WASHINGTON — At least 19 women at a Georgia immigration facility are now alleging that a doctor performed, or pressured them to undergo, "overly aggressive" or "medically unnecessary" surgery without their consent, including procedures that impact their ability to have children, according to a new report and other records obtained by the Los Angeles Times.
The new report was written by a team of nine board-certified OBGYNs and two nursing experts, each affiliated with academic medical centers — including those at Northwestern University, Baylor College and Creighton University — who reviewed more than 3,200 pages of records obtained for the 19 women. It comes just a month after a whistleblowing nurse at the Irwin County Detention Center set into motion a series of congressional inquiries and federal investigations into immigrant women's care at the facility, which is overseen by Immigration and Customs Enforcement.
The 19 women were all patients of Dr. Mahendra Amin, the primary gynecologist for the Irwin County Detention Center, the report says. The records, including pathology and radiology reports, prescriptions, surgical impressions and consent forms, sworn declarations and telephone interviews, detail and support the women's allegations of medical abuse by the doctor, according to the report.
The medical experts found an "alarming pattern" in which Amin allegedly subjected the women to unwarranted gynecological surgeries, in most cases performed without consent, according to the five-page report, which was submitted Thursday to members of Congress.
"Both 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," the report states.
The medical team conducted its review in tandem with a coalition of advocates and lawyers representing the women that has been investigating the allegations, from Project South, the Georgia Latino Alliance for Human Rights, Georgia Detention Watch, the South Georgia Immigrant Support Network, the Southern Poverty Law Center Immigrant Freedom Initiative, the American Immigration Lawyers Association, and Innovation Law Lab.
Many alleged victims, the vast majority of whom are Black and Latino, from the Caribbean, Africa and Latin America, are coming forward for the first time to report their allegations of mistreatment since a nurse at the facility filed the 27-page whistleblower complaint last month, along with advocacy group Project South. The complaint to the Homeland Security Inspector General in turn prompted national outcry, congressional inquiries, and federal investigations.
Women under Amin's care were administered birth control and underwent procedures without their consent, including to remove their reproductive organs, such as the uterus, ovaries and fallopian tubes, according to the report and interviews by the Times with women whose cases were reviewed by the medical team.
One woman, Amanda, said she awoke from surgery with Amin, chained to a hospital bed.
The 28-year-old immediately asked a nurse: "Do I still have ovaries? Can I still have kids?"
The surgeries he'd done on her — a cystectomy and "dilation and curettage," a procedure to scrape tissue from inside her uterus — were without her consent, according to Amanda. Her medical records show the procedures were done, but do not include a signed consent.
Danielle Bennett, spokeswoman for Immigration and Customs Enforcement, the agency overseeing immigration detention referred the Times to the Homeland Security inspector general.
"Out of deference to the ongoing OIG investigation, ICE is not providing any new comment or making public any additional data regarding this matter," Bennett said.
The Inspector General's office did not immediately respond to requests for comment.
Scott Grubman, Amin's lawyer, said in an emailed statement to the Times that he is "legally prohibited from responding to anything related to medical care on a specific patient without that patient signing a HIPAA release allowing him to do so."
"Dr. Amin strongly denies all of the allegations many of which have already been proven false," Grubman continued. "We have gathered evidence and spoken with various witnesses ... who confirm that Dr. Amin always acted appropriately with patients, obtained informed consent, and used translators/interpreters whenever necessary."
"Dr. Amin is a highly respected physician who has dedicated his adult life to treating a high-risk, underserved population in rural Georgia. Dr. Amin is fully cooperating with investigators and looks forward to the investigations clearing his good name and reputation."
Scott Sutterfield, a spokesman for LaSalle Corrections, the private, for-profit prison company that contracts with ICE and operates Irwin, said in an emailed statement that "Company policy prohibits comment during pending investigations" but went on to say LaSalle is "fully cooperating" with the investigation.
"We are confident the facts will demonstrate the very malicious intent of others to advance a purely political agenda," Sutterfield continued. "It is well established that LaSalle Corrections provides high quality medical services in safe, secure, and humane residential environments, and our company strongly refutes allegations to the contrary."
In September, Kenneth Cuccinelli, the acting deputy of Homeland Security, said in an interview that an initial DHS review found the allegations of medical malpractice were not substantiated by any documentation, but that the department would conduct a broader audit.
House Speaker Nancy Pelosi said in a statement last month that the emerging allegations of medical abuse against the women at Irwin echo "some of the darkest moments in our nation's history."
The Homeland Security department pays independent doctors such as Amin, who practices gynecology in nearby Douglas, Georgia, for the procedures they perform on patients in immigration detention.
According to the report, women were referred to Amin even for clearly non-gynecological complaints, such as rib pain or a belly button hernia. Then he "pressured" them into or performed procedures or surgeries that weren't medically necessary, or to which they never consented, the report said.
In one example, the report noted that Amin performed a transvaginal ultrasound on a 35-year-old woman who'd requested treatment for hot flashes — and had no reproductive organs to examine because she'd previously undergone a total hysterectomy.
If women refused or pushed back on the procedures recommended by Amin, some were retaliated against, the report said, including being involuntarily sent for psychiatric evaluation.
