Deliberate Indifference: Records show ICE’s systemic failures at Georgia detention facility at the center of gynecological abuse investigations
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ICE failed to properly monitor informed consent protocols used by a doctor accused of performing non-consensual gynecological procedures on women detained at Irwin County Detention Center in Georgia. The facility also had other longstanding problems and systemic oversight failures that are currently the focus of several federal investigations.
U.S. Immigration and Customs Enforcement did not monitor the informed consent protocols used by a doctor accused of performing non-consensual gynecological procedures on women detained at Irwin County Detention Center (ICDC) in Georgia, according to records (part one, part two) obtained by CREW, the National Immigration Project, and Project South in an ongoing lawsuit. The records also show systemic problems that went beyond a single doctor, including a lack of Spanish-speaking medical staff at the facility, violations of ICE detention standards for medical care and vetting medical providers, and a history of complaints raised by Mexico’s Consulate and advocates.
ICDC, a county-owned prison run by LaSalle Corrections, has contracted with ICE to detain immigrants since 2011. In May, the Department of Homeland Security announced it was severing ICE’s contracts with ICDC “as soon as possible”— a decision reportedly motivated by the “open and unresolved” investigations of abuse at the facility.
Those investigations were prompted by an alarming whistleblower complaint filed last September by Project South and partner organizations. The complaint detailed accounts from detained immigrants and a whistleblower nurse alleging a lack of COVID-19 protocols and egregious medical abuse, including claims of a doctor performing invasive gynecological procedures on detained women without their informed consent. Later reporting identified the accused doctor as Mahendra Amin, an OB-GYN based in Douglas, Georgia.
For years, advocates in Georgia have been raising red flags about ICDC. In 2017, Project South and the Penn State Law Center for Immigrants’ Rights released a report on human rights abuses and constitutional violations at ICDC, including lack of medical care, lack of mental healthcare, unsanitary conditions, lack of prenatal care for women, aggressive use of solitary confinement and more. Since the release of that report, Project South and grassroots partners such as Georgia Latino Alliance for Human Rights and Georgia Detention Watch continued to raise concerns about the treatment of immigrants detained at ICDC, including by sending letters to the Georgia congressional delegation, the United Nations and the Inter-American Commission on Human Rights.
Project South’s complaint last fall sparked outcry from 173 Members of Congress and investigations by the Department of Justice’s Civil Rights Division and Department of Homeland Security Inspector General, which remain ongoing. The Federal Bureau of Investigation is investigating claims of medical abuse by Amin involving both detained and non-detained former patients — with “some allegations going back decades.” Class action litigation was also filed detailing the extent of abuses suffered by women ICE confined at ICDC.
While much of the recent discussion about ICDC has focused on Amin, many questions remain about what measures, if any, ICE took to prevent medical abuse at the facility and to ensure medical providers obtained informed consent before performing invasive procedures on people detained there, particularly non-English speaking people. The new records, obtained from ICE through a Freedom of Information Act lawsuit, reflect what appear to be systemic oversight failures by the agency.
- No Monitoring of Doctors’ Consent Protocols, Use of Language Translation Services
- New Details on Claims for Payment Submitted for Gynecological Procedures
- Belated Language Service Guidance from ICE
- Lack of Proof that Medical Professionals Underwent Peer Review Protocols
- Complaints Raised by Mexico’s Consulate
- Other Deficiencies Reported By Detention Inspectors
No Monitoring of Doctors’ Consent Protocols, Use of Language Translation Services
In one email exchange from late September 2020, the Consulate General of Mexico expressed concerns to ICE about Y.J., a Mexican national who underwent gynecological procedures by Amin while detained at ICDC. Y.J’s case was detailed in a January 15, 2021 report by Special Rapporteurs of the United Nations Humans Rights Council, who noted she was “allegedly subjected to an unwarranted gynecological surgery…without her full informed consent, partially due to lack of language interpretation.”
