Transcripts For CSPAN Fmr. Detainee Testifies On Medical Car

The up be up to date with late nest publishing with book tvs podcasts about books. With current Nonfiction Book releases plus bestseller lists as well asle Industry News and trends through insider news. Find it now on cspan now, our free mobile app, or wherever you get your podcasts. Following an 18 month long investigation a Senate Homeland security subcommittee found women detainees at an immigration facility in georgia were subjected to excessive, invasive and often unnecessary gynecologic procedures. A former detainee was on capitol hill to give her account of being treated by doctors without her consent of she was joined by two physicians who independently reviewed other patients charts and records. This is just under two hours. I. Youre watching live on cspan. Before we begin this hearing, guests and viewers should be advised that this hearing will discuss the medical abuse of women in the custody of the u. S. Government and that the subject matter is deeply distressing and highly sensitive. 18 months ago, i launched a p. S. I. Investigation focused on the medical treatment of women detained by the department of homeland scus. Id like to thank Ranking Member johnson and his staff for their contributions to this bipartisan investigation. Our findings are deeply disturbing. It is the bipartisan finding of the subcommittee that female detainees in georgia were subjected by a d. H. S. Contracted doctor to excessive, invasive, and often unnecessary gynecological surgeries and procedures with repeated failures to obtain informed medical consent. This is an extraordinarily disturbing finding. And in my view represents a catastrophic failure by the federal government to respect basic human rights. Among the serious abuses this subcommittee has investigated during the last two years, subjecting female detainees to nonconsensual and unnecessary gynecological surgeries is one of the most nightmarish and disgraceful. The subcommittee has been thorough, interviewing more than 70 witnesses and reviewing more than 540,000 pages of records. I want to thank and commend the staff who have worked on this for the last year and a half. The subcommittee engaged medical experts including dr. Peter shirooni, ob gyn, who has conducted reviews of other matters for the h. H. S. Inspector general, and who independently reviewed more than 16,000 pages of medical records obtained by the subcommittee. The subcommittee also contacted dr. Mueller, ob gyn who also reviewed extensive records related to the records. Both doctors will testify today and i thank you both for your service to the subcommittee and the u. S. Senate. These medical experts reviewed the clinical conduct of dr. Ma hend rah amin, an ob gyn doctor contracted by the dp of Homeland Security. Who has subjected female detainees to unethical gynecological care, quickly scheduled surgeries when nonsurgical options were available, performed unnecessary injections and treatments and often proceeded without informed consent. In addition to this expert review of medical records, the subcommittee analyzed relevant data secured from i. C. E. And the results of our analysis were shocking. For example, from 2017 to 2020, dr. Amin accounted for just 6. 5 of all offsite ob gyn visits for all i. C. E. Detainees nationwide yet during the same period, this single doctor, according to i. C. E. Statistic, performed 82 of all dilationcurettage surgeries. 93 of all contraceptiven injections. And 34 of all surgeries performed on the population. One doctor, 6. 5 of ob gyn visits. 82 of the d c surgeries. 93 of contraceptive injections. 94 of laparoscopic surgeries to remove lesions performed on the entire nationwide i. C. E. Detainee population. The subcommittee sought an interview with dr. Amin in this investigation and when he decline wed issued a subpoena. Dr. Amin invoked his fifth amendment right not to testify and has not spoke within the subcommittee. We will also be joined today by an extraordinarily courageous woman, karina cisneros, who was born in mexico and brought to the United States as an 8yearold child. She began working at 15 and by 18 was married to a spouse who physically abused her. After she called the police to her home during an incident of domestic abuse, karina was arrested and although all charges against her were dropped, she wound up detained at Irwin County Detention Center in georgia because of her immigration status. Just four months earlier, karina had given birth to her 4monthold daughter who was still breastfeeding at the time. Now forcibly separated from her infant daughter, karina had not yet received her postpartum exam and sought care while in detention. Karina was sent to dr. Amin. As we will hear, her encounter with dr. Amin left her deeply disturbed and it may only be because some allegations of medical abuse became public at this time that karina was spared further abuse. On behalf of the u. S. Senate, karina, i thank you for your decision to join us here today and your service to the country. Today well also question dr. Stewart smith who leads the i. C. E. Health Service Corps and is responsible for all medical care provided to all i. C. E. Detainees nationwide. Dr. Kuthari, the d. H. S. Inspector general, and dr. Pamela hearn, medical director for lasalle kreks. Among the questions we will ask today, why are doctors who treat detainees not properly vetted by the department of Homeland Security when such a vet would have revealed in this case that the doctor in question had been previously sued by the department of justice and the state of georgia for performing excessive and unnecessary procedures. Had been dropped by a major insurer for excessive malpractice claims. And was not Board Certified. What Due Diligence did the department of Homeland Security perform in signing off on each of these procedures . Because indeed, they did sign off on each of these procedures. Why was the inexplicably high number of surgeries performed by a single physician, not a red flag that attracted greater scrutiny . What responsibility is borne by the private Detention Center operator for mistreatment of detainees housed in their facilities when that misdream occurs at an offsite medical facility. All these and more will be the subject of vigorous questioning today. Senator johnson will be joining us later in the hearing and at this time id