Report 2013-120 Recommendation 2 Responses

Report 2013-120: Sterilization of Female Inmates: Some Inmates Were Sterilized Unlawfully, and Safeguards Designed to Limit Occurrences of the Procedure Failed (Release Date: June 2014)

Recommendation #2 To: Correctional Health Care Services, California

To ensure that it can better monitor how its medical staff and contractors adhere to the informed consent requirements of Title 22, sections 70707.1 through 70707.7, the Receiver's Office should develop a plan by August 2014 to implement a process by December 2014 that would include providing additional training to prison medical staff regarding Title 22 requirements for obtaining informed consent for sterilization procedures, including the applicable forms and mandatory waiting period requirements, to ensure that consent is lawfully obtained.

1-Year Agency Response

The Utilization Management (UM) program conducted a webinar training for all schedulers on September 8, 2014 and September 15, 2014, titled "Sterilization of Female Inmates" and covered Gynecological Procedure Checklist / Sterilization Procedures.

In December 2014, a representative of the Receiver's Office of Legal Affairs presented webinar training to medical staff with the primary goal to ensure adherence to the informed consent requirements of Title 22, Sections 70707.1 through 70707.7. Attendees included statewide clinical staff and California Correctional Health Care Services' (CCHCS) headquarter staff. The training emphasized the requirements for obtaining informed consent for sterilization procedures and the correct documentation required to support how and when the informed consent process took place. CCHCS intends to provide periodic training.

To ensure that consent is obtained and is proper, the UM program, which oversees and monitors the delivery of network health care services for all institutions have implemented procedures and processes to monitor and track every referral that has potential for sterilization. Upon approval of the procedure, the institution clinical staff has been advised of protocol that requires the operating surgeon complete the Gynecologic Procedures Checklist and send to UM. UM then issues an approval letter to the institution. UM maintains a spreadsheet to monitor adherence to informed consent requirements. (See Attachment #1)

  • Completion Date: December 2014
  • Response Date: June 2015

California State Auditor's Assessment of 1-Year Status: Fully Implemented


6-Month Agency Response

A representative of the Receiver's Office of Legal Affairs presented a webinar related to the subject of informed consent and informed consent for sterilization procedures. Attendees included clinical staff from California Institution for Women and the Central California Women's Facility. (See Attachments #1)

  • Completion Date: December 2014
  • Response Date: December 2014

California State Auditor's Assessment of 6-Month Status: Partially Implemented

The Receiver's Office did not substantiate its claim of full implementation. The Receiver's Office provided a one-time training which does not fully implement the recommendation. Although providing training about Title 22 is likely beneficial to prison medical staff, the recommendation calls for the Receiver's Office to establish a process to better monitor adherence to informed consent requirements which includes training. Moreover, despite the Receiver's Office directing prison medical staff to ensure that community hospital staff obtain consent for sterilization, prison medical staff are still required to ensure that consent is obtained and is proper. In our opinion, it is reasonable for prison staff to require and receive periodic training to ensure they perform their role effectively,

  • Auditee did not substantiate its claim of full implementation

60-Day Agency Response

Proposed Action Plan:

Provide additional training to prison medical staff regarding Title 22 requirements for obtaining informed consent.

Status/Comments:

A PowerPoint presentation for training has been drafted and is currently under review on the subject of informed consent.

  • Estimated Completion Date: To be determined
  • Response Date: August 2014

California State Auditor's Assessment of 60-Day Status: Partially Implemented


All Recommendations in 2013-120

Agency responses received are posted verbatim.


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