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Madrigal v. Quilligan was a 1978 federal class action lawsuit from Los Angeles County, California, involving sterilization of Latina women that occurred either without informed consent, or through coercion. [1] [2] Although the judge ruled in favor of the doctors, the case led to better informed consent for patients, especially those who are not native English speakers.
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California had one of the highest sterilization rates in the country during the time of Madrigal v. Quilligan. The eugenics movement, which was part of the sterilization campaign, strived to deem those unfit for procreating as candidates for sterilization. There was also a funding program enacted that gave money to states based on the amount of sterilization procedures performed. Beginning in 1909, these procedures were supported by federal agencies that began to disperse funds in conjunction with the family planning initiative. [3] With support from the federal government and an influx of immigrants from Mexico, California saw some of the highest rates of sterilization. Forced sterilizations occurred in part due to the notion that immigrant families would put a strain on fiscal budgets, and thus sterilization offered a means of population control, as well as lifelong birth control. In the case of Madrigal v. Quilligan, many unsuspecting women were coerced to sign paperwork to perform sterilization, while others were told that the process could be reversed. None of the women were fluent in English. [4]
From the 1960s to 1970s, the Chicano Movement was a social and political movement to advocate against the previous racism of citizens of Mexican descent, who were often marginalized in the United States. The fight for equality started long before the movement, but activists consolidated their efforts during the 1960s when race was an extremely prevalent issue in America. [5] When the case of Madrigal v. Quilligan surfaced to the public, the leaders of the Chicano movement recognized that sterilization was another injustice that was targeted to Mexican and middle-class women. An important part of Mexican culture is the ability of mothers to have children and have enough sons to support their husbands. This case connected to a broader topic of human reproduction in the Chicano movement. Latina women were seen as "hyper fertile" and their "children are sometimes called anchor babies." [6] Even though the women did not win their case, they were able to cause a significant amount of change for women in the future with the amount of attention Latina women's reproduction rights were receiving. The case led to hospitals making the patient more aware about what sterilization does to their fertility and consent forms were easier to read for women whose first language was not English.
Decided: June 7, 1978 (Central District of California, Docket Number: CV-75-2057-EC) Affirmed by the Court of Appeals for the Ninth Circuit at 639 F.2d 789.
Plaintiff: 10 sterilized women
Defendant: James Quilligan (County hospital obstetricians). In addition to Quilligan, hospital officials doctor John Doe and executive director Jerry Bosworth as well as federal officials Mario Obledo, Secretary of Health, Jerome Lackner, the director of the California Department of Health, and Caspar Weinberger, the Secretary of the US Department of Health, Education, and Welfare, were also defendants. [7]
Prosecutors: Antonia Hernandez and Charles Nabarrete of the Los Angeles Center for Law and Justice
Charges: Through the lawsuit, the plaintiffs and the lawyers had three goals in mind: strengthening federal and state policies on voluntary and informed consent for sterilization, acquiring financial compensation for the women, and demanding that someone be held accountable for the tubal ligations performed. Hospital officials, however, asserted that they believed their actions were not criminal, always kept the health and safety of the women in mind, and never coerced the women into sterilization. The plaintiffs charged that their civil and constitutional rights to bear children had been violated, and that between 1971 and 1974, they had been forcibly sterilized by obstetricians at County Hospital. Specifically, they signed consent forms under duress, hours or minutes before or after labor, or had never been informed, or had been misinformed, that their "tubes would be tied." [3] Some women alleged that they were forced to sign papers that gave the doctors the right to perform these operations under coerced circumstances or under false impressions. One of the women for whom the case gets its name, Dolores Madrigal, signed the sterilization paperwork because they had told her that her husband had already approved and signed the paperwork, when indeed he had not. [3]
Other than Benker and the plaintiffs, the prosecution called multiple witnesses to testify for the case.
