Sterilizing the Poor
Dreifus, Claudia
Sterilizing the Poor CLAUDIA DREIFUS They sit quietly on her lap as she weeps: the two living children of Guadalupe Acosta, two little girls with coffeetone skin and classic Indian faces. Clean...
...Before this sterlization expose broke, his was one of the great medical success stories: a distinquished career...
...And the sympathetic doctor, feeling h e ' s done his best, sterilizes her...
...You don't consider asking a woman about the procedure after labor, pushing...
...In my opinion, there is no physician on staff here who wants to sterilize people for welfare reason or other reasons...
...Only four physicians could honestly and unequivocably state that they had trained at hospitals that were clean...
...And it is because of this sterilization that Lupe Acosta* s common law husband abandoned her...
...Not true...
...County Women's Hospital...
...That usually wasn't hard to get...
...I know these doctors and I've worked with them and I feel they're solely interested in the patient's interest...
...Some patients were misled into thinking their tubes could be " u n t i e d " at some time in t he future...
...The child's head was more than just too big...
...For three nights, Rosenfeld and I wandered through the bleak hallways of the house staff dorm—a building which one intern jocularly described as "decorated in a style of early hysterectomy...
...Built into Mexican culture is the idea of machismo, a value that says a man's masculinity is measured by t h e number of children his wife produces...
...Antonia Hernandez, Attorney, Model CitiesLaw Center There is a wounded innocence to Dr...
...Ultimately, we are all, as Guadalupe Acosta understood, helpless in the face of a medical system that has little accountability...
...A gynecologist earns nothing for dispensing condoms or t h e birth-control pill...
...A female intern in a nearby room had recently completed obstetrics rounds at Riverside General Hospital in nearby Orange County...
...Nevertheless, the same medical practice that sell tubals to the poor under the stress of labor, sells my affluent friends the lie of Band-Aid simplicity for a dangerous operation...
...I didn't want to go to L.A...
...At L.A...
...Diaz, then thirty-two years old, was a legally immigrated resident of the United States and because her husband had not yet attained that status, it was decided she should journey to Los Angeles alone for theinfant'sbirth...
...County dorm...
...A former medical student from the University of Chicago, where the patient population is primarily black: "No one ever said to a woman, 'We don't trust you with taking the pill,' it would be presented very positively...
...Rosenfeld and I are looking for two things: we want to know whether t h e L.A...
...These documents are so filled with pain that even the cold, objective tone of legalese cannot blunt the suffering that has obviously occurred: Maria Hustado: "I do not remember the doctor telling me anything about tubalization...
...County obstetrics staff, in its zeal to sterilize, was dispensing medical misinformation as it it were aspirin...
...These women, with one exception, were all sterilized at County...
...Quilligan says...
...That is the defensive response most people have when I tell them the L.A...
...Quilligan is asked about Bernard Rosenfeld, who has been conducting "informal studies" of physicians' attitudesfor some year now...
...We have tried in every instance to comply with what we thought was good medical practice,'' Dr...
...As Dr...
...We abstracted those guidelines and put them out as law, h e r e ." Not quite...
...When he came back, he hit me in the stomach and said, * Now lady, let us do what we have t o . ' I felt very sick...
...All that I remember is after the doctor injected my dorsal, spinal cord, he told me, 'Mama sign here...
...And of the fifty-one respondents who did answer the poll, one in three gave replies that showed conformity with the letter and spirit of the Federal guidelines...
...I don't know about things like t h a t , ' ' she replied, clutching at her two b a b i e s . ' 'You go to the hospital so sick, so dependent, one doesn't ask questions...
...Andat L.A...
...She may go home and change her mind...
...Then, when he began to raise the issue of forced sterilization with the house staff...
...I kept telling t h em to do something to bring the baby They kept me in that condition from six o'clock in t h e evening till three o'clock in t h e morning...
...But if a woman came in with five children, we'd sell the operation—sure...
...At that moment, I thought— but I didn't say it, 'What is it to you...
...The two other children, t h e pain was nothing like this...
...County's dormitory for house staff...
...County Medical Center, certain John Doe doctors (the women do not know the names of their sterilizers), the State of California, and the U.S...
...This will be the easiest thing for u s . ' Mostly, we'd approach women with large families and we'd tell them this was the best solution...
