Survivors from California’s Period of Forced Sterilization Denied Reparations

In March 2006, Sharon Fennix, then incarcerated at Valley State Prison in California’s Central Valley, was transported to Madera Community Hospital for surgery.

A prison doctor had recommended that she have non-cancerous growths removed from her uterus and, according to Fennix, she was told that the procedure wouldn’t have lasting impacts and recovery would be quick. She was given a dose of anesthesia, and the last thing she remembers was counting backward while two correctional officers wheeled her gurney down a hallway.

When she woke up from the operation, she said her entire hospital gown was soaked with sweat. She remembers turning to the correctional officer in the room and saying, “I feel like something’s wrong.”

Approximately two weeks later, the follow-up visit with the prison doctor who ordered the surgery, Dr. James Heinrich, also left her deeply unsettled. The conversation is carved into her mind.

“There was sweating, bleeding and pain,” Fennix recently told KQED. “It plunged me into menopause.”

She asked Heinrich how long her side effects would last. Fennix said she was told what she was experiencing was normal and the growths on her uterus might return. Puzzled and upset, she wondered why surgery was necessary if the growths could come back.

According to Fennix, she demanded to know what happened to her body during surgery. But the more she probed, the more Heinrich tried to rush her out of his office. Finally, he explained that a surgeon had put a boiling solution in her uterus. Toward the end of the appointment, Fennix said he looked at her file and remarked on the fact that she was serving a life sentence.

She would never get out, she recalled Heinrich saying, so she didn’t need children.

“He was very cunning the way he said that to me,” Fennix said.

It would take nearly a decade for Fennix to fully understand what had happened to her. Before she was released from prison, another doctor explained that she had undergone an endometrial ablation, a procedure that damages the uterine lining.

“My hope and my dream was always to have a child and be free,” Fennix said. “To give my son a sister or brother.”

But pregnancy would be unlikely.

According to the American College of Obstetricians and Gynecologists, if a pregnancy occurs after the procedure, “the risks of miscarriage and other problems are greatly increased.”

“I would make sure that [a person is] 110% sure that they do not want children before we discuss an ablation,” said Kavita Shah Arora, division director of General Obstetrics, Gynecology and Midwifery at the University of North Carolina at Chapel Hill, and former chair of the ACOG’s national ethics committee. “I think it really boils down to, what informed consent was given? Were patients aware of the impact on future fertility?”

Fennix said she never provided informed consent.

When the state passed historic legislation in 2021 that provided financial reparations to people who were forcibly or involuntarily sterilized, an advocate from the California Coalition for Women Prisoners thought Fennix had a clear-cut case and persuaded her to apply. Fennix submitted her first application on Jan. 3, 2022, two days after applications opened. Seven months later, she received a denial letter from the state’s Victim Compensation Board, which administers the program.

Fennix, who was 43 when she had the surgery, said she felt insulted by the rejection.

“You dehumanized me,” she said. “You took my body. How dare you later on tell me that I don’t deserve to be one of the ones that gets reparations for it?”

As the application period for the reparations program winds to a close in December, Fennix and those who received endometrial ablations are at the heart of a dispute over who should be recognized as a survivor of a shameful chapter in California’s history.

A year-long investigation by UC Berkeley’s Investigative Reporting Program and KQED found that the compensation board has denied a majority of applicants and repeatedly rejected ablations as a procedure worthy of recognition. The investigation included 30 public records requests, the review of more than 3,000 pages of documents — and interviews with survivors, advocates, medical experts and lawmakers.

Among the applicants who volunteered their demographic information, the majority self-identified as Black or African American. Approximately 47% self-identified as male, 40% female and 4% transgender. While reporting this story, KQED spoke with six ablation survivors who were denied reparations.

