Immigration officials did not document the medical necessity of at least two hysterectomies they authorized for women in their custody, according to a new report by the Department of Homeland Security’s inspector general.
Investigators contracted with an OB-GYN to review six hysterectomies performed on migrant women who were in federal custody. The doctor found that in two of the cases, officials had failed to document whether it was medically necessary, the watchdog report states.
“Our contracted OB/GYN concluded that for two of six hysterectomies performed, the detained non-citizens’ [Immigration and Customs Enforcement Health Service Corps] medical files did not demonstrate that a hysterectomy was the most appropriate course of treatment and was medically necessary,” investigators wrote. “[Immigration health] officials agreed that their medical files did not contain the necessary documentation to demonstrate the medical necessity of these two hysterectomies.”
The Office of the Inspector General (OIG) finding was part of a larger review that concluded Immigration and Customs Enforcement (Ice) did not follow proper procedures to authorize dozens of such surgeries between fiscal years 2019 and 2021. Looking at a sample of 227 major surgeries, investigators found 72 of them – about a third – did not follow proper procedures.
The report does not offer any detail on the circumstances of the hysterectomies.
While a clinical director is supposed to approve all major surgeries, investigators found these surgeries were approved by other healthcare personnel, like a nurse or nurse practitioner.
Based on that sample, the OIG said it could infer with 95% confidence that between 137 and 217 of 553 major surgical procedures were not properly approved in the timeframe it studied.
Clinical directors “have a specific level of training and expertise, including a medical degree or equivalent and at least 3 years of medical training leading to board eligibility or certification that distinguishes them from other medical practitioners”, the report said.
The inspector general’s report recommended immigration officials implement a policy requiring clinical directors to document their approvals. In a formal response, Ice said it concurred with the recommendation, but said it already had such procedures in place.
The OIG said the report was delayed by more than 100 days by immigration officials’ refusal to allow access to data. The office said it was initially denied access to all “health records systems containing authorizations and medical billing data for off-site visits for detained non-citizens” without explanation. Immigration officials then provided a subset of that data.
In 2020, a nurse working at an Ice facility in Georgia filed a whistleblower complaint alleging detainees were being subjected to alarmingly high rates of hysterectomies.
“Everybody he sees has a hysterectomy – just about everybody,” a nurse, Dawn Wooten, stated in her complaint. “I’ve had several inmates tell me that they’ve been to see the doctor, and they’ve had hysterectomies, and they don’t know why they went or why they’re going,” Wooten said in her complaint. The doctor performing the procedures, Mahendra Amin, had become so notorious, she said, he was known as the “uterus collector”.
More than 40 women joined a complaint as part of a class action lawsuit in December 2020 saying they underwent unnecessary and medically invasive procedures at a Georgia facility.
An 18-month congressional investigation into the facility found “female detainees appear to have undergone excessive, invasive, and often unnecessary gynecological procedures”.
A hysterectomy can result in a portion or all of woman’s uterus being surgically removed, sometimes with other reproductive parts, and after which she cannot have children.