...house staff has witnessed a good deal of coercion during t r a i n i n g . ' ' Most of t h e patients that are sterilized are seen by these residents h e r e , " asserts Quilligan, " a n d they don't tell me that t h e r e ' s a lot of coercive sterilization going on...
...Acosta's caesarean delivery, her common-law husband came to her bedside...
...These institutions—plus another twelve hospitals responding to this questionnaire—should be subject to immediate withdrawal of funding because they are in complete n o n - c o m p l i a n c e . . . . " But will those hospitals lose their Federal monies...
...Nine of them had either witnessed coercion or worked under conditions that could easily lead to it: hard-selling, dispensing of misinformation, approaching women during labor, offering sterilization at a time of stress, on-the-job racism...
...Acosta attended weekly pre-natal clinic sessions at County— where, not once, was she counseled about sterilization...
...Tothis d a y , " she says—speakingina low voice, so that her husband, who sits outside, will not hear, " h e is very angry...
...We would explain the world population problem...
...Diaz explains all this as she pours coffee for me and her lawyer, Antonia Hernandez...
...An intern who had done his medical school rounds at UCLA—Cedars of Lebanon Hospital in Los Angeles: "I did see instances of women in labor being asked...
...E. J . Quilligan, Chairman of the L.A...
...According to a study made by ElissaKrauss for the American Civil Liberties Union, few major teaching hospitals are following the 1974 HEW orders...
...As for t h e Health Research Group's study on sterilization he grimaces at the mere mention of it...
...Because Mrs...
...However, on August 20, 1973, eleven months and eleven days pregnant, Lupe Acosta entered L.A...
...Not really," she replies...
...A. County Medical Center, one of the three top obstetrics residencies in the country...
...County General Hospital on August 21,1973...
...The doctors we interview seem to accept coercion as an everyday fact of medical life—few of them are even aware of the moral significance of what they have witnessed...
...Once a woman has had a tubal, she must consider herself permanently, irrevocably sterile...
...According to that same study, the death rate for IUD is nine per million women...
...Or she may find her husband is angry...
...Less than a third of the queried chairmen granted the ACLU the courtesy of a reply...
...they simply cut without permission...
...the chairmanship of the Obstetrics and Gynocology Department at USCL...
...They're slick now...
...Louis: "Whether or not a patient was approached positively about sterilization depended on the doctor's own approach . A woman on welfare with a large family was more likely to be approached earlier than a woman not on welfare...
...It is a warm July afternoon...
...Acosta has given birth to four infants, it is only these two children—the middle ones—that she has been able to nurture and raise...
...Why are women approached about sterilization during labor...
...Diaz, pregnant with a third child, was living with her family in Hermosillo, Mexico...
...The children have been brought because, w e l l . . . babysitters are expensive...
...He said, 'If I had signed t h e paper, would I have sent you for t h e Pill ? ' " The relationship between Guadalupe Acosta and her common-law husband of eight years quickly deteriorated...
...An intern previously at Barnes Hospital, St...
...Sign here.' " MariaE...
...Besides—no judicial award can ever compensate a woman for her stolen fertility...
...County Medical Center seems now to be one of the few institutions in the United States actually conforming to law...
...Nonsense," says Dr...
...Alan F. Guttmacher, t h e leading American authority on contraception, explains: "By tradition the American obstetrician is prepared to sterilize any patient who desires it at t he time of t h e third caesarean section...
...the evidence still isn't in...
...If there was a big rush, the staff wouldn't bother...
...There was a basic social pressure that three children were enough...
...Yes, I went there because I thoughtitwould be b e t t e r , " explains Mrs...
...H e told me the baby was alive and in an incubator," she says, weeping at the mere recollection...
...Now when I was down in Nicaragua, there we pushed...
...Lis eyes gleamed when he spoke of hysterectomy: "In Houston, a lot of well-to-do women would come in and they'd want hysterectomies because their friends had them...
...I know that I didn't because there was a nurse or a receptionist at the hospital who showed me t h e chart and there was no indication that I approved...
...Edward James Quilligan'smannerasheshifts about restlessly during an interview in his textbook-lined office at L.A...
...Ever since the operation, I am very inattentive...
...That's a candid admission...
...I was in great p a i n ," she tells us...
...And it was after that delivery that doctors at L. A. County sterilized her...
