by Ariana Figueroa, Georgia Recorders [This article first appeared in the Georgia Recorder and in the States Newsroom, republished with permission]
November 15, 2022
WASHINGTON — U.S. Senate members on a committee of inquiry grilled federal immigration officials on Tuesday over a bipartisan report that detailed how migrant women were subjected to questionable gynecological procedures in a Georgia immigration detention center.
The U.S. Senate Permanent Investigations Subcommittee released an 18-month bipartisan report that found migrant women detained at the Irwin County Detention Center, known as the ICDC, in Georgia, were subjected to “excessive, invasive and often unnecessary gynecological procedures ‘ and many of the women did not agree or understand the procedures they were undergoing.
Following the report’s release, the panel held a hearing to question Assistant Director Stewart D. Smith of the US Department of Homeland Security’s US Immigration and Customs Enforcement Health Service Corps and Pamela Hearn, the medical director of LaSalle Corrections, which has federal agencies Contracts to operate detention centers across the country, including one at the ICDC.
The report focused on one doctor, Dr. Mahendra Amin, who was tasked with treating inmates and performing “high rates” of unauthorized hysterectomies on ICDC inmates.
“It’s hard for me to think of anything worse than the federal government subjecting incarcerated women to unnecessary gynecological surgeries,” said Democratic Senator Jon Ossoff of Georgia, chair of the panel.
dr Margaret G. Mueller, associate professor of obstetrics and gynecology at Northwestern Medicine, who testified before senators, said the women in the detention center were subjected to aggressive, unnecessary procedures. She said there have been instances where Amin has not obtained consent.
“This must not happen again,” she said.
Witness reports abuse
One of the witnesses, Karina Cisneros Preciado, told senators how Amin diagnosed her with an ovarian cyst when she had a Pap smear at the medical center. The treatment he undertook included a Depo-Provera injection, a type of birth control that suppresses ovulation.
Cisneros Preciado said she had no idea she was being given birth control and said she declined because many of the women in her family had had bad reactions to certain types of birth control.
The PSI report noted that another doctor who treated Cisneros Preciado found no signs of a cyst.
Democratic US Senator Maggie Hassan of New Hampshire said she was concerned that Cisneros Preciado said she never gave consent during her treatment. Hassan asked Cisneros Preciado if Amin asked about her family medical history before prescribing the shot.
Cisneros Preciado said he never did.
“To this day, I’m very scared of going to a doctor for me and my kids,” she said.
Cisneros Preciado said she was brought to the United States when she was eight. She told senators that when she married at 18, their relationship became abusive and when she called the police to prevent one of her children from being molested, she was arrested.
While charges were dropped because of her immigration status, she was transferred to pre-trial detention center shortly after the birth of her daughter.
Cisneros Preciado said she was still breastfeeding when she was taken to the detention center. She said she had been separated from her daughter for seven months and when she was finally released, “her daughter was already on the way, she didn’t know who I was. She was afraid of me.”
In December 2020, former ICDC inmates filed a class-action lawsuit against ICDC, ICE, Amin, Irwin County Hospital and other federal and non-federal parties alleging that patients underwent non-consensual and unnecessary pelvic hygiene procedures.
Cisneros Preciado is one of the plaintiffs in this class action lawsuit.
The subcommittee on its report summoned Amin to testify, but “through his attorney he produced an affidavit stating that he declined to testify against self-incrimination under his Fifth Amendment privilege,” the report said.
Amin has no board certifications, and in 2013 the Justice Department and the state of Georgia sued him alleging that he committed Medicaid fraud by ordering unnecessary and excessive medical procedures. That lawsuit was settled in 2015, when Amin and his co-defendants were ordered to pay the federal government $520,000 in settlements without admitting wrongdoing.
Ossoff questioned Smith, who is responsible for the health care of the inmates, how his agency allowed this to happen and why there was no oversight of Amin.
“We were not aware of these complaints,” Smith said. “Until the whistleblower complains.”
