A prison doctor investigated by the California medical board after ordering tubal ligations without state approval is responsible for hundreds of other inmate sterilizations, The Center for Investigative Reporting has found.
Dr. James Heinrich also has a history of medical controversies and malpractice settlements both inside and outside prison walls. Female patients have accused him of trying to dictate their reproductive decisions, unsanitary habits and medical malpractice.
Despite that history, Heinrich was not only hired by the prison system, but also kept on once a federal judge appointed a receiver to clean up the prisons medical system.
Heinrich, 69, retired from Valley State Prison for Women in 2011 after six years. Federal authorities rehired Heinrich as a contract physician, and he continued treating inmates at Valley State though December 2012.
An earlier CIR investigation, published in July, found that more than 100 tubal ligation surgeries took place without the required state approval from 2006 to 2010. At the time, prison documents indicated there were 148 of those surgeries. Analysis of subsequent data and documentation provided under the state Public Records Act shows there were 132 because some were double counted.
The women were signed up for the surgery while pregnant at the two womens prisons that house pregnant inmates, the California Institution for Women in Corona and Valley State Prison for Women in Chowchilla. Valley State became a mens prison in 2013.
Newly obtained state prison data indicate that more than half of those surgery referrals 74 were made at Valley State. More than two-thirds of those referrals came from Heinrich or a nurse on his staff, according to the prisons medical service request records.
Heinrich previously told CIR that the money spent sterilizing inmates was minimal compared to what you save in welfare paying for these unwanted children as they procreated more.
The fuller profile of Heinrich emerged from interviews and a review of hundreds of pages of court, medical and prison files and contracting and cost data.
In addition to tubal ligations, Heinrich arranged other types of sterilizations 378 times from 2006 to 2012. These included hysterectomies, removal of ovaries and a procedure called endometrial ablation, which destroys the uterus lining.
Although these sterilizations are not banned in California prisons, the quantity attributed to Heinrich ultimately caused federal administrators to take note, said Dr. Ricki Barnett of the federal receivership.
The California Department of Corrections and Rehabilitation hired Heinrich in December 2005 to head obstetrics and gynecology at Valley State. A few months later, U.S. District Judge Thelton Henderson of the Northern District of California appointed a receiver to take over inmate health care after ruling that the states medical treatment of prisoners violated the constitutional ban on cruel and unusual punishment.
Overall, the number of sterilization surgeries sharply increased after Heinrich joined the prison system. From 2006 to 2008, Valley State averaged 150 sterilization surgeries of all types annually six times that of the Central California Womens Facility, the largest womens prison in the state.
Heinrich would not talk to CIR for this story. His attorney, Ronald B. Bass of Walnut Creek, said he couldnt comment on Heinrichs role in the increased number of sterilizations because he hadnt seen the data underlying CIRs findings. However, Bass said that Heinrich followed proper medical procedures and standards. In a letter, he said the likely reason for the spike was that Heinrich saw more patients in an effort by the state to provide better care.
In response to CIRs initial reporting, the federal receivership decided to bar Heinrich from future prison work, according to spokeswoman Joyce Hayhoe. State lawmakers held hearings in August and ordered the Medical Board of California and California State Auditor to investigate.
The medical board will not disclose the targets of its investigation or whether a review is ongoing. Bass said his client inquired in November and was told he was not under review.
Crystal Nguyen, a former Valley State inmate who worked in the prison infirmary, received a letter in August asking her to participate in a medical board examination of Heinrich. A month later, Nguyen said, she told an investigator that Heinrichs habits, like eating while conducting vaginal exams, were well known by inmates and staff.
He would be eating popcorn all the time. Popcorn, cheese and crackers. And he would be examining while he would be eating, she said. And to me, thats not hygienic. It was gross.
To protect against infections, state and federal safety rules ban health care professionals from having food and drink in areas where patients are treated.
In 2009, Heinrich said in a court deposition that he had eaten in the exam room while inmates were present. However, today, through attorney Bass, Heinrich denies that.
Several former inmates told CIR that Heinrich pushed hysterectomies and other sterilizing surgeries during routine visits, often giving misleading information about the medical reasons.
Tamika Thomas, 36, of Stockton saw Heinrich in 2006, during a stint at Valley State for assault with a deadly weapon. Thomas said she wanted birth control to better regulate her menstrual cycle. Heinrich instead recommended surgery that would stop the bleeding by heating the inside of her uterus. Thomas claims Heinrich never told her the surgery would sterilize her. Thomas agreed to the procedure and regrets it, she said.
Bass dismissed Thomas contention, saying she would have learned about the sterilizing effects of the procedure from at least one of the medical providers or from the consent forms.
By late 2007, federal officials discovered problems with Heinrichs care.
A team of federal examiners visited Valley State to investigate the death of two inmates babies during childbirth. They found one newborn died, in part, because Heinrich, staff and another prison doctor each gave the mother the wrong prenatal medicine. The other death resulted from Heinrich failing to perform a routine prenatal test for bacteria, according to court documents.
Heinrich maintained in his written summary of the case and via his attorney, Bass, that the test was overlooked because the inmate had numerous unscheduled medical visits with emergencies that required immediate attention. Depositions of Heinrich and staff, taken by lawyers for the childs mother, established that the inmate wasnt in critical condition during every visit.
In 2010, the attorney generals office and the state prison system filed documents acknowledging that Heinrich had been negligent. The state paid the woman $150,000 to settle her claims, documents show.
Prison officials also investigated Heinrich in 2008 after then-inmate Michelle Diaz accused him of unprofessional and unsanitary behavior during a Pap smear. According to a complaint she filed with the prison, Diaz, 36, told Heinrich she had irritation outside her vagina, but Heinrich inserted his fingers inside her. Diaz said that she noticed Heinrich wasnt wearing a glove and exploded in anger. Then without warning, she said, Heinrich applied a burning chemical to her vaginal area.
Diaz filed a complaint against Heinrich on March 28, 2008. One of Heinrichs regular nurses confirmed that Heinrich didnt warn Diaz before treating her, according to notes of the interview that became public in a federal lawsuit. The nurse also said it was Heinrichs practice to use one glove, not two, when doing Pap smears. Using one glove is not considered a standard practice.
Prison officials concluded that Heinrich violated policy and that he should have warned Diaz about the chemical procedure, a May 2008 memo filed in court shows.
Lawsuits in private practice
Other controversies dogged Heinrich in the years prior to his joining the state prison.
From the mid-1990s to 2004, Heinrich paid $342,000 in legal settlements related to claims of negligence and incompetence during surgeries and deliveries at NorthBay Medical Center in Fairfield.
Lawsuits are common among OB-GYNs because of the sensitive nature of their work. Bass said the settlements dont represent the quality of Heinrichs care. He said Heinrich performed about 8,000 procedures over his career, 99.875 percent of which didnt lead to lawsuits. Bass added that Heinrich never had his hospital privileges revoked, always passed his specialty exams and is well-regarded by his peers.
Former patient Suzzanne Black said Heinrich rarely had time to see her in 1995 because he was shuttling so many people in and out. She compared his private practice in Fairfield to an assembly line. Black received a $225,000 settlement after her daughter suffered permanent nerve damage during childbirth.
I came from the very, very best care in Anchorage (Alaska) to the very, very worst in California, Black said. He treated me like a cow.
CIR asked the state prison system whether officials were aware of Heinrichs past medical settlements before he was hired. State officials declined to comment, citing personnel privacy laws.