...We knock on doors, introduce ourselves as researchers doing a "rough study" on informed consent practices, and ask interns and residents to tell us what they have witnessed at other institutions where they have trained...
...v. E.J...
...No one was pushed, though...
...In 1972, Mrs...
...Diaz, Mrs...
...Diaz broke down...
...elective tubal ligation—470 per cent...
...require a careful counseling procedure so t h a t patients truly learn that t h e operation is permanent and that there are other birth control choices...
...You're not my husband.' " When Mrs...
...It's not that I don't understand them, it's that I'm not t h e r e ." It was a different story for Maria Diaz (not her real name...
...Now the child is three years old and I think I should be pregnant now, a c c o r d i n g t o t h e p a t t e r n l ' d e s t a b l i s h e d ^ u t l c a n ' t . I go to the doctor every month for the nerves...
...Detroit's blacks, they're really very anti-white...
...She said, 'Your husband did.' And then I told them he wasn't my husband...
...Did you sign a paper for the caesarian...
...In November 1974, when the guidelines were nearly half a year old, Krauss sent questionnaires to the heads of OB-GYN departments of 154 ranking teaching hospitals...
...Quilligan was compelled to issue a memo to his impeccable staff: "Effective immediately, patients will no* b e approached for the first time concerning sterilization when they are in labor...
...We'd ask a woman in labor, if her chart wasn't available...
...The three of us are sitting in the living room of her spotlessly clean cottage in Glendale, California...
...And then, there were two doctors just pushing down on my stomach and Icouldn' t . . . I couldn't stand it...
...Diaz who, like her husband, works as a baker...
...The bill for an IUD insertion is rarely more than $100...
...Of those six, three had trained at Catholic institutions where sterilization is strictly prohibited...
...Sometimes, the physicians even disposed of the minimum legal nicety of a signed consent form...
...Nothing has gone right in her life since August 1973...
...tubal ligation after delivery—151 per cent...
...With sixteen year olds, you needed the parents' permission...
...That is the response of educated middle-class women when they hear about forced sterilization...
...County as an isolated fluke...
...It seems so unfair...
...Rosenfeld going around saying that they have...
...She was, as a result, forced on welfare...
...when he made all t he noise that led to The Big Scandal—well, then, Rosenfeld was "not renewed" for his second year of training...
...It means that Dr...
...But then, we went to our own family doctor and he told us there was nothing wrong with her...
...I thought I was going to die...
...Personally, I'm just anxious to see the patient get what she wants...
...Rosenfeld in reply...
...County, we found four doctors who had worked at institutions where the operation was softly, slickly sold...
...Fighting...
...It can't happen here...
...What we're doing," Dr...
...There should be a waiting period and the minimum age should be twenty-one...
...A group of specially trained female counselors has been hired...
...Many of the women thought their tubes could be untied...
...He says, 'Surely we will part...
...Well, let's just say we counsel them so that they don't want i t , " he replies...
...You never lacked home...
...There was concern by some of the students that minority groups were getting pushed, so t h e hospital became very careful...
...Health Research GroupReporton Surgical Sterilization, October 1973 " I n 1968, my own mother went into County to give birth to my baby sister...
...There is profit in it...
...And also because Lupe Acosta finds it hard to be away from them for any sustained period of time...
...People sometimes have to tell me things twice...
...conformity by California with the 1974 Federal ban on sterilization of women under t h e age of twenty-one—the California limit is eighteen...
...At one major teaching hospital, the Women's Hospital Los Angeles County Medical Center, the following increase in the number of sterilization procedures occurred in t h e two year interval between July 1968 and July 1970: Elective hysterectomy—742 per cent increase...
...Acosta, a large, somber-looking woman of thirty-five, has taken the morning off to talk with me...
...My brother-in-law told me it would be better for the baby to be born in the United S t a t e s , " she recalls...
...This is happening all over t he country," asserts Dr...
...the other three were USC-L.A...
...Then the tubal ligation hemorrhaged and she was hospitalized...
...Acosta from her lawyer: "Do you remember signing a consent form...
...What's more, the women are suing for financial damages...
...I told them I could not accept that...
...I t ' s very difficult to understand a patient's motives when she's changed her mind," he explains...
...It's best for you that you not have any more children...
...The chart said I rejected all their efforts for sterilization, but I don't remember everything...
...The operation is the reason she cries throughout our interview, t h e reason she holds her two daughters to her body so tightly...