“It feels so clear — based on the spirit of the law, based on the idea of who is perpetuating the harm — that if someone says, ‘I’m not able to have children’ and it’s documented that they had a procedure that limits your ability to have children, that feels like it should be sufficient,” said Jennifer James, an associate professor of sociology at UCSF and member of the California Coalition for Women Prisoners, or CCWP, who has assisted survivors with their applications.

Additionally, since 2014, California’s prison health care services have categorized ablations and dozens of other treatments as potentially sterilizing, according to a memo circulated among prison health care leadership.

The board declined to respond to specific questions but said in a statement that it has worked “to meet the requirements established in the law.”

Fennix appealed her case. That, too, was rejected. She went through the application and appeals process a second time. She was denied at every stage.

In rejecting Fennix’s first appeal, the board said that ablations don’t qualify as sterilizations under the law and cited the Mayo Clinic website, writing that pregnancy “can and does occur after an endometrial ablation.” The board left out what followed on the website: “The pregnancy is higher risk to you and the baby.”

Next week, Fennix and another formerly incarcerated woman who received an ablation will file a petition in state courts aimed at testing the state’s implementation of the reparations law.

Her case, Fennix said, reflects a hole in the state’s efforts to compensate survivors of state-sponsored sterilization.

“I’m not able to reproduce,” she said. “And so, how am I not sterilized?” 

‘It’s another betrayal’

When legislators passed the reparations law, California became the first and only state in the country to publicly recognize its role in prison sterilizations. Through monetary compensation and memorialization efforts, the state aimed to “raise public awareness about the discriminatory harms” survivors of forced sterilization had faced.

The state allocated $7.5 million to the two-year program, with $4.5 million earmarked for compensation, $1 million for memorialization and $2 million for program administration and outreach. Each individual whose application is approved receives $15,000. A second and final payment of $20,000, signed into law by Gov. Gavin Newsom in September, will be processed by October 2024. Up to $1 million of any remaining compensation funds could be extended for survivors if legislation is passed in the next few years.

As of Oct. 25, 108 out of 510 applications had been approved.

Those who championed the legislation estimated that there were roughly 600 living survivors of forced or involuntary sterilization. The actual number of survivors, however, may never be known due to various limitations, such as medical records retention policies. A 2014 state audit found that at least 794 people in state prisons underwent various procedures that “could have resulted in sterilization” between 2005 and 2013.

People who had been forcibly or involuntarily sterilized while incarcerated in state prisons after 1979 or at state-run hospitals, homes and institutions during the eugenics era between 1909 and 1979 could qualify for reparations. But advocates, like CCWP, say that the board is looking for a level of proof that’s unreasonably difficult to meet. For example, they say medical records are more heavily weighted than a personal statement from the survivor, even though the board is required by law to accept multiple forms of documentation to prove that sterilization was more likely than not forcible.

“It isn’t gray to us because the stories are so convincing about how people were just pressured into signing the consent and didn’t understand what they were signing,” said Diana Block, a legal advocate at CCWP. “But those are all things that are so difficult and challenging to prove.”

A significant hurdle has been the lack of consistency and clarity around the compensation board’s definition of sterilization. According to its own guidelines, which KQED obtained through a public records request, the board describes the condition as “the removal of one’s ability to have biological children through medical procedures.”

But the only method medical experts use for sterilization — or what is now called permanent contraception due to the coercive history of sterilization — is a vasectomy or tubal procedure, which cuts, burns, occludes or removes the fallopian tubes.

Medical experts such as Carolyn Sufrin, an associate professor and OBGYN at Johns Hopkins University, also agree that various treatments can profoundly affect fertility.

Endometrial ablations, for example, are typically offered when a person is experiencing abnormal uterine bleeding, such as heavy or irregular periods that are not caused by cancer. While experts say an ablation is not clinically defined as sterilization, they contend the procedure should not be done for people who have any desire for future childbearing.

“Chances of a pregnancy at all or healthy pregnancy are vastly reduced,” Sufrin said. “I believe that people who had this procedure should receive reparations because this is a procedure that, after it, all medical recommendations say, ‘Do not get pregnant after this.’”

