The Madrigal Ten

Joanne Freeman:
In the summer of 1975, a group of women in California banded together to file a class action lawsuit. Their mission was to seek justice for pregnant women who had endured manipulation and coercion from doctors. These women claim their rights as patients had been ignored because of their race, and because they did not speak English. Who were these women, they became known as the Madrigal 10.

Maya Manian:
The Madrigal 10 were a group of Mexican American women who alleged that they suffered coerce sterilizations at the Los Angeles County USC Medical Center back in the 1970s.

Joanne Freeman:
This is Maya Manian she’s a visiting professor at Howard University School of Law and has researched the story behind the lawsuit, Madrigal v. Quilligan. As Maya mentioned, the Madrigal 10 alleged that in the early 1970s, doctors at the Medical Center in Los Angeles coercively sterilized them.

Maya Manian:
What the women’s stories exposed was common patterns in the ways Medical Center staff coerced these women into undergoing sterilization procedures. All of the 10 cases involve women whose primary language was Spanish and each of the women underwent a tubal ligation after childbirth by cesarean section. What was happening is that nurses and physicians exploited the fact that the women had limited English language skills and were seeking medical care for childbirth. There were a number of different ways this was happening.

Maya Manian:
First, all of the women were approached for consent to sterilization while in the midst of labor. Some of them testified that they were also heavily medicated at the time, and they were pressured into signing English language consent forms that they could not understand.

Maya Manian:
Second, most of the women had to resist multiple requests by multiple staff to submit to sterilization. From coming in for intake to being wheeled into the OR to have their C-section. Then third, in addition to being repeatedly pressed to sign these English language sterilization consent forms which they couldn’t understand while they’re in the midst of labor pains, many of the women lack accurate information about the need for and consequences of a tubal ligation. They would think that well, if you can get your tubes tied, you could get them untied, that it was reversible. They did not understand the consequences of this surgery.

Joanne Freeman:
But the malicious practices in the medical center didn’t go unnoticed. A doctor named Bernard Rosenfeld suspected he was witnessing sterilization abuse in the maternity ward and decided to blow the whistle.

Maya Manian:
What Dr. Rosenfeld did is he managed to get medical records of what he saw as sterilization abuse of women seeking medical care at the maternity ward. He managed to bring this to the attention of two lawyers in the area. He was reaching out, working after his shift, reaching out to journalists, to civil rights groups, to government officials in the hopes of spurring some legal action.

Maya Manian:
His efforts finally paid off when his concerns came to the attention of Antonia Hernandez and Charles Nabarrete, who were two of the lead attorneys in the Madrigal v. Quilligan case, and they were very young, Mexican American attorneys.

Joanne Freeman:
Well, let’s talk a little bit about some of the details there because it’s an amazing story, and the details are as shocking as anything else about this case. Maybe tell us a little bit about in the 1960s, and in the 1970s, what is it precisely that was going on in that maternity ward? What were these doctors doing or saying to these women?

Maya Manian:
Each of these women provided testimony during this court case. Just to give you a few examples to give you a flavor of why this was coercive and why women of color who were fighting this coined the term sterilization abuse, because it was seen as an abuse of the process of getting informed consent before treatment. For example, one of the women Georgina Hernandez, testified she arrived at the hospital, she was bleeding, she was experiencing labor pains. Staff pressed her to consent to sterilization at the time of admission, but she refused. She said no, but her labor progressed. The doctors felt a ceasarean delivery was necessary, even though she had already refused to submit to sterilization while she was in labor and heading into an emergency C-section.

Maya Manian:
She was asked again about having her tubes tied. Hernandez later recalled, she recalled a woman coming to her right before she’s about to go in for the surgery to deliver her baby and she says, “I don’t remember seeing this woman’s face, I just remember a voice telling me you better sign those papers or your baby could probably die here.”

Maya Manian:
This was the pattern, 10 stories like this, with this very, very similar pattern of being coerced or pressured under these very scary circumstances into consenting to a surgery, that some of them did not understand what the consequences were.

Joanne Freeman:
Obviously, based on what you’re telling us, then this is something like a campaign being carried out against these Latina patients. What is the rationale that these doctors are using that makes them feel that this is a logical thing to do?

