almost $150,000 the state had paid doctors to perform these improper procedures wasn’t a huge amount “compared to what you save in welfare paying for these unwanted children—as they procreated more.” While Heinrich’s case has attracted attention because of these comments, he is far from the only doctor involved in the surgeries, which were performed at outside hospitals and took place as a result of a “massive systemic failure,” according to Jennifer James, an associate professor at the University of California–San Francisco, who has been working with people applying for the program.

In 2021, California lawmakers took a major step to make amends for these harms, passing a law to create a $4.5 million compensation fund for victims of state-sponsored sterilizations. California is the third state to embark on such a program, following North Carolina and Virginia. But as the deadline to apply for compensation approaches on December 31, just 108 people have been approved out of an estimated 600 victims who may still be alive. In total, 513 applications have been submitted and 358 have been denied, according to the California Victim Compensation Board, which is administering the program. About three dozen more cases are being reviewed and 12 have been closed as incomplete due to a lack of documentation. A lack of evidence showing a person was in a facility or received a sterilization is the most common reason for denial, Lynda Gledhill, the board’s chief executive, told The Nation.

“We do need some evidence, right?” Gledhill said. “There has to be something that shows that the person was in the facility at the required time and the sterilization occurred for the purposes of birth control.” The board later clarified that this statement by Gledhill was incorrect. Applicants can be approved if their sterilization meets one of three requirements: either it was not medically necessary, it happened without demonstrated informed consent, or it was performed for the purposes of birth control.

Gledhill said her staff have combed through records at the state archives and perused typewritten records to try to verify claims. “When you put up posters in correctional facilities, offering money, you get a lot of applications, and you get a lot of people who, quite frankly, literally say that, you know, there was something in the Kool-Aid that caused me to be sterilized,” Gledhill said, when asked why the denial rate has been so high. “The numbers are inflated, to some extent, because of the nature of the population that saw the opportunity to apply for money.”

An investigation by KQED found that the state has rejected compensation claims for patients who underwent endometrial ablations, a procedure that damages the lining of the uterus and vastly reduces the chances of carrying a healthy pregnancy. Records obtained by KQED show that Dr. James Heinrich ordered at least 80 ablations between 2006 and 2012, including one performed on Sharon Fennix, who said she recalled Heinrich telling her that because she was serving a life sentence, she didn’t need children. “My hope and my dream was always to have a child and be free,” Fennix told KQED. “To give my son a sister or brother.”

Another of those denied is Greenie, a transgender man who was incarcerated at Valley State Prison when he began experiencing abdominal pain in 2002, as Victoria Law reported for The Nation in January. Greenie said he met with Dr. Heinrich, who informed him that he had an ovarian cyst and recommended removal of his left ovary. Greenie, then 30, was sent out for surgery at a local hospital, where the doctor said, ‘They want me to take both your ovaries, but I’m not going to do that. You’re too young. We’re not going to do that.’”

In 2009, Greenie’s pain returned and he was told by Heinrich that he had cysts on his remaining ovary. When Greenie awoke from the surgery to remove the cysts, the surgeon told him that he didn’t have a right ovary, so he had just stitched him back up. “I had two ovaries when I had surgery in 2002, one removed, so where did my other ovary go?” Greenie wrote to me in a note from prison in October.

Greenie said he has applied twice for compensation from the sterilization fund and been denied due to a lack of supporting documentation. He said has tried to get an ultrasound to prove that his ovaries are gone but has been denied that, too.

“I feel every inmate that was sent out by Doctor [Heinrich] should be given reparations,” Greenie wrote.

Carmen Worthy was denied compensation, too, she told me in a message from prison. In September 2019, Worthy underwent a partial hysterectomy to treat fibroids; a partial hysterectomy involves removing the uterus but leaving the cervix. She said a doctor told her it was the best option to treat fibroids that were causing her pain and heavy bleeding. Her application for compensation was denied even though she submitted her medical records.

“They told me I didn’t qualify because I consented,” Worthy wrote to me from prison. “I felt I had no other option. Did the doctor offer other options? Yes, he did, however in the same breath stated that those would not be effective because [the fibroids] will grow back.”

Jennifer James, the professor and advocate, said the state should default to issuing compensation, rather than denials. “Everybody in this group has had the state take away their rights, take away their agency, take away their autonomy, tell them that they’re not worthy of their own healthcare decision-making,” James told The Nation. “The default should be to believe people and to compensate people.”

While a 2014 state law bans sterilizations that are not medically necessary, James said she remains concerned about reports that show sterilizing procedures are still occurring in California prisons. “My big concern is we don’t have good ways of understanding if there is proper informed consent and have done little to address the structural limitations on consent, decision-making, and patient provider relationships for incarcerated patients,” she wrote to The Nation. In a statement, California Correctional Health Care Services, which provides health care in California’s prisons, said it is complying with state law that allows sterilizations only if they are medically necessary and less invasive measures are nonexistent or declined by the patient. A second, independent physician consults with the patient before any sterilizing procedure and “a patient’s consent would be obtained after they are made aware of the full impact of the procedure, including the potential impact to reproductive capacity,” CCHCS said. Heinrich did not respond to multiple attempts to reach him for comment.

How do you put a price on the loss of autonomy and fertility from forced sterilization? Those who have received compensation have so far gotten $15,000 and will receive a second payout of $20,000. For Gooseberry, who was recently laid off from her job as a hotel housekeeper in New Orleans, it hardly feels like enough. She used the money to pay her rent for six months, buy a TV, couch, and a new computer.

“No amount of money, I think, can take away the hurt or the feeling of loss, of being less than a woman,” she told me. “I’m grateful, but it don’t fix what happened.”

“I never really got over it,” Gooseberry, who is now 55, added. “I still think about it.”

Moonlight Pulido received a payout, too. She was incarcerated at Valley State Prison for Women in 1997. In 2005, Dr. Heinrich told her she had two growths that could turn into cancer. “I thought I was signing up for a life-saving procedure,” she said. “Lo and behold, he had a different motive.” She said she didn’t read the paperwork she was given. When she woke up, she was drenched in sweat. Later, she learned she’d undergone a full hysterectomy.

Pulido said she got a pass to see Dr. Heinrich and asked him what had been done to her. Pulido said he closed the door, sat down on a stool, and went on a rant about how pretty girls like her got pregnant and taxpayers had to pay for their children to be on welfare.

While Pulido did not intend to have more children, the loss of her uterus has impacted her deeply. “It affects me every day,” she said. “I’m Native American and we’re grounded in Mother Earth.” When her $15,000 in compensation arrived, she put a rubber band around it and put it in a safe in her room. “For what was done to us, it didn’t feel like that was enough,” she said.

Editor’s Note: This article has been updated to reflect the fact that a statement made by the California Victim Compensation Board about the requirements for compensation was incorrect. A corrected statement from the CVCB is now included.

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