By David Siders

More than one-quarter of inmate sterilizations performed in California from mid-2005 to mid-2013 followed deficient consent procedures, including 18 cases in which the waiting period between consent and surgery was potentially violated, the state auditor said Thursday.

State Auditor Elaine Howle said in a report that of 144 inmates sterilized using bilateral tubal ligation, 39 inmates were sterilized "following deficiencies in the informed consent process."

In addition to cases in which the auditor said waiting periods may have been violated, the auditor found no evidence in 27 of 39 cases that the inmate's doctor had signed a required consent form.

"Our legal counsel has advised us that, based on these facts, a court would likely conclude that these 39 inmates' consent was not lawfully obtained," Howle said in her report.

Howle was particularly alarmed by cases in which doctor signatures were missing from consent forms.

"The missing physicians' signatures on some of the inmates' consent forms are especially concerning because of what the physician signature certifies: that the required waiting period has been satisfied and that the patient appears mentally competent and understands the lasting effects of sterilization," Howle wrote. "The physician is the last check in the informed consent process and provides the patient with the final opportunity to change her mind."

The federal health receiver's office, which oversees medical care in state prisons, said in a written response that the audit's findings "date back to policy that was in effect in 1999, or possibly even before," noting the audit's finding that the use of sterilization has decreased significantly in recent years.

The receiver's office said many of the auditor's concerns will be addressed by adopting her recommendation that the receiver defer the procedure for obtaining consent to hospitals where sterilizations are performed.

The state Senate passed legislation in May that would forbid jails and prisons from sterilizing inmates for the purpose of birth control, after the Center for Investigative Reporting found doctors under contract with the California Department of Corrections and Rehabilitation sterilized nearly 150 inmates without required approvals.

The Assembly has yet to act on the legislation. Some critics of the legislation have said it would limit medical options for inmates.

Sen. Hannah-Beth Jackson, D-Santa Barbara, who wrote Senate Bill 1135, said in a prepared statement, "We knew there was a problem with unlawful and coerced sterilizations in the prison environment, but this report shows it is far more serious and systemic than we had thought."

Sen. Ted Lieu, D-Torrance, said the audit "shocks the conscience."

(c)2014 The Sacramento Bee (Sacramento, Calif.)