Woman; 328; Sterilization and Consent

What. Changed. And welcome to woman Our topic tonight is sterilization and consent.

With me is Antonio Hernandez an attorney with the Los Angeles Center for Law and Justice. Also with me is Claudia Dreyfus a journalist for such publications as the progressive the nation of Rolling Stone and many others. Claudia was recently awarded a grant from the investigative journalism to write on the issue of forced sterilization. Welcome to both of you. Thank you. I think we should define our terms immediately. What kind of sterilization procedures are available be they forced or not forced. That is there are two kinds of tubal ligations. You can have an ordinary woman a doctor performs an incision into the abdomen and cuts the fallopian tubes and then ties them. And then one is read it effectively sterile or there can be what they call the bend aid tubal ligation laparoscopic where they inflate the abdomen with gas

and then burn and cauterize the fallopian tubes and that to leave one sterile. The third possibility is hysterectomy for sterilization. But the point is that neither of these really three procedures are terribly safe or good. And that they're quite dangerous. They're probably more dangerous than long term use of the pill or the IUD and they're even more dangerous and really harmful to people when people are coerced into that which is what's been happening in Los Angeles and all over the country. There was a case recently called the case I think which really was the first time the media gave this topic any consideration and really brought it to a lot of people's attention. And Tony can you tell us a little bit about the real case what happened was I believe this was in South Carolina. There was just two young women one was 14 and one was 15. Federal funds were used for the station of these two young women. And.

As a consequence of that because the funds were federal. H e w the Department of Health that you education no welfare. And because of a lawsuit. Brought. By the father of the children. H e w now has a regulation of guidelines that states that no federal funds will be used for the sterilization of women under 21. So was that the only violation in that case the federal funds. No there's been other violations. You really cannot cite and know the exact number of violations I am familiar also with CPS case. That also was publicized. It's a case I also believe is South Carolina where a doctor. Made it mandatory. That a condition of him rendering his services. Aw there woman if she was on welfare. I would have to consent to sterilization. And then of

course the case I'm involved with and this in Los Angeles would talk about that a little bit later. What I'd like you to do though is to list the violations because I want to be clear about that. Well as I understand what has been happening is that in a lot of cases a lot of the women are approached as to whether or not they want to be sterilized during labor. And in other cases with the abuse is. Oh bother to obtain the consent of the women. What's been going on all over the country not just in L.A. or in the south but probably an inner city in teaching hospitals all over the country is that when women go in. For to give birth to children or for an abortion or in situations of stress they are approached by doctors and asked if they want to get their tubes tied now. To. A complete mis naming of the operation tubal ligation tubes that can cut them. And people think that

that's a reversible operation. Women who go into the hospitals don't speak English don't know the language and certainly don't know that can't be taught. And what's been happening is that women under the most extreme situations of stress which childbirth is. Their own. Do you want to get your tubes tied. If they don't or if they're told it's a temporary procedure. They often consent. And it's happening in epidemic proportions. I think I have some proof of that. The case is the most dramatic case because there are 11 women involved and tell you about. Without their knowledge in some cases against their will under tremendous conditions of coercion. And it's just not me. Before we talk about until it is 11 women then to me it's because it's health education and welfare. Is. There a regulatory agency that controls this right I mean they wrote the guidelines and so on and have the power to enforce

it. Well. Only comes in. When federal funds are used. And I want to clarify this federal funds are used in most cases of low income families or in cases where the families the women are either receiving public assistance or are lower class people who qualify for Medicare Medicaid. Now whenever either of these two programs come into play then federal funds are used and it is then that the federal regulations the federal guidelines for the STO sation come into play and should be followed. What are the guidelines. OK. It sort of has taken the position of doing it piecemeal. As a consequence of the real sisters case we had. But. What we know is the moratorium that federal funds should be used for the sterilization of women under 21. Also as a consequence of the rel sisters case judge herself ordered

that guidelines consistent consistent with due process we promulgated. They've been in the process of doing that. Also subsequent to our filing of the suit the suit I'm involved with other guidelines have come into play. And at Preston. No federal funds should be used for Association of Women under 21. There should be a what we call noticed and on all consent forms the notice is that no public assistance funds or no funds will be withdrawn if the individual decides not to be sterilized. There should always be a 72 hour wait between the person signing of the consent form and the actual operation. They're also supposed to be an explanation of the wrists the dangers the benefits. A total counseling of all alternative. Type

