On January 3, the U.S. Department of Homeland Security’s (DHS) Office of Inspector General (OIG) released a report entitled “Medical Processes and Communication Protocols Need Improvement at Irwin County Detention Center.” The report stemmed from whistleblower complaints about medical neglect inside the facility, including allegations that immigrant women were being subjected to forced hysterectomy procedures, and validates some of the concerns whistleblowers had about the detention center.
Advocacy groups Project South, Georgia Detention Watch, Georgia Latino Alliance for Human Rights, and South Georgia Immigrant Support Network filed the whistleblower complaint on September 14, 2020 on behalf of immigrants detained at Irwin County Detention Center, or ICDC, “and Dawn Wooten, a nurse employed by ICDC, who is a protected whistleblower,” previous WNN reporting states. The complaint detailed numerous, extremely concerning practices that were detrimental to the health and wellbeing of detainees being held at ICDC, which is located in Ocilla, Georgia and owned by private prison company LaSalle Corrections. Among the allegations were claims that the facility failed to enforce COVID-19 safety measures and retaliated against employees who spoke out about violations of the prevailing health guidelines at the time.
But one of the most heinous allegations in the whistleblower complaint came from several detained immigrants and Wooten, who alleged that there was a high rate of hysterectomies being performed on immigrant women at ICDC. The complaint expanded on concerns that individuals at ICDC broached regarding the number of hysterectomies being performed and highlighted Wooten’s concerns about “proper informed consent.” Wooten was quoted in the complaint as saying: “These immigrant women, I don’t think they really, totally, all the way understand this is what’s going to happen depending on who explains it to them.”
The complaint also cited a woman who had a hysterectomy procedure done at ICDC and said that “the doctor’s office did not properly explain to her what procedure she was going to have done. She reported feeling scared and frustrated, saying it ‘felt like they were trying to mess with my body.’” Additionally, this individual said that when she asked questions about the procedure, “she was given three different responses by three different individuals.”
The day after her whistleblower complaint was submitted, Wooten spoke to the press about what she witnessed at ICDC. She described how she became a whistleblower after observing how the facility handled the COVID-19 pandemic response. “I was called in one day and I was demoted, and I know I was demoted because I raised questions” about the detainees’ treatment during the pandemic, Wooten said. “I was told not to tell officers that there were detainees that they dealt with day in and day out that were positive.”
The whistleblower disclosures about ICDC drew widespread attention and later spurred a Congressional investigation into the allegations regarding the high numbers of hysterectomies. On September 23, 2020, Representatives Pramila Jayapal (D-WA), the Vice Chair of the Subcommittee on Immigration and Citizenship, along with Chairman of the Committee on the Judiciary Jerrold Nadler (D-NY) and Zoe Lofgren (D-CA), Chair of the Subcommittee on Immigration and Citizenship, sent a letter to then-DHS Acting Secretary Chad Wolf urging him to address the complaints, according to the press release. The press release named Dr. Mahendra Amin as the doctor who allegedly performed the hysterectomies.
Members of the Congressional Hispanic Caucus and the House Judiciary Committee called for an investigation into the allegations, and on September 26, 2020, several immigrant women detained at ICDC testified about their experiences before members of Congress. “The women said they had been placed in solitary confinement or treated for mental illness when they reported unwanted procedures or resisted seeing the doctor who performed them. They also alleged the doctor conducted internal pelvic examinations without wearing gloves and did not explain that procedures could leave them infertile,” an article from The Atlanta Journal-Constitution states.
Then-DHS Deputy Secretary Ken Cuccinelli said at the time that the allegation is “‘clearly false and should never have been made in the first place…We take the health and welfare of even people we’re deporting very seriously,’” according to the article.
On October 2, 2020, the House of Representatives passed a resolution “condemning the unwanted, unnecessary medical procedures — including partial and full hysterectomies — performed on immigrant women without their full, informed consent” at ICDC, the press release states. The resolution was co-sponsored by 225 Congress members and also urged DHS “to take a series of specific actions including immediately complying with all related investigations.” According to the press release, many of the hysterectomies performed on women at ICDC were performed by Amin, “without their knowledge or consent,” and “resulted in sterilization.”
