Senate investigation of medical abuse at Georgia ICE facility confirms women’s stories

The findings of a bipartisan Senate subcommittee’s investigation into allegations of medical abuse at a privately run detention center confirmed what detained women have maintained for years: They were subject to unnecessary gynecological procedures. The 18-month investigation examined an allegation made by former Irwin County Detention Center (ICDC) nurse, Dawn Wooten, that a doctor performed “high rates” of nonconsensual hysterectomies on women detained at the Ocilla, Georgia, facility. As Prism previously reported, the physician at the center of the allegation is Dr. Mahendra Amin, who was not mentioned by name in the original complaint filed by Project South and other advocacy organizations with Wooten’s assistance. While the Senate Committee on Homeland Security and Governmental Affairs did not corroborate Wooten’s claim of mass hysterectomies, they determined women detained at ICDC were “subjected to excessive, invasive, and often unnecessary gynecological procedures.” According to the 108-page report released during a Nov. 15 Senate panel hearing about the treatment of women at ICDC, Amin performed nearly one-third of certain types of OB-GYN procedures on detained people across the country between 2017 and 2020—and more than 90% of other kinds of procedures. This includes 44 laparoscopies to excise lesions and 102 Depo-Provera injections, which accounted for 93% of all such injections provided by all OB-GYNs contracted by the Department of Homeland Security (DHS) to treat detained patients. It is the information about Depo-Provera injections that Sonia Dodd, a former U.S. permanent resident, found particularly interesting because she struggled to access the hormonal medication while detained for a short stint at ICDC before Immigration and Customs Enforcement (ICE) deported her in June 2020. In 2009, Dodd was in an abusive relationship when she and three of her children were indicted for crimes related to the possession and distribution of marijuana. On the “bad advice” of an attorney, she said she pled guilty, not understanding she would be stripped of her immigration status and subject to deportation. Dodd spent over a decade incarcerated and detained. During this time, she was a patient of Amin’s in two different contexts: first, in 2009 while incarcerated at ICDC for 18 months before the prison became an immigration detention center, and then again in 2020 when the facility was under the control of ICE and used to detain immigrants. Dodd remembers Amin for being “rough, rude, and unprofessional,” sentiments that Karina Cisneros Preciado echoed in her emotional testimony during the Senate panel hearing. Cisneros Preciado was still breastfeeding her newborn when she was arrested after calling the police to report ongoing abuse from her partner. Criminal charges were dropped against the undocumented mother of two, but she was transferred to ICE custody. At ICDC, Cisneros Preciado was sent to Amin in 2020 for a postpartum check-up, where she said Amin barely acknowledged her, roughly examined her pelvis, diagnosed her with a cyst, and administered an injection. She also said she was made to sign a paper she didn’t understand. According to Dodd, Amin would hold needed treatment “over your head” unless you received what she characterized as additional and “unnecessary” care. In ICE custody, Dodd went to Amin requesting a Depo-Provera injection to lessen the excessive bleeding and cramping she experienced during menstruation. Dodd claims Amin wouldn’t administer the injection unless she first received a pelvic exam. “It was very much like, ‘You have to do this to get this,’ even though it was in my medical records that I was getting Depo in prison, and I just had an ultrasound,” said Dodd, noting that she heard troubling stories from other detained women who were treated by Amin. “I told him what I needed, and he didn’t listen. He was awful.” Dodd said during her first appointment, Amin gave her a “rough exam without gloves” and then didn’t give her the Depo injection. The day of another scheduled appointment with Amin, presumably when she would get her Depo injection, Dodd said she had a panic attack and refused to go. When detention center staff couldn’t coerce her into attending the appointment, Dodd alleges they locked her in a cell. Former patients outside ICDC—all low-income women who were in need of sexual and reproductive health care in rural Georgia—have also made allegations of medical abuse against Amin. Some of their claims go back decades. Still, Dodd said she has often wondered if the medical abuse experienced by detained women was swept under the rug because they were immigrants who were “locked up.” Some of Amin’s detained patients at ICDC were newly arrived monolingual Spanish speakers who did not receive interpretation services at their appointments. Dodd was a green card holder who speaks English and spent most of her life in the U.S., but she argues these facts did not put her in a better position to advocate for herself. “Personally, I think what it boiled down to was that we were in custody, and we were immigrants, period,” Dodd said. “That’s all that mattered. [Amin] thought nobody would care about what happened to us.” Before she was sent to federal immigration custody, Dodd was incarcerated for a time at a prison