Hillary Westfall never agreed to be sterilized. She arrived at California’s Valley State Prison for Women already diagnosed with endometriosis, a painful condition in which tissue similar to that which lines the uterus grows outside the uterus. In 2008, the prison’s sole gynecologist, James Heinrich, scheduled her for laparoscopic surgery at an outside hospital to have those tissues removed. Or that’s what she was told.

Instead, she told The Nation, Westfall woke up “cut from hip to hip.” Hospital staff told her that the excess tissue had been removed.

After returning to prison, Westfall began sweating profusely and continually. Without an undershirt, sweat would run down her back, leaving a wet line on her shirt. Her incision was regularly infected and she repeatedly had to see Heinrich for treatment.

Six years after the procedure, after being transferred to the Central California Women’s Facility, she asked about birth control to stop the constant sweating. The doctor told her that she had been given a hysterectomy because of a supposed history of cancer. (Later, another prison doctor reviewed her records and said there was no indication of a history of cancer.)

She’s not alone. Between 2005 and 2013, California sterilized over 850 people in women’s prisons. More than 400 of those sterilizations had been arranged by Heinrich, who in a 2013 interview with Reveal justified these sterilizations by saying it saved “in welfare paying for these unwanted children—as they procreated more.” Following Reveal’s exposé, the federal receiver overseeing prison medical care barred Heinrich from prison work. And the press officer for California Correctional Health Care Services (CCHCS), which administers prison health care, told The Nation that, when CCHCS became aware of these sterilization procedures, it stopped them and provided training to ensure they did not recur in the future. California lawmakers banned sterilization for the practices of birth control within the state’s jails and prisons in 2014.

For years after these revelations of sterilization abuse, advocates, including the legal organization Justice Now, the California Coalition for Women Prisoners, and formerly incarcerated women, pushed for financial reparations for people who had been sterilized while imprisoned. Their efforts stalled in the legislature three times, but on July 12, 2021, lawmakers passed it as part of the state budget, making California the first state to offer financial compensation for sterilization survivors.

But since the program passed, some current and formerly incarcerated women and trans men say they have struggled to receive compensation, or have been denied outright, while several others told The Nation that they never received applications from the compensation board.

Westfall received a letter stating that she was approved for compensation in September. When her $15,000 check arrived at the prison, officials held it for over 60 days. After the funds cleared, she sent the bulk to her mother, who has taken care of both Westfall and Westfall’s son throughout her incarceration.

Still, she says that no amount of money will make up for what was done. “We didn’t go into this [advocacy] for the money,” she reiterated. “We wanted people to know what the prison was doing.”

Concerns About Approval Rates

Under California’s Forced or Involuntary Sterilization Compensation Program, the state has allocated $4.5 million (or approximately $25,000 each) to be split evenly among people who have been sterilized while confined in a state institution between 1909 and 1979 or while imprisoned after 1979. Survivors must apply before December 31, 2023. If they are denied, they can submit another application.

The program has an additional $2 million for administration and outreach, which includes identifying, locating, and informing survivors, some of whom may not be aware they had been sterilized. Finally, the program earmarks another $1 million as a reminder of the state’s not-so-distant history of eugenics. The California Victims’ Compensation Board is administering the program, while state agencies will decide on the placement of the memorial markers and plaques.

“Reparations for people in prison is just enormous in and of itself,” said Diana Block, a founding member of the California Coalition for Women Prisoners, which works with people incarcerated in the state’s women’s prisons. “It’s really important to emphasize the acknowledgement of harm towards incarcerated people, their human rights and in this case, their bodily autonomy. In so many other arenas, there is no such acknowledgement. Hopefully, it can set a precedent.”

But even as they laud this precedent, advocates and incarcerated survivors wonder if enough is being done to inform and assist all survivors, especially with the December 31 deadline, the fact that prison medical records are nearly impossible to obtain, and that many may still not know that they had been sterilized.

In an email, VCB information officer Heather Jones told The Nation that the board sent notification letters to those whom the prison system had identified as having been sterilized while in state custody. “We have also provided electronic copies of applications, forms, flyers and posters to all prisons and sent 807 printed posters to prisons. We have been told that those posters have been posted in prison common areas.”

Several women and trans men in prison told The Nation that posters about the program were displayed in housing units, though one person said that he had yet to see any.

While the state auditor had identified 852 people who had been sterilized in prisons between 2005 to 2013, the compensation board had received only 310 applications as of December 30, 2022. Of those, 51 applications have been approved, 48 to people who were sterilized while imprisoned.

One hundred and three people have been denied, although 10 have appealed their denials, currently under review. (Another 153 are being processed, and three were closed as incomplete.)

When asked about the high number of denials and low rate of approvals, Jones said in an e-mail, “Many people are not sure whether they were sterilized or not. We are urging people to apply, even if they do not know for sure if they qualify. If it turns out that they do not qualify for compensation, their applications are not approved.” Citing confidentiality laws, she declined to comment on individual scenarios.

