The state auditor blasted federal and state oversight of sterilization surgeries for female prison inmates on Thursday, finding numerous illegal operations and violations of California's informed-consent law.

Of the 144 tubal ligations performed on inmates from fiscal years 2005-06 to 2012-13, auditors found, more than a quarter were done without lawful consent, according to the report by State Auditor Elaine Howle.

The findings "made me sick to my stomach," said state Sen. Ted Lieu, D-Torrance (Los Angeles County), who was the first to call for the Medical Board of California to investigate the surgeries after the Center for Investigative Reporting broke the story nearly a year ago. That probe has not been completed.

Charges of coercion

Former inmates and prisoner advocates have said prison medical staffers coerced the women, targeting those deemed likely to return to prison after they were released. The new audit notes that all women receiving tubal ligations in state prisons from 2005 to 2013 had been incarcerated at least once before. However, prison medical officials have denied any ill intent.

In addition, the audit found:

-- Inmates receiving tubal ligations typically had been pregnant five or more times before being sterilized.

-- Most of the women tested at less than a high school level of reading proficiency, with about one-third reading below the sixth-grade level.

-- In 27 cases, the inmate's physician did not sign the required consent form asserting that the patient appeared to be mentally competent and understood the lasting effects of the procedure and that the required waiting period had been satisfied.

-- There were 18 cases with potential violations of the required waiting period between when the inmate consented and when the surgery actually took place. State law mandates a 30-day wait to ensure patients aren't pressured or rushed.

With some overlap between the missing physician signatures and waiting-period violations, the number of illegal operations totaled 39, the report found.

Lack of consent

The audit also found that some doctors falsified the consent forms, indicating the proper waiting period had passed when it clearly had not.

The audit noted that the federal receiver's office, which took over medical care in the state's prisons in 2006, maintains that it has no legal duty to make sure prison employees comply with the consent procedures, which Lieu called "ludicrous."

Liz Gransee, spokeswoman for the federal prison receiver, confirmed that the office's lawyers disagree with the audit's conclusions. Nonetheless, Gransee said, the office will implement the audit's recommendations.

In the audit, the office says it has initiated staff training, among other measures.

Assemblywoman Bonnie Lowenthal, D-Long Beach, and Sen. Hannah-Beth Jackson, D-Santa Barbara, requested the audit in August in response to the Center for Investigative Reporting's investigation.

'Systemic' problem

On Thursday, Jackson described the results as shocking.

"Based upon the auditor's report, the problem is far more systemic," she said. "We now have clear proof that the prison environment is an environment where consent simply cannot be obtained in a responsible, reliable manner for these procedures."

Cynthia Chandler, an adjunct professor at the Golden Gate University School of Law and co-founder of the prisoner rights group Justice Now, called the report a good first step. She also called for state reparations for the women who were sterilized.

Justice Now has been raising questions about prison sterilizations since the early 2000s, after receiving medical reports and allegations of abuse from incarcerated women.

"We were dismissed as heretics despite having evidence abuse and illegal sterilizations were occurring," Chandler said. "This report feels like an incredible step and vindication for people who work toward challenging human rights abuses."

The state auditor urged federal officials to forward the names of physicians involved in the illegal surgeries to the Medical Board and the state Department of Public Health for further investigation and disciplinary action. That would include 17 doctors and eight hospitals.

The Center for Investigative Reporting's investigation, published in July, found that inmates were signed up for the surgery while pregnant at two women's prisons: the California Institution for Women in Corona (Riverside County) and Valley State Prison for Women in Chowchilla (Madera County). Valley State became a men's prison in 2013.

Focus on facility

State prison data indicate that more than half the surgeries from 2006 to 2010- 74 - were requested by Valley State. More than two-thirds of those requests came from Dr. James Heinrich, Valley State's OB/GYN, or a nurse on his staff.

Heinrich previously said that the money spent sterilizing inmates was minimal "compared to what you save in welfare paying for these unwanted children."

In response to the Center for Investigative Reporting story, Jackson introduced a bill that would ban all inmate sterilizations for birth control purposes. Under SB1135, such surgeries would be performed only during life-threatening emergencies and to cure physical illness.

The Senate approved the measure last month. It is now before the Assembly.