BILL ANALYSIS
SENATE COMMITTEE ON PUBLIC SAFETY
Senator Elaine K. Alquist, Chair A
2005-2006 Regular Session B
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AB 478 (Lieber)
As Amended May 3, 2005
Hearing date: June 14, 2005
Penal Code and Uncodified Law
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medical care of pregnant inmates
HISTORY
Source: Author
Prior Legislation: None
Support: American Civil Liberties Union; American College of
Obstetricians and Gynecologists; California Catholic
Conference of Bishops; California Medical
Association; California Association for Nurse
Practitioners; Family Council; Friends Committee on
Legislation; California National Organization for
Women; California Attorneys for Criminal Justice;
Commission on the Status of Women; California Public
Defenders Association
Opposition:None known
Assembly Floor Vote: Ayes 49 - Noes 26
KEY ISSUES
should prenatal care for pregnant state and locally incarcerated
inmates be required, as specified?
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Should the Department of corrections (CDC) be prohibited from
shackling inmates who are in labor or in recovery while they are
being transported, as specified?
(continued)
should CDC be required to transport pregnant inmates who are in
labor in the least restrictive way possible, as specified?
PURPOSE
The purpose of this bill is to 1) provide pregnant state and
locally incarcerated inmates with prenatal care, as specified;
2) require the Department of Corrections (CDC) to transport
pregnant inmates in the least restrictive way possible; and 3)
prohibit CDC from shackling pregnant inmates who are temporarily
being transported to a hospital, are in labor or in recovery,
unless deemed necessary for the safety and security of the
inmate, the staff, and the public.
Existing law establishes that a pregnant prisoner is entitled to
a determination of the extent of her necessary medical services
and to the receipt of these services from the physician and
surgeon of her choice. Provides that the prisoner shall pay for
any expenses occasioned by the services of a physician and
surgeon whose services are not provided by the institution.
(Penal Code 3406.)
Existing law directs the California Department of Corrections
(CDC) to establish community treatment programs for women in
state prisons with children under the age of six years that
provide for the release of the mother and child to a public or
private facility in the community suitable to their needs.
(Penal Code 3411.)
Existing law limits eligibility for these community treatment
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programs to the following:
a) Applicants who are serving a maximum of six years,
are the primary caretaker of the child, and have not been
determined in any court proceeding to be an unfit parent;
and,
b) Applicants who do not pose an unreasonable risk to
the public. Factors taken into consideration include,
but are not limited to:
i. Convictions for a sex
offense; a violent offense, arson; or
possession for sale, manufacture, or
transportation of a controlled substance.
ii. Probability that the inmate
may abscond from the program.
iii. Probability that the
inmate's conduct will adversely affect herself
or other participants in the program. (Penal
Code 3417(a).)
Existing law requires the CDC to provide pregnant inmates who
meet the eligibility requirements access to community treatment
programs. (Penal Code 3419.)
Existing law permits a pregnant inmate to be temporarily taken
to a hospital outside the prison for the purposes of childbirth
and provides for the care of any children so born until suitably
placed. (Penal Code 3423.)
Existing law requires the Board of Corrections (BOC) to
establish minimum standards for local detention facilities and
to review such standards biennially and make any appropriate
revisions. (Penal Code 6030.)
Existing law limits the CDC to use restraints only when an
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inmate is transported between locations, an inmate's behavior
indicates a reasonable likelihood to become violent or attempt
escape, or medical staff determines it is necessary to prevent
self-inflicted injury. (15 California Codes of Regulation
3268.2(a).)
Existing law limits the CDC to only provide medical services to
inmates when a physician has determined the service to be
medically necessary to protect life, prevent serious illness or
disability, or alleviate severe pain. (15 California Code of
Regulations 3350.)
Existing law limits the CDC to only provide dental services that
are necessary to meet basic needs, which include, but are not
limited to, treatment of injuries, acute infection, severe pain,
or spontaneous bleeding, and repairs to dental prosthetic
appliances. (15 California Code of Regulations 3355.1.)
This bill does the following:
Requires community treatment programs for eligible pregnant
inmates to provide, but not be limited to, prenatal care,
access to prenatal vitamins, childbirth education, and infant
care.
Requires that pregnant inmates be transported to a hospital
outside the prison in the least restrictive way possible.
Prohibits shackling a pregnant inmate by the wrists or ankles
during labor, which includes, but is not limited to, transport
to a hospital, delivery, and recovery.
Establishes minimum standards for pregnant inmates who are
ineligible for community treatment programs to include:
a) A balanced, nutritious diet approved by a
doctor;
b) Prenatal information and health care
including, but not limited to, access to necessary
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vitamins, as recommended by a doctor;
c) Information pertaining to childbirth
education and infant care; and,
d) Regular dental cleanings.
Requires the BOC to establish standards for local detention
facilities that include the aforementioned minimum standards.
COMMENTS
1. Need for This Bill
Background provided by the author indicates that:
This bill repeals CDC's ability to shackle a pregnant
inmate while she is being transported to and from a
hospital facility when she is in labor, during delivery,
and post delivery.
Additionally, this bill requires that all female inmates
who are incarcerated at a facility run by the CDC to
receive prenatal health care, including immediate access to
prenatal vitamins and regular dental cleanings.
