Letter to the Honorable Chad F. Wolf, Acting Secretary of the U.S. Department of Homeland Security - Lawmakers Launch Investigation Into Administration's Handling of Alleged Mass Hysterectomies at ICE Detention Facility

Letter

Pursuant to Rules X and XI of the U.S. House of Representatives, we write with concern
regarding the recent whistleblower complaint filed with the U.S. Department of Homeland
Security (DHS) Office of the Inspector General (OIG) alleging widespread disregard for public
health and lack of quality medical care for immigrants detained in the Irwin County Detention
Center (ICDC) in Ocilla, Georgia.
1
According to the complaint, ICDC repeatedly violated
Centers for Disease Control and Prevention (CDC) coronavirus disease of 2019 (COVID-19)
guidance, failed to provide general medical care to those detained, and facilitated a high rate of
hysterectomies on women under questionable conditions.
If this complaint is true, it is absolutely unacceptable and horrific treatment of individuals
in DHS detention. Furthermore, the complaint details conditions that threaten the public's health
in the midst of a pandemic.
2
In light of these allegations, as the Committee of jurisdiction over
public health and health care in the United States, we seek information as to what steps DHS has
taken to investigate the conditions at ICDC and elsewhere, and what actions are being
implemented to address and prevent such circumstances in other detention facilities.
The complaint to OIG details alarming disregard for and direct violation of CDC Interim
Guidance on Management of Coronavirus Disease in Correctional and Detention Facilities for
both employees and those detained in the Ocilla facility.3
These include reports from detained
immigrants that they are not able to be socially distant and have to wait days for new face masks
1 Letter from Project South, et al. to Inspector General Joseph V. Cuffari, Office of
Inspector General, Department of Homeland Security, et al. (Sept. 14, 2020).
2 Id.
3 Id.
FRANK PALLONE, JR., NEW JERSEY
CHAIRMAN
GREG WALDEN, OREGON
RANKING MEMBER
ONE HUNDRED SIXTEENTH CONGRESS
Congress of the United States
House of Representatives COMMITTEE ON ENERGY AND COMMERCE
2125 RAYBURN HOUSE OFFICE BUILDING
WASHINGTON, DC 20515-6115
Majority (202) 225-2927
Minority (202) 225-3641
The Honorable Chad F. Wolf
October 1, 2020
Page 2
and cleaning supplies to sanitize their surroundings. One immigrant stated that, "There is no
social distancing…we breathe the same air, we sneeze, we cough next to each other."4
In
addition, contrary to CDC guidance,5 ICDC has allowed the transfer of detainees in and out of
the facility. The complaint states that the ICDC Warden persisted in transferring detainees over
the objections of the facility's medical director. This reportedly includes transferring detainees
who were known to have COVID-19 and failing to properly quarantine individuals as they
arrived at the facility.
The complaint further claims that there is a lack of COVID-19 testing, even for
individuals who are more vulnerable to the virus or are exhibiting symptoms, and underreporting
of confirmed cases within the facility.
6
In addition, ICDC employees are allegedly instructed to
work even if they are exhibiting COVID-19 symptoms or obtain a positive test result. Such
actions, if true, put ICDC employees and detained immigrants at risk of spreading or succumbing
to the novel virus that has now claimed more than 205,000 lives in the United States.7
The complaint also includes numerous reports of a general lack of medical care and
delayed, or poor, care when it is provided.8
For example, detainees' medical request forms were
allegedly shredded, medical records for patients never examined have been allegedly fabricated,
and medical symptoms displayed or conveyed by patients were reportedly routinely ignored.
Unsanitary conditions in the medical and quarantine units, including dirty exam tables and
watered-down disinfectant, were also reported. According to the complaint, care was also
delayed, and in some instances when detained immigrants did receive medical care it was "poor
treatment by certain medical staff." This included showing disrespect to the patients, particularly
Hispanic patients, for not speaking English and refusal to believe the patient when they reported
pain.9
Most alarmingly, the complaint claims that a high rate of hysterectomies were performed
on women detained at ICDC.
10 According to the complaint, some of the women expressed that
they did not understand why the procedure had been performed. Reportedly, one such woman
was given three different answers by three different people as to why she needed to undergo a
4 Id.
5 Centers for Disease Control and Prevention, Interim Guidance on Management of
Coronavirus Disease 2019 (COVID-19) in Correctional and Detention Facilities
(www.cdc.gov/coronavirus/2019-ncov/community/correction-detention/guidance-correctionaldetention.html) (accessed Sept. 23, 2020).