...more than sixty professional publications...
...My friends are middle-class and well educated...
...Why did you let them do this to you?' " Since t h e operation, Maria Diaz says, she has become nervous, rare...
...when he began speaking with newspaper reporters...
...I didn't see any prejudice against Mexicans or blacks per se, but the ward patients weren't given as much information on sterilization as t h e private patients...
...I got angry and I cried, 'If you're going to do anything, do it, but let me have my baby now because I feel I am going to die.' I remember very little after that because it was like a dream and I was in great pain...
...T h e doctors would say, 'Do you want to go through this again?' Mostly, the doctor's individual philosophy towards sterilization had a lot to do with whether or not a patient was approached...
...Even if they had been given all the facts...
...You know, you look at a fetus and you see it is a formed human being, so we didn't do many...
...He told me that he didn't sign anything except for a paper for a caesarean...
...I t ' s expedient," the intern explains...
...I wear a most unjournalistic pair of dungarees...
...There were so many young girls and most of them had a real low mentality...
...In those cases, we'd ask 'em, often when they were in labor, if they wanted tubal ligations...
...Elective hysterectomy is $600—plus...
...County man provided us with the most bone-chilling statement of all: " I guess the problem we have here is a problem of philosophies...
...The day after Mrs...
...The other doctor would have the other leg open...
...There wasn't any racism there...
...County trained...
...Though Mrs...
...They were having all these meetings about 'genocide.' " A similarly pleasant doctor up t h e hallway claimed his training institution, Jefferson Davis Hospital—Baylor Medical School in Houston, Texas, was a good deal less discriminating: "Our patient population was 80 per cent black, 15 per cent Chicano and 5 per cent what you'd call poor white t r a s h , ' ' he twangs in a voice of pure honey...
...Those regulations specifically ban sterilizations on women under twenty-one...
...they were Mexican and poor...
...Nevertheless, Dr...
...Nevertheless, the attending staff continued pressing her for sterilization...
...I don't have t h e figures in front of me, but I don't think the total ever got above 5 or 6 per cent of all who came in...
...for tubal ligation, 1,000 per million...
...For that last month of term, Mrs...
...County department of obstetrics and gynecology, says, "Rosenfeld was evaluated and found to be an unsatisfactory doctor...
...Rosenfeld wears his medical whites—he is an MD...
...I once asked her if she thought the physicians at L.A...
...It would get some of t h e residents really mad...
...It's possible in t h e pain . . . but I don't remember doing t h a t ." Mrs...
...There was a language problem...
...However, average fees for a tubal ligation begin at $300...
...Then, after several more hours of labor, she was informed that the child would be born by caesarean section.' 'I told them I could not accept the caesarian operation because my husband was not there and I could not do as I pleased When they were talking about the caesarian, I heard the doctors use the word 'tubes.' The doctors said they were going to tie my tubes because it would be dangerous for me to have more children...
...In 1973, he was an obstetrics resident here...
...I kept saying no and the doctors kept telling me that this was for my own good...
...Given the reality of machismo, a sterile woman is considered worthless—useless...
...County et...
...Quilligan wants us to know what a trial this has been for the hospital.' T h e thing t h a t ' s bothered me most," he complains, " i s how the adverse publicity has affected our p a t i e n t s . . . . They come here in great fear, feeling that we're going to grab them and sterilize them—which is the furthest thing from our mind...
...A question to Mrs...
...The residents didn't like to do them...
...Apparently, but that is hardly saying much...
...To prove her point, Hernandez hands me the legal documents ofDolores Madrigal et...
...She was crying with pain...
...Yes, certainly, their statistics are correct," he says...
...Though tubal ligation is one of the few operations that is 99 per cent elective, an unusual number of Chicanas were told that would die if they did not submit...
...And, if one is to believe the sworn affidavits of eleven women, the L.A...
...For the longest time, we were very worried...
...No more babies...
...For Buddy Rosenfeld, our visit to County is an odd kind of homecoming...
...the doctors call it "Band-Aid surgery...
...He is a fiftyish man...
...I s it possible that you told them verbally to go ahead...
...A month after delivery, she arrived at County for the standard post-natal check-up...
...If a resident wanted to practice doing a laparoscopic [tubal ligation], he'd push it, sure...
...It is possible that ten or twenty years from now we may see a cancer epidemic among pill users...