Maya Manian:
Well, I should note here that the doctors deny that. The doctors who testified and to this day the doctors deny that there was any such campaign. That there was any such policy to coerce these women into sterilization. Now, there’s contradictory testimony not only from the women themselves, but there was another witness that was called to the stand on behalf of the woman, this woman Karen Banker, who was a medical student at the time, and who said she was a first hand witness to what was happening on the maternity ward.

Maya Manian:
She testified that the rationale was to cut the birth rate of people of color in the county. She testified that she heard that as the rationale, and that she also witnessed what these women were describing. That a doctor would hold a painkiller in front of a mother who was in labor pains and say, “Do you want the painkiller? Sign the papers. You need to sign the papers now.”

Maya Manian:
Now the women and their lawyers said the rationale was this racialized targeting of poor women. This is going back to a long history in California in particular, of targeting the reproduction of Mexican Americans and the Mexican population, particularly because of these racialized notions that Mexican women are hyper-fertile, that Mexican people have large families, and this is a population that we don’t want to grow.

Joanne Freeman:
Then how does this play out in the courtroom once they’re there?

Maya Manian:
There’s two phases to this litigation. In their challenge the Madrigal 10, they filed their lawsuit in June 1975, and they pursued two avenues of relief. One is known as injunctive relief, and the other is damages. Injunctive relief means they wanted a court order changing federal and state policies on informed consent. They want to actually change the rules going forward, so that this doesn’t happen to more women in the future.

Maya Manian:
In particular, they say it’s coercive and unfair to use English language forms that are written at a level that most of your patient population cannot understand. We want to change this to appropriate Spanish language consent forms and we want other safeguards to protect against coerced sterilization.

Maya Manian:
They sought injunctive relief to toughen up federal and state policies on informed consent to sterilization. That was the first phase of the case. The second phase of the case, the legal term is damages, and that is financial compensation for these 10 women’s injuries. That is to recognize we were injured, and we deserve financial compensation for that.

Maya Manian:
In the first phase, seeking injunctive relief that would strengthen sterilization consent policies, the women achieved a victory, they actually won a court order to improve those policies and to change the consent forms. One of those key achievements was adding waiting periods to sterilization, which we still have today. We still have laws where you have waiting periods prior to a sterilization procedure. It is because of this history. It’s not because of a paternalistic notion that people don’t know whether or not they should get sterilization, it’s because of this history of sterilization abuse, to make sure that it’s not being pressured in high pressure circumstance.

Joanne Freeman:
It was given up basically under duress is right.

Maya Manian:
Under duress. That’s what they’re trying to avoid.

Joanne Freeman:
Now, what did the defendants argue against all of these pretty logical arguments? What was the defendants’ case?

Maya Manian:
That was the second phase of the case, which was do we give damages to these 10 women? Do we admit or does the court agree that these 10 women had their reproductive rights violated, had their right to procreate violated? That they were coerced into sterilization? The doctors testified that they had a custom in practice of looking at the sterilization consent form. That they didn’t remember these individual plaintiffs, this is a very, very busy maternity ward. They don’t remember each individual plaintiff. But they said, “We respect consent,” is what the doctor testified. “We do that by looking at these forms.”

Maya Manian:
Ultimately, Judge Curtis credited the physician’s testimony that, generally speaking, we look at these forms, and that’s a custom and practice to rely on these forms to be certain that informed consent was granted. Now, Curtis, actually didn’t dispute the testimony of the women, but just that I don’t see a pattern here of racialized targeting of these women’s reproduction. He was very dismissive to the Madrigal 10’s argument that this was racialized targeting of their reproduction. Instead, he just thought as each one is just an individual case, and unfortunately, there was a breakdown in communication, but I don’t see any reason to say that these women should win damages here.

Maya Manian:
In a nutshell, in an inversion of their intended purpose, Curtis treated these consent forms as a shield against physician liability, rather than as a means to protect patient autonomy. Our modern understandings of informed consent law is that it’s a protection of the patient’s decision making and bodily autonomy. It’s supposed to be a benefit to the patient. Here, it’s just a shield for the physician against viability.

Maya Manian:
Unfortunately, the women did not win compensation for themselves, but they did achieve victory for changing along going forward for women coming after them.

