Procedures. A former detainee gave her personal account of being treated by doctors without her consent. She was joined by two physicians who independently reviewed other patients charts and records. This is just under two hours. The subcommittee on investigations will come to order. Before we begin, guess and viewers should be advised this hearing will discuss medical abuse the custody of u. S. Government and the subject matter deeply distressing and highly sensitive. Eighteen months ago i launched psi investigation focused on medical treatment of women detained by the department of homeland security. The investigation has been bipartisan start to finish and i would like to think i can remember johnson and his staff for their contributions. Our findings are deeply disturbing. Its bipartisan finding of the subcommittee female detainees in georgia were subjected by dhs contacted doctor excessive, invasive often unnecessary gynecological surgeries and procedures with repeated failures to obtain informed medical consent. This is extraordinarily disturbing finding and in my view, represents catastrophic failure by the federal government to respect basic human rights. Among the serious abuses, the subcommittee investigated during the last two years, subjecting female detainees to nonconsensual unnecessary gynecological surgeries is one of the most nightmarish disgraceful. The subcommittee has been thorough interviewing 70 witnesses and reviewing more than 540,000 pages of records and i want to thank and commend the staff who have worked on this for the last year end a half. The subcommittee engaged medical experts including doctor peter, ob gyn previously conducted medical reviews of other matters for the hhs Inspector General and independently review more than 16000 pages of medical records obtained by the subcommittee. The subcommittee subject mueller, extensive medical records related to the investigation. Both will testify today and i think you both for your service to thee subcommittee and the u. Senate. These medical experts reviewed conduct of doctor mahendra, ob gyn doctor contracted by the department for men security whose subjective female detainees to aggressive unethical gynecological care quickly scheduled surgeries when nonsurgical options were available, performed unnecessary injections and treatments and often proceeded without informee consent. In addition to this review of medical records, the subcommittee analyzed relevant data from ice and results of the analysis were shocking. For example, 2017 to 2020, doctor amin accounted for 6. 5 of all offsite ob gyn visits or all isa detainees nationwide. Yet during the same period, this single doctor according to ice statistics performed 82 of all dilation surgery, 93 of all contraceptive injections and 94 of all lever soccer surgery to remove lesions formed on the entire ice detainee population nationwide. We are very those statistics. 6. 5 of ob gyn visits, 82 the surgeries, 93 contraceptivepi injections, 94 laparoscopic surgeries to remove lesionse performed on the entire nationwide ice detainee population. The subcommittee sought an interview during the investigation and when he declined, we issued a subpoena. Doctor fleming invoked for a minute right to test testify and not spoken with the subcommittee. He will be joined by an extraordinarily courageous woman, karina cisneros. She 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. Although all charges against her were dropped she wound up detained at the Detention Center in georgia because of her immigration status. Four months earlier4, shed gin birth to her four month old daughter still breastfeeding at the time. Now forcibly separated from her infant daughter, karina had not yete received postpartum exam ad sought care while in detention. She was sent to doctor amin. As we will hear her encounter, it left her deeply disturbed ane 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, i thank you for your decision to join us today and your service toto the country. We will also question doctor stuart smith who leaves the ice Service Corps and responsible for all medical care provided to all isa detainees nationwide. Doctor joseph, dhs Inspector General and doctor pamela hearne, medical director of corrections. Among essential questions we will ask today, why are doctors who treat detainees not properly vetted by the department of comment security with such of that would have revealed in this case the doctor in question had been previously sued by the department of justice and the state of georgia performing excessive unnecessary seizures, dropped by a major insurer or excessive malpractice claims and not Board Certified . What do diligence to the of comment security perform signing off on each procedure . They did sign off on each procedure. Why wasrg inexplicably high numr of surgeries performed by a single physician, not a red flag that attracted greater scrutiny . What response ability formed by the private Detention Center operator for mistreatment of detainees house in their facilities when the mistreatment occurs at an offsite medical facility . All of these and more will be the subject of vigorous questioning today. Senator johnson will join us later in the hearing and i would ask unanimous consent to enter his Opening Statement into the record. We will call our first panel of witnesses for thiska afternoons hearing. Ms. Karina, formerly detained ae the owen county Detention Center in georgia doctor peter sharon, medical expert subcommittee engaged to duct a review of medical records of patients treated by doctor amine detained at the Detention Center in georgia. Hell testify remotely. Doctor Margaret