ask unanimous consent to enter his Opening Statement into the record. We will now call our first panel of witnesses for this afternoons hearing. Ms. Karina cisneros precioada was formerly detained at the center in georgia. Doctor rooney was engaged to review medical records of those treated. He will be testifying remotely. Dr. Margaret muler is a medical expert and physician who was part of an independent medical review team that conducted a review of medical records for detainees treated by dr. Amin. I appreciate all of you for being with us today and look forward to your testimony. The rules and custom of the subcommittee require all witnesses to be sworn in. So at this time i would ask you to please stand and raise your right hand. Do you swear that the testimony you are about to give before this subcommittee will be the truth, the whole truth and nothing but the truth so help you god . Let the record reflect the witnesses answered in the affirmative. You may take your seats. We will be using a timing system today. We ask that you try to limit your Opening Statements to around five minutes, but if you need a bit more time its not a problem, just let me know. Ms. Cisneros preciado, thank you for joining us, and if youre ready, well hear from you first. Karina thank you for the opportunity to share my story with you today. I was brought to the United States when i was 8 years old. I am now a 23yearold mother of 2. I have a 1yearold and a 2yearold. When my daughter was 4 months old i called the police to stop ongoing abuse from her father. This led to me being arrested and even though the charges were dropped i still ended up at icbc for almost seven months away from my dawrk away from my family. At icbc i became 72176 instead of karina. At icdc, i went through hell. This place was extremely filthy. The showers were moldy. The water cooler where we drank water from, there was mold in the spout. We were given dirty and used underwear to wear. At icbc i seek help, medical help because i had not had my postpartum checkup from my daughter. After several requests i finally got an appointment to see a doctor. The nurse told me i was going to get a pap smear. When the day came, they handcuffed me, they put a chain around my waist, all the way down to my ankles. When we arrived at the clinic, we were taken in one by one by an escort and the rest stay in the car with another officer. In the clinic they took my blood pressure, my temperature, my weight, with my handcuffs still on. Once in the room they took my handcuffs off so i could get undressed. When dr. Amin comes in, he doesnt acknowledge me. He doesnt say a word. He just sits in front of me and starts prepping for the procedure which he does not explain. Then, he just says, open your legs. And continues with, its going to be cold. And inserts a white tube instead of me. Inside of me. He wiggles it around roughly. It was extremely uncomfortable. As im about to look at the monitor thats next to me he immediately pulls it out and tells me i have a cyst on my left ovary and im going to get a depo shot for it and if it doesnt dissolve in four weeks i have to come back for surgery. Then he asks the nurse how many more. And he just walks off. I get dressed and they put the handcuffs back on and another nurse comes in and she gives me the shot on my arm and makes me sign a paper which i dont i didnt have a chance to read it or hold it. I was in handcuffs. I just signed it. Back in the van, the other women asked me if i had gotten the shot to not have babies as well. I didnt know what it was, it wasnt explained to me. Thats when i learned it was Birth Control and if i would have known, i would have said something as the woman the women in my family had very bad experiences from Birth Control. Back when we get back to icbc i learn the story of many other women the doctor told the same thing to. They all had cysts on their ovary, all had shots, some even got surgeries. I thank god that the news came out because he didnt get to do anything else to me. The reason im telling this story is because this shouldnt happen to anyone anymore. Were not were not animals. Were human. Were not just a number. Thank you for your time. Senator ossoff thank you. Dr. Mueller, well hear from you now, please. Dr. Mueller thank you. Senator ossoff, senators, staff senator oreceive make sure senator ossoff make sure your microphone is on, please. Dr. Mueller is this better . Thank you. The first thing i want to do is take this opportunity to praise karina for her courage and bravery for coming today. Although difficult to hear and heartbreaking, it certainly gives voice to the medical records that i reviewed and my colleagues reviewed as well. My name is margaret mueller, im a physician and i hold specialty board certification in ob gyn and subspecialty board certification in female pelvic medicine and Reconstructive Surgery. I have a faculty appointment at Northwestern University where i serve as Program Director for the female public medicine and Reconstructive Surgery fellowship. I was part of an independent medical review team made up of nine other Board Certified ob gyns and two nurse practitioners. In 2020, we reviewed the medical records of 19 women who alleged medical abuse and mistreatment wile in detention at Irwin County Detention Center. Since that summary was prepare and publied ive reviewed additional medical records that make it clear that this pattern of mistreatment and abuse was not limited to those 19 women. Our findings identified a disturbing pattern of overly aggressive gynecologic care many times involving unnecessary diagnostic procedures and in some cases unnecessary or inappropriate surgical procedures. Often significant steps in the appropriate evaluation and management of common gynecologic qurns completely omitted leading to unindicated procedures. Our review, more concern glirk identified serious failure by the facilityassigned gynecologist to obtain meaningful informed consent from the women he was treating. The unindicated and underconsented procedures including transvaginal ultd rah sounds, a procedure in which a woman is undress fled waist down and a medical professional inserts a wand or probe into the vagina to image the reproductive female organ, uterus, cervix, fallopian tubes an ovaries. Pap smears, where a woman is undressed if the waist down and a medical professional inserts a speck lum and