BILL ANALYSIS                                                                                                                                                                                                    �



                                                                  SB 1135
                                                                  Page  1

          Date of Hearing:   August 6, 2014

                        ASSEMBLY COMMITTEE ON APPROPRIATIONS
                                  Mike Gatto, Chair

                   SB 1135 (Jackson) - As Amended:  June 26, 2014 

          Policy Committee:                             HealthVote:19-0
                       Public Safety                    Vote: 7-0

          Urgency:     No                   State Mandated Local Program:  
          Yes    Reimbursable:              Yes

           SUMMARY  

          This bill,  as proposed to be amended  , prohibits sterilization of  
          an individual under the control of the Department of Corrections  
          and Rehabilitation (CDCR) or a local correctional facility,  
          except when medically necessary.  It also:

          1)Requires, if a sterilization procedure is performed, certain  
            related services be provided, including psychological  
            consultation and medical follow-up, unless the procedure is  
            necessary for the immediate preservation of the individual's  
            life in an emergency medical situation.

          2)Requires CDCR to publish data, and county jails or other  
            institutions of confinement to provide data for publication by  
            the Board of State and Community Corrections, on  
            sterilizations performed, as well as to notify individuals in  
            custody, as well as staff, of certain information related to  
            sterilization. 

           FISCAL EFFECT  

          1)Minor and absorbable state costs; CDCR indicates this bill  
            aligns with their current practice.

          2)Potential, likely minor, state-reimbursable mandate costs to  
            offer additional services and follow specified procedures  
            related to sterilization, to notify incarcerated individuals  
            and employees, and to publish reports. 

           COMMENTS  









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           1)Purpose.  The author contends that this bill is needed because  
            women were robbed of their reproductive choice by coerced  
            sterilization procedures while being housed in state  
            correctional facilities.  

           2)Background  .  In June of this year, the California State  
            Auditor released report 2013-120:  "Sterilization of Female  
            Inmates:  Some Inmates Were Sterilized Unlawfully, and  
            Safeguards Designed to Limit Occurrences of the Procedure  
            Failed," which examined sterilization cases from the last  
            eight years within CDCR.   The report found the state entities  
            responsible for providing medical care to these inmates, CDCR  
            and the Receiver's Office, sometimes failed to ensure that  
            inmates' consent for sterilization was lawfully obtained.  The  
            Auditor also found procedures for documenting consent of  
            inmate's doctors were not followed; violations of the required  
            waiting period between when the inmate consented to the  
            procedure and when the sterilization surgery actually took  
            place were also noted.  The report finds adherence to informed  
            consent procedures has greatly improved, and the number of  
            sterilization procedures has declined significantly since 2010  
            when the Receiver's office asserts it became aware of the  
            issue.   

          3)Support  .  The California Correctional Health Care Services  
            (Receiver's office) supports this bill, stating it is  
            consistent with their current regulations and that codifying  
            these protections will ensure they remain enforced.  This bill  
            appears consistent with, but more prescriptive than, current  
            regulations, which prohibit a number of surgeries if not  
            medically necessary, including vasectomy and tubal ligation. 

            This bill is sponsored by Justice Now and supported by  
            numerous groups, including women's advocacy organizations,  
            Planned Parenthood Affiliates of California, the American  
            Civil Liberties Union of California, and some criminal justice  
            advocacy organizations, among others.  

           4)Concerns  . The California Medical Association (CMA) and the  
            American College of Obstetrics and Gynecology (ACOG) express  
            unreserved condemnation of coerced sterilization. Both groups,  
            however, express concern that the bill also prohibits doctors  
            from performing elective sterilization even if incarcerated  
            individuals desire sterilization for purposes of birth  
            control.  In particular, ACOG and CMA indicate tubal ligation  








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            done at the time of a cesarean delivery is the most medically  
            appropriate time to perform the procedure, and that many women  
            in community settings choose elective sterilization while  
            undergoing a cesarean delivery.   Prohibiting elective tubal  
            ligation at that time necessitates another surgery under  
            general anesthesia if a woman chooses this form of birth  
            control, raising the risks of complications. The groups  
            conclude they fully support a woman's right to procreative  
            choice.
           
          5)Staff Comments  .  This bill requires every correctional  
            facility to 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 related to the prohibition of sterilization  
            procedures.  It is unclear whether this broad notification to  
            all incarcerated inmates is necessary. It appears this mandate  
            could be tailored to better reflect situations where  
            notification is most appropriate. 

           6)Amendments  require the Board of State and Community  
            Corrections to publish county data on any sterilization  
            procedures performed, and clarify that CDCR must publish data,  
            not a report.


           Analysis Prepared by  :    Lisa Murawski / APPR. / (916) 319-2081