Five of Amin's patients interviewed by the Times, whose cases were reviewed as part of the report, shared similar stories about their surgeries and they said the doctor had a reputation at the Georgia facility.
"We found it to be weird that so many women were having the same surgeries," said Shereace, 34, who asked to be identified by her first name for protection since she's been deported to Jamaica, a country she left when she was 5 years old.
She requested to see Amin because her previous doctor had told her to monitor her abnormal pap smears. After she woke up from one procedure, she said Amin told her her tubes were "damaged and no good, and he let me know I'm never going to be able to have kids."
"I was crushed," she said. "I was hearing in some of the stories they were saying that he was removing women's tubes without their permission. I thought: What if he just removed my tubes?"
She says she's still not sure what Amin did because she hasn't been able to afford to go to the doctor.
"Even before I went to go see Dr. Amin, I heard a lot of stories about him," Shamekia McKay told the Times. "I thought, 'I don't think I want him to touch me.' ... Because we're immigrants, they just did whatever they wanted to do with us."
Amanda, the woman who said she woke up from surgery in a panic, was born in Guyana, and detained at Irwin for 17 months.
She said that Amin had told her that her life was at risk because of an ovarian cyst that could rupture. She tried to ask questions, she said, but was told if she refused care, ICE would delay or refuse future medical care she may need.
"I felt pressured to do it; I signed the paper," Amanda said. She said she asked for her records from Irwin officials to give to her attorney, but said she was never provided them.
She said Amin told her he'd just drain the cyst. She consented to neither of the surgeries he performed instead, she said, and no records of such a consent have been provided to her.
Wendy Dowe, 48, who was deported to Jamaica in May after more than 20 years in the U.S., said of Irwin: "They treat you like you're not human."
She said she told Amin, "I've got the right to know what's going on with me." But after surgery, she was surprised to see bandages on her stomach. She had to write to Amin's medical office, she said, to ask: "What type of surgery did I have?"
Later, she said she refused to get a surprise hysterectomy as Amin and others asked her: "How many kids you got? Well, I don't see why you can't take it out."
The independent medical review of Dowe's records conducted as part of the report found the recommended procedure was unwarranted.
For most of the women, "Dr. Amin's 'findings' justifying surgery are unsupported by all other available sources of information," the report states.
According to the report's authors, as well as the women and their lawyers, several of the women were not given their medical records, which the women and their lawyers characterized as retaliation for their complaints.
Of the records the reviewers did obtain, many were incomplete or inaccurate, the report says, with a number of the surgeries Amin performed not recorded correctly or omitted completely.
Because the records produced by the Irwin detention center, Irwin County Hospital and Amin "appear to be incomplete," the report says, and because ICE and Irwin officials have obstructed medical records requests, many of the women do not yet fully know what was done to them.
Dr. Ted Anderson, director of the gynecology division at Vanderbilt University Medical Center, who helped lead the review, said the most immediate concern from the procedures is "a person's future fertility." For example, he said, "If you remove the fallopian tube, it's a sterilization procedure, even if it was done for some other reason ... If you remove both of the ovaries, you're surgically menopausal."
In the thousands of pages of records for all 19 women, the report's authors said they only found one signed consent — in English, for a woman whose primary language is Spanish. "This is unacceptable from a medical ethics perspective," the report states.
At least 23 of the total number of women so far identified by the coalition as Amin's patients remain detained at Irwin, and four are detained elsewhere, the women's lawyers say. The rest have been released, either in the United States or abroad, or deported.
Pauline Binam can never forget what the doctor told her when she came out of anesthesia: "He cut it out, and I wouldn't have kids naturally any more."
"I didn't have to suspect anything — he told me himself," Binam, who came to the United States from Cameroon with her family when she was 2 years old, told the Times. According to Pauline and her records, obtained by the Times, Amin had removed one of her fallopian tubes without her consent. "I started crying – I was in shock and a daze ... him just making that decision for me."
Binam, the first of Amin's alleged victims to go public, was pulled off a deportation flight to Cameroon last month after congressional intervention, but remains still at risk of removal.
ICE uses Irwin along with the U.S. Marshals Service as part of an inter-governmental agreement. LaSalle Corrections, which runs the facility, also operates 25 other detention facilities, correctional centers, and jails.
Last year, the Homeland Security Inspector General found that ICE's multilayered contracting system "does not adequately hold detention facility contractors accountable for not meeting performance standards."
Inspection reports from the detention oversight arm of ICE's Office of Professional Responsibility, the most recent in March, show that Irwin is consistently in violation of national detention standards that "directly affect detainee life, health, safety, and/or well-being."
The inspection reports also show that Irwin refers more than 1,000 detainees a year for outside medical attention, "far more," than most detention facilities of its size, according to a New York Times analysis.
Lawmakers have accused ICE and LaSalle of "stonewalling Congress by withholding documents."
Meanwhile, the five women who've been released or deported from Irwin are struggling to get by, and awaiting answers. For Dowe and her three U.S.-citizen daughters now in Jamaica, she said, "It's been hard to adjust."
"Because I am an immigrant, and I'm Black, that's why this happened," Dowe said, but added, "No I am not giving up. I still have hope that I will get some form of justice."
Visit the Los Angeles Times at www.latimes.com(c)2020 Los Angeles Times, Distributed by Tribune Content Agency, LLC.