In a September 21 email, William Lozano Arciniega of the Mexican Consulate wrote to ICE Atlanta Assistant Field Office Director Patrick Musante that a medical file for Y.J. provided by ICE contained “no consent forms…with the detainee’s signature.” This lack of documentation prompted Lozano to ask about ICE’s protocols for ensuring detained people consented to “invasive procedures.”
Musante responded by shifting responsibility to Amin, writing “[c]onsent forms are obtained by the surgeon” and a “request to Dr. Amin’s office and to the hospital must be sent to get those records.” He added that ICE “cannot request [Y.J.’s] hospital records” since she was no longer in federal custody.
Musante’s email suggests a hands-off approach by ICE, under which it did not track, monitor, or audit whether (or how) outside medical providers obtained informed consent from people detained at ICDC. This conclusion is supported by a separate email summarizing informed consent protocols at ICDC, which mentions no scrutiny by ICE of outside specialists’ consent practices:
Musante’s statements and the lack of documented consent in Y.J’.s detainee medical file conflict with an ICE detention standard providing that “[c]onsent forms…shall be documented and placed in the detainee’s medical file,” and that “separate documented informed consent is required for invasive procedures.” The standards add that “[i]nformed consent standards shall be observed and adequately documented. Staff shall make reasonable efforts to ensure that detainees understand their medical condition and care.”
The ICE official’s assurance that “[a]ll detainees retain the right to refuse any medical treatment” is also contradicted by firsthand accounts of women detained at ICDC, who described being forced to undergo gynecological procedures by Amin after explicitly refusing them. Other women recounted feeling powerless to refuse unwanted procedures due to the coercive conditions of the medical encounter, in which they were handcuffed, given no explanation of why they were there, and expected to follow instructions.
Other emails indicate ICE did not monitor outside medical providers’ use of language translation services to obtain informed consent from non-English speaking people detained at ICDC.
In a September 17 email to several ICE officials, a New York Times reporter asked whether ICE had “records of translation or interpretation for any of [redacted] visits with detainees” at ICDC. The context of the email indicates that the redacted name is Amin.
The inquiry prompted internal conversations within ICE. Chief of Staff for the Assistant Field Office Director Kristen Sullivan wrote to an employee in ICE’s Health Service Corps to ask “what translation service” the doctor used, adding “We/ICDC wouldn’t track this, correct?”
In a later email, Sullivan reported the doctor “uses a language line service,” but that “we do not track his usage.”
ICE detention standards require consent forms to be provided “in a language the detainee understands.” If such forms are not available, “professional interpretation services will be provided…and documented on the form.”
LaSalle Corrections’ website similarly says that “[o]ur staff understands the importance of maintaining proper documentation of medical records that is critical for effective treatments. Constant and clear communication with inmates and amongst the staff are essential for an efficient healthcare delivery system.”
Despite these policies, several non-English speaking women who have accused Amin of medical abuse reported that he did not use a translator to explain proposed procedures, and frequently ignored requests to “provide interpretation or to speak to each woman in a language she could understand”— raising questions about ICE’s apparent failure to monitor doctors’ consent protocols and use of language translation services.
New Details on Claims for Payment Submitted for Gynecological Procedures
The records also provide new details on the number of claims for payment submitted by Amin for gynecological procedures performed on women detained at ICDC.
A September 16 email thread with the subject line “IRWIN CO report and Amin claims data” identifies claims submitted for 6 hysterectomies, 71 other procedures, and 448 “specialty care/follow-up visits” performed between 2015 and 2020. It adds, “[redacted] did submit claims on the 6 detainees below for hysterectomies performed between 2017-current date.” The redacted name is likely Amin since his name appears unredacted in the email’s subject line.
According to a September 22 report by the Washington Post, “ICE said its own records show that [only] two female detainees at Irwin have been referred for hysterectomies since 2018.” And a local hospital that is reportedly “the only place where such a procedure would be performed in small Irwin County” stated that “just two women in immigration custody have been referred to the hospital for [hysterectomies] since 2017.” It is unclear what explains the apparent discrepancy between the number of claims submitted for hysterectomies listed in the September 16 email and the number of procedures reportedly performed.
