by Craig Klugman
In a startling whistleblower report, Dawn Looten who is a licensed nurse practitioner at the Irwin County (GA) Detention Center (ICDC) stated that patients were denied COVID tests, medical records were altered and destroyed, and most disturbingly, that a very high number of hysterectomies were performed on detained immigrant women who may not have understood what was being done to them. Nurse Wooten is represented in this matter by the Government Accountability Project and Project South which spoke to others with knowledge of the prison. A detained immigrant reported on 5 women who had undergone hysterectomies who “reacted confused” about what had been done to them: “When I met all these women who had had surgeries, I thought this was like an experimental concentration camp. It was like they’re experimenting with our bodies.”
The allegations are about hysterectomies and other inappropriate gynecological procedures done without consent or necessity. Among the cases in the report are a woman whose wrong ovary was removed because of a cyst and the doctor went in and took out the other ovary, leaving her sterile. Nurse Wooten relayed stories of women who did not understand what was happening to them. This lack of consent is in part of a language barrier (many of the patients were Spanish speaking women) and in part that the women were told different things at different times. When patients tried to refuse the procedure, health care staff are reported as getting angry.
The Detention Center is a private prison run by LaSalle Corrections. ICDC is in Ocila, Georgia and has space for 1,200 inmates, most of whom are detained immigrants. In July the Government Accountability Project released a report about another LaSalle institution, Richwood Correctional Center in Louisiana and has urged the Office of the Inspector Generalto begin in an investigation into COVD-19 practices at LaSalle facilities. Congressional Democrats (170 of them) have also asked the OIG to begin an investigation into the allegations and requested a report by September 25. ICE has denied the accusations, saying that only 2 women have been referred for hysterectomies.
The hysterectomies appear to have been performed by Mahendra Amin who practices gynecology in nearby Douglas, Georgia. Amin graduated from medical school in 1979 (school unreported) and is an immigrant himself. In 2015, he settled with state prosecutors over allegations of submitting fraudulent Medicare and Medicaid claims. Amin has denied any wrongdoing.
Rep. Pramila Jayapal (D-WA) stated that she spoke with 3 attorneys representing women at ICDC who had been “subjected to forced, invasive procedures by a gynecologist connected with the private, for-profit detention center”. Jayapal reports that there are 5 attorneys with knowledge of 17 or 18 victims of one physician. Given that detainees may be fearful or repercussions if they come forward, there may be many more victims. Rep. Sheila Jackson Lee (D-TX) intervened to have one detainee/victim/patient taken off a plane at O’Hare airport who was being deported to Cameroon. Jayapal believes that ICE might have been “trying to rush through her deportation” (ICE says it was a paperwork error that led to deplaning). That patient, Pauline Binam is one of the first first-hand accounts of wrongdoing. She states that she woke up and was told by Amin that he had removed her fallopian tube and would require assisted reproduction to conceive.
Assuming that this complaint is shown to be true, there are several different bioethics lenses through which one can examine this case. In terms of politics, some commentators have suggested that this is another case of an administration that has refused abortions to minors in immigrant detention and represent a continued assault against women’s reproductive health and control of their bodies. Another narrative would liken this story to the long history of eugenicswhere U.S. states sterilized people who were considered undesirable because of race or perceived cognitive abilities. A third narrative would be from the view of research ethics and human rights, a perspective that suggests that since these women are being detained in prisons, that this story might be one similar to the Nuremburg Trials where Nazi doctors were tried for performing experiments and medical procedures on patients without their permission (and often absent knowledge). The first tenet of the Nuremberg Code—“The voluntary consent of the human subject is absolutely essential”—appears to have been violated in this case.
A feminist reading would suggest that a male physician viewed women’s bodies as objects over which he had power. Through the lens of race, one might find that these women of color were “othered”. Given that they were detained by immigration, imprisoned, allegedly assaulted, and in at least one case deported is an example of systemic racism stripping them of their humanities, their voice, and human rights. If one considers the unnamed detainee’s earlier statement that it was like a “concentration camp” and that Amin was “experimenting with our bodies” then this case might superficially call back to J. Marion Sims who treated Black slaves between 1845 and 1849 who suffered from fistulas. On the one hand, Sims gave medical treatment to women who were shunned by their peers and would not have received treatment otherwise. On the other hand, Sims is criticized for experimenting on a vulnerable population who were slaves and thus could not necessarily freely consent. Amin would have a hard time justifying that he was experimenting in 2019/2020 on these women in the name of science under modern research ethics and legal codes. The lesson is that there is a long history of medical science treating women of color as objects on which to act (or to ignore), rather than as human beings to help.
This is a story that will be unfolding and its implications for bioethics will only be known in time. In the meantime, Wooten has been demoted based on not going to work while waiting the results of a COVID-19 test, though she and her supporters view the move as retaliatory.