There’s no evidence at this point to substantiate a whistle-blower’s shocking allegation that a doctor was performing unneeded hysterectomies on unsuspecting detainees at a US Immigration and Customs Enforcement facility in Ocilla, Ga.
But it seems clear that something very disturbing was happening at the facility — and that ICE’s approach to detention, and care for its detainees, needs to change.
Last weekend, Mexico’s Foreign Ministry announced that it had identified two migrant women who may have received unwanted surgeries while there. In a comprehensive investigation published last month, The New York Times documented several cases of invasive gynecological surgeries — short of hysterectomy — that might have been unwarranted, or performed without the detainee’s consent or full understanding. The paper interviewed more than a dozen women who were worried about the gynecological care they received while at the facility, which is managed by a private company through an ICE contract.
All of the women were sent offsite to be seen by Dr. Mahendra Amin, who has been identified by ICE as the primary gynecologist for the Irwin County Detention Center. The Times obtained the medical files for seven of them and asked five gynecologists to review them. The experts found that Amin “consistently overstated the size or risks associated with cysts or masses attached to his patients’ reproductive organs,” according to the paper. Amin, who practices in the neighboring town of Douglas, “seemed to consistently recommend surgical intervention, even when it did not seem medically necessary at the time and nonsurgical treatment options were available.”
One immigrant from Mexico who was at Irwin told the Times she complained of rib pain and asked a nurse for help. Inexplicably, she was sent to see Amin, who performed a vaginal ultrasound on her. He then determined she had cysts in her ovaries that needed to be removed via surgery. Amin wrote in her medical file that she had symptoms like heavy menstruation and pelvic pain, but the woman told the Times she never had, or complained about, those symptoms. And yet, she had the procedure. According to the Times investigation, the woman’s pathology reports show that the cysts were not dangerous and did not require surgery. Three days after she had the procedure, she was deported.
The Office of Inspector General at the Department of Homeland Security, which oversees ICE, announced an investigation into the Georgia facility last month. That’s a necessary first step. But there is a larger problem that must be addressed. The disturbing allegations at ICDC are consistent with the troubles that have long plagued a federal system over-reliant on private prison companies to run detention facilities. ICE is notoriously secretive, but privatization only exacerbates the lack of transparency and accountability. Detention contractors don’t have to comply with federal open records laws and other constitutional requirements and have been accused of cutting services to maximize their profits.
The Irwin detention center is run by LaSalle Corrections, a private company that operates detention centers, jails, and prisons throughout the South. Just days after the whistle-blower made the complaint public, the family of a woman who died after spending two months at a LaSalle-run jail in Texas last year filed a wrongful death lawsuit against the company in federal court. The lawsuit argues that LaSalle has “engaged in a pattern, practice and custom of unconstitutional conduct toward inmates with serious medical needs,” and goes on to describe previous instances of neglect that have resulted in other deaths under the for-profit jail’s custody.
Nationwide, more than 70 percent of the immigrant detainee population — at a daily average above 50,000, which is a record high — is held in for-profit facilities. The privatization of immigration detention did not start with this administration, but the industry — valued at more than $3 billion — has expanded under Trump.
Medical neglect in immigration detention facilities is a well-documented problem. A 2018 Human Rights Watch report found that substandard care contributed to half of the deaths in ICE detention between 2015 and 2017. This year has been particularly deadly for ICE detainees: 21 immigrants died in custody, according to agency data, the highest number since 2005. In July, at another LaSalle-run detention center, in Louisiana, two other whistle-blowers alleged that a refusal to follow COVID-19 protocols resulted in an outbreak of 65 cases of the virus among detainees, and that LaSalle downplayed the coronavirus threat early on. The company denied the anonymous allegations.
If unnecessary gynecological procedures did occur at Irwin, financial motives can’t be ruled out, since Amin has previously been accused of submitting fake or inflated billings to Medicare and Medicaid. Amin’s attorney told the Times that his client “strongly disputes any allegations that he treated any patient with anything other than the utmost care and respect.” ICE’s medical director, Ada Rivera, said in a statement, “All female ICE detainees receive routine, age-appropriate gynecological and obstetrical health care, consistent with recognized community guidelines for women’s health services” and that the agency would cooperate with DHS’s independent investigation. In an initial statement, LaSalle Corrections strongly refuted the whistle-blower’s allegations, but declined to speak with the Times about its reporting.
It’s critical to get to the bottom of what happened and to hold any wrongdoers accountable.
More broadly, reducing reliance on for-profit facilities would be a wise move. One smart way to do it would be to shift more undangerous, low-priority detainees into supervised release — using electronic monitoring to track their movements, combined with check-in visits at ICE offices to ensure compliance with release conditions. These programs work: According to ICE’s own data from 2011 to 2013, more than 90 percent of the relatively small number of immigrants in supervised release programs showed up for their required court hearings. And such programs are cost-effective. A recent report from the National Immigration Forum, a pro-immigration nonprofit, calculated that in 2018 the federal government spent a daily average of $208 per immigrant detainee; in contrast, alternatives to detention can cost as little as 70 cents to $17 per person per day.
The case is clear: Our immigration detention system doesn’t have to be so costly, secretive, and devoid of accountability. Moving away from privatized detention is an overdue step in the right direction.
Editorials represent the views of the Boston Globe Editorial Board. Follow us on Twitter at @GlobeOpinion.