Amanda thought she was going to the doctor for a simple procedure to drain an ovarian cyst, but when she arrived at Irwin County Hospital from ICE’s Irwin County Detention Center in July 2019, a nurse told her she would be having surgery.
Amanda, who asked to be identified by a pseudonym because she has an open immigration case and fears retaliation, said she was filled with terror at the thought of being put under anesthesia. She was also confused; surgery was not at all what her gynecologist had told her to expect.
"He said draining a cyst is minor," Amanda told BuzzFeed News. "I asked him if I would need any downtime, and he told me, 'No, I'm just draining the cyst' and that it wasn't a big procedure."
Her gynecologist was Mahendra Amin, the doctor at the center of accusations of carrying out gynecological procedures on women in immigration detention without their consent. Amin, who until recently had been treating immigrant women detained at Irwin County Detention Center, has denied the allegations through his attorney and did not respond to repeated requests for comment.
So far, there has been no evidence to support the accusations of mass sterilizations on immigrants at the ICE detention center. But several people have since come forward to accuse Amin of conducting gynecological procedures on women without their consent.
BuzzFeed News has spoken to four women or their attorneys who allege Amin conducted medical procedures on them without revealing or fully explaining what he planned to do. This, they and their lawyers say, meant the women did not give consent.
In Amanda’s case, she said it was only moments before she was wheeled into surgery that she first heard the name of the procedures Amin planned for her — a dilation and curettage — and what it entailed: dilating her cervix and scraping her uterus. She would also have an ovarian cyst removed. Amanda said all of this was explained to her by a nurse, not Amin.
BuzzFeed News reviewed some of her medical files to confirm she was treated by Amin and had the two procedures.
Amanda said she had asked the nurse if she could have a few moments to notify her immigration attorney, whom she looked to as her advocate while she was in ICE detention, but was told no. Amanda then asked if she could have more time to think about whether to go through with the surgery. Again, she was told no.
The nurse said if she did not submit to the procedure that instant, she would be transported back to the Irwin County Detention Center, and authorities would make a determination that she had refused treatment, which Amanda understood to mean she might not be able to access further care for the cyst.
Amanda said she kept thinking about the risks of complications Amin had warned her about if they didn't drain the cyst.
"I felt pressured. I knew I only had a few seconds to make a decision," she said.
Amanda went ahead with the procedure and signed what she believes were consent forms, but said she felt coerced. She said she had asked for copies of the forms but did not receive them.
She woke up from the surgery scared and handcuffed to a hospital bed.
"It was really heartbreaking, especially waking up being shackled to the bed and feeling like I was waking up from a bad dream and realizing it wasn't a dream, it was reality," Amanda said.
The allegations against Amin came after a whistleblower — Dawn Wooten, who worked as a nurse at the detention center — filed a complaint with the Department of Homeland Security's Office of Inspector General. Wooten, whose complaint primarily focused on medical care and COVID-19 testing inside the facility, also alleged that unwanted hysterectomies were being performed on immigrant women. Wooten didn’t name the doctor — but soon after, Amin’s name was made public by advocates and attorneys.
In 2015, Amin, Irwin County Hospital, and other doctors reached a $520,000 settlement with the state of Georgia and the federal government after having been accused by authorities of falsely billing Medicare and Medicaid. In a statement to WALB News, Amin's attorney said none of the physicians involved in the case paid any money as part of the settlement and were released from any liability.
ICE officials have said that they “vehemently” dispute implications that detainees were used for “experimental medical procedures,” and that the “welfare and safety of ICE detainees” was one of the agency’s highest priorities.
“All female ICE detainees receive routine, age-appropriate gynecological and obstetrical health care, consistent with recognized community guidelines for women’s health services,” said Ada Rivera, medical director of the ICE Health Service Corps.
Rivera said that two individuals at the facility were referred to private facilities for hysterectomies.
“Based on their evaluations, these specialists recommended hysterectomies. These recommendations were reviewed by the facility clinical authority and approved,” she said in a statement. “To be clear, medical care decisions concerning detainees are made by medical personnel, not by law enforcement personnel. Detainees are afforded informed consent, and a medical procedure like a hysterectomy would never be performed against a detainee’s will.”
ICE officials have said they would cooperate with the DHS Office of Inspector General’s investigation into the matter. The agency has also noted that surgical procedures require consent from the detainee.
ICE contracts with LaSalle Corrections, a private prison company, to operate the Irwin County Detention Center in Ocilla, Georgia. On Aug. 12, before Wooten’s whistleblower complaint was filed, women detained at the ICE facility sent a letter to advocacy organizations about conditions inside the facility during the coronavirus pandemic. They described dirty cells, lack of social distancing, and retaliation from guards when they asked to be tested for COVID-19. The women also said they were put on lockdown for 14 days by guards after recording a video posted online complaining about the conditions and expressing their fears of contracting the virus, sometimes breaking down.
"Even though we are terrified, we continue to raise our voice because the abuses and conditions in which they have us are deeply concerning. WE CRY OUT FOR HELP!!!" the letter stated.
Vân Huynh, an attorney for Pauline Binam, a 30-year-old woman from Cameroon, said her client was sent to Amin after experiencing an irregular menstrual cycle. Binam was set to get a procedure to clean the lining of her uterus and scrape off a cyst that would hopefully regulate her menstrual cycle again. But when Binam woke up from the general anesthesia after the surgery in August 2019, Amin told her he had removed one of her Fallopian tubes.