Joanne Freeman:
The judge in that case, essentially dismissed the healing component of this and clung to the forms.

Maya Manian:
Clung to the forms and credited the physician’s testimony over the women’s.

Joanne Freeman:
Did the Madrigal 10 ever receive any kind of an apology from anybody, like the State of California for the events that transpired?

Maya Manian:
No, unfortunately, they did not. Now, I should note that in 2003, California did issue a formal apology for its history of coercive sterilization, although it did not award victims any reparations, but this was not specific to the Madrigal 10. This was even going back to the era of eugenic sterilization. Today, we think of California as very progressive, very reproductive rights friendly. But California actually in 1909, was the third state to adopt laws authorizing the sterilization of the “feeble minded” and feeble minded in quotes, that was the language used in eugenic sterilization laws. California actually accounted for one third of the 60,000 non-consensual sterilizations that were performed throughout the US in the early 20th century in this eugenics era, but there was no specific apology to the Madrigal 10.

Joanne Freeman:
It’s a practice with deep roots. It’s a practice that to some degree still confronts some denial. To what degree is sterilization still a threat for some people today?

Maya Manian:
It is very much still a threat for some people today. It’s not gone away, and there are other ways in which sterilization is still a concern. Although, technology has changed. Now we have what are called LARKs, long acting reversible contraception. Now, LARKs are a wonderful thing. Sterilization is a wonderful thing for people who want it. Reproductive technologies are a double edged sword. They have promise and peril. They help women and pregnant people or could be pregnant people control the reproduction, but they can also be so easily abused.

Maya Manian:
There’s a lot of enthusiasm around LARKs, but reproductive justice advocates also fear that these will be used to target low income populations in the same way that the era of family planning, federal funding for family planning was ushered in the ’60s and ’70s, and that was the double edged sword. Poor women got access to these technologies, but then they also suffered abuse.

Maya Manian:
We see that today. There’s been reporting about large programs where the state will pay for insertion of a long acting removal contraception but not removal, in which case you have effectively been sterilized. We always have to think about the double edged sword of technologies that we have available to help people control their reproduction, but in the wrong hands, they can lead to abuse. That is still a concern today, especially when we think about this in connection with the full spectrum of reproductive health policy.

Maya Manian:
Sterilization is very much linked to our policy on contraception, on abortion, on welfare and even back in the ’70s, reproductive justice advocates, women of color were linking these different issues. This is the early ’70s. There’s Roe v. Wade is happening, there’s talk about, and debates about not only about sterilization abuse but also about abortion. Back in the ’70s, activists, reproductive justice and rights activists noted or argued that cutting back on access to abortion is going to mean increased sterilization abuse. Because how are poor women especially going to control their reproduction? If they can’t afford to pay for contraception, they can’t afford another child, welfare payments are cut back, they can’t access abortion care, because of all the increasing restrictions put on abortion. The only funded alternative left is sterilization. There’s different ways you can think about sterilization being coerced.

Joanne Freeman:
Maya Manian is a visiting professor at Howard University’s School of Law. You can find her research on Madrigal v. Quilligan in the book, Murray, Shaw and Siegel’s, Reproductive Rights and Justice Stories.

Brian Balogh:
That’s going to do it for us today, but you can keep the conversation going on long. Let us know what you thought about the episode or ask us for questions about this. You’ll find us at backstoryradio.org, or send an email to backstory@virginia.edu. We’re also on Facebook and Twitter, @BackStoryRadio. Whatever you do, don’t be a stranger.

Joanne Freeman:
BackStory is produced at Virginia Humanities. Major support is provided by an anonymous donor, the National Endowment for the Humanities, the Joseph and Robert Cornell Memorial Foundation, the Johns Hopkins University and the Arthur Vining Davis foundations. Additional support is provided by the Tomato Fund cultivating fresh ideas in the arts, the humanities and the environment.

Speaker 1:
Brian Balogh is Professor of History at the University of Virginia. Ed Ayers is Professor of the Humanities and President Emeritus of the University of Richmond. Joanne Freeman is Professor of History and American Studies at Yale University. Nathan Connolly is the Herbert Baxter Adams Associate Professor of History at the Johns Hopkins University. BackStory was created by Andrew Windham for Virginia Humanities.