6 See note 1.
7 Centers for Disease Control and Prevention, CDC COVID Data Tracker
(covid.cdc.gov/covid-data-tracker/#cases_casesinlast7days) (accessed Sept. 30, 2020).
8 See note 1.
9 Id.
10 Id.
The Honorable Chad F. Wolf
October 1, 2020
Page 3
hysterectomy. According to the complaint, rather than using the language line as medical staff
were required to do, staff would attempt to communicate and explain the medical procedure
merely by "Googling Spanish."11 In additional reporting since the complaint was made public,
other women previously detained at ICDC also shared their experiences of being pressured to
undergo the procedure.12
Informed consent for all medical care, including reproductive health, is imperative to
ensuring quality health care, public health, and patient trust. Particularly given our nation's
troubling history of inflicting nonconsensual or coercive medical practices on people of color
and people with disabilities--and practices that resulted in sterilization--informed consent is
foundational to sound medical care practices. 13 In order for a patient to provide informed
consent, as the American Medical Association's Code of Medical Ethics states, clinicians should
"present relevant information accurately and sensitively, in keeping with the patient's
preferences."14 Further, according to the American College of Obstetricians and Gynecologists,
when it comes to procedures that may result in sterilization, "coercive or forcible sterilization
practices are unethical and should never be performed."15 Especially in settings where patients
are detained or incarcerated, the power dynamics presented only reinforce the critical need for
unambiguous and fully informed consent.
Given public health guidance and these clear medical guidelines, we are deeply
concerned by the reported conditions and events outlined in the complaint to the DHS OIG. For
the reasons summarized above and detailed further in the complaint, we request a briefing and a
response to the following questions by October 15, 2020.
1. Was DHS aware of any medical care or public health concerns at ICDC prior to the
September 14, 2020, complaint to OIG? If so, what concerns were known to DHS?
What steps, if any, did DHS take prior September 14, 2020, and after, to address the
substandard quality of health care and public health threats, particularly related to
COVID-19 and reproductive health care?
11 Id.
12 More migrant women say they didn't OK surgery in detention center, Associated Press
(Sept. 18, 2020); Immigrants Say They Were Pressured Into Unneeded Surgeries, New York
Times (Sept. 29, 2020).
13 The American College of Obstetricians and Gynecologists, Committee Opinion
Number 695, Sterilization of Women: Ethical Issues and Considerations (Apr. 17, 2020)
(www.acog.org/-/media/project/acog/acogorg/clinical/files/committeeopinion/articles/2017/04/sterilization-of-women-ethical-issues-and-considerations.pdf).
14 American Medical Association, Code of Medical Ethics, Opinion 2.1.1 (2016)
(www.ama-assn.org/system/files/2019-06/code-of-medical-ethics-chapter-2.pdf).
15 See note 13.
The Honorable Chad F. Wolf
October 1, 2020
Page 4
2. What steps, if any, has DHS taken, in consultation with the Department of Health and
Human Services (HHS), including CDC or other health agencies, to investigate the
conditions at ICDC and other facilities under DHS authority?
3. Since COVID-19 was declared a public health emergency in the United States on January
31, 2020, what steps has DHS taken to prevent the spread of COVID-19 in its detention
facilities, as well as those operated by contractors? What is DHS's testing strategy for
employees working in DHS detention facilities and individuals in DHS custody? Please
provide the number of COVID-19 tests that have been performed and specify how these
align with the testing strategy's target goals. In addition, please detail the protocols in
place should an individual who is detained or a detention facility employee have a
positive test for COVID-19.
4. Is DHS aware of any prior complaints or has DHS investigated any complaints related to
the lack of informed consent for medical procedures? If so, please list the facilities where
these complaints occurred and whether any were related to medical procedures that led to
sterilization.
5. Does DHS track the number of medical procedures, including hysterectomies, performed
on detainees in DHS custody and the medical indication for each such procedure? If so,
please provide the total number of hysterectomies performed and the medical indication
for the procedure per month by facility, and the percentage of females detained who
received hysterectomies per month as compared to the overall population of females
detained per facility in the same period for the past 48 months. Please provide all
supporting documentation provided to detainees prior to the procedure.

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