Senate Committee Finds Medical Abuse of Detained Women at Georgia ICE Facility

More than two years have passed since whistleblower Dawn Wooten alleged that a gynecologist at an Immigration and Customs Enforcement (ICE) detention center in Georgia was performing unnecessary and unwanted medical procedures on women in custody at the Irwin County Detention Center (ICDC) in Ocilla, Ga., including performing hysterectomies without consent.

Several governmental investigations followed, including one launched by the Senate Permanent Subcommittee on Investigations led by Sen. Jon Ossoff, a Democrat from Georgia. Ossoff, his Republican counterpart Ron Johnson of Wisconsin, and the subcommittee released the bipartisan results of their 18-month-long probe on Tuesday, one of the first to be concluded since the allegations were made in September 2020.

The subcommittee determined that the women detainees at the Irwin County Detention Center “appear to have been subjected to excessive, invasive, and often unnecessary gynecological procedures.” The subcommittee’s 103-page report found that the charge of unnecessary hysterectomies was not true. “The Subcommittee found this allegation to be false, and ICE determined that the two hysterectomies Dr. Amin performed on ICDC detainees appeared to be medically necessary,” the report says.

The subcommittee held a hearing on Tuesday afternoon that included testimony from Karina Cisneros Preciado, a 23-year-old woman who was detained at Irwin between July 2020 to January 2021, and was treated by Dr. Mahendra Amin, the gynecologist who allegedly performed the unwanted or unnecessary procedures. Medical experts, an official at the ICE Health Service Corps, an official at the U.S. Department of Homeland Security Office of Inspector General, and an official at LaSalle Corrections, the private company that owns and runs the Irwin County Detention Center, also testified.

In an interview with TIME prior to the hearing, Cisneros Preciado described how Amin failed to communicate with her about the procedure he was performing or why—a vaginal ultrasound that required inserting a wand into her vagina, though she had been informed by a nurse prior that she was going to be receiving a pap smear—or what her medical options were. “All he said was open your legs,” she says. Cisneros Preciado added that she is a survivor of sexual assault. “It made me remember what I went through, and made me feel like I had no rights, like I had no control over my body.”

In May 2021, the Department of Homeland Security (DHS) announced that it would end its use of the Irwin County Detention Center. Amin is no longer treating patients. A class action lawsuit that includes 41 of the women treated by Amin, remains ongoing.

Amin has repeatedly denied the accusations against him. He was subpoenaed by the subcommittee for deposition, the report says, but he declined to participate, citing his Fifth Amendment rights.

In an affidavit to the subcommittee, Amin maintained his innocence, the report says. The report also includes a statement that was sent by Amin to a LaSalle employee after allegations against him emerged. “To be clear, I vigorously deny these allegations, and am confident that a full review will demonstrate that the care that I provided to all of my patients, including those housed at ICDC, was medically necessary and appropriate, and always done with the full informed consent of the patient,” Amin wrote, according to the report of the subcommittee, which obtained a copy of the statement.

Project South, which filed the first allegations for Wooten, including those accusing doctors of performing unnecessary hysterectomies, said the investigation confirms some of its earlier reports.

The subcommittee’s “revelations confirm our worst fears about systemic medical abuse perpetrated against immigrant women at Irwin County Detention Center and exemplify complete lack of ICE oversight. The report verifies that detained women were subjected to excessive, invasive, and often unnecessary gynecological procedures,” Priyanka Bhatt, senior staff attorney at Project South tells TIME in a statement. “The horrifying reality is, that in many cases, these women did not know exactly what was being done to their bodies….We demand justice for the survivors and remain steadfast in our belief that the practice of immigrant detention must end.”

When asked by TIME to address the earlier allegations of hysterectomies performed without consent that the subcommittee found to be untrue, Bhatt sent a follow-up statement that said in part: “The brave immigrant women who came forward in the OIG complaint shared their experiences as they knew them. They were not given proper information about medical procedures; they were scared and frustrated after being given conflicting information about what was being done to their bodies; they had witnessed other women suffer from invasive procedures; and they had expressed concerns about what they believed were high rates of hysterectomies being performed at the facility. The seriousness of these allegations, corroborated by a whistleblower nurse, led us to highlight the issue in our complaint to the OIG and call for an immediate investigation.”