in Florida where an OB-GYN sexually assaulted women during exams. While she was never a victim of the abuse, she told Prism she still gets angry thinking about the conditions that women behind bars are forced to endure. “It is a nightmare to have no choice—to need medical care and to have no other choice but to go to the man they assign you to,” Dodd said. “Catastrophic failure” Sen. Jon Ossoff, D-Ga., chair of the Senate Homeland Security and Governmental Affairs Committee’s permanent subcommittee on investigations, called the findings of their investigation “deeply disturbing” and denounced what he called “a catastrophic failure by the federal government to respect basic human rights.” “Among the serious abuses this subcommittee has investigated during the last two years, subjecting female detainees to nonconsensual and unnecessary gynecological surgeries is one of the most nightmarish and disgraceful,” Ossoff said during the Nov. 15 hearing. According to the subcommittee’s report, ICE also did not conduct thorough oversight of off-site medical providers and procedures, as evidenced by the agency’s contract with Amin despite his prior history. In 2013, the Department of Justice and the State of Georgia sued Amin, claiming he committed Medicaid fraud by ordering unnecessary and excessive medical procedures. That lawsuit was settled in 2015 when Amin and his co-defendants admitted no wrongdoing and paid a $520,000 settlement to the federal government. While sexual and reproductive health care can be hard to come by in rural areas, Dr. Peter Cherouny, an OB-GYN physician who previously conducted medical reviews for other federal agencies, expressed confusion as to why Amin—who has no board certifications—was contracted by federal agencies to provide care to vulnerable detained patients. Cherouny was tapped by the Senate permanent subcommittee on investigations to better understand Amin’s treatment of women at ICDC. During an interview with the subcommittee, Cherouny noted that there appeared to be board-certified OB-GYN providers in the vicinity of ICDC. The physician said he was “concerned” with how and why Amin was selected. Cherouny conducted an independent review of more than 16,600 pages of medical records pertaining to 94 women Amin treated at ICDC. While Dodd could not receive the Depo-Provera injection she desperately needed, Cherouny found that Amin did not give “adequate time to affect a clinical response” in most of the 40 cases examined where Amin did administer Depo-Provera injections for abnormal uterine bleeding. The adequate time for a response to the medication is six months, according to Cherouny. Amin generally used two-to-six weeks of clinical response time before declaring that Depo-Provera failed and surgery was needed. The commission found “repeated failures to secure informed consent for off-site medical procedures” performed on detained women. The report also details how medical care provided to women at ICDC was known by DHS to be “deficient,” though neither ICE or LaSalle Corrections, the private prison company that runs the facility, “took effective corrective action.” Cherouny identified significant issues with the care Amin provided to women at ICDC, including the assessment that Amin was “woefully behind the times,” did not meet current standards of care, had a “lack of knowledge or capability,” and provided “pretty good medicine for the 1980s.” The cases reviewed were between 2017-2020. Because Amin is not a board-certified OB-GYN, he likely does limited or no continuing education to stay current on medical practices. According to Cherouny, Amin appears to have “limited knowledge and/or skill in Pap smear management” and is “clearly not skilled in ultrasound of the female pelvis.” The government’s expert also noted that Amin “appears to frequently confuse normal findings for pathology and uses these as indications for surgery.” These practices do not comply with the American Institute of Ultrasound in Medicine guidelines. Three additional physicians who reviewed medical records as part of a class-action lawsuit filed by formerly detained women against Amin and other parties also concluded that Amin subjected women to “aggressive and unethical gynecological care.” Dodd’s case was rejected as part of the larger class action, but she continues to track developments related to ICDC and hopes that one day she will be able to reunite with her family in the U.S. The subcommittee’s investigation was a “step in the right direction,” according to Dodd, but she also expressed frustration that the public doesn’t listen to survivors. “Honestly, my reaction to all of this was really, ‘Oh, so now they believe us?’ Now that [officials] are saying it, I guess people will listen,” Dodd said. Accountability, redress, and justice Though it’s been two years since Project South’s original complaint about ICDC went public, the organization’s legal and advocacy director, Azadeh Shahshahani, said the subcommittee’s thorough investigation and report were a “welcomed step.” The hearing also put ICDC back in the spotlight—and the lack of accountability is glaring. “What we don’t have yet is accountability and redress and justice for the survivors of human rights violations at the Irwin County Detention Center,” said Shahshahani, noting that some women detained at ICDC were deported before their stories could be known. During the hearing, Stewart Smith, the assistant director of ICE’s Health Service Corps, which provides health care oversight to detention facilities, claimed his agency was unaware of the issues at ICDC until Project South’s complaint. Shahshahani said this speaks to the lack of vetting performed by ICE and LaSalle. The attorney also said Smith’s claim is false. “We know that ICE knew about these abuses as far back as 2018, and yet they didn’t do anything. Once we filed the complaint and Congress and the public started taking notice—[and] instead of actually cooperating with the investigation and taking action to redress the injustices—[ICE] promptly proceeded to basically clean up their tracks by deporting as many witnesses and survivors as they could before courts, and Congress stepped in to stop these deportations.” In 2020, Prism reported the story of Maria, who alleged Amin gave her a hysterectomy without her full and informed consent. She was deported to El Salvador shortly after. It is unclear if the cases of women like Maria, who were deported after being treated by Amin, were part of the Senate panel’s investigation. The New York Times confirmed that in 2018, at least one attorney brought complaints about ICDC’s gynecological care to the attention of top officials, yet referrals to Amin continued. “This is documented,” Shahshahani said. “There is documentation of their awareness. The fact that they allowed the abuses to continue tells you that they frankly did not care about the dehumanization of migrants and Black and brown women that was happening in the custody of the U.S. government.” The federal agency did not respond to questions about Smith’s testimony or clarify the timeline regarding the allegations against the OB-GYN. A spokesperson for ICE told Prism in an email they could not “provide anything additional.” LaSalle Corrections, the private prison company that ICE contracted to run ICDC, also continues to evade accountability. Facilities run by the private prison company regularly come under fire for the neglect and abuse of incarcerated people and detained immigrants. In the last few years alone, a stream of lawsuits have been filed against LaSalle for wrongful death, medical neglect, and sexual assault. Recent investigations into facilities run by the private prison company detail rampant anti-Black racism and lax training of employees, leading to heinous human rights violations. In November 2021, DHS Office for Civil Rights and Civil Liberties instructed ICE to stop detaining immigrants at LaSalle’s Winn Correctional Center in Winnfield, Louisiana, because of “a culture and conditions that can lead to abuse, mistreatment, and discrimination against detainees.” Earlier this year, Michael Sheppard, former warden of the LaSalle-run West Texas Detention Center in Sierra Blanca, Texas, was arrested alongside his twin brother for allegedly killing a migrant and wounding another. Sheppard has a long, well-documented history of violence and abuse toward migrants, yet remained employed by LaSalle until the week of the killing in September of this year. In 2019, after Congress mandated that ICE decrease the overall number of detained immigrants, the federal agency spent more than $20 million on new contracts for prisons in Louisiana. Much of the money went to LaSalle, which also continues to run the Irwin County Detention Center. The facility was ordered closed by the Biden administration in May 2021, though it’s currently being used by the U.S. Marshals Service. Of all those who have not been held accountable, Amin is perhaps the most notable. The Georgia doctor did not provide testimony as part of the Senate panel’s investigation, invoking his Fifth Amendment privilege against self-incrimination. Amin remains under investigation by multiple federal agencies, including the Federal Bureau of Investigations (FBI). As Prism reported in May 2021, the FBI is looking into allegations of medical abuse and neglect made by Amin’s former patients. A spokesperson for the FBI’s Atlanta division confirmed the investigation is ongoing. In the meantime, Amin’s medical license is still active in Georgia, where he continues to provide sexual and reproductive health care. Amin last renewed his medical license on Feb. 1, 2021, and it is set to expire on Feb. 28, 2023. Physicians in the state must renew their medical licenses every two years, according to the Georgia Composite Medical Board (GCMB), the state agency that oversees the licensing of physicians and enforcement of the Medical Practice Act. The agency is also responsible for evaluating when a physician’s professional conduct or ability to practice medicine warrants modification, suspension, or revocation of their license. These actions are usually triggered by a complaint. Serious complaints, criminal violations, and public safety threats are referred directly for formal investigations by the board’s agents, who are certified law enforcement personnel and trained in investigations. These investigations can be lengthy and still result in no action. Daniel Dorsey, executive director of GCMB, told Prism in an emailed statement that he cannot comment on any pending complaint or investigation. However, Dorsey confirmed that—like many other agencies—GCMB is “looking into the matter against Dr. Amin.” For more information, visit us at http://www.beverlyhillsimmigrationlaw.com/index.html.