ICE Should Have Uncovered Medical Mistreatment of Female Detainees, Senator Says

Expert witnesses at a Senate subcommittee hearing Tuesday described unnecessary and sometimes inappropriate diagnostic and surgical procedures for female detainees at a Georgia detention center by a Department of Homeland Security-contracted ob/gyn.

The findings from an 18-month investigation into the actions of Mahendra Amin, MD, at the Irwin County Detention Center (ICDC) in Ocilla, Georgia, are “disturbing” and reflect “a catastrophic failure by the federal government to respect basic human rights,” said Sen. Jon Ossoff (D-Ga.), chair of the Permanent Subcommittee on Investigations of the Senate Committee on Homeland Security and Governmental Affairs.

As part of the 2020 independent medical review team, Margaret Mueller, MD, of Northwestern University Feinberg School of Medicine in Chicago, analyzed the medical records of 19 women who alleged they had been medically mistreated by Amin while detained at ICDC.

This review uncovered a “disturbing pattern of overly aggressive gynecologic care, many times involving unnecessary diagnostic procedures and in some cases, unnecessary or inappropriate surgical procedures,” she said, including transvaginal ultrasounds, Pap smears, loop electrosurgical excision procedures (LEEP), dilation and curettage (D&C) procedures, and laparoscopies.

In several cases, Amin also performed “incorrect procedures.” One such case resulted in a woman receiving inadequate treatment for cervical cancer, and in another, a woman of reproductive age experienced the “unnecessary removal of a significant portion of her cervix.”

All of the procedures involved risks, Mueller added. For example, laparoscopic procedures include the immediate risk of injury to a portion of the intestine, LEEP procedures carry the risk of potential preterm birth over the long term, and D&C procedures can lead to infertility.

During the hearing, the subcommittee heard from Karina Cisneros Preciado, a former ICDC detainee, who was separated from her two young children, including her 4-month-old daughter, when she was taken into custody.

After several requests for a postpartum check-up, she and other female detainees were taken to a clinic where they were treated by Amin, said Cisneros Preciado.

She was told she was getting a Pap smear, but when Amin came in the room, he inserted a white tube into her vagina, “wiggled it around roughly,” and then told her she had a cyst on her ovary. She was then told she would get a shot, and if the cyst didn’t dissolve in 4 weeks, she would return and undergo surgery. She was given a form to sign, but no time to read it. On the way back to the detention center, she learned that the shot she had been given was birth control.

She also learned that other detainees had all been told the same thing by Amin. “They all had cysts on their ovaries. They all got shots, and some of them even got surgeries,” Cisneros Preciado said.

Based on the review of the medical records and detainee accounts, there appeared to be no informed consent, no discussion of less invasive options, and a “total absence of shared decision-making,” Mueller said.

During the hearing, Ossoff sought to show how poor oversight by U.S. Immigration and Customs Enforcement (ICE) had led to the poor treatment of female detainees.

Ossoff asked Stewart Smith, DHSc, assistant director for the ICE Health Service Corps, whether he knew Amin had previously been sued by the Department of Justice in Georgia for “performing unnecessary and excessive medical procedures.” Smith said that he was not aware of this at the time Amin was hired.

Asked whether he knew that despite only treating 6.5% of ICE’s ob/gyn patients, Amin had performed 90% to 95% of the agencies’ laparoscopies and D&C procedures, Smith said that he did not.

When asked if he vets physicians that the ICE Health Service Corps hires, Smith explained that providers are not “contracted directly” with ICE and they are considered if they are licensed in the state and have been provided credentialing and privileges at different facilities. Even if there is a “red flag” in the National Practitioner Data Bank, that doesn’t mean that a provider won’t have a license, he noted. Smith also alluded to the challenges of hiring and retaining staff for these positions.

“In Dr. Amin’s case, he was the only provider in the area that was willing to see these patients,” he added.

Ossoff told Smith that the subcommittee’s own investigation turned up concerns that ICE should have uncovered. Amin had been sued by the federal and state governments, “dropped” by a major insurer for “excessive malpractice claims,” and he wasn’t board-certified.

“Those I think would have at least been warning signs to watch a little more carefully,” Ossoff said.

Asked whether he took responsibility for what had occurred, Smith responded, “Ultimately, I do. I’m the responsible party to make sure that the right processes and procedures are in place.”

While there currently isn’t a mechanism for tracking these surgical procedures, new systems are being put in place to do exactly that.

“Any responsibility that we have, we take very seriously. We want to fix this system, so it doesn’t happen again,” Smith said.