My name is Monica. I was delivered by Dr. B in the Bellflower Hospital at the very end of Winter, 1975. My pediatrician was Dr. C, a wonderful man who made my many childhood trips to the doctor's office as enjoyable as possible. Since June of 1998, I have paid for my own coverage as I am self-employed. I am writing to you today to tell you about my choice to have a tubal ligation, and my recent experiences with several doctors under your supervision in regards to this choice.

I have taken the matter of tubal ligation into serious, intense, thorough, and realistic consideration. After countless hours of thought, research, discussion, contemplation, and soul searching, I have determined a tubal ligation, as opposed to other methods of long-term birth control, is the correct choice for me personally and for my relationship.

My personal reasons for not desiring children are many and varied. But most importantly, I have always situated my life and decisions around not having children as this has been one of my greatest fears. Indeed, the thought of being pregnant equates to me, as the end of my life and future. I do not want to have to make the decision whether to keep a child and permanently alter the course of my entire life, or to abort the child and live with the knowledge I destroyed a potential life. Sterility would enable me to put this fear of pregnancy and abortion to rest.

There is no doubt in my mind that if I was to become pregnant, I would have the child aborted as soon as possible. However, of the two operations, my research shows that a properly performed tubal ligation poses far less safety risks then does an abortion.

I have considered all that bringing a child into this world encompasses and it is not how I desire to live the rest of my adult life. Motherhood would force me to put my individuality, goals, dreams, and aspirations on indefinite, if not infinite, hold. I also feel that abandoning my individuality for motherhood would cause me to resent any offspring, which would be extremely unfair to them. All children deserve a loving home with parents who are willing to selflessly put the needs of their child(ren) above their own.

I have a family history of Diabetes on my father's side of the family. My father has controlled his Diabetes with diet and exercise for at least fifteen years. I do not feel comfortable that I may knowingly place an unborn child at risk for contracting an incurable, lifestyle-changing disease. As a Latina with a family history of Diabetes, I also run a risk of contracting gestational diabetes, which could pose a risk to myself and unborn child.

I am in a stable, loving, and nurturing long-term, monogamous relationship. My boyfriend, Kevin, and I have lived together nearly three years. We have talked about not having children many times and in great detail. After careful and thorough consideration of the dramatic and permanent impact a child would have on our lives, we've decided to remain childfree. Quite simply and honestly, we are unwilling to make the sacrifices good parents need to make in order to raise happy, healthy, and well-adjusted children. As responsible adults, we've chosen sterilization as it has proven to be the safest, most cost-effective long-term method of birth control.

In addition, we have decided that a tubal ligation is preferable to a vasectomy, a less complicated procedure, as it gives me added protection from pregnancy in the case of rape. I am aware in that if I am raped, I can seek emergency contraception or an abortion. However, as a five year survivor of date rape, I know what the act of rape can do to one's soul. If I was ever raped again, I would find my sterilization to be a comfort as my already painful recovery process would not be worsened by high doses of artificial hormones or the painful process of aborting a child conceived by rape.

I have researched the many varied methods of birth control available, and I have found that for my needs of an effective, low-risk, cost-efficient, and long-term method of birth control, a tubal ligation is my best option.

I have previously been prescribed three different types of monophasal birth control pills (OrthoCyclen, Levelin, and Ovcon35) from age 19 through age 24. My first two years of use (OrthoCyclen) went well. However, the positive side effects (no menstrual cramps and light periods) began to be replaced with negative side effects (depression and nausea). After three to three-and-a-half years of using these various prescriptions, their negative side effects were increasingly interfering with my quality of life. Knowing it would be unwise to continue to take birth control pills for much longer, I researched other types of birth control methods. After carefully weighing all methods against my present and desired future lifestyle, I came to the following conclusions:

(1) Hormonal methods are unfavorable for me due to the negative side effects and long-term costs incurred.
(2) I am deterred from using an IUD due to the risks and side effects associated with their practiced usage
(3) Barrier methods are too restrictive and extraneous for a monogamous couple in a committed relationship.

In August, 1999 after careful consideration and discussion with Kevin, I decided to discontinue using the Pill altogether. Our plan has been to use condoms until I was able to obtain a tubal ligation. As the procedure is clearly covered in my benefits package, I began the process of obtaining a physician experienced in such surgery in September of 1999. I first spoke with NP S, who kindly gave me some literature and a few tips on what kind of doctor I needed to contact. Shortly after this appointment, I made another appointment to see Dr. F on 25th of October for a consultation regarding the procedure.

In between my visit with NP S and my appointment with Dr. F, I continued to obtain specific information regarding tubal ligations from several key texts and websites hosted by established institutions in the health field, such as The Mayo Clinic, the American Medical Association, Planned Parenthood, and Kaiser Permanente. I printed the data out upon a few dozen sheets of paper, and read through them several times. The more I read, the more convinced I was that a tubal ligation was for me. I brought this information with me to my appointment with Dr. F, to illustrate that I was making an informed decision, and wasn't requesting a procedure that I hadn't fully considered.