Sufrin referenced a patient brochure for NovaSure, one of the most common mechanisms used to perform an endometrial ablation, which states, “A pregnancy after an ablation is very dangerous for both the mother and the fetus since the uterine lining would not be able to properly support fetal development.” Contraception is recommended after ablation because of the dangers associated with a possible pregnancy.

According to the denial of Fennix’s second appeal, the compensation board rejected her application because the legislation did not define “sterilization,” so it relied on the “ordinary plain meaning, which is the permanent inability to produce offspring.” The board cited Black’s Law Dictionary.

The board also cited a 2014 criminal law that banned procedures that “render an individual permanently incapable of reproducing” except for in a life-or-death situation or when medically necessary. Based on the language of that law, the board said it believed ablations don’t meet the criteria for reparations because legislators “intended sterilization to mean a permanent form of birth control.”

Former state Sen. Hannah-Beth Jackson, who authored the 2014 law in response to the state audit on coercive sterilizations, said she suspected the board was narrowly interpreting the reparations law.

“If a procedure is so overwhelmingly likely to lead to sterilization, in my opinion, that should entitle someone to reparations,” she said. “But if it means that you have to go back in and identify all of the procedures that could lead to sterilization, then so be it.”

Emails obtained through a public records request show the compensation board staff has also questioned how it determines who should receive compensation: “We went round and round about ablations, and we are not doctors. We always felt there should be more medical evidence to support our decision.”

Cynthia Chandler, the policy chief for Alameda County District Attorney Pamela Price and a lawyer who helped draft the reparations law, first heard about ablations in the early 2000s when her legal organization was contacted by a cluster of people who described a “grotesque” procedure that was sometimes performed without anesthesia.

According to Chandler, people reported “the most painful, terrifying experience of their life … and even if some of them were medically necessary, people had no information about what was happening to them.”

To Chandler, ablations were an example of the many procedures used to limit incarcerated people’s fertility by a group of unethical physicians. When a coalition of reparation advocates asked her to help draft the bill, she said that she and her colleagues consciously decided not to define sterilization nor list specific qualifying medical procedures because they knew they would not be able to capture them all.

Instead, Chandler and her colleagues listed a number of criteria to qualify for compensation. Among the requirements, applicants needed to show that they had been sterilized while incarcerated and that the procedure wasn’t a medical response to a life-or-death situation.

Chandler said that if she had known that the board would define sterilization in a way that wasn’t based on “medical realities,” she would have written the legislation differently. 

“This is the state’s one and only opportunity to make amends, and this is how they’re behaving with it,” said Chandler, who also drafted the 2014 law that the compensation board referenced in Fennix’s appeal denial. “I’m horrified at how language that I actually wrote could be so weaponized to remove it so far from its actual meaning.”

Though the compensation board has declined to view ablations as a form of sterilization for the purposes of reparations, state officials have been aware of its sterilizing potential for at least a decade.

On March 19, 2014, three months before the state concluded its audit on forced sterilization in California prisons, Dr. Ricki Barnett, then the deputy medical executive at the California Correctional Health Care Services, sent a memo to top prison health care officials.

In 2006, the California Department of Corrections division of health care services was put under federal oversight for the state’s 33 institutions after a class-action lawsuit, Plata v. Schwarzenegger. The case brought to light the dire environment of prison medical care in California, which the court ruled was a violation of the Eighth Amendment’s ban on cruel and unusual punishment. Twelve of the state’s institutions remain under federal oversight.

The subject line of Barnett’s 2014 memo read, “Prospective Review for Procedures that have Sterilization Risks.” What followed was an urgent message: Effective immediately, all of the procedures that [the health care services] deemed to have “the potential for sterilization or diminished capacity for future conception” must go through a heightened level of review. Ablations were included in this list, along with nearly 50 other procedures.

