BILL ANALYSIS �
Senate Appropriations Committee Fiscal Summary
Senator Kevin de Le�n, Chair
SB 1135 (Jackson) - Inmates: sterilization.
Amended: March 24, 2014 Policy Vote: Health 9-0, PS 6-0
Urgency: No Mandate: Yes
Hearing Date: May 12, 2014 Consultant: Jolie Onodera
This bill meets the criteria for referral to the Suspense File.
Bill Summary: SB 1135 would prohibit sterilization, with limited
exceptions, of an individual under the control of the Department
of Corrections and Rehabilitation (CDCR) or a county, and
imprisoned in a state prison or a reentry facility, community
correctional facility, county jail, or any other institution in
which an individual is involuntarily confined or detained under
a civil or criminal statute.
Fiscal Impact:
Minor ongoing costs (General Fund) to CDCR to provide
psychological consultations, as CDCR has indicated the
provisions of this bill are consistent with current policy.
Potentially significant state-reimbursable costs (General
Fund) incurred by local agencies statewide for mandated
medical professional activities including second opinion
in-person consultations, psychological counseling, and
medical follow up to the extent sterilization of an
individual is considered or performed under limited
circumstances in county facilities.
Minor to significant state-reimbursable costs (General
Fund) to local agencies to provide notification to all
applicable employees and persons in custody of the rights
and responsibilities specified in this measure, as well as
prepare and publish an annual report on sterilizations
performed. Costs would be dependent on the volume and method
in which notification is provided, which is not currently
specified.
Background: Existing CDCR regulations limit the provision of
medical services for inmates to only those services that are
medically necessary. However, articles published by the Center
for Investigative Reporting (CIR) in July 2013 and February 2014
cited that between 2006 and 2010, at least 148 women received
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tubal ligations in violation of CDCR regulations at two state
prisons: California Institution for Women in Corona and Valley
State Prison for Women in Chowchilla.
Proposed Law: This bill would prohibit sterilization for the
purpose of birth control, including but not limited to, during
labor and delivery, of an individual under the control of the
CDCR or a county and imprisoned in the state prison or a reentry
facility, community correctional facility, county jail, or any
other institution in which an individual is involuntarily
confined or detained under a civil or criminal statute.
Specifically, this bill:
Prohibits sterilization through tubal ligation,
hysterectomy, oophorectomy, or any other means of rendering
an individual permanently capable of reproducing, except in
the following circumstances:
o The procedure is required for the immediate
preservation of the individual's life in an emergency
medical situation.
o The procedure is required for the necessary
treatment of a physical medical condition, excluding
birth control, and only if all of the following
requirements are satisfied:
� Less drastic measures to address the
medical need are nonexistent, are refused by the
individual, or are first attempted and deemed
unsuccessful.
� A second physician independent of,
and not employed by, but authorized to provide
services to individuals in the custody of, and to
receive payment for those services from, the
department or county department overseeing the
confinement of the individual conducts an
in-person consultation and confirms the need.
� Patient consent is obtained after
the individual is made aware of the full and
permanent impact the procedure will have, as
specified.
Provides that if a sterilization procedure is performed
pursuant to the provisions of this bill, pre-sterilization
and post-sterilization psychological consultation and
medical follow up, including providing relevant hormone
therapy to address surgical menopause, shall be made
available to the individual sterilized while under the
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control of the department or the county.
Requires CDCR and county jails or other institutions of
confinement to:
o Publish an annual report of sterilizations
performed, disaggregated by race, age, medical
justification, and method of sterilization, including
but not limited to hysterectomy and oophorectomy.
o Provide notification to all individuals under
their custody and to all employees who are involved in
providing health care services of their rights and
responsibilities under the bill's provisions.
Provides that an employee of the CDCR, county jail, or
other institution of confinement who reports the
sterilization of an individual performed in violation of
this section is entitled to the protections available under
existing law related to retaliation and the California
Whistleblower Protection Act, as specified.
Includes uncodified legislative intent language.
Related Legislation: SB 1079 (Rubio) 2012 would have codified
existing regulations limiting medical services to CDCR inmates
to only those services which are medically necessary, excluding
treatment for sexual dysfunction or infertility, gender
reassignment surgery, and weight reduction surgery. This bill
failed passage in the Senate Committee on Public Safety.
Staff Comments: The CDCR has indicated minor, if any, costs
associated with the provisions of this measure, as CDCR has
indicated the provisions of this bill are largely consistent
with existing policy. The provision of psychological
consultations both pre- and post-procedure is a new requirement,
however, the number of inmates that would require these services
is estimated to be very small, and therefore, costs are
estimated to be less than $25,000 annually.
This bill imposes a state-mandated local program requiring
county jails and other detention facilities to perform
additional duties including independent, second opinion
in-person consultations, pre- and post-sterilization
psychological counseling, and medical follow up to the extent
sterilization of an individual is considered or performed under
limited circumstances in county facilities. While it is not
anticipated that county facilities will perform these procedures
frequently, to the extent the procedure is considered but not
ultimately performed would impose some cost on counties to
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obtain a second independent physician opinion on the medical
need. In the limited circumstances in which a procedure is
completed, costs to counties would include both pre- and
post-sterilization counseling and medical follow-up, including
hormone therapy.
This bill also imposes an annual reporting requirement and
notification requirements on CDCR and local agencies, the local
costs of which could be determined to be state-reimbursable
should a test claim be filed with the Commission on State
Mandates. As discussed below, costs would be dependent on the
volume and manner in which these activities are accomplished.
Recommended Amendments: As currently drafted, the bill may not
cover individuals under the custody of the Department of State
Hospitals (DSH). While the bill provides that it applies to "any
other institution in which an individual is involuntarily
confined or detained under a civil or criminal statute," the
bill also requires that the individual in custody must also be
under the control of either CDCR or the county. The author may
wish to consider an amendment to include DSH commitments if the
intent of author is to address all involuntarily confined
individuals statewide.
The bill requires CDCR and local facilities to publish an annual
report, but does not designate to what entity the reports should
be submitted. The author may wish to consider an amendment to
assign submittal of the annual reports to the Legislature, or to
the appropriate fiscal and policy committees of the Legislature.
For clarity and to reduce potential costs, the author may wish
to consider an amendment specifying the method in which the
notification to employees and persons in custody is to be
accomplished, for example, by distribution of a form notice. In
the absence of this clarification, the workload and costs to
orally provide this information to each employee and person in
custody could be substantial.