Belated Language Service Guidance from ICE
On October 5 — three weeks after the September 14 whistleblower complaint came to light — an ICE Assistant Field Office Director emailed ICDC’s warden detailed guidance on “Limited English Proficiency-Language Access Services at ICDC.”
The employee asked the warden to “review” the guidance and “implement within your facility,” suggesting ICDC had not previously done so.
In the same email, the Assistant Field Office Director noted ICDC was planning to hire a “Spanish speaking staff member for your medical unit.”
The email’s timing suggests it was prompted by the whistleblower complaint. But even before that complaint, advocates had long decried the lack of Spanish-speaking staff at ICDC.
One attorney who worked out of ICDC for two years reported that “there was only one facility employee who was fluent in Spanish. Employees would sometimes use phone translation services or apps to communicate, but often they wouldn’t make the effort.” These reports are again at odds with ICE detention standards, which require facilities to “provide appropriate interpretation and language services for [limited english proficiency] detainees related to medical and mental health care. Where appropriate staff interpretation is not available, facilities will make use of professional interpretation services.”
Lack of Proof that Medical Professionals Underwent Peer Review Protocols
A March 2020 inspection report of ICDC by ICE’s Office of Detention Oversight (ODO) found numerous violations of ICE detention standards and other deficiencies. Among them was ODO’s finding it “could not validate if peer reviews” by an “external state physician” had been completed for “independently licensed medical professionals” providing care to people detained at ICDC.
It is unclear whether ODO’s finding means that Amin in particular did not undergo external peer review as required by ICE detention standards. But ICE drew criticism last fall when The Daily Beast revealed that Amin is not even a board-certified OB-GYN. And an October 2020 report by a team of nine board-certified OB-GYNs who reviewed patient medical records found that “Dr. Amin and the referring detention facility took advantage of the vulnerability of women in detention to pressure them to agree to overly aggressive, inappropriate, and unconsented medical care.”
Amin also reportedly has a history of medical malpractice suits and settlements, and was party to a $520,000 settlement with the federal government in 2015 to resolve allegations of Medicaid and Medicare fraud.
Complaints Raised by Mexico’s Consulate
Communications with the Consulate General of Mexico reveal further claims of abuse and neglect at ICDC going back as far as 2018.
In an August 2018 letter to ICE Atlanta Field Office Director Sean Gallagher, Consul General Francisco Javier Diaz de Leon recounted multiple complaints his office received from Mexican nationals detained at ICDC during the Consulate’s site visit earlier that month. They alleged “verbal abuse and continuous discrimination” by ICDC staff; unsanitary food that “contain[ed] worms,” was “mold[y]” or “[r]otten,” or “leftover…from other detainees”; and “showers, hallways and dining areas [that] were moldy and infested with insects (flies and cockroaches).” These reports are consistent with Project South’s 2017 findings of rocks, nails and cockroaches found in food at ICDC.
The Consulate described the situation as “highly alarming” since it jeopardized the “overall health” of people detained at ICDC.
The letter also detailed several individual claims of mistreatment at ICDC, including by two transgender women who reported sexual harassment and misgendering by facility staff, and improper use of solitary confinement practices.
ICDC’s reported placement of people in punitive solitary confinement conditions based on their transgender status may have violated a 2013 ICE directive, which draws a line between “administrative” and “disciplinary” segregation.
Under the directive, “administrative segregation” based on “sexual orientation or gender identity” is a “non-punitive form of separation from the general population,” in which the detained person must “receive the same privileges as detainees housed in the general population.” “Disciplinary segregation,” by contrast, is a “punitive form of separation” that is “authorized only pursuant to the order of a facility disciplinary panel, following a hearing in which the detainee is determined to have committed serious misconduct in violation of a facility rule.”
The Consulate’s letter also recounted a detained woman’s claim that she had not received “any thorough gynecological examinations” despite reporting being the victim of a sexual assault prior to her arrest.
Another woman reported being unable to inform nurses about a medical condition during intake “due to language barriers,” further indicating systemic problems relating to ICDC’s use of language translation services and lack of Spanish-speaking staff.
