Report 2013-120 Recommendation 5 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 #5 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 working with Corrections to establish a process whereby inmates can have witnesses of their choice when consenting to sterilization, as required by Title 22, or working to revise such requirements so that there is an appropriate balance between the need for secure custody and the inmate's ability to have a witness of her choice.

Agency Response*

The California Department of Corrections and Rehabilitation and California Correctional Health Care Services have concluded that compliance within a correctional setting is not feasible.

  • Response Type†: 1-Year
  • Estimated Completion Date:
  • Response Date: June 2015

California State Auditor's Assessment of Status: Will Not Implement

Title 22 is very clear in stating that an individual has given informed consent to sterilization "only if" certain requirements are met. One of these requirements is being permitted to have a witness of the patient's choice present when consent is obtained. Having the patient's choice of a witness present serves as a safeguard to help ensure that the patient understands the procedure and truly desires to be permanently sterilized. A witness also helps protect the State from allegations that the inmate was coerced into her decision to be sterilized. The Receiver's Office offered no information to suggest that it was working to revise the Title 22 requirements for witnesses in a correctional setting. We stand by our recommendations. The Receiver's Office response that it cannot comply with existing law, without noting its next steps, is not a complete response to our recommendation.


Agency Response*

CDCR and CCHCS will continue to explore the extent to which partial compliance may be feasible and under what circumstances.

  • Response Type†: 6-Month
  • Estimated Completion Date:
  • Response Date: December 2014

California State Auditor's Assessment of Status: Will Not Implement

Under Title 22, the provision of a witness is required for lawful consent for procedures where the purpose of sterilization is to render the patient incapable of reproduction.


Agency Response*

Proposed Action Plan:

Discussion regarding this recommendation with CDCR is ongoing.

Status/Comments:

A meeting with CDCR was held on July 22, 2014 to discuss with establishment of the process. CDCR and CCHCS have discussed the interplay of the statutory requirements and the difficulties in full compliance in a correctional setting. We will continue to explore the extent to which partial compliance may be feasible and under what circumstances.

  • Response Type†: 60-Day
  • Estimated Completion Date: To be determined
  • Response Date: August 2014

California State Auditor's Assessment of Status: Pending


All Recommendations in 2013-120

†Response Type refers to the interval in which the auditee is providing the State Auditor with their status in implementing recommendations made in an audit report. Auditees must submit a response regarding their progress in implementing recommendations from our reports at three intervals from the release of the report: 60 days, six months, and one year or subsequent to one year.

*Agency responses received after June 2013 are posted verbatim.


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