of birth control. And it's still the station is one of the components of birth control. Also. Counseling. And. As of August 15 of this year there's also going to be monitoring that is all. Hospital providing hospitals that receive. Federal funds have to report to AGW. The number of sterilisations done this is going to be done on a quarterly basis and I think it's progress in the sense that for the first time we'll be making an attempt. To regulate. What is actually happening at the hospitals or at the level where the individual comes into contact with the doctors and they really kind of interesting about the Department of Health Education and Welfare as. A whole involvement in this is that it came about after the big scandal with the sisters the real sisters were 12 and 14 years old and they were sterilized. And. That

they issued orders and these these guidelines which are in effect. Have the force of law. In. In 1970 for six months afterwards the American Civil Liberties Union. Sent out it a study. Alyssa Kraus who was at that time there sent out a study to about 150 major teaching hospitals around the country and asked them Are you complying with these guidelines are you permitting we'll informed consent for your patients and. Are you actually you know not pressuring them are you approaching women during labor or not. And this was six months after the guidelines were published. Well only about a third of return on their inquiries and they found the most amazing thing they found that there were only about three hospitals out of a hundred fifty six they questioned that were in full compliance with the law. Three out of one hundred fifty six. They also found a quote from their own study 36 major teaching hospitals were in noncompliance and massively. That's

not their quote. And they also said that. There were also another 12 who were in noncompliance. And to my knowledge the Department of Health Education and Welfare has done. Very little if anything to cut off federal funding from these hospitals. And in fact. A lot of the doctors who heard of the ACLU study the doctors who are heads of departments said they had never even heard of these rules before. It was surprising to them. It never occurred to them to enforce these laws so as not done much about. Publicizing these laws that are very important to save people's lives. Seems to indicate that they're going to be trying in the near future to enforcement. But do you think that's going to be enough. Well there's a problem in that even if you have it. And it's something I'd like to get into later. You've got the problem of the attitudes of doctors towards the poor which is incredible. And you've got a problem that it's not one thing that's creating for sterilization. It's the fact that doctors have a great deal of

power. To do what they want with patients. And what you've got is indigent patients coming into teaching hospitals young doctors needing to do all kinds of pelvic operations after all gynecology is a surgical specialty. So they're practicing on somebody and they need to do pelvic. And so they do they encourage tubal ligations. You have the problem that other doctors have very strong attitudes on population and they have the power to work it out on people. You have the problem that there are other doctors who are just and who Nicks. And the problem of some doctors thinking they're helping women by preventing them from having children they may want to have too many proof that the teaching hospitals are doing the operations just for practice. Well I think. That if we talk about the case a little more so than get into the proof.

OK. And to tell us about your 11 women are you basically a federal suit. Well let me start by saying at the youth inception we began to sue and who's left at this point in time. We filed suit June 18th of this year. We were suing. The state of California. The director and head of the L.A. County Medical Center and the individual doctors who performed the sterilizations what it involved is we have 10 women who were sterilized. We have one woman who was to be sterilized but was saved last minute. And we have an organization that's represented and that you can a community of the Southwest and particularly of California Los Angeles. What we're seeking what we are seeking was number one that you come up with regulations that we felt were consistent with due process that is most of our women are Spanish speaking cheek honest. They do not speak

English. In a lot of cases they did not sign consent forms so we didn't have the problem of consent forms. However of those few that did sign consent forms they were written in English. So we were asking one of the things was that the consent form in order to obtain free and voluntary consent. And that is the federal requirement. We felt that it should be in the language the individual understands in our instance Spanish. We're also seeking that the consent form be written at a reading level that the individual that goes to these types of hospitals understands. We were also suing. The individual doctors for monetary damages. Right now what has happened to us subsequent to our sued AGW has to come up with regulations with clarifications indicating that informed consent means that the consent forms have to be in Spanish and they have come up with what we call the monitoring that is going to make the