For the case, attorneys Antonia Hernandez and Charles Navarrete and Gloria Molina, a leader of the Chicana feminist movement, sought out and interviewed women sterilized at the Los Angeles County Hospital. [8] Bernard Rosenfeld was the whistleblower that first brought attention to the problem within the USC hospital. Rosenfeld, so horrified by the practices he witnessed while at the hospital, gathered evidence of the unlawful sterilizations and wrote letters to civil rights groups and journalists. [11] When Hernandez and Navarrete's legal group discovered the case, they, along with leaders in the Chicana feminist movement, began to interview the women found on the released medical records from the hospital. Many of the women did not even know that they had been sterilized and also thought that the procedure was reversible. Gloria Molina played a large role in convincing the ten Plaintiffs, mainly from East Los Angeles, to come forward and testify with their stories. [11] From their stories, four similarities emerged in the way that the women were sterilized by medical staff. First, some women were repeatedly asked to give consent while in labor pains and sometimes heavily medicated. Second, almost all the Latina women had to resist multiple attempts by doctors and nurses to submit to sterilization. Third, because of the language barrier and the lack of access to sterilization forms in Spanish, many of the plaintiffs were uniformed regarding the effects and needs of their tubal ligations. Fourth, some of the women never actually signed the form for the doctors just waived consent. [8]
Maria Hurtado headed into the LA County Hospital and was informed that she needed an emergency caesarean section. While under the influence of anti-pain medication and labor pain, she signed a consent form thinking it was for the c-section operation, when in fact it was for sterilization. She did not know that had been sterilized until she returned to the hospital for a check-up six weeks later. [8]
Similarly to Hurtado, Rebecca Figueroa was also sent in for an emergency c-section and signed two English consent forms, which she was unable to read, believing that they were for the c-section. [8]
Helena Orozco testified that she had to repeatedly turn down urges by medical staff for complete sterilization. As her labor progressed and while in extreme pain on the operation table, the doctors asked her again to be sterilized, and she finally gave in. [8]
Georgina Hernandez was one of the women who never consented to a tubal ligation, but was sterilized by doctors anyway. When she came into the hospital experiencing lots of bleeding and pain, she denied the initial push for sterilization. Later, she was asked again while in labor and going into the emergency room for a c-section and remained firm in her refusal for sterilization. However, despite her clearly not giving consent, the doctor told staff that she agreed to sterilization before the operation. She found out that she was no longer able to have children 3 weeks later. [8]
Dolores Madrigal, the woman for whom the case is named, had refused multiple attempts for sterilization by the medical staff. In the midst of extreme labor pain, she heard the nurse tell her husband that she could die if she had another child. Thus, while in labor she signed the form without knowledge of what the form actually said. Like other women, she too believed that the process was reversible. [8]
Similar to Madrigal, Estella Benavides was also told that another pregnancy could kill her, so while in labor, she signed the consent form for sterilization. In her testimony she recounted that she did not think that is would be permanent and the doctors claimed that they were protecting her, when in fact they coerced her into an uninformed sterilization. [8]
Maria Figueroa was under anesthesia and in labor while the doctor was asking for her consent to sterilization. Under the pressure of the doctor and in extreme discomfort, she consented to sterilization if the baby was a boy, but when she gave birth to a girl, the doctor sterilized her anyway. She did not officially give consent at all because no forms were signed, yet Figueroa was sterilized anyway. [8]
Guadalupe Acosta's child was born deceased and she was sterilized after her c-section procedure. She never signed any consent forms and only found out about her sterilization when she returned to the hospital two months later for birth control. [8]
"Jovita Rivera said a doctor told her she should have her 'tubes tied' because her children were a burden on the government ..." —Los Angeles Times, June 19, 1975 [11]
Jovita Rivera was under anesthesia after her c-section procedure and testified that she could not remember anything, yet the doctor insisted that she verbally consented to the sterilization procedure. She was unaware that the sterilization was irreversible and no consent form was signed. [8]
"And this lady came, I don’t remember seeing her face, I just remember her voice telling me, 'Mijita, you better sign those papers or your baby could probably die here.'"—Consuelo Hermosillo, interview. [11]
Medical staff informed Consuelo Hermosillo that she was "high-risk" and thus could die from having another baby in an attempt to persuade her to give consent to sterilization. While in labor and awaiting surgery for c-section, the medical staff told Hermosillo that she could not continue with her c-section until she consented to tubal ligation. It extremely upset her, but in order to keep her baby alive, she signed the consent form. [8]
In an unpublished opinion, the Judge sided with the County Hospital, citing that the doctors had the interest of the patients in mind when deciding to pursue these procedures and that the doctors did not do anything wrong. He conveyed that the procedure was not objectionable if a physician believed that a tubal ligation could improve a perceived overpopulation problem, as long as said physician did not try to "overpower the will of his patients." [3] Additionally, Judge Curtis asserted that there was just a breakdown in communication between the doctors and patients. Furthermore, he believed he could not charge doctors of sterilizing without consent because many of the women literally signed the consent forms. [12] He also ruled that the women's emotional breakdowns after sterilization were caused by their inability to give birth and raise a big family, which is an important part of their Latina culture, and not by the sterilization itself. [12] In the end, he believed that the women were at fault and it was their cultural background that heightened the supposed trauma that they experienced.