After another ICDC site visit in August 2019, the Consulate wrote to ICE about two new cases of possible medical neglect at the facility.
In one case, a woman reported experiencing a swollen abdomen and pain and numbness in her legs after undergoing a “gynecological surgery” the preceding month. In the other, a pregnant woman reported not receiving “any type of prenatal care treatment” at ICDC despite having “a history of failed pregnancies.”
Other Deficiencies Reported By Detention Inspectors
Contractors hired by ICE to inspect ICDC for compliance with detention standards, as well as ICE’s own inspectors, repeatedly found deficiencies relating to healthcare, detention conditions, and mistreatment of people detained at the facility.
A June 2018 report by contracted inspectors from the Nakamoto Group found that people detained in ICDC’s Special Management Units, who are segregated from the facility’s general population, had not received daily visits from healthcare providers as required by ICE detention standards.
The Nakamoto Group’s June 2018 report also noted “twelve use of force” incidents at the facility, three of which involved staff using pepper spray (or “Oleoresin Capsicum”) on detained people. Although the inspectors noted that reports of one “calculated use of force” incident “indicated that force was applied per standard guidelines,” it added that ICDC “was not able to produce the video of the incident” and that a “note in the use of force file indicated that the video could not be located.”
This lack of a recording conflicts with an ICE detention standard requiring that all “[c]alculated use-of-force incidents shall be audio visually-recorded.”
The inspection reports also show ICDC’s failure to take corrective action despite repeated findings of the same deficiency.
In 2018, Nakamoto Group inspectors found that ICDC staff failed to consistently respond to questions, grievances, and requests submitted by detained people within 72 hours, as required by ICE detention standards. The inspectors designated this a “repeat deficiency,” indicating it had been noted in prior inspections yet remained uncorrected.
In 2019, inspectors again noted the same “repeat deficiency,” suggesting it remained uncorrected for at least three years. After a random review of requests that year, inspectors noted that at least twenty detainee requests had not been dated or signed by the ICE officer on site at the time.
ICE’s own inspectors from ODO also cited ICDC for numerous deficiencies.
In the March 2020 ODO inspection report discussed above finding deficiencies in ICDC’s peer reviews of medical providers, inspectors also found that “patient examination tables [at ICDC] are torn beyond repair, making cleaning and decontamination impossible,” and that “cabinets, drawers, and doors” in the facility’s examination rooms “were broken and held together with tape.” ODO’s inspection coincided with the onset of the COVID-19 pandemic in the United States, making its findings of deficient medical facilities at ICDC all the more troubling.
The inspectors further found that ICDC did not have required postings notifying detained people about available disability accommodations.
Like the Nakamoto Group inspectors, ODO also cited ICDC for deficiencies in its detainee grievance system, including the failure to log electronically-filed grievances and failure to forward grievances alleging staff misconduct to ICE’s Atlanta Field Office.
Weekly reports from ICE Detention Standards Compliance Officers relayed other troubling findings about ICDC.
A March 2020 weekly report noted claims that an “ICDC officer, on multiple occasions, exposed himself [and] made sexual comments and gestures in front of [a] detainee.”
An August 2020 weekly report found that two people at ICDC were held in solitary confinement for over 75 days, three people were held for 45-59 days, two people were held for 30-44 days, two people were held for 15-29 days, and 27 were held for 0-14 days.
According to the United Nations, “solitary confinement of more than 15 consecutive days is…a form of torture.” The reported segregation practices at ICDC may also violate an ICE detention standard that permits people to be held in disciplinary segregation for a maximum of 30 days absent “extraordinary circumstances.”
The newly released ICE records confirm longstanding problems at ICDC that go beyond a single doctor. With several federal investigations underway, the government must thoroughly examine not only Amin’s conduct, but also systemic oversight failures by ICE at ICDC and other detention centers across the country. The government must also take steps to make victims whole and hold wrongdoers accountable, both to affirm the dignity of detained people and to deter future abuses.