However, when I attended my appointment scheduled on 25 October with Dr. F, Dr. F did not show. Indeed, I have no idea what Dr. F looks like to this day. To my dismay and disbelief, I was shuffled to a Dr. G, a resident student of Dr. F's. Now Dr. G was considerably more concerned with trying to convince me not to have the procedure than to listen to why I desired it. He constantly insisted that I would change my mind one day. I replied that I very much doubted I would, and if I did, I would deal with such a predicament that I willingly had put myself in. He remained obstinate in his position though and constantly suggested an IUD instead. When he was finally convinced that I would not change my mind, he left for a few minutes to consult with Dr. F. (As it turns out, Dr. F was in an office close by, but did not take the time to talk to me in person as a patient of his, even though I specifically scheduled an appointment with him.)

When resident G returned, I was offered three options:

(1) Use an IUD
(2) Undergo a psychiatric evaluation AND
(3) Seek a referral to another doctor who would be willing to perform this covered procedure for me.

While I was dismayed that he would not consider my reasons, I chose options 2 and 3 as I was already at Kaiser and not familiar with my coverage requirements for this unexpected request. I turned in a referral for an evaluation, and left the office.

On my way home, I decided to call Kaiser Member Services and file a complaint regarding the lack of consideration afforded me. I did not appreciate paying to see one physician, only to have a less experienced and wholly unannounced resident interview me. I was also beginning to wonder why they wanted me to undergo a psychiatric evaluation in order to receive a tubal ligation. Despite all my research and questions offered to Kaiser personnel, I could not locate any female having previously been asked to undergo a psychiatric evaluation when she expressed a desire to have a child. Neither could I locate any male patient that was requested to have a psychiatric evaluation as a prerequisite to having a vasectomy performed.

While I begrudgingly scheduled the psychiatric appointment for November 1st, I soon after considered that it was both absurd and insulting to be sent to a psychiatrist simply because of my personal decision to become sterile. As a mentally competent adult over the age of 21, I have a legal right to a tubal ligation. On October 27th, I canceled the psychiatric evaluation and filed a second complaint to Member Services on this issue. My reasoning for this complaint was tempered by reading these quotes from the Kaiser Personal Advantage II plan agreement from which I am a member:

Page 19: We cover the following:
Tubal Ligations

Page 42: You have the right to:
-Receive care with dignity and respect
-Express you wishes concerning your care

Page 43: We do not discriminate in our delivery of health care services and supplies on the basis of age, (race, color, national origin, religion, sex, sexual orientation, or physical) or mental disability

During the first week of November, approximately a week after I had filed my second complaint, I spoke with a representative at member services to check upon the status of my grievance. At this time, I requested a new appointment with "a doctor who would be willing to perform this operation", and I was told specifically that my request would be granted.

On the morning of November 5th, Member Services called me to offer an appointment with very short notice-- one for only four hours away. The appointment, while offered with an unexpected urgency, was expressed as being with a senior physician (Dr. M) who had been predicated in the details of my situation and briefed on the details of my complaints. I happily accepted the appointment, even though it meant losing several hours of work from my job.

My visit with Dr. M however, was a complete waste of my time. Like Dr. G, Dr. M was more concerned with talking me out of the procedure than with listening to me, my concerns or wishes. At this point, I was extremely frustrated and angry that I was lead to believe I would talk to a doctor willing to sterilize me. Soon after leaving Dr. M's office, I broke down in tears in the nearest restroom. I felt as if I was deliberately brought to Dr. M's office to be scared into submitting into a psychiatric evaluation and IUD and out of a tubal ligation, despite my repeated opposition to both "options." This was certainly not respectful treatment nor a means to receive a Kaiser covered procedure. In fact, Dr. M did not even have the courage to charge me for the visit, which exemplified how much of a waste of time it was for all parties involved.

After composing myself enough to leave the restroom, I checked out of the office and headed for the nearest Member Services office to file my third complaint in regards to this matter. In sharp contrast to the doctors, member services was sympathetic, understanding, and willing to treat me as an individual rather than a potential legal risk.

Many people have asked me what would happen if I was sterilized and one day wanted to have a child of my own. Quite simply, if I believed there was the slightest chance that I want to have children of my own one day in the future, I would not want to be sterilized. I understand that there are young women who have been sterilized who later changed their minds and were devastated that they could never bear children of their own. However, each woman is a unique being, and one's individual situation should be considered above the actions of her similarly gendered peers.

Sterilization does not mean never having children in my life. On the contrary-- I see sterilization as a way to positively influence the lives of many children as a mentor, counselor, teacher, or foster parent. These arenas would also give me a chance to reach more families than I would if I was busy attempting to raise my own children.

In conclusion, I urge you to grant me a tubal ligation performed without any further intimidation or coercement from Kaiser staff. I have every intention of having this procedure performed by the health plan I pay over $1200 a year for and will continue fighting such disrespectful treatment via legal arbitration, small claims court or any other legal means, including using the media. (see page 37 of the Kaiser Personal Advantage II plan agreement).

Thank you for your attention.