One of the denied applicants, Zyaire Smith, who entered prison in 1992 at age 19, sought medical help for the heavy and painful periods that had plagued him since he first began menstruating.
“They lasted seven to nine days,” he told The Nation. “There were lots of blood clots that came out looking like chunks of meat.”
In prison, both bleeding and pain worsened.
In 2005 or 2006, he saw Heinrich, who offered to perform a Pap smear. When Smith declined, Heinrich offered an ultrasound and, since the procedure did not involve penetration, Smith agreed.
The ultrasound revealed fibroid tumors. Heinrich recommended that Smith undergo a hysterectomy.
“I didn’t know exactly what that meant,” Smith recalled, “but I knew that there were a lot of people having hysterectomies [at the prison]. They were giving hysterectomies like they were giving chow—grab a tray, get a hysterectomy. That’s how it was going.” (He also recalled that many Black women and trans men, like himself, seemed to be receiving hysterectomies around that time.)
Smith, who had never had surgery, declined. Heinrich offered another option—ablation, a procedure in which the uterine lining is destroyed without necessitating any surgical cuts. The process is not recommended for people who might want to become pregnant in the future, a fact that Heinrich never told Smith.
He said neither Heinrich nor any other medical provider about the long-lasting consequences of the procedure. Not knowing any of these, Smith agreed.
Dr. Carolyn Sufrin is an associate professor of gynecology and obstetrics at the Johns Hopkins School of Medicine and has worked extensively on reproductive health issues in women’s prisons. She told The Nation that the standard of care for fibroids and heavy bleeding starts with reversible contraceptive methods, such as oral contraceptives, contraceptive implants, or IUDs. Ablation is suggested if these options fail and, she added “after thorough counseling and giving the patient the choice.”
Smith, now out of prison, applied for compensation. In September, he received a letter of denial.
While ablation is not classified as a sterilizing procedure, it decreases the chances of pregnancy and healthy pregnancy outcomes, Sufrin explained. “We do not recommend anyone get pregnant after an ablation,” she said. “This procedure is intended for people who are done with childbearing.”
When asked about the denials issued to those who had had ablations, Sufrin pointed to the American College of Obstetricians and Gynecologists, which warns against post-ablation pregnancy. “Certainly, there are case reports of normal pregnancies after endometrial ablation, but there is also data showing increased risks. It’s the accepted standard of care that we recommend against pregnancy to people who’ve had an ablation.”
Greenie also received a denial letter. Greenie, who is still in prison and plans to reapply for compensation, asked that The Nation not publish his legal name.
Greenie arrived at Valley State Prison for Women in the 1990s. In 2002, he began experiencing pain in his abdomen. Heinrich told him that he had a cyst on his left ovary and recommended that the entire organ be removed.
“I was fine with that,” Greenie said in a phone interview with The Nation. But, he said, “I remember that the doctor [at the hospital] kept saying, ‘They want me to take both your ovaries, but I’m not going to do that. You’re too young. We’re not going to do that.’” (That year, Greenie had turned 30.)
Seven years later, Greenie saw Heinrich again, who told him there was a cyst on his remaining ovary. Within 24 hours, Greenie was sent to the hospital for another laparoscopic surgery, an extremely fast turnaround time in a prison medical system that typically moved at a glacial pace. When he woke, he received some confusing news—the surgeon told him that his right ovary had already been removed.
“That makes me believe that, in 2002, they took both my ovaries without my knowledge because I had both of them prior to that [procedure],” he said. But he never received any paperwork verifying the missing organ. When he attempted to obtain his hospital records, he received a note stating that the hospital keeps records for only 10 years.
Greenie had served time with several members active in the California Coalition for Women Prisoners, who told him about the compensation program. He applied, but received a denial letter stating that because his records indicated that he still had one ovary, he had not been sterilized and was thus ineligible.
For Greenie, the issue is not about whether he can still become pregnant, but that Heinrich—and prison authorities—took the liberty of removing both ovaries without his consent. “If I didn’t give you permission to do this to my body, then why did you do it?” he asked. The experience has left him with a permanent distrust of seeking medical care.
The denial letter, dated August 18, gave him 30 days to appeal. But Greenie did not receive the appeal form within those 30 days. The form letter stated that he is allowed to reapply and he plans to do so, hoping for a better outcome.
“Money’s not gonna make it better,” he acknowledged, but he had been hoping to use the funds to help his aging mother pay her rent and install a special bathtub to prevent slips and falls. It would also enable him to buy hygiene items and other necessities while in prison without having to stretch his family’s finances.
“Is there any way you can help me get my reparations?” he asked just before our call ended.