On April 29, 2021, Detention Watch Network published a press release announcing that “no immigrant women are currently detained” at ICDC, “as verified by groups on the ground.” The four groups that helped Wooten file her whistleblower complaint celebrated the news, but the press release states that “advocates are gravely concerned about the fact that men are still detained at Irwin and that some of the women, including women who have come forward with abuse allegations, have been deported.” The press release also mentions that “some women have been transferred and are now detained at the corporate-run Steward Detention Center, which is one of the deadliest facilities in the country.”
On May 20, 2021, DHS Secretary Alejandro Mayorkas sent a memo to U.S. Immigration and Customs Enforcement (ICE) advising ICE to terminate contracts with two detention facilities, one being ICDC, according to previous WNN reporting. In a statement, Mayorkas said, “We have an obligation to make lasting improvements to our civil immigration detention system…DHS detention facilities and the treatment of individuals in those facilities will be held to our health and safety standards. Where we discover they fall short, we will continue to take action as we are doing today.” The DHS OIG report confirms that the contract with LaSalle Corrections went into effect on October 7, 2021, “and as of September 3, 2021, ICE no longer house[s] detainees at ICDC.”
DHS OIG’s Report: The Findings
The January 2022 DHS OIG report examined medical practices at ICDC through telephone interviews with “ICE personnel, ICDC officials, and detainees.” Investigators “also viewed surveillance video from common and housing areas. To assess medical care, [investigators] utilized medical experts from the National Commission on Correctional Health Care (NCCHC) Resources, Inc. 12 to conduct a virtual tour of the ICDC medical unit and medical records review.”
The investigation found that “ICDC generally met ICE detention standards, which specify that detainees have access to appropriate and necessary medical, dental, and mental health care. However, the NCCHC Resources medical team’s evaluation of ICDC’s medical processes found the facility’s chronic care, continuity of care, and medical policies and procedures to be inadequate.” Additionally, “[t]he medical team identified additional concerns in seven other areas: health assessments, medication administration, sick call, health records, program administration, emergency care, and women’s health.”
The report confirms some concerns that the whistleblowers voiced in the original complaint, including the claims that the facility did not “adequately implement and enforce social distancing protocols” for detainees. The report elaborates on allegations that ICDC staff were subjected to retaliation after speaking out about conditions at the facility, explaining: “We found that most of the ICDC staff we interviewed did not report fear of retaliation; most said they were comfortable bringing their concerns to either their supervisors or directly to the warden.” However, numerous “staff members reported their voices were not always acknowledged or concerns were not always addressed, and that communication from management could be better.” Additionally, the report says that “[s]everal ICE officers were hesitant to speak up about conditions at ICDC, specifically regarding COVID-19 protocols” and some ICE officers “did not feel comfortable voicing concerns about the facility conditions.”
In an interview, one ICE officer “alleged that a systemic issue existed within ICE leadership” located in the Atlanta Field Office that rendered the office unwilling “to hear complaints or concerns about detention facilities.” This officer also said that they believe individuals are reluctant “to use other means to voice concerns, such as filing an OIG Hotline complaint, due to the impression that one’s identity would be compromised as the calls are recorded.”
Expanding more on the adherence to COVID-19 guidelines, DHS OIG found that “ICDC and ICE management did not adequately or consistently keep facility employees, ICE staff, and detainees informed of COVID-19 protocols and guidance.” The report explains that the investigation “also found that detainees’ communication with, and access to, their ICE deportation officers were limited.” DHS OIG notes again that “some ICE officers stated they were not comfortable expressing concerns with detention conditions.”
Notably, the report did not specifically mention the allegations of a high rate of hysterectomies being performed on immigrant women to which Wooten drew attention in the complaint. In fact, in the “women’s health” category of the report, the report states that “the NCCHC Resources team determined women’s health care to be appropriate. However, off-site specialty provider care information was not consistently returned to the ICDC medical unit.” Though, DHS OIG states that it “initiated a separate audit which will focus on how surgical procedures are authorized and approved for detainees across ICE detention facilities.” In a video that summarized the report’s findings, DHS Inspector General Joseph V. Cuffari was quoted as describing the audit as a “systemic review of ICE’s surgical approved procedures.”
