Wednesday, July 31, 2013

In Re Maria B. (Cal. Ct. App. - July 31, 2013)

Look, I understand our nation's troubling history with sterilization of the mentally disabled as much as anyone.  It's a sordid tale.

But enough already.

Maria B. is a 25-year old woman.  She has cerebral palsy.  She's mentally disabled.  She has hydrocephalus, an accumulation of excess fluid in the brain.  She's got surgically implanted shunts that drain excess fluid from her brain to her abdominal cavity.

In short, she's got serious medical problems.

Add to all of this the fact that she's got serious problems with her menses.

Maria started having her period at 11, and it's gotten worse ever since.  She has increasingly irregular cycles. She has excessive bleeding.  Often 26 days a month (!).  She often can't stand up without bleeding through her sanitary napkins and clothes.  Plus she's got low iron, chronic fatigue, bloating and abdominal cramps.

Plus migraines like you wouldn't believe.  Often causing her to collapse in pain, several that required trips to the emergency room, and six or seven hospitalizations.

In short, it's a nightmare.

Doctors have tried everything for Maria's menstrual problems and resulting symptoms.  A neuroloigist tried numerous pills and narcotics to stop the pain.  Didn't work.  Neurosurgeons performed several surgeries to adjust her shunts to try to relieve the migraines.  No luck.  An obstetrician and gynecologist put Maria on birth control pills to regularize and control her periods.  Unsuccessful.  They did a D&C to reduce the lining in her uterus to try to reduce the bleeding.  Worked for a little bit, but then back to normal.  Tried another birth control regiment.  No joy.

Then tried Depo Provera shots.  Those worked for a a couple months.  Yay!  But you can only get those shots every 90 days.  So during the last month or so, the migraines returned, and Maria had to repeatedly visit the ER and endure the pain until the next shot.  Plus you can only do the shots for two years anyway because they destroy your bone density.  So not a solution.

Essentially, they've tried everything.  Clearly regulating Maria's menses significantly helps with her pain.  But nothing's worked.

So Maria's limited conservator -- her mother -- decides, upon the advice of Maria's physicians, to take out Maria's uterus and ovaries.  That will prevent Maria from ever having children.  But it's also got a very good shot and relieving her pain.  Plus it'll avoid the need for numerous shunt surgeries, taking medication that may well destroy her liver, having continuing CT scans that irradiate Maria's brain and cause cancer, etc.

Maria's totally on board.  She tells the doctors she definitely wants the surgery.  Doesn't need to have kids. Knows the consequences.  Wants the devastating headaches to finally stop.  Do it.

Not so fast.

Before you sterilize someone in a conservatorship, you've got to go to court.  Which in turn requires a very heavy demonstration of need.  So we have a trial.  A two-day bench trial.  In which Maria, Maria's mother, Maria's doctors, and everyone else testifies.  Plus we appoint a public defender to "represent" Maria and to oppose (?!) the procedure she's expressly requested.  Then, when the trial court approves the procedure as demonstrably and clearly in Maria's best interests, we have the public defender file an appeal.  All the while requiring Maria to continue to endure the excruciating pain.

To its credit, the Court of Appeal affirms the trial court.  Moreover, to their credit, it looks like everyone involved in the case expedited things as quickly as they could.  Including stipulating to make the Court of Appeal's decision final ten days after the opinion is issued.  So Maria can get relief as quickly as possible.

But that still takes over a year.  A year of contested judicial proceedings before we can give someone the relief to which they're clearly entitled.

Crime victims in federal court are entitled to testify at sentencing proceedings, and if they have to file a writ or appeal to do so, the Court of Appeals has to decide these things within 72 hours.  I wonder whether people like Maria shouldn't be granted analogous rights.  Their burden seems even more severe.  And their relief is demonstrably much less timely.

Good result here.  I just wish it could have happened more quickly.