Wooten is now represented by the Government Accountability Project, a DC-based whistleblower protection organization. The group’s senior counsel Dana Gold told TIME in a statement: “It is clear that excessive and unnecessary gynecological procedures led to sterilization or damaged reproductive health on numerous detainees, all without their informed consent. For those who have suffered such traumatic experiences, the precise medical terminology used to describe the invasive surgeries performed on their uterus—especially given that the women so often didn’t even know what procedure the doctor was performing—is cold comfort.”

Wooten said in a statement to TIME that she is glad she came forward. “I remember as a nurse noticing that a doctor was doing a lot of procedures, and management did not want to admit what was going on,” Wooten said. “I am glad that I spoke up in time to stop anything worse from happening to the women. That makes it all worth it.”

“This may be the tip of the iceberg,” Elora Mukherjee, an attorney representing the 41 women in the class action lawsuit, said in an interview after the hearing. “This is one facility out of many throughout the United States.” Said Mukherjee: “One thing that’s notable about today’s hearing is the subcommittee’s bipartisan recognition that the abuses at the Irwin County Detention Center are among the worst in modern U.S. history.”

What the investigation found

The 103-page report released Tuesday morning shed light on the scope of the procedures performed by Amin between 2017 and 2020. The investigators found that though Amin accounted for roughly 6.5% of total OB-GYN visits by ICE detainees nationally during that period, he performed about 90% of four specific gynecological procedures on the detainees nationally, including laparoscopies (a procedure used to check the organs in the belly or pelvis through an incision), Depo-Provera injections (a method of birth control), dilation and curettage (a surgical procedure to remove abnormal tissue), and limited pelvic exams.

Investigators enlisted the help of Peter Cherouny, an OB-GYN physician who has conducted medical reviews for the Department of Health and Human Services Office of Inspector General in other contexts, and Margaret Mueller, an associate Professor of Obstetrics and Gynecology at Northwestern University. Cherouny determined, after reading more than 16,600 pages of medical records, that Amin’s use of certain surgical procedures to be “too aggressive” and inappropriate, the report says. Mueller reached a similar conclusion.

“These unnecessary medical procedures were performed without adequate consent, which means more than just placing a signed consent form in a chart, but a documentation of an appropriate discussion of less invasive options,” Mueller said in her opening testimony on Tuesday.

The report also detailed Amin’s background. In 2013, Amin was sued by the state of Georgia and the Department of Justice “claiming he had committed Medicaid fraud by ordering unnecessary and excessive medical procedures,” the report says. Amin and codefendants settled that lawsuit in 2015 and paid the government $520,000 while admitting no wrongdoing, according to the Subcommittee report.

Investigators also describe shortcomings in ICE health care management. The rate and type of procedures performed by Amin did not raise a red flag with the ICE Health Service Corps (HSC), the body that oversees medical care provided at ICE detention centers by its own staff and by contracting outside medical care. An ICE HSC regional official approved each procedure performed by Amin before it was authorized.

ICE HSC’s assistant director Stewart Smith told the subcommittee on Tuesday that it was not aware of the lawsuit against Amin prior to his hiring, and only found out after the allegations against him were made public.

‘Do you take responsibility?’

In Cisneros Preciado’s opening testimony on Tuesday, she described calling police on her partner during a domestic violence incident. She was arrested that night, and after charges were dropped, she was sent to the ICDC because she is undocumented. She had given birth to her daughter only four months prior, she said, and needed to see a gynecologist for postpartum care. That is how she encountered Amin.

During her screening, Amin told her she had a cyst in her left ovary, and told her she needed a Depo-Provera injection but did not tell her it was a form of birth control. Otherwise, Amin barely spoke, Cisneros Preciado says. She signed a consent form quickly while still in handcuffs.

Only three Senators attended the hearing: Ossoff, Sen. Maggie Hassan, a Democrat from New Hampshire, and Sen. Alex Padilla, a Democrat from California.

“It’s hard for me to think of anything worse… than the federal government subjecting incarcerated women to needless gynecological surgery,” Ossoff said during the hearing. “This is one of the most appalling things this subcommittee has seen in the last two years.”

Much of the toughest questioning was directed at Stewart Smith, assistant director of ICE HSC.

“Do you take responsibility?” Ossoff asked Smith.

“Yes sir,” Smith said. “Ultimately, I do.”

Smith told the committee that ICE HSC did not have the mechanisms in place to properly vet contractors at the time that Amin was employed.

“What would you say to the women who went through this?” Ossoff asked.

“It’s disheartening,” Smith said, “and it’s very disturbing… we want to fix this system so that it doesn’t happen again.” He stopped short of an apology.