a brush is used to exfoliate cells to send to the the pathologist. A procedure in which this is typically performed in the office however under dr. Amins care it was performed in the operating room under anesthesia where a speck lum is inserted into the vagina and electric cautery is used to burn or remove or cauterize a significant portion of a womans cervix. Dilation and curettage which you heard about, a surgical procedure performed again in an operating room under anesthesia where a speck lum is inserted into the vagina and instruments are used to open a womans cervix, obtaining access to the endometrial cavity or inside of the uterus. Once that is done scene rat instrument is used to scrape the inside lining of the endometrial cavity to provide a pathologic specimen. Finally, laparoscopy, a surgical procedure in the operating room under general anesthesia where one or more small incisions is made in the oabd, a camera is introduced and different instruments are used to either remove or repair tissue or organs. Additionally in several cases women actually had incorrect procedures performed by dr. Amin. These incorrect procedures resulted in nurmt one, a woman being inadequately treed for a Cervical Cancer and number two, a reproductiveaged woman undergoing unnecessary removal of a significant portion of her cervix. Just as examples. Due to these incorrect procedure, both women and expect to require further and future procedures and monitoring none of which would have been necessary had the appropriate procedures been done in the first place. All of these procedures involve risks. Those risks are those that are directly attributed to procedure, for example, an injury to a bowl or portion of the intestines at the time of a laparoscopic procedure, and pose downstream consequences. Preterm birth or labor following a procedure or infertility and fertility implications following a d c. These unnecessary medical procedures were performed without an adequate consent which means more than just placing a signed consent form in a chart but a documentation of an appropriate discussion of less invasive options that might be appropriate for the management for a patient, us that signifying a meaningful shared Decision Making discussion between a patient and her physician. This lack of adequate informed consent was apparent for our from the medical records but krb rated further by the stories like you heard from karina where it was identified that there was a total absence of shared Decision Making in the process between the patient and the physician. Informed consent discussion should explore number one the patients symptoms and degree of bother from those symptoms, number two, the full raining of Treatment Options available for a specific condition ranging from least invasive, for example, observation if appropriate, to most invasive, as an example, surgery. And then finally the risk, the benefits and alternatives of all those proposed management strategies. Importantly if a patient has no symptoms or has or if a particular surgery is unindicated than the then the intervention exposes the patient to unwarranted risk without any medical benefits. Finally, many of these concerns are magnified by the vulnerable nape of these women. As you heard many of need women identify as trauma survivors, several report a history of either rape, sexual abuse or Sexual Assault. All were incarcerated and unable to choose a medical professional with whom they felt comfortable. In that setting these women were forced to relen quish their autonomy and their decision to participate in their own medical care. Autonomy is one of the four pillars of medical ethics and represents a patients right to make decisions regarding her health care. Without the medical provider trying to unduly influence her decision. More simply stateds the right to refuse or choose medical care without the fear of retaliation. By nature of their these women d not have a choice. Some were retaliated against if they asked for a second opinion. This further compounds the pattern of care we identified. The manner in which these women were treated as they were subjected to aggressive, unnecessary, unindicated and incorrect procedures and procedures often without any benefits and usually without informed consent is unacceptable by my standard and cannot be allowed to happen again. Thank you for your investigation and your time today. I look forward to your questions. Senator osoff thank you for your testimony. And dr. Cherouny will be joining us remotely. Dr. Cherouny good afternoon. My name is Peter Cherouny and professor at the university of vermont in the department of object stet particulars and gynecology call sciences. I have sent in a c. D. And i previously been involved with the United Statesgovernment as you have heard as well as internationally including the review that was mentioned. I will try not to be repetitive. As most of us if everything dr. Mueller said was correct and i was asked to review the care to immigrants within the United States immigration and Customs Enforcement custody at the Nonfiction Book<\/a> releases plus bestseller lists as well asle Industry News<\/a> and trends through insider news. Find it now on cspan now, our free mobile app, or wherever you get your podcasts. Following an 18 month long investigation a Senate Homeland<\/a> security subcommittee found women detainees at an immigration facility in georgia were subjected to excessive, invasive and often unnecessary gynecologic procedures. A former detainee was on capitol hill to give her account of being treated by doctors without her consent of she was joined by two physicians who independently reviewed other patients charts and records. This is just under two hours. I. Youre watching live on cspan. Before we begin this hearing, guests and viewers should be advised that this hearing will discuss the medical abuse of women in the custody of the u. S. Government and that the subject matter is deeply distressing and highly sensitive. 