Sterilization is any of a number of medical methods of permanent birth control that intentionally leaves a person unable to reproduce. Sterilization methods include both surgical and non-surgical options for both males and females. Sterilization procedures are intended to be permanent; reversal is generally difficult.
Tubal ligation is a surgical procedure for female sterilization in which the fallopian tubes are permanently blocked, clipped or removed. This prevents the fertilization of eggs by sperm and thus the implantation of a fertilized egg. Tubal ligation is considered a permanent method of sterilization and birth control.
Compulsory sterilization, also known as forced or coerced sterilization, refers to any government-mandated program to involuntarily sterilize a specific group of people. Sterilization removes a person's capacity to reproduce, and is usually done by surgical or chemical means.
E (Mrs) v Eve, [1986] 2 S.C.R. 388 is a judgment by the Supreme Court of Canada regarding a mother's request for the consent of the court to have her disabled daughter sterilized. This was a landmark case which is influential in Canadian legal decisions involving proxy-consented, non-therapeutic medical procedures performed on people of diminished mental capacity.
Essure was a device for female sterilization. It is a metal coil which when placed into each fallopian tube induces fibrosis and blockage. Essure was designed as an alternative to tubal ligation. However, it was recalled by Bayer in 2018, and the device is no longer sold due to complications secondary to its implantation. The company has reported that several patients implanted with the Essure System for Permanent Birth Control have experienced and/or reported adverse effects, including: perforation of the uterus and/or fallopian tubes, identification of inserts in the abdominal or pelvic cavity, persistent pain, and suspected allergic or hypersensitivity reaction. Although designed to remain in place for a lifetime, it was approved based on short-term safety studies. Of the 745 women with implants in the original premarket studies, 92% were followed up at one year, and 25% for two years, for safety outcomes. A 2009 review concluded that Essure appeared safe and effective based on short-term studies, that it was less invasive and could be cheaper than laparoscopic bilateral tubal ligation. About 750,000 women have received the device worldwide.
Tubal reversal, also called tubal sterilization reversal, tubal ligation reversal, or microsurgical tubal reanastomosis, is a surgical procedure that can restore fertility to women after a tubal ligation. By rejoining the separated segments of the fallopian tube, tubal reversal can give women the chance to become pregnant again. In some cases, however, the separated segments cannot actually be reattached to each other. In some cases the remaining segment of tube needs to be re-implanted into the uterus. In other cases, when the end of the tube has been removed, a procedure called a neofimbrioplasty must be performed to recreate a functional end of the tube which can then act like the missing fimbria and retrieve the egg that has been released during ovulation.
Wrongful birth is a legal cause of action in some common law countries in which the parents of a congenitally diseased child claim that their doctor failed to properly warn of their risk of conceiving or giving birth to a child with serious genetic or congenital abnormalities. Thus, the plaintiffs claim, the defendant prevented them from making a truly informed decision as to whether or not to have the child. Wrongful birth is a type of medical malpractice tort. It is distinguished from wrongful life, in which the child sues the doctor.
Eugenics, the set of beliefs and practices which aims at improving the genetic quality of the human population, played a significant role in the history and culture of the United States from the late 19th century into the mid-20th century. The cause became increasingly promoted by intellectuals of the Progressive Era.
LM & Others v Government of Namibia is a legal case regarding coerced sterilisation of three women in Namibia in 2005 and 2007. The women argued they had not properly consented to sterilisation due to not being informed of the contents of the consent form, not understanding the medical staff, or coercion by being told their caesareans would not be performed unless they consented to the sterilisation. All the women were HIV-positive and believe they were targeted for sterilization based on this.
Eugenics in California is a notable part of eugenics in the United States. As an early leading force in the field of eugenics, California became the third state in the United States to enact a sterilization law. By 1921, California had accounted for 80% of sterilizations nationwide. This continued until the Civil Rights Movement, when widespread critiques against society's "total institutions" dismantled popular acceptance for the state's forced sterilizations. There were an estimated 20,000 forced sterilizations in California between 1909 and 1979; however, that number may be an underestimation. In 2021, California enacted a reparations program to compensate the hundreds of still living victims from its eugenics program.