...prohibit operations on women less than seventy-two hours after they have signed consent forms...
...We turn down a lot of patients for sterilization...
...What baby?' he asked...
...Sterilizing the Poor CLAUDIA DREIFUS They sit quietly on her lap as she weeps: the two living children of Guadalupe Acosta, two little girls with coffeetone skin and classic Indian faces...
...Although official policy has changed, the attitudes of t h e doctors didn't...
...consent forms in English and Spanish...
...With their hands...
...Others were told that there were legal or medical limits on t he number of caesareans that patients were permitted—an untruth to say t he least...
...On a smoggy day last autumn, Lupe Acosta's man abandoned her and the two children...
...I inquire...
...consent forms written on a reading-level comprehensible to all women...
...Now, that can get you into trouble because some patients will say, 'I don't ever want to have another baby...
...Sterilization was offered to women in labor no matter what their age...
...Although it's like asking a drowning person, do they want to get out of the water...
...One doctor would have one leg open...
...No more than here...
...Legal remedies for coercion are rare, expensive, and generally unavailable to the poor...
...When Lupe Acosta got home that night, she was alternating between fury and hysteria...
...There has yet to be a full generation of women who have used oral contraception for their full fertility-life...
...Ihadaprivate doctor...
...Women were approached in clinic and sometimes during labor, sure...
...Quilligan wants me to know about all the fine improvements that have been made on his service: "In early 1974, the HEW guidelines came out stating that certain criteria had to be followed if Federally funded hospitals were to maintain their grants...
...They became slicker at talking patients into tubals...
...Finally, Dr...
...It can't happen to me...
...The parents weren't in labor...
...The plaintiffs demand a new set of self-enforcing Federal guidelines that will make coercion more difficult...
...Most of the patients are Mexican and they have a different philosophy from us...
...I was sweat all over, sweat...
...Between 10 and 30 per cent of all women who agree to it later regret the operation...
...membership on nearly every important policysetting council within his speciality...
...I don't remember signing anything...
...There are constant problems...
...Yeah, maybe I did ruin a promising career, but L.A...
...I t ' s dangerous for her to speak up with her husband not yet fully immigrated...
...Six doctors gave us answers that amounted to "no opinion...
...They can have little rap sessions with the girls and ask questions," he says...
...County Women's Hospital...
...In Mexico, the people are very, very poor and it's best that you not have more children...
...My common-law husband, he told me to get the Pill at the hospital," she recounts...
...For a year, I was sick with the wound—the scar that did not close 1 feel very bad and I want more people to know this so it won't happen to someone e l s e ." " S h e ' s a brave woman," Antonia Herandez tells me later...
...Suddenly, the doctor is the bad guy...
...I mean, I helped curb some terrible suffering...
...The patients there were also Mexican...
...There was beginning to be a whole lot of trouble...
...So if there is very little forcible sterilization going o n , " I interject, "then why are so many women suing— here and elsewhere...
...I was groggy from the drugs, exhausted from the labor, as well as from the doctor's constant pressuring...
...How do you manage t h a t ? " I inquire...
...A tube was pushed into her vagina...
...But t h e doctors told the women little of this...
...I ask...
...for laparoscopic tubals, the mortality rate goes down to 300 per million...
...But the point is this: based on what we now know, as dangerous as the Pill is, it seems to be safer than sterilization...
...Bad guy or good guy...
...Consent forms were pushed at women in the throes of labor— women who were drugged,women who were under anesthesia...
...Few of us do...
...Because of t h e abnormality, t h e pregnancy lasted eleven months...
...When I asked the woman doctor, she asked me if I knew what had happened to me...
...Doctors who learn to push sterilization on indigent patients during training will do the same in private practice...
...I didn't see any real pushing but it was often suggested after labor," she commented dryly...
...Figueroa...
...I pushed one doctor because I couldn't stand the pain...
...I inquire...
...A doctor asked me if I wanted to have a tubal ligation 1 told the doctor that I did not want to be sterilized since my husband and I planned to have another child...
...It was Mrs...
...Sometimes she gets pains from the tubal ligation...
...Another intern, formerly at UCSF-San Francisco General Hospital: "K was always explained—if the patient asked, yes, she'd be told it was permanent...
...You would get the feeling from the article that we sterilized everyone who walked in, when that just isn't the case...