States the regions the providers the hospitals. Report quarterly report as to how many sterilization are performed using federal funds. How that will work I don't know. But. Because of that longer party fund and now we have the state of California and then we see reading level that is a reading level that the individual can understand. We're asking of course Spanish consent forms. We had our preliminary injunction hearing on October 6 and the judge has ordered the plaintiffs to come up with a consent form that we feel is at a stick's great reading level and we feel that this level will be adequate. Why did you do that. Yes we are in the process of coming up with a consent form at the sixth grade level and to tell me something with the women involved in the suit was one of our plaintiffs. A lot of people have misconceptions. As to who are the women who were being

sterilized. And one of Mrs. several of misconceptions some of them being that number one. Coming from the southwest California Los Angeles we have two problems. Most people believe that if you are. From Mexico Mexican descent that you are undocumented that is you're illegal. Number two if and when you are not undocumented. Then you are on welfare. All of our 11 plaintiffs and I might state at this point that there are not just 11 I talk to hundreds of women. But of the 11 plaintiffs that we have now all were married. None were on public assistance. And some had made and paid for pride of it. Medical arrangements prior to giving birth to the children but for medical reasons were transferred to L.A. county mental hospital. One point plaintiff evolvers. She had had complications was seen a private physician. Had medical insurance that was

supposed to cover for her care. However there was some abnormality. She was 11 months pregnant and was told by her private house doctor that she had to go to L.A. County Medical Center. During labor. They approached her and she negated throughout. The shoot. Not one of her still lives. She did know she was sterilized. She did not sign a consent form. She was only thirty two only has two little girls. As a consequence of this station there has been some physical injuries she has had to be hospitalized with him or just some bleeding. She suffers from nervousness. And is consistently absent minded. Her marriage has gone. Down. She had a relationship with a common law marriage relationship with her common law husband of eight years. He has now walked off her life. She is presently working for a laundry company somewhere for a dollar seventy five dollars so a dollar

seventy five an hour and that and trying to support two children so really almost without exception at least the women involved in the case have had serious marital problems resulting from their suicide. Yes one of the one of the things that a lot of people don't realize is it's Joe sation worst involuntary sterilization. Does not involve the woman. But it has far reaching consequences for the entire marriage the relationship the children the husband. And a lot of these women are going to for men just. Marital problems and tragedies because of what has happened. What are you going to say. I spoke with many of the plaintiffs in the case and in speaking with them was very much like speaking with really victims because they have been violated in a way that they had no control over and that the kind of butchery of their lives was just the most horrible thing to see I mean in the middle of the interview is. Not a terribly emotional person and yet I

found myself crying. And. Because there were such situations. There were women whose marriages could never be the same because both partners had suffered so badly. There were women who had been abused during labor. One woman had beaten when she refused the sterilization. The women who consistently said no I will not be sterilized and woke up in the morning and discovered that they were. There were other women that they never even knew they were sterilized until community organizers approached them and said Is there a possibility this might be the case with you. When they were doing some canvassing of the area to discover how widespread this was there were there was one woman who's a plaintiff in a separate case who was sterilized went back to L.A. County Medical Center and had. At the same hospital and all you inserted after her sterilization. But the toll on the people's lives is something

that you cannot really imagine. I mean it's broken lives that will never be the same. And. What really. Is astounding is the attitudes of the doctors. When I was in L.A. a couple of months ago it's the proof you process the proof right. It's one of the things I did was I I went around L.A. County medical centers dormitories for house stuff and interns and residents with another physician. And I did not identify myself as a reporter. And what we've said is we've knocked on doors like Fuller Brush and we say ha we're doing an informal study on wouldn't form consent will you tell us what you're seeing. And other hospitals where you've done work where you've interned or done your obstetrics rounds as a medical student. And we spoke to 23 doctors in L.A. County. Non of them had seen hard selling or abuse or had worked under conditions that led to abuse elsewhere throughout the country. And L.A.

County is one of the top obstetrics residents sees. So you get the best doctors from all of the country coming there. There were only four doctors and that I spoke to would say unequivocally they had worked under conditions that were clean in that way. Yet none of them had spoke. You know. I mean they had seen women pushed into operations they didn't want and nobody said anything. But the thing about sterilization is that it's irreversible except in 10 to 20 percent of all cases if it's tubal ligations and then it takes a very expensive dangerous operation to do it. They had seen women being given operations they didn't need. What kinds of operations. Hysterectomy. Well hysterectomy because a lot of obstetrics surgeons want to graduate up if you can get to do a tubal ligation then you mastered that why not do a hysterectomy which is really dangerous. There's a lot of that there's a lot of selling unnecessary operations.

