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Sacramento, California -

The illegal sterilisation of dozens of female prisoners in California demands an investigation, a report said on Thursday.

The state audit asks California's medical board and Department of Public Health to look into 17 doctors and eight hospitals involved in 39 illegal sterilisations that were performed without inmates' lawful consent. At issue is whether the women were properly told of the nature and permanence of the procedure.

The legal advocacy group Justice Now raised the issue in January 2010, and the issue surfaced again after the Centre for Investigative Reporting found that doctors sterilised nearly 150 female inmates without proper state approval over five years.

The 39 cases were among 144 between 2006 and last year in which inmates had tubal ligations or other procedures for the sole purpose of sterilising them. Another 650 inmates had other medical procedures that could have resulted in sterilisation.

In 27 cases, the inmate's doctor did not sign a required consent form saying the patient appeared mentally competent, understood the permanent effect and had waited at least 30 days to give the patient time to reconsider.

Margarita Fernandez, a spokeswoman for the California State Auditor, said the sterilisations were performed by private doctors at hospitals outside the prisons. Surgeries on prison inmates are typically performed at outside facilities.

“Clearly this demonstrates a real systemic problem that frankly implicates the entire culture,” said state Senator Hannah-Beth Jackson, who said she found it shocking that nearly 30 percent of the procedures were performed without obtaining proper consent.

Jackson is the author of legislation which would bar the state's prisons and jails from sterilising inmates for the purpose of birth control. It passed the Senate last month, 36-0, and is awaiting consideration in the Assembly.

Jackson fears that inmates may feel pressure to have the sterilisations, a topic that was not part of the auditor's review.

“The experience in and of itself is extraordinarily coercive,” Jackson said of obtaining health care behind bars. “It's very difficult for a woman to exercise her free will under those circumstances.”

The 39 cases will be referred to the department and medical board, said Liz Gransee, a spokeswoman for the federal court-appointed official who controls prison medical care. She said the investigations are confidential.

The federal receiver's office took control of prison medical care in 2006, but said it didn't learn about the sterilisation procedures until the group Justice Now raised the issue in January 2010. The receiver's office previously said it immediately took steps to stop the practice.

Justice Now did not immediately comment on the audit.

Auditors found the receiver's office failed to make sure its own staff obtained necessary approvals from inmates and from two medical procedure review committees before inmates were sterilised. They recommended that the federal receiver adopt better procedures to monitor its own medical staff and medical providers who work under contract with the state. That includes improving medical record-keeping and making sure inmates give their informed consent to medical procedures. - Sapa-AP