CCHCS and CDCR declined to respond to questions about the memo but said in a statement that when they became aware that “non-medically necessary procedures resulting in sterilization were being performed on patients, the procedures were stopped.”

Before the memo was issued, the doctor who ordered Fennix’s ablation, Heinrich, signed off on tubal ligations, hysterectomies, the removal of ovaries and endometrial ablations between 2006 and 2012, according to The Center for Investigative Reporting, which first reported the illegal sterilizations. According to state prison medical records obtained by KQED, he ordered at least 80 ablations during that time, as the one performed on Fennix.

Heinrich told The Center for Investigative Reporting that the state wasn’t paying doctors a significant amount of money for the sterilizations “compared to what you save in welfare paying for these unwanted children — as they procreated more.”

Heinrich did not respond to repeated attempts for comment. When a reporter recently knocked on the door of his Castro Valley home, a woman who answered slammed it in the reporter’s face.

Clairreatha Brown, who is incarcerated at Central California Women’s Facility in Chowchilla, said Heinrich pressured her into an ablation in 2008 when she was 30. He never mentioned that the procedure would impact her fertility, she said, though his secretary told her she would not have children because of the procedure. But Brown said she was made to feel that there were no other options.

Brown’s application for reparations was also denied, catching her off guard.

“It’s another betrayal,” Brown said.

‘I’m going to need a second opinion’

Despite Heinrich’s expectations, Fennix was released from prison in 2017. Four years later, she completed her parole.

“I am just so ecstatic with this world and not being in that box,” she said.

Fennix, now 60, is the director at a community wellness center and a coordinator at a health care organization for formerly incarcerated people in Northern California. She begins her day at 3 a.m. The morning is the most gratifying time of day because she said she can sit on her porch and watch the sunrise.

“These are the times I can cry for the little girl who spent 38 years in prison,” she said.

While Fennix was incarcerated, she met Chandler, the attorney who helped write the reparations law, when she had come to the prison to meet with her clients. After Fennix’s first reparations application and appeal were both denied, Chandler introduced her to WookSun Hong, an attorney at the Bay Area Legal Incubator, an organization that supports attorneys who serve underrepresented communities. Hong helped her file a second application.

This time, the application included a declaration from Amy Huibonhoa, a board-certified OBGYN who noted the serious risks associated with pregnancy after ablation. Huibonhoa stated that it is “imperative” for informed consent to cover those risks, along with its negative impact on fertility. Fennix was still denied.

Hong suggested they petition the state court, arguing that the government isn’t adhering to the law. It is slated to be filed next week. According to Hong, the petition is important because he believes the compensation board’s grounds for denials are arbitrary and not based on the law or science.

“The whole purpose of the Victim Compensation Board is to compensate the victims,” Hong said. “But it’s almost like they’re acting like insurance adjusters. They are trying to find the excuse to deny the claim.”

Continuing to push is Fennix’s way of demanding that the board begin to fully comprehend the extent of the damage that was done to people like her.

“I’m hoping [the compensation board] realizes that they sterilized a lot of us and that they should give people options, not just do what they want to do with our bodies,” she said. “It’s not about the money more than it is about the fact that these people don’t want to take accountability, and they don’t want to say that they actually ruined my body based on a procedure that didn’t have to happen.”

Fennix said her body continues to feel off-kilter and the symptoms she experienced after having an ablation have largely remained the same. Now, anytime she needs to have a procedure done, she takes extra time and caution.

“I’m going to ask a thousand questions,” she said. “I’m going to need a second opinion.”

Cayla Mihalovich is a reporter with the Investigative Reporting Program at the UC Berkeley Graduate School of Journalism.

More information on how to apply for compensation for involuntary sterilization can be found at the California Victim Compensation Board website. Applications are available in English and Spanish. 

Anyone needing assistance with the application can call the compensation board’s toll-free helpline at 1-800-777-9229 from 8 a.m.–5 p.m. Monday-Friday.