But what what happened when I went around and did this survey was that more and more talk to the doctors. And there was an absence of any kind of moral judgments about what they saw a lot of alone a willingness to speak up. And I'd like to read just some of the quotes of some of the doctors that I spoke to. Because it illustrates. I don't know what's missing. A sense of humanity about the people they're talking about treating. I don't know if. This was a young physician very blonde very smiling he was sort of the kind of man maybe my mother would have wanted me to marry ten years ago. I I think she would have been delighted. And yet a doctor no less. Right. And he said innocently in his room with a smile that was all pure gold. And he was talking about doing his own wrongs at a major hospital in Detroit inner cities so we know the population is black. This is what he said. Most of the population was black. I'm quoting inner city. We had a lot of young girls come

in 13 years old and 16 and they'd have two or three children. In those cases we'd ask them often when they were in labor if they'd want to belike ations. There was so many young girls. And they really had a low mentality. We tell about birth control and they just wouldn't take it. They'd have one baby and would tell about birth. When they come back again pregnant the next year 15 or 16 year olds. It would get some of the residents reeling that. So we do offer an tubal ligations sometimes during labor. And then he said. With 16 year olds you need the parents permission. This seemed to irritate him a lot. But he said that wasn't hard to get because the parents were in labor. Some parents much to his surprise he said said no because they like the kids. And in the meantime there was another intern sitting in the room. He said You mean you sterilise 16 year olds. And he said well you know if they had two kids. And it was as if nothing was going on. I mean. Abnormal.

I spoke to another doctor at L.A. County who told a woman who told me she had worked at it at another hospital near L.A. where they were routinely approaching women and labor and she did not feel that this was coercive. That's terribly coercive to say to someone in the greatest of human pain. Do you want to. Be sterilized and never have to suffer this pain again. What happens to the women who agree to it. When they're asked. Well in labor and they agree to it. What happens to them afterwards if they ever reach a point where they regret it. The regret rate on sterilization is 30 percent and it's really want to hire on any kind they were but they are unwilling to agree so it's somewhere between 15 and 30. It's higher. Much higher among women who were the doctor who suggested it first. But what's interesting about this woman. She said she didn't think it was coercive to approach people during labor and then she said but then I was down in Nicaragua and there we really are worse. I wonder what they were doing down in

Nicaragua. But. On that too. A. Couple of evenings I went over to Martin Luther. Are we running out of time. We don't have a lot of time left. Let's talk about the fact that you feel that it's a national problem. Do you feel that it's only limited to. Chicano women. No not at all and. A couple of nights I went over to Martin Luther King Medical Center which is in Watts and there were a lot of young interns there who were blocking who had studied at institutions that serve black populations and they were very aware of the genocide question. And. I had one having spoke to three interns who. Had had worked at Howard. University Medical Center in Washington D.C. and they so many Southern blacks coming in through emergency. One doctor told me this. A woman came into emergency and I noticed she didn't have any children I asked her why she said she came from a town in North Carolina. She said her mother was on welfare in this town and the woman said they sterilize the daughters

of all the women on welfare when they turned 15. Another intern in the room at that point said she was at a school in Mississippi and two young women came in for a check up. And this is her quote. One was 16 one was 18. We did a routine pelvic on them. One woman didn't have a uterus and she didn't know it. And a 16 year old. She'd gone to some hospital had a child there. The other woman had a tubal ligation the 18 year old. She didn't know it. And this. Intern. Said she'd only been at this place in Mississippi for two weeks and she'd run across two cases of the abuses. The doctors I spoke to would come from hospitals all over the country. And Martin Luther King out of 11 8 had had some experience with abuse from all of I think it established it said it's a national problem. Yeah. And Tony you were talking earlier we have only one minute but you were talking about some myths. That you felt were were very prevalent about sterilisation. Can you run those down quickly force.

Well I think one of the myths that most people feel is number one that the tubes tight. Is a matter of course they are not tied the tubes are severed and then they are tied and they're tied because if they didn't time you bleed to death. The other myth is that most people feel that. If you have more than three says Terri and that's the limit. There is no such thing. Certainly not fearful candidate. That's not true it is not true. 5:6 it's an individual thing and it depends on the individual woman. And the other myth is that. Still sation a tubal ligation to say. That it's a complete myth. It is one of the most dangerous and of course a hysterectomy being the other most dangerous forms of elective surgery it is 100 percent elective. We have it two seconds. Is it effective the tubal ligation. No it's not there. There's a there is a failure rate one in a hundred. But more than that I'm sorry. Thank you both for being here. Thank you for

watching and good night. Woman was produced by w n e d TV which is soley responsible for its content and was funded by a public television stations. The Ford Foundation and the Corporation for Public Broadcasting. I.