In the 1960s and 1970s, the Indian Health Service (IHS) and collaborating physicians sustained a practice of performing sterilizations on Native American women, in many cases without the free and informed consent of their patients. In some cases, women were misled into believing that the sterilization procedure was reversible. In other cases, sterilization was performed without the adequate understanding and consent of the patient, including cases in which the procedure was performed on minors as young as 11 years old. A compounding factor was the tendency of doctors to recommend sterilization to poor and minority women in cases where they would not have done so to a wealthier white patient. Other cases of abuse have been documented as well, including when health providers did not tell women they were going to be sterilized, or other forms of coercion including threatening to take away their welfare or healthcare.
African Americans', or Black Americans', access and use of birth control are central to many social, political, cultural and economic issues in the United States. Birth control policies in place during American slavery and the Jim Crow era highly influenced Black attitudes toward reproductive management methods. Other factors include African-American attitudes towards family, sex and reproduction, religious views, social support structures, black culture, and movements towards bodily autonomy.
Sterilization law is the area of law, that concerns a person's purported right to choose or refuse reproductive sterilization and when a given government may limit it. In the United States, it is typically understood to touch on federal and state constitutional law, statutory law, administrative law, and common law. This article primarily focuses on laws concerning compulsory sterilization that have not been repealed or abrogated, i.e. are still good laws, in whole or in part, in each jurisdiction.
No Más Bebés is an American documentary film that tells the story of immigrant women who were sterilized upon going into labor. Having been sterilized without knowing at the Los Angeles County-USC Medical Center, the mothers sued county doctors, the State of California, and the United States government. Having collected hospital records from a whistleblower, Chicana lawyer Antonia Hernandez led the lawsuit against powerful institutions.
Minnie Lee and Mary Alice Relf are two African-American sisters who were involuntarily sterilized by tubal ligation by a federally funded family planning clinic in Montgomery, Alabama in 1973. News coverage of a class-action lawsuit filed by the Southern Poverty Law Center brought U.S. government-funded sterilization abuse to the national spotlight.
Antonia Hernández is an attorney, activist, and philanthropist. She currently serves as president and CEO of the California Community Foundation. Hernández was counsel for the plaintiffs in Madrigal v. Quilligan (1975), a class-action lawsuit filed by ten women of Mexican descent who were involuntarily sterilized at the Los Angeles County Hospital. She is also the first Latina woman to serve as staff counsel to the U.S. Senate Judiciary Committee from 1979 to 1980. In addition, Hernández served on the campaign team for Senator Ted Kennedy in his 1980 presidential campaign. She served as president and general counsel of the Mexican American Legal Defense and Education Fund (MALDEF) from 1985 to 2004.
Sterilization of Latinas has been practiced in the United States on women of different Latin American identities, including those from Puerto Rico and Mexico. There is a significant history of such sterilization practices being conducted involuntarily, in a coerced or forced manner, as well as in more subtle forms such as that of constrained choice. Forced sterilization was permissible by multiple states throughout various periods in the 20th century. Issues of state sterilization have persisted as recently as September 2020. Some sources credit the practice to theories of racial eugenics.
Salgo v. Leland Stanford Jr. University Board of Trustees was a 1957 court case that helped to establish what the practice of informed consent was supposed to look like in the practice of modern medicine. This was evaluated with respect to the California Court of Appeals case where Martin Salgo sued the trustees of Stanford University and Stanford physician Dr. Frank Gerbode for malpractice as he claimed that they did not inform him nor his family of the details and risks associated with an aortogram which left him permanently paralyzed in his lower extremities.
Ascension is a large private Catholic healthcare system in the United States. Ascension had 142,000 employees, 142 hospitals, and 40 senior living facilities operating in 19 states and the District of Columbia as of the end of 2021. Ascension is the largest nonprofit and largest Catholic health system in the United States. It also operates a conglomerate of for-profit firms, including subsidiaries involved in private equity, venture capital, insurance, medical software, and pharmacy delivery. From 2014 to 2017 it co-owned a facility in the Cayman Islands.
Compulsory sterilization of disabled people in the U.S. prison system was permitted in the United States from 1907 to the 1960s, during which approximately 60,000 people were sterilized, two-thirds of these people being women. During this time, compulsory sterilization was motivated by eugenics. There is a lengthy history when it comes to compulsory sterilization in the United States and legislation allowing compulsory sterilization pertaining to developmentally disabled people, the U.S. prison system, and marginalized communities.
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