18 months ago, i launched a p. S. I. Investigation focused on the medical treatment of women detained by the department of homeland scus. Id like to thank Ranking Member<\/a> johnson and his staff for their contributions to this bipartisan investigation. Our findings are deeply disturbing. It is the bipartisan finding of the subcommittee that female detainees in georgia were subjected by a d. H. S. Contracted doctor to excessive, invasive, and often unnecessary gynecological surgeries and procedures with repeated failures to obtain informed medical consent. This is an extraordinarily disturbing finding. And in my view represents a catastrophic failure by the federal government to respect basic human rights. Among the serious abuses this subcommittee has investigated during the last two years, subjecting female detainees to nonconsensual and unnecessary gynecological surgeries is one of the most nightmarish and disgraceful. The subcommittee has been thorough, interviewing more than 70 witnesses and reviewing more than 540,000 pages of records. I want to thank and commend the staff who have worked on this for the last year and a half. The subcommittee engaged medical experts including dr. Peter shirooni, ob gyn, who has conducted reviews of other matters for the h. H. S. Inspector general, and who independently reviewed more than 16,000 pages of medical records obtained by the subcommittee. The subcommittee also contacted dr. Mueller, ob gyn who also reviewed extensive records related to the records. Both doctors will testify today and i thank you both for your service to the subcommittee and the u. S. Senate. These medical experts reviewed the clinical conduct of dr. Ma hend rah amin, an ob gyn doctor contracted by the dp of Homeland Security<\/a>. Who has subjected female detainees to unethical gynecological care, quickly scheduled surgeries when nonsurgical options were available, performed unnecessary injections and treatments and often proceeded without informed consent. In addition to this expert review of medical records, the subcommittee analyzed relevant data secured from i. C. E. And the results of our analysis were shocking. For example, from 2017 to 2020, dr. Amin accounted for just 6. 5 of all offsite ob gyn visits for all i. C. E. Detainees nationwide yet during the same period, this single doctor, according to i. C. E. Statistic, performed 82 of all dilationcurettage surgeries. 93 of all contraceptiven injections. And 34 of all surgeries performed on the population. One doctor, 6. 5 of ob gyn visits. 82 of the d c surgeries. 93 of contraceptive injections. 94 of laparoscopic surgeries to remove lesions performed on the entire nationwide i. C. E. Detainee population. The subcommittee sought an interview with dr. Amin in this investigation and when he decline wed issued a subpoena. Dr. Amin invoked his fifth amendment right not to testify and has not spoke within the subcommittee. We will also be joined today by an extraordinarily courageous woman, karina cisneros, who was born in mexico and brought to the United States<\/a> as an 8yearold child. She began working at 15 and by 18 was married to a spouse who physically abused her. After she called the police to her home during an incident of domestic abuse, karina was arrested and although all charges against her were dropped, she wound up detained at Irwin County Detention Center<\/a> in georgia because of her immigration status. Just four months earlier, karina had given birth to her 4monthold daughter who was still breastfeeding at the time. Now forcibly separated from her infant daughter, karina had not yet received her postpartum exam and sought care while in detention. Karina was sent to dr. Amin. As we will hear, her encounter with dr. Amin left her deeply disturbed and it may only be because some allegations of medical abuse became public at this time that karina was spared further abuse. On behalf of the u. S. Senate, karina, i thank you for your decision to join us here today and your service to the country. Today well also question dr. Stewart smith who leads the i. C. E. Health Service Corps<\/a> and is responsible for all medical care provided to all i. C. E. Detainees nationwide. Dr. Kuthari, the d. H. S. Inspector general, and dr. Pamela hearn, medical director for lasalle kreks. Among the questions we will ask today, why are doctors who treat detainees not properly vetted by the department of Homeland Security<\/a> when such a vet would have revealed in this case that the doctor in question had been previously sued by the department of justice and the state of georgia for performing excessive and unnecessary procedures. Had been dropped by a major insurer for excessive malpractice claims. And was not Board Certified<\/a>. What Due Diligence<\/a> did the department of Homeland Security<\/a> perform in signing off on each of these procedures . Because indeed, they did sign off on each of these procedures. Why was the inexplicably high number of surgeries performed by a single physician, not a red flag that attracted greater scrutiny . What responsibility is borne by the private Detention Center<\/a> operator for mistreatment of detainees housed in their facilities when that misdream occurs at an offsite medical facility. All these and more will be the subject of vigorous questioning today. Senator johnson will be joining us later in the hearing and at this time id ask unanimous consent to enter his Opening Statement<\/a> into the record. We will now call our first panel of witnesses for this afternoons hearing. Ms. Karina cisneros precioada was formerly detained at the center in georgia. Doctor rooney was engaged to review medical records of those treated. He will be testifying remotely. Dr. Margaret muler is a medical expert and physician who was part of an independent medical review team that conducted a review of medical records for detainees treated by dr. Amin. I appreciate all of you for being with us today and look forward to your testimony. The rules and custom of the subcommittee require all witnesses to be sworn in. So at this time i would ask you to please stand and raise your right hand. Do you swear that the testimony you are about to give before this subcommittee will be the truth, the whole truth and nothing but the truth so help you god . Let the record reflect the witnesses answered in the affirmative. You may take your seats. We will be using a timing system today. We ask that you try to limit your Opening Statement<\/a>s to around five minutes, but if you need a bit more time its not a problem, just let me know. Ms. Cisneros preciado, thank you for joining us, and if youre ready, well hear from you first. Karina thank you for the opportunity to share my story with you today. I was brought to the United States<\/a> when i was 8 years old. I