Binam, who was 29 at the time, was upset by the news and unclear what the long-term implications of the procedure were, Huynh said.
"She was very shocked and upset to learn about this post-surgery while sitting in a wheelchair," Huynh told BuzzFeed News. "When she relayed this to me, she was still sitting in this wheelchair crying."
Binam would not have consented to having a Fallopian tube removed, Huynh said. But Amin told Binam that when he was doing the dilation and curettage surgery to remove the cyst, he found abnormalities and clots in the tube and made the medical decision to remove a portion of it, Huynh added.
Huynh also questions whether leaving the Fallopian tube would have been life-threatening and if Amin could have waited to get Binam's permission.
"People who are in immigration detention are robbed of so much time with their family, and it's a physical and emotional strain," Huynh said. "Now ... immigrants in detention are being robbed of future opportunities to be able to conceive children."
The Irwin County Detention Center sits in a rural area of Georgia. People outside of detention don't have many nearby options for medical care, and there are even fewer for immigrants in detention, Huynh said.
"It sets up the possibility for wrongdoing," Huynh said. "This is a highly vulnerable population. There are many people who don't speak English well or comfortable enough in common English to be able to understand complicated medical issues."
Elizabeth Van Nostrand, associate professor for health policy and management at the University of Pittsburgh's Center for Public Health Practice, said in order for a patient to give consent, a physician has to inform patients on numerous topics, including the risks and benefits, alternative treatment, and the consequences of not being treated.
In general, a patient has to have time to ask questions and reflect on what the physician said. Ensuring consent may also mean having an interpreter or being able to communicate clearly with someone who has a hearing impairment. It depends on the needs of the patient, Van Nostrand said.
Amanda said she was once asked by a nurse at Irwin County Hospital to interpret for an ICE detainee who did not speak English.
It's not enough for a person to have signed a consent form, Van Nostrand said. Signing a consent form doesn't remove the liability from a physician who does not explain treatments or procedures in a clear way or give the patient the opportunity to ask questions.
"It's definitely evidence, but it is not ironclad," Van Nostrand said.
Doctors are able to conduct procedures they didn't get consent for if an emergency arises during a surgery — if someone is at risk of bleeding out, for example, Van Nostrand said. What's considered an emergency varies, but generally it means imminent danger of death or a permanent health impairment. But if it's not an emergency, it is incumbent on the surgeon to finish the first procedure and obtain consent for the second one, she added.
"Consent implicitly means someone understands and it appears,” Van Nostrand said. “From what I read, that it's not always what's going on."
The burden of proving whether someone gave consent is going to fall on the women and not the doctor in a negligence or malpractice case, Van Nostrand said. Their attorneys would have to prove that it was more likely than not that consent for the procedures wasn't given by the women.
Immigrants in detention are a vulnerable population who can react differently than if they were an empowered group, Van Nostrand said. Some immigrants may feel intimidated or afraid to rock the boat and ask too many questions. They may also fear that if they keep asking questions they won't get any treatment at all.
ICE's policies on medical care said a detention center's healthcare practitioner needs to obtain signed and dated consent forms for all detainees before any treatment, except in emergency circumstances. As a rule, ICE's national detention standards state, medical treatment inside their facilities will not be administered against a detainee's will unless the situation is an emergency.
In cases when a detainee is sent outside of an ICE detention facility, a spokesperson for the agency said, a detainee having a medical procedure or surgery at a hospital “would sign consent at the hospital or medical facility just like any private citizen.”
Elizabeth Matherne, an immigration attorney in Georgia who works with people detained at Irwin Detention Center, said she's spoken to at least four women as far back as summer 2018 who have complained to her without prompting about Amin's treatment, describing it as "very rough" or saying that it "hurt."
One of her clients, Nancy Gonzalez Hidalgo, said she saw Amin multiple times without an interpreter despite not speaking English.
"She expressed that the treatment was very rough and she didn't understand what the treatment was, how he was treating her, and what the treatment plan was," Matherne told BuzzFeed News.
After seeing Amin, Gonzalez Hidalgo was told she had an infection and was prescribed antibiotics, but never received them when she returned to the Irwin County Detention Center. Gonzalez Hidalgo was really sick; when Matherne met with her in person, she was worried she would die. Matherne said she watched as Gonzalez Hidalgo, who had a fever, cried and struggled to sit up.
"Nancy's personality is very calm and pulled together, and I could tell she wasn't dramatizing or trying to act," Matherne said. "She was in so much pain she couldn't sit up."
Matherne demanded that Gonzalez Hidalgo be sent to a different doctor, who gave her a prescription for antibiotics and diagnosed her with a uterus infection. She later recovered.
Matherne said the women had not been fully told what the gynecological procedures would be or what the pros and cons were of having it done.
"It was, 'You're coming back on this date.' And that was the extent of what they were told," Matherne said.
ICE detainees will often complain that they are ignored or mistreated when they say they need medical attention, Matherne said.
"That is terrifying, and it feels like an extension of the dehumanization and revictimization," Matherne said. "I hate the word 'victim,' but in this situation, it's just stripping women of autonomy and empowerment and creating the facade of choice."
After her surgery, Amanda said, she had three incisions on her body and realized a piece of her navel had been removed, a constant reminder of her scarring experience.
“I noticed it on my own,” she said, “and in my mind, all I could think was, what else happened to my body while I was unconscious?"