Ossoff continued to press Smith about how Amin was allowed to treat the inmates, despite not being board certified and while being sued by the government and the state of Georgia for Medicaid fraud.
“It’s a pathetic failure,” Ossoff told Smith. “What we heard today is that there was no real verification.”
Congress was brought to the attention of Congress in 2019 by a whistleblower, Dawn Wooten, a registered nurse who worked at the Irwin County Detention Center.
Whistleblower Dawn Wooten was a registered nurse who worked at the Irwin County Detention Center. She claimed women at the facility were sent to an outside medical provider, Amin, who performed gynecologic procedures — including but not limited to hysterectomies — without their informed consent.
Leading US Democrats also initiated their own investigations into the facility after Wooten’s allegations.
In May 2021, DHS directed ICE to terminate its contract with ICDC, and as of September 2021, all immigrant detainees were removed from that facility and transferred to other detention facilities.
And as of October 2021, ICE terminated its contract with LaSalle. However, the federal government still has contracts with LaSalle to operate other detention centers in the United States
Hearn, representing LaSalle, clarified that LaSalle is not involved in reviewing outside medical providers like Amin, “nor could we have done so under the contracts or regulations governing our involvement with the ICDC.”
However, the ICDC is currently authorized to arrest individuals in the custody of the US Marshals Service.
The almost 100-page report contains interviews with more than 70 contemporary witnesses. Investigators reviewed more than 541,000 pages of records from the detention center, the US government, LaSalle Corrections and Irwin County Hospital.
At the Irwin County Detention Center in 2017-2020, about 4% of the inmates housed there were women. The report found that during that period, Amin accounted for about 6.5% of all gynecology visits among inmates and performed more than 90% of the major obstetric-gynecology procedures on female inmates nationwide.
“Dr. Amin was a clear outlier in both the number and type of procedures he performed compared to other gynecologists treating ICE detainees,” the report reads.
Of these procedures, he performed 44 laparoscopies to remove lesions, accounting for 94% of all procedures performed on all ICE inmates; performed 102 Depo-Provera injections, or 93% of the injections administered to ICE inmates by all OB-GYN specialists; performed 163 limited pelvic exams, or 92% of the limited pelvic exams performed on all ICE inmates; and 53 dilation and curettage procedures, or 82% of all D&C procedures, performed by all OB-GYN specialists treating ICE inmates.
All external medical experts interviewed in the PSI report determined that Amin was not following current medical guidelines for patient care, and all medical experts determined that “Dr. Amin followed a treatment pattern for nearly all of the patients he treated, regardless of their specific diagnosis or condition.”
These medical experts the committee interviewed were part of a medical team tapped by attorneys and advocacy groups involved in the December 2020 lawsuit to review the medical records of 19 ICDC detainees that Amin treated.
“These experts concluded that Dr. Amin subjected women to aggressive and unethical gynecological treatment,” the report said. “They found out that Dr. Amin quickly scheduled surgeries when nonsurgical options were available, misinterpreted test results, performed unnecessary injections and treatments, and proceeded without informed consent.”
The report interviewed six women who were ex-prisoners treated by Amin.
“These women described that after being treated by Dr. Amin felt confused, scared and hurt,” the report reads. “Several reported that they are still living with physical pain and uncertainty about the impact of his treatments on their fertility.”
The report found these women were not told what procedures they were going through, and when they asked for more information, Amin told them he was “unauthorized” to give them more information.
The report detailed how a former licensed practical nurse who worked with Amin observed patients sign informed consent forms when they were “about to drift off to sleep” from anesthesia and “just coherent enough” to sign the medical forms.
Georgia Recorder is part of States Newsroom, a network of news outlets supported by grants and a coalition of donors as a 501c(3) public charity. Georgia Recorder maintains editorial independence. If you have any questions, contact the editor, John McCosh: [email protected] Follow Georgia Recorder on Facebook and Twitter.