am now a 23yearold mother of 2. I have a 1yearold and a 2yearold. When my daughter was 4 months old i called the police to stop ongoing abuse from her father. This led to me being arrested and even though the charges were dropped i still ended up at icbc for almost seven months away from my dawrk away from my family. At icbc i became 72176 instead of karina. At icdc, i went through hell. This place was extremely filthy. The showers were moldy. The water cooler where we drank water from, there was mold in the spout. We were given dirty and used underwear to wear. At icbc i seek help, medical help because i had not had my postpartum checkup from my daughter. After several requests i finally got an appointment to see a doctor. The nurse told me i was going to get a pap smear. When the day came, they handcuffed me, they put a chain around my waist, all the way down to my ankles. When we arrived at the clinic, we were taken in one by one by an escort and the rest stay in the car with another officer. In the clinic they took my blood pressure, my temperature, my weight, with my handcuffs still on. Once in the room they took my handcuffs off so i could get undressed. When dr. Amin comes in, he doesnt acknowledge me. He doesnt say a word. He just sits in front of me and starts prepping for the procedure which he does not explain. Then, he just says, open your legs. And continues with, its going to be cold. And inserts a white tube instead of me. Inside of me. He wiggles it around roughly. It was extremely uncomfortable. As im about to look at the monitor thats next to me he immediately pulls it out and tells me i have a cyst on my left ovary and im going to get a depo shot for it and if it doesnt dissolve in four weeks i have to come back for surgery. Then he asks the nurse how many more. And he just walks off. I get dressed and they put the handcuffs back on and another nurse comes in and she gives me the shot on my arm and makes me sign a paper which i dont i didnt have a chance to read it or hold it. I was in handcuffs. I just signed it. Back in the van, the other women asked me if i had gotten the shot to not have babies as well. I didnt know what it was, it wasnt explained to me. Thats when i learned it was Birth Control<\/a> and if i would have known, i would have said something as the woman the women in my family had very bad experiences from Birth Control<\/a>. Back when we get back to icbc i learn the story of many other women the doctor told the same thing to. They all had cysts on their ovary, all had shots, some even got surgeries. I thank god that the news came out because he didnt get to do anything else to me. The reason im telling this story is because this shouldnt happen to anyone anymore. Were not were not animals. Were human. Were not just a number. Thank you for your time. Senator ossoff thank you. Dr. Mueller, well hear from you now, please. Dr. Mueller thank you. Senator ossoff, senators, staff senator oreceive make sure senator ossoff make sure your microphone is on, please. Dr. Mueller is this better . Thank you. The first thing i want to do is take this opportunity to praise karina for her courage and bravery for coming today. Although difficult to hear and heartbreaking, it certainly gives voice to the medical records that i reviewed and my colleagues reviewed as well. My name is margaret mueller, im a physician and i hold specialty board certification in ob gyn and subspecialty board certification in female pelvic medicine and Reconstructive Surgery<\/a>. I have a faculty appointment at Northwestern University<\/a> where i serve as Program Director<\/a> for the female public medicine and Reconstructive Surgery<\/a> fellowship. I was part of an independent medical review team made up of nine other Board Certified<\/a> ob gyns and two nurse practitioners. In 2020, we reviewed the medical records of 19 women who alleged medical abuse and mistreatment wile in detention at Irwin County Detention Center<\/a>. Since that summary was prepare and publied ive reviewed additional medical records that make it clear that this pattern of mistreatment and abuse was not limited to those 19 women. Our findings identified a disturbing pattern of overly aggressive gynecologic care many times involving unnecessary diagnostic procedures and in some cases unnecessary or inappropriate surgical procedures. Often significant steps in the appropriate evaluation and management of common gynecologic qurns completely omitted leading to unindicated procedures. Our review, more concern glirk identified serious failure by the facilityassigned gynecologist to obtain meaningful informed consent from the women he was treating. The unindicated and underconsented procedures including transvaginal ultd rah sounds, a procedure in which a woman is undress fled waist down and a medical professional inserts a wand or probe into the vagina to image the reproductive female organ, uterus, cervix, fallopian tubes an ovaries. Pap smears, where a woman is undressed if the waist down and a medical professional inserts a speck lum and a brush is used to exfoliate cells to send to the the pathologist. A procedure in which this is typically performed in the office however under dr. Amins care it was performed in the operating room under anesthesia where a speck lum is inserted into the vagina and electric cautery is used to burn or remove or cauterize a significant portion of a womans cervix. Dilation and curettage which you heard about, a surgical procedure performed again in an operating room under anesthesia where a speck lum is inserted into the vagina and instruments are used to open a womans cervix, obtaining access to the endometrial cavity or inside of the uterus. Once that is done scene rat instrument is used to scrape the inside lining of the endometrial cavity to provide a pathologic specimen. Finally, laparoscopy, a surgical procedure in the operating room under general anesthesia where one or more small incisions is made in the oabd, a camera is introduced and different instruments are used to either remove or repair tissue or organs. Additionally in several cases women actually had incorrect procedures performed by dr. Amin. These incorrect procedures resulted in nurmt one, a woman being inadequately treed for a Cervical Cancer<\/a> and number two, a reproductiveaged woman undergoing unnecessary removal of a significant portion of her cervix. Just as examples. Due