The Nation spoke to two trans men who were denied, in essence, because their procedures, despite the complications for future pregnancies, weren’t considered full sterilizations.

One of the denied applicants, Zyaire Smith, who entered prison in 1992 at age 19, sought medical help for the heavy and painful periods that had plagued him since he first began menstruating.

“They lasted seven to nine days,” he told The Nation. “There were lots of blood clots that came out looking like chunks of meat.”

In prison, both bleeding and pain worsened.

In 2005 or 2006, he saw Heinrich, who offered to perform a Pap smear. When Smith declined, Heinrich offered an ultrasound and, since the procedure did not involve penetration, Smith agreed.

The ultrasound revealed fibroid tumors. Heinrich recommended that Smith undergo a hysterectomy.

“I didn’t know exactly what that meant,” Smith recalled, “but I knew that there were a lot of people having hysterectomies [at the prison]. They were giving hysterectomies like they were giving chow—grab a tray, get a hysterectomy. That’s how it was going.” (He also recalled that many Black women and trans men, like himself, seemed to be receiving hysterectomies around that time.)

Smith, who had never had surgery, declined. Heinrich offered another option—ablation, a procedure in which the uterine lining is destroyed without necessitating any surgical cuts. The process is not recommended for people who might want to become pregnant in the future, a fact that Heinrich never told Smith.

He said neither Heinrich nor any other medical provider about the long-lasting consequences of the procedure. Not knowing any of these, Smith agreed.

Dr. Carolyn Sufrin is an associate professor of gynecology and obstetrics at the Johns Hopkins School of Medicine and has worked extensively on reproductive health issues in women’s prisons. She told The Nation that the standard of care for fibroids and heavy bleeding starts with reversible contraceptive methods, such as oral contraceptives, contraceptive implants, or IUDs. Ablation is suggested if these options fail and, she added “after thorough counseling and giving the patient the choice.”

Smith, now out of prison, applied for compensation. In September, he received a letter of denial.

While ablation is not classified as a sterilizing procedure, it decreases the chances of pregnancy and healthy pregnancy outcomes, Sufrin explained. “We do not recommend anyone get pregnant after an ablation,” she said. “This procedure is intended for people who are done with childbearing.”

When asked about the denials issued to those who had had ablations, Sufrin pointed to the American College of Obstetricians and Gynecologists, which warns against post-ablation pregnancy. “Certainly, there are case reports of normal pregnancies after endometrial ablation, but there is also data showing increased risks. It’s the accepted standard of care that we recommend against pregnancy to people who’ve had an ablation.”

Greenie also received a denial letter. Greenie, who is still in prison and plans to reapply for compensation, asked that The Nation not publish his legal name.

Greenie arrived at Valley State Prison for Women in the 1990s. In 2002, he began experiencing pain in his abdomen. Heinrich told him that he had a cyst on his left ovary and recommended that the entire organ be removed.

“I was fine with that,” Greenie said in a phone interview with The Nation. But, he said, “I remember that the doctor [at the hospital] kept saying, ‘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.’” (That year, Greenie had turned 30.)

Seven years later, Greenie saw Heinrich again, who told him there was a cyst on his remaining ovary. Within 24 hours, Greenie was sent to the hospital for another laparoscopic surgery, an extremely fast turnaround time in a prison medical system that typically moved at a glacial pace. When he woke, he received some confusing news—the surgeon told him that his right ovary had already been removed.

“That makes me believe that, in 2002, they took both my ovaries without my knowledge because I had both of them prior to that [procedure],” he said. But he never received any paperwork verifying the missing organ. When he attempted to obtain his hospital records, he received a note stating that the hospital keeps records for only 10 years.

Greenie had served time with several members active in the California Coalition for Women Prisoners, who told him about the compensation program. He applied, but received a denial letter stating that because his records indicated that he still had one ovary, he had not been sterilized and was thus ineligible.

For Greenie, the issue is not about whether he can still become pregnant, but that Heinrich—and prison authorities—took the liberty of removing both ovaries without his consent. “If I didn’t give you permission to do this to my body, then why did you do it?” he asked. The experience has left him with a permanent distrust of seeking medical care.

The denial letter, dated August 18, gave him 30 days to appeal. But Greenie did not receive the appeal form within those 30 days. The form letter stated that he is allowed to reapply and he plans to do so, hoping for a better outcome.

“Money’s not gonna make it better,” he acknowledged, but he had been hoping to use the funds to help his aging mother pay her rent and install a special bathtub to prevent slips and falls. It would also enable him to buy hygiene items and other necessities while in prison without having to stretch his family’s finances.

“Is there any way you can help me get my reparations?” he asked just before our call ended.