In terms of medical care overall, DHS OIG found that ICDC’s “medical unit did not have consistent guidance or provider-developed guidelines for chronic care” – instead, medical staff “reported using several different guidance documents for care.” The report also states that the medical team did not adequately monitor and document “the current status of detainees with chronic conditions.” ICDC’s medical unit was found to have a lack of a “continuous quality improvement program,” the purpose of which “is to improve health care by identifying problems, implementing and monitoring corrective action, and studying the improvement program’s effectiveness.” The report notes that “ICDC did not provide documentation showing any organized approach to evaluate the delivery of health care services.”
DHS OIG’s Recommendations
The report includes five recommendations for the Executive Associate Director of Enforcement and Removal Operations to direct the Atlanta Enforcement and Removal Field Office responsible for Irwin County Detention Center to implement. The first two recommendations mention the ICE Health Service Corps (IHSC), the provider of “direct on-site medical services” that operates in “at least 20 facilities that house ICE detainees for more than 72 hours.”
“Recommendation 1: Ensure IHSC coordinates with ICDC medical unit to update processes and documentation for chronic care cases and develop a continuous quality improvement program.
Recommendation 2: Ensure IHSC conducts training with ICDC medical unit about medication administration and health records documentation.
Recommendation 3: Coordinate with ICDC management staff to develop a communication plan to keep detainees informed during a pandemic or other emergency situations, and to include related policy and protocols, potential exposures, quarantine/isolation status, and testing procedures.
Recommendation 4: Develop a plan to enhance communication among Atlanta Field Office staff, permanent on-site ICE staff, and ICE detailed staff to ensure awareness of pandemic-related policy, protocols, and conditions.
Recommendation 5: Coordinate with ICDC management staff to review and update the ICDC Detainee Handbook to ensure it contains current contact information for the ICE ERO Atlanta Field Office and the scheduled hours and days that ICE ERO staff are available to detainees.”
After outlining the recommendations, the report details ICE’s comments about each of the recommendations. Recommendations 1-3 and 5 were marked as “non-concur” as ICE no longer uses the ICDC facility. For these recommendations, the report does state: “Should detainees again be housed at ICDC at some point in the future, ICE will ensure that all applicable detention standards are followed, as appropriate.”
That leaves recommendation 4, which centers around communication between ICE’s Atlanta Field Office and other ICE staff. ICE responded that it “acknowledges the importance of strong communication practices to fully implement ICE’s policies and protocols that protect employees and people detained by ICE from COVID-19.” The agency said that the Atlanta Field Office “will supplement, reinforce, and enhance a communications plan and leadership will directly engage in enhancements to that plan.” To boost communication, the Field Office Director will conduct quarterly “town-halls” for all ICE employees, “daily meetings with his staff and Deputy Field Office Directors,” and “weekly meetings with the Assistant Field Office Directors throughout the area of responsibility.” Another plan of note is the Atlanta Field Office having “a full-time staff devoted to messaging and sending communications throughout the Field Office,” which aims to increase awareness and communication of “broadcast messages and policies from ICE Headquarters or Field Office leadership.”
Of ICE’s plan to address recommendation 4, OIG wrote: “We consider these actions responsive to the intent of the recommendation, which is resolved and open. We will close this recommendation when we receive documentation showing the Atlanta Field Office implemented the stated enhancements to the communications plan to include evidence of the mandatory bi-weekly meetings with individual detention facilities’ ICE personnel.”
In response to the report, Dana Gold, lead counsel for Wooten and Senior Counsel for Government Accountability Project, expressed gratitude that the report “largely validates” many of the concerns Wooten brought up. “Yet we remain frustrated that the very whistleblower whose disclosures led to this important report continues to wait for a decision on her whistleblower retaliation complaint filed with the OIG more than fifteen months ago…Ms. Wooten herself, a single Black mother of five struggling to provide for her family, continues to suffer the adverse effects of retaliation,” Gold stated in a January 12, 2022 press release. “We hope that the DHS OIG will now take care of the whistleblower who served the public interest by choosing to speak up instead of stay silent.”