to these incorrect procedure, both women and expect to require further and future procedures and monitoring none of which would have been necessary had the appropriate procedures been done in the first place. All of these procedures involve risks. Those risks are those that are directly attributed to procedure, for example, an injury to a bowl or portion of the intestines at the time of a laparoscopic procedure, and pose downstream consequences. Preterm birth or labor following a procedure or infertility and fertility implications following a d c. These unnecessary medical procedures were performed without an adequate consent which means more than just placing a signed consent form in a chart but a documentation of an appropriate discussion of less invasive options that might be appropriate for the management for a patient, us that signifying a meaningful shared Decision Making<\/a> discussion between a patient and her physician. This lack of adequate informed consent was apparent for our from the medical records but krb rated further by the stories like you heard from karina where it was identified that there was a total absence of shared Decision Making<\/a> in the process between the patient and the physician. Informed consent discussion should explore number one the patients symptoms and degree of bother from those symptoms, number two, the full raining of Treatment Options<\/a> available for a specific condition ranging from least invasive, for example, observation if appropriate, to most invasive, as an example, surgery. And then finally the risk, the benefits and alternatives of all those proposed management strategies. Importantly if a patient has no symptoms or has or if a particular surgery is unindicated than the then the intervention exposes the patient to unwarranted risk without any medical benefits. Finally, many of these concerns are magnified by the vulnerable nape of these women. As you heard many of need women identify as trauma survivors, several report a history of either rape, sexual abuse or Sexual Assault<\/a>. All were incarcerated and unable to choose a medical professional with whom they felt comfortable. In that setting these women were forced to relen quish their autonomy and their decision to participate in their own medical care. Autonomy is one of the four pillars of medical ethics and represents a patients right to make decisions regarding her health care. Without the medical provider trying to unduly influence her decision. More simply stateds the right to refuse or choose medical care without the fear of retaliation. By nature of their these women d not have a choice. Some were retaliated against if they asked for a second opinion. This further compounds the pattern of care we identified. The manner in which these women were treated as they were subjected to aggressive, unnecessary, unindicated and incorrect procedures and procedures often without any benefits and usually without informed consent is unacceptable by my standard and cannot be allowed to happen again. Thank you for your investigation and your time today. I look forward to your questions. Senator osoff thank you for your testimony. And dr. Cherouny will be joining us remotely. Dr. Cherouny good afternoon. My name is Peter Cherouny<\/a> and professor at the university of vermont in the department of object stet particulars and gynecology call sciences. I have sent in a c. D. And i previously been involved with the United States<\/a>government as you have heard as well as internationally including the review that was mentioned. I will try not to be repetitive. As most of us if everything dr. Mueller said was correct and i was asked to review the care to immigrants within the United States<\/a> immigration and Customs Enforcement<\/a> custody at the Irwin County Detention Center<\/a>. It included from the Detention Center<\/a> from Irwin County Hospital<\/a> and the provider records dr. Amin. I wasnt involved in the selection of the patients records and i dont have knowledge of the accessibility of the patients from this Detention Center<\/a>. My time is limited and move onto the summary. The main part of concern as you have already heard is the use of inhospital procedures regarding things as men truly pleading. Dial d and c of the utter russ and exploratory laparoscopic procedures to look at the pelvis and evaluate whats going on. These have been replaced by outpatient medical Treatment Options<\/a> in order to establish diagnosis. The provider does use some of these diagnostic tools and often incorrectly and without adequate documentation to be useful. The use of shots for the management of menstrual bleeding without allowing time for an assessment. Also, vaginal ultrasound does not follow guidelines for either performance or documentation proposed by our professional such as the instyte of ultrasound. He removed benign leagueses such as f. B. I. Rhode islands of the utter russ. And and using a magnifying glass to better visualize abnormalities which have been reported on a pap smear and surgical removal of a small piece of tissue from the cervix to get path logic evaluation from the pap smears no useful tissue for diagnosis that could guide further care. And thats the whole point of the procedure within the diagnostic care. Other concerns i can expand on it, if you like during questioning regarding treatment of vaginal fin if he canses and and diagnosis of endoe mimi tree owes is and options for care and consent are noted. Thank you for the opportunity to help in the Quality Assessment<\/a> of quality of care for this population. Senator osoff thank you for your testimony and thanks to dr. Cherouny and dr. Mueller for the hours of work in helping the subcommittee understand the records we have secured. We will turn to firstround of questions and i will be asking the first questions. Ms. Preciado. I thank you for your testimony and presence here. It is deeply appreciated and took courage and im grateful and sharing what you have been through with the American People<\/a>. I want to review about your story and how you came to be detained at Irwin County Detention Center<\/a>. You were brought to the United States<\/a> when you were just a child, is that right . Ms. Preciado yes. Senator osoff how old were you . Ms. Preciado eight years old. Senator osoff have you ever known a home other than the United States<\/a> . Ms. Preciado no. Senator osoff