The State of California currently operates four prisons for
women and 2 to 4% of the women entering prison are
pregnant. Reports from Amnesty International and the San
Francisco NOW Women in Prison Task Force tell of neglect in
the health care of women prisoners.
In October 2000, the California Joint Committee on Prison
Construction and Operations conducted a hearing that
brought to light the shocking medical plight of women
inmates at California facilities. For example, female
inmates from the Central California Women's Facility
reported being denied health care for serious conditions
such as sickle cell anemia, Hepatitis C, and prenatal
health care.
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However, before any action could be taken, the California
Joint Committee on Prison
Construction and Operations was disbanded, and very little
has changed in the health care of women prisoners.
This bill takes a step in correcting the critical problems
that women prisoners face from a lack of adequate health
care.
2. History of the Issue
The author has submitted the following background regarding the
issues addressed by this bill:
Women who are pregnant at the time of being sentenced to
the CDC are received at either Valley State Prison for
Women or the California Institution for Women in Corona and
are assigned to an OB/GYN doctor at the prison. These
women spend the bulk of their pregnancy in the general
population of the prison, with no special diet or other
assistance with prenatal care.
Once these women go into labor, they are shackled to and
from the hospital to give birth, as well as during labor.
They are unshackled once a doctor makes a diagnosis that
they are in labor, and they are shackled again after the
birth and during recovery. Such treatment is in violation
of international standards (Rule 33 of the UN Standard
Minimum Rules) and the American Correctional Association,
which states that restraints should only be used if
absolutely necessary to prevent escape.
3. International Law
Adopted in 1955 by the First United Nations (UN) Congress on the
Prevention of Crime and the Treatment of Offenders, the United
Nations Standard Minimum Rules for the Treatment of Prisoners is
the foremost body of international law concerning the treatment
of prisoners. Rule 33 prevents the use of restraints except
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during transfer to prevent escape or on medical grounds as
directed by a doctor. Arguably, this rule would prevent
shackling a woman in labor because the shackles are not
necessary to keep a pregnant woman from escaping and hindering
her medical needs.
Rule 22 requires the services of a qualified dental officer and
Rule 23 requires pre-natal and post-natal care and treatment for
pregnant inmates and the child. Arguably, these rules require
California to provide pregnant inmates with the necessary
pre-natal care, including special dietary and dental concerns.
4. Youthful Offenders
As before the committee, this bill does not include female
inmates in the California Youth Authority or local juvenile
detention facilities. The author may wish to make this
provision applicable to these female inmates.
SHOULD THIS BILL BE AMENDED TO APPLY TO YOUTHFUL FEMALE
OFFENDERS IN THE CALIFORNIA YOUTH AUTHORITY AND LOCAL JUVENILE
DETENTION FACILITIES?
5. Pre-natal Dental Care
This bill would require regular dental cleanings for pregnant
inmates. According to the America Dental Association:
During pregnancy, one's body's hormone levels rise
considerably. Gingivitis, especially common during the
second to eighth months of pregnancy, may cause red, puffy
or tender gums that tend to bleed when brushed. This
sensitivity is an exaggerated response to plaque and is
caused by an increased level of progesterone in the system.
A dentist may recommend more frequent cleanings during the
second trimester or early third trimester to help avoid
problems.
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SECTION 1 OF THE BILL REGARDING INMATES ELIGIBLE FOR COMMUNITY
TREATMENT PROGRAMS DOES NOT MENTION DENTAL CARE. SHOULD THIS
LEVEL OF CARE BE ADDED HERE?
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6. CDC Regulations
The CDC's current rules and regulations do not stipulate the
care the CDC will provide to pregnant inmates. The regulations
concerning medical and dental services do not direct the CDC on
what services to provide to pregnant inmates. The regulations
concerning food service do not address the dietary needs of
pregnant inmates. Finally, the regulations concerning physical
restraint do not limit the use of restraint on inmates during
labor while outside of the prison facility.
7. Arguments in Support of This Bill
The American College of Obstetricians and Gynecologists states,
in part, that:
Physical restraints have interfered with the ability of
physicians to safely practice medicine by reducing their
ability to assess and evaluate the physical condition of
the mother and the fetus, and have similarly made the labor
and delivery process more difficult than it needs to be,
thus, overall putting the health and lives of the women and
unborn children at risk. Typically these inmates have
armed guards on-site, which should be more than adequate to
protect personnel helping a pregnant, laboring woman or to
prevent her from fleeing.
The California Medical Association states, in part, that:
Prenatal care has consistently been shown to be a
cost-effective tool in preventing birth defects, and
protecting the health of the infant and the mother.
Additionally, shackling of a prisoner during childbirth may
be unnecessarily uncomfortable and dangerous for the female
inmate, while providing little additional public safety
protections.
The Commission on the Status of Women states, in part, that:
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This measure states that inmates shall be transported to
the hospital in the least restrictive way possible, limits
shackling during labor, and establishes a minimum care for
pregnant inmates who are ineligible for community treatment
programs.
AB 478 establishes essential minimum standards of medical
care, most notably prohibiting the archaic, inhumane, and
potentially dangerous practice of shackling women during
labor. Shackling during labor may cause complications
during delivery such as hemorrhage or decreased fetal heart
rate.
This measure takes basic steps to ensure that women are
treated humanely and with dignity while pregnant in
custody.
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