...Those over eighteen you didn't need the parents'permission...
...We'd tell them about birth control and they wouldn't take it...
...About the lawsuit: Mrs...
...The Department of Health, Education, and Welfare has yet to move against a single institution named by the ACLU...
...Bernard "Buddy" Rosenfeld, the thirty-three-year-old co-author of the Ralph Nadersponsored Health Research Group study on forced sterilization...
...County Hospital," she b e g i n s . ' ' I h e a rd they didn't treat you right there and that they made t h e women suffer...
...Few of the plaintiffs spoke more than minimal English...
...To prove his point, t h e two of us sneak our way past security at USC—L.A...
...The doctors told her that she would have to get her tubes tied because if she had another baby, she would die...
...We also want to know whether the 1974 Federal guidelines against coercive sterilization are being enforced...
...Quilligan, Director of Obstetrics at USC-L.A...
...This was not a high sterilization rate compared to the rest of the country...
...For the caesarian, y e s , " Maria Diaz answers, "but for the tubal—no...
...County were racist...
...Maria Diaz was approached repeatedly during the final stages of her labor...
...That was the last time I saw the clock—the last time I remember anything...
...Diaz discovered she was sterile some weeks later during her post-natal clinic visit...
...County house staff, recent arrivals from some of the ranking medical schools around the country, have seen abuses similar to those that have occurred here...
...It should be said, however, that we still do not know all the long-term effects of use of the birth control pill...
...We are asking for money,'' explains Antonia Hernandez, "because money is the only thing that doctors understand...
...We could have had many, many more plaintiffs on the lawsuit, but the women were afraid of the Immigration and Naturalization Service...
...Judging from o u r ' 'rough study'' interviews, forced sterilization is a part of academic training at more than a few major teaching hospitals around the nation...
...Acosta, and nine other Los Angeles area Chicanos are suing USC-L.A...
...Only when I left the hospital—perhaps an exit paper...
...For three-and-a-half hours, they sat in the waiting room until the hospital would admit her...
...Thirty-six major teaching hospitals are in non-compliance with Federal regulations on sterilization," said the ACLU report...
...Diaz wrote her spouse of the operation, he sent back a letter saying he didn't understand what she was talking about...
...I didn't see anything," said one L.A...
...Well, y e a h . . . if they had two kids...
...What's their motive...
...There is now a special sterilization counseling clinic, one of few in t h e country...
...He supports his family by working the midnight shift at half a dozen private hospital emergency rooms around Los Angeles...
...In December 1974, Robert Kistler, an investigative reporter for the Los Angeles Times, telephoned Quilligan to ask him if h e was complying with the then seven month-old HEW orders...
...Not forgetful, inattentive...
...Quilligan, who according to t h e December 3, 1974, Los Angeles Times commented: "Well, I would have to agree with that, in some areas, we're probably not following them at the present t i m e ." Eventually, County did move into full compliance with Federal regulations...
...Department of Health, Education and Welfare...
...Quilligan understands that t h e type of counseling a patient receives will determine her ultimate decision...
...I said, 'No.' And then the doctor told me, 'Well, you won't need the Pill because they tied your t u b e s . ' I said that I didn't sign anything...
...And now he must face lawsuits and accusations and suspicious journalists...
...Even if they had spoken the language...
...How magic number three was derived is unknown to m e . ' ' "It would be a mistake to think of the situation at L.A...
...For instance, a friendly intern who has just completed studies at Wayne State Medical School in Detroit, recounts the most remarkable things in perfect innocence: ' * Most of our patient population was black, inner city,'' he explains...
...We spoke with twentythree doctors...
...None of the physicians we speak with know that I am a reporter, that I am making careful notes after each interview, that their comments will see print...
...County, until most recently, counseling was a haphazard business, dependent on circumstance and the whim of the attending doctor...
...That's the word she uses: rare...
...Rosenfeld asks...
...My evaluations were above average...
...And they object strongly to Dr...
...Yet, one study showed 1,594 serious complications and nineteen deaths of out 63,845 operations surveyed...
...Maybe the indications weren't so strong, but why shouldn't we take her womb if it makes her feel b e t t e r ? '' Several of my friends have recently submitted to tubal ligations...
...Though a costly operation for reversal exists, it is successful in only 10 to 20 per cent of all cases...
...Another L.A...
...Very, very hard...
...Something unfortunate was Dr...