you currently live in florida and mother of two children . Ms. Preciado yes, sir. I have a boy who is one and my daughter is two. Senator osoff before you were detained, did you ever have any trouble with the law . Ms. Preciado never. Senator osoff you were in an abusive spousal relationship, correct . Ms. Preciado yes. Senator osoff you called the police during the incident. But rather than arresting your partner, you were arrested. Ms. Preciado yes. Senator osoff you wound up at Irwin County Detention Center<\/a>. Ms. Preciado yes. Worst place i have ever been in my life. I went from being a mother to just being a number. They didnt care ourselves or our needs and didnt care about none of that. Senator osoff you had just given birth to your daughter, is that right . Ms. Preciado yes. Senator osoff three months beforehand. Ms. Preciado my daughter was four months. Senator osoff you were still breastfeeding your daughter. Ms. Preciado yes. Senator osoff you were taken from her . Ms. Preciado yes. Senator osoff how long were detained at ircounty county. Ms. Preciado almost seven months. Senator osoff seven months from your newborn daughter. Ms. Preciado yes. Senator osoff what was it like being reunited with your daughter after being released . Ms. Preciado a mixture of feelings, when i left her, she was just a baby. When i came to a baby. She knew my mother as her mother and was scared of me. She wouldnt come too me. It was hard, but it was the best moment because i got to see her after so long. I was crying for her every night and wishing i just would wake up anymore. I finally got to see her and it is extremely hard for me to be here because i left her again. And she is away from me right now and really hard for me. Senator osoff take your time. No problem. Now when you arrived at Irwin County Detention Center<\/a>, you had not yet had your postpartum exam, correct. Ms. Preciado yes. Senator osoff you required medical attention and you wound up in dr. Amins office. Ms. Preciado yes. Senator osoff how did that experience make you feel . Ms. Preciado made me feel like i had no control over my body. Before this experience, i had suffered from Sexual Assault<\/a> before as a child. So the experience with dr. Amin made me feel like i had no control over my body, no say, no vote. When he didnt explain the procedure and he was doing a vaginal ultrasound, i had that done before. I didnt think i could ask any questions. I was told by the nurse that i was getting a pap smear. He made me feel miserable. Senator osoff during that appointment, did dr. Amin address any concerns or ask any questions . Ms. Preciado no. Senator osoff he prescribed an injection. Ms. Preciado yes. Senator osoff dune what the injection was . Ms. Preciado i learned in the car when one of the other woman told me what it was. Senator osoff other women had experienced a similar pattern of treatment from dr. Amin. Ms. Preciado yes. Senator osoff did anyone ask for your consent to receive that shot . Ms. Preciado i signed the paper, but i didnt know what it was. They told me, sign here. And i didnt have a voice. So i just signed. Senator osoff dr. Mueller, you reviewed extensive medical records. And one of the things i think is important to make clear is that the experience that ms. Preciado is no means and consistent with a pattern in the care provided by this doctor to women who were incarcerated and to women who are powerless. How, what, ms. Preciado conforms with the pattern you saw in the medical records and reflect as a moment as a practitioner on the particular sensitivity required when treating people who are incarcerated and i willied to senator has and for hassan. Dr. Mueller she does give voice to the medical records. This was repeated over and over and over again. Almost all of the women who came to see him for a concern or something unrelated, received a shot for unclear indications, received pap smear when they didnt need a pap smear and managed incorrectly or inappropriately following that. I am a medical expert. My role is to review the medical records, but it was such a concerning pattern and gave you pause and i am starting to understand perhaps why this is happening. Karina mentioned and gave further insight this is a very population, this is not like your mother or sister and look to see who has the best reviews or see a provider for the first time and see if she feels comfortable to put her care in their hands. This is not a provider that many of these women would have ever wanted to go back to. Clearly he did not take this seriously. He was not operating from a standpoint of providing traumainformed care realizing this is a vulnerable population, taking a history indicating that a woman has been a victim of a Sexual Assault<\/a>. This is basic standard medical school equivalence to performing a basic history and physical. And without that, you cannot have a meaningful informed consent because you have no understanding of the risks you might be exposing a patient to and their medical history. Senator hassan. Senator hassan thank you for holding this hearing and to the investigation. To ms. Preciado, thank you for coming forward. It is extraordinarily difficult to do what you are doing and share such personal information. I hope you will take solace sharing information in the way you are sharing it, we are able to move forward and change. Your courage is remarkable and making a difference for others. I hope a little bit more solace today. It is difficult to know. It was disturbing to hear and read your system on a number of levels. But i was very concerned that you didnt have a chance to ask any questions when you were seen by dr. Amin and couldnt say no what he planned to do. I want to follow up on senator osoffs questions. Did dr. Amin ask questions about your medical history or whether you had previous sifts . Senator hassan dr. Muellers testimony says, if a patient has no symptoms not bothered by her storms or surgery is not indicated, then that exposes the patient to unwanted risks without any benefits. The doctor expected a large number of invasive procedures. 90 of four types of invasive procedures performed on all i. C. E. Detainees were performed by dr. Amin despite 4 of the National Detainee<\/a> population. Dr. Mueller, what is your best assessment why a doctor would perform extreme measures on these women . Dr. Mueller as a medical expert, i can review the medical records and tell you if this was beneath the standard of care, what is typically done. It is difficult for me to comment on the motivation behind that type of medical care, but i do think that you shed light on the potential motivation and i think that potential motivation could include billing, et cetera. Again, my role as a medical expert is to comment on the medical records, but just as a person i would survive that. Senator hassan it is clear that it is sometimes better for actual procedures as opposed to consultations, is that an assessment or statement you generally agree with . Dr. Mueller depending on the contract setup. If this is something that is a reimbursement incentive for the amount of procedures, that would be motivation. Senator hassan dr. Cherouny, do you have an assessment why the doctor would perform an invasive procedure on these women . Chon chon coming from the dr. Cherouny when we look at Quality Improvement<\/a> and assessment we do inclued punishment and get quality information to do an assessment and improvement. Simply a lack of knowledge or a way to move forward are reasons. Certainly using what would have been somewhat standard medicine 30 years ago, perhaps and what we have today, there is dramatic improvement in both medical care, in other words, not Surgical Care<\/a> and medical imaging. It has really helped and can drive a better assessment of surgical necessities, which really cant say was used in this case, and vaginal ultrasound is what he used, sometimes at the hospital. But most times in his office. Just a lack of documentation that was hard to say it was successful and helped with the care of the patient other than finding the nine leagueses which he used as indications for surgery, which is outside the current quality demand of gin quoll lag call air. Senator hassan your testimony you and the medical review team found a disturbing medical care sometimes ininvolving unnecessary procedures. Some women presented with symptoms that were not evaluated, diagnosed or are are the patient undergoing medical procedures. Could you elaborate on what information should be shared with the patient . What requirement or expectation is there regarding possible language barriers as well . Know and based on the report that women detained at the icdc have received a far lower level of care that they should have received. Based on your testimony, the work of the medical review team and this subcommittees investigation, it appears as though many, if not most, patients seen by dr. Amin have little to no discussion of their conditions or alternative Treatment Options<\/a>. Werent these women titled to a higher level of care than they received, including at least a reasonable discussion of their conditions and possible Treatment Options<\/a> . Dr. Mueller absolutely. I find this to be a grave miscarriage of justice that these women were exposed to this type of treatment. Sen. Hassan i appreciate that. I regret the circumstances that bring us here today but i am very, very grateful for your testimony and all of the witnesses. Thank you. And thank you, mr. Chair. Thank you, senator hassin. Dr. , wed hassan. Dr. , wed like to turn to you to discuss the potential longterm consequences of surgery and other gynecological procedures that are not medically indicated on these women. Women and iowa to remind everybody again, we are and i want to remind everybody again, were talking about dozens of cases that the experts here have reviewed in which incarceratedded women were subjected to unnecessary, often nonconsensual and extremely invasive gynecological procedures and surgeries. Invass and surgeries. This is one of the most outrageous things that this committee has investigated and i think it would be helpful if you could discuss what the longterm risks, longterm impacts on health, physical and Mental Health<\/a> can be from that kind of mistreatment. Dr. Cherouny take a small step back and just say that a large number of these procedures have been changed to the point where we can do outpatient evaluation to find the appropriate diagnostic issues with a given patient. What was used here was the d and c and laparoscopic evaluation in the abdomen were invasive procedures and large times were benign issues which did not require intervention or were not evaluated close enough to see if that was the patients complaint. When that happens, there are a number of things that occur and dr. Mueller has testified to. Shortterm infection, pleading, as long as scarring around the reproductive organs and could be infertility and scarring that could be consistent longterm pain. These are things that are not insignificant and which is why medicine has tried to minimize the necessity of these procedures over the course of decades to get to the point where we can identify the individuals where the risk benefits show up and the potential risker. Again, vast majority of these risk benefit than the one ha that is to evaluate. And overall benefit from one of these procedures. Senator osoff thank you for your service. Ms. Breeze addo, if there is anything you would like to add and the American People<\/a> to hear, the floor is yours. Ms. Preciado because of this incident with happened with dr. Amin, i am extremely scared to go to any doctor for myself and for my kids. It was extremely traumatic. And i dont know if i can get over it and scared to take my kids to the doctor. It was horrible. And the reason im sharing my story because i dont want to have it happen to any other person. They shouldnt be separated from their family or be scared to go to the doctor when we are supposed to be able to trust them. Thank you. Senator osoff thank you. That concludes the first Witness Panel<\/a> at todays hearing. We will take a brief recess and welcome the second panel to the witness table","publisher":{"@type":"Organization","name":"archive.org","logo":{"@type":"ImageObject","width":"800","height":"600","url":"\/\/ia801501.us.archive.org\/19\/items\/CSPAN_20221116_224200_Fmr._Detainee_Testifies_on_Medical_Care_While_in_ICE_Detention\/CSPAN_20221116_224200_Fmr._Detainee_Testifies_on_Medical_Care_While_in_ICE_Detention.thumbs\/CSPAN_20221116_224200_Fmr._Detainee_Testifies_on_Medical_Care_While_in_ICE_Detention_000001.jpg"}},"autauthor":{"@type":"Organization"},"author":{"sameAs":"archive.org","name":"archive.org"}}],"coverageEndTime":"20240619T12:35:10+00:00"}