...I became very angry," she says, "and I asked him why he had done that—he had no right...
...Quilligan explains, "isthatevery patient has to go through t h e counseling clinic and they have to take a test at the end of it to make sure they know what's happening...
...Often an intern would say, 'I want to do a tubal.' That was a big influence in prompting them to do it—they wanted to get another tubal under their belt...
...Rosenfeld's interviews have shown that t h e L.A...
...N o , " she answers...
...The women were pressured into the procedure during t h e stress and agony of childbirth—a time when they could not possibly make an informed decision about an irreversible operation...
...Rosenfeld's training remains incomplete...
...But more was to come...
...they claim the practice of pushing these operations on the poor is a part of national sterilization epidemic they want stopped...
...County in the final stages of labor...
...County is now one of the cleanest institutions in the country...
...Tubals are way up and the birthrate is way down...
...Finally, I told the doctor, 'Okay, if it's a boy, go ahead and do i t . . . . My daughter Elizabeth was born by caesarian operation...
...When I was being examined, they pushed very hard on the stomach," she recalls...
...She was drugged and "they had already given me anesthesia when I signed the consent form for the caesarian and they were still insisting that I would accept the tubal operation and I was still saying, 'No, no, no.' " Finally, Mrs...
...When I heard that, I started to c r y , ' ' she recalls.' 'The doctor said, 'Don't cry...
...If a woman came in with two children and wanted a tubal, we would try to talk her out of it...
...People would come in with nine children and they didn't have food and we pushed t h e m ." A pediatric intern, formerly at New York's Bellevue Hospital: "There was a large Puerto Rican population and I think a lot of women didn't know the full consequences of what was happening to them...
...A few unadvertised, unpleasant bits of information about tubal ligation: t h e death rate is significantly higher than for long term use of the IUD or t h e Pill...
...Not likely...
...The doctor answered that he could not recall seeing them...
...Quilligan looks at me coldly...
...Without her informed consent...
...On the walls hang dimestore prints of John F. Kennedy and Emiliano Zapata—and also, lovingly mounted crayon scribblings by t h e children...
...Some of t h e parents said, 'No.' They liked having t h e babies around...
...The fourth child died shortly after birth atL.A...
...Interestingly, USC-L.A...
...when he signed his name to t h e Health Research Group study...
...When I was nine months pregnant, he told me that the baby's head was too big and I would have to go to the County Hospital because they had better equipment...
...Seven days later the doctor came round to take out the stitches and I asked him how my baby was...
...And my nerves and my head are in great p a i n , " she complains...
...Clean and pretty in their starched dresses, the girls are with their mother as we meet in the East Los Angeles offices of her attorney, Antonia Hernandez of the Model Cities Law Center...
...According to the Health Research Group study on "Surgical Sterilization Present Abuses and Proper Regulation," the death rate on hysterectomy (often improperly used for sterilization) is 1,000 deaths per million...
...We had a lot of young girls come in . . . thirteen and sixteen and they'd have two or three children...
...Tour baby died when it was born.' " That's how Acosta learned the fate of her fourth child...
...she was in labor...
...I could cross the border freely and my husband could not—so I went alone...
...it was severely malformed—anencephalic, it had no brain...
...You never lacked food...
...Besides, I think what I did was in t h e best tradition of medicine...
...county story...
...This is t h e best thing for you...
...a woman involuntarily sterilized suffers many of the permanent psychological impairments of a rape victim...
...County doctor defensively...
...Acosta, of all the protagonists, who had the sharpest focus on what had happened...
...Without her knowledge...
...While my husband was visiting me in t h e medical center, the doctor came to my bed and informed me that he had performed a tubal ligation on m e ." Reading through the papers, one begins to perceive a pattern...
...There was a first baby, born in Mexico, who was taken from her and given to a relative for adoption...
...bald and heavy...
...You mean you sterilized sixteen year olds?'' asks an incredulous intern from Milwaukee, who has been sitting on the side, taking the discussion in...
...On April 6, 1972, Maria Diaz and her brother-in-law arrived at L.A...
...for pills, it is thirty-one per million...
...I remember that honey-voiced gynecologist-to-be from Houston whom we spoke with one summer evening in the L.A...
...But we didn't do many abortions, though...
...So Kistler read the rules to Dr...
Vol. 39 • December 1975 • No. 12