Mueller is a medical expert and physician part of an independent medical review team that conducted a review of medical records for detainees treated by doctor amine. I appreciate all of you being with us today and look forward to your testimony. The rules and customs of ther subcommittee require witnesses to be sworn in so i ask you stand and raise your right hand. You swear the testimony you are about to get before the subcommittee will be the truth, whole truth and nothing but the truth so help you god . Of the record reflect answers in the affirmative, take your seats. Well use a timing system and w, ask you try to limit Opening Statements to around five minutes but if you need more time, not a problem, let me know. Thank you again for joining us. We will hear from you first. Good afternoon and thank you for the opportunity to share my story with you today. My name is karina, i was brought to the United States was eight years old, 23yearold mother of two and a 1yearold and a 2yearold. When myp daughter was four months, 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. Almost seven months away from my daughter, away from my family. At ac dc, i became 72176 instead of karina. At icbc i went through hell. This place was extremely filthy. The showers were moldy, where wh drank water from, there was mold in the spout. We were given dirty underwear to wear. At icbc, i seek help, medical help n because i have not had my postpartum checkup for my daughter. After several requests, i finally got an appointment to see a doctor. A pap smear. When the day came they handcuffed me and put a chain down to my ankles. When we arrived taking one by one by an escort and the rest with another officer. In the clinic they took my what pressure and temperature and weight with my handcuffed still on. Once in the room they took my handcuffs on offsite to get undressed. When doctor amine comes in, he doesnt acknowledge me, he doesnt say a word, he just sits in front of me and starts prepping procedure which he does not explain. Then he says open your legs and continues with its going to be cold and inserts a white tube inside of me. He wiggles around roughly, it was extremely uncomfortable. As im about to look at the monitor next to me, he pulled it out tells me i have a cyst on my left ovary and if it doesnt dissolve in four weeks i will have to come back for surgery. Then he said how many more . He just walks off. I get dressed and they put handcuffs back on and another nurse comes in and she gives me a shot on my arm and makes me sign a paper which 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 woman asked me if i had gotten the shots and if you have babies, i didnt know what was. It was now explained to me and thats when i learned it was birthcontrol. If i would have known, i would have said something as the woman in my family had bad experiences from birthcontrol. Getting back to icbc, i learned of the story of other women doctor amine told the same thing to, they had cysts on the ovaries and got shots and some even surgery. I got the news came out because he didnt get to do anything else to me. The reason i am telling this story is because this shouldnt happen to anyone anymore. We are not animals, we are human. We are not just a number. Thank you for your time. Thank you. Good afternoon. Senators and staff and guests. Could you ensure your microphone is on . You will see a green light. It is lit up his is better . Yes. Thank you. Thank you. The first thing i want to do is take the opportunity to praise karina for her courage and bravery coming today. Although difficult to hear and heartbreaking, it gives voice to the medical records i reviewed and my colleagues reviewed asol well. My name is Margaret Mueller, im a physician and i hold special board certification obgyn and sub board certification in Reconstructive Surgery. I have a faculty appointment at rvnorthwestern University School of medicine where i serve as a Program Director for the female public medicine Reconstructive Surgery fellowship. As mentioned, i was part of an independent medical review team made up of nine other Board Certified obgyns and nurse practitioners. In 2020 we reviewed medical records of 19 women who alleged medical abuse and mistreatment while in detention at urban county Detention Center. Since that was prepared and published, i reviewedional medical records that make it clear this pattern of mistreatment and abuse is not limited to the 19 women. Our findings identified a disturbing pattern of overly aggressive gynecologic care, many times involving unnecessary diagnostic procedures and some cases unnecessary or inappropriate surgical procedures. Often significant stepsps in the appropriate evaluation management of common gynecologic conditions were completely omitted leading to an indicated unnecessary procedures. Our review work concerning the identified serious failure by the facilities signed gynecologist doctor amine to obtain meaningful informed consent from the women he was treating. The on indicated under consent of procedures including transvaginal ultrasound, a procedure in which a woman is undressed from the waist down and medical professional inserts a want or probe into the china and the reproductive female organs, uterus, cervix, fallopian tubes and ovaries, pap smears, a procedure in which a woman is undressed from the waist down and medical professional interest into the chinaty and exfoliates to send o the pathologist. A procedure in which typically performed and however, performed in the operating room center and is inserted into the regina, electrocautery is used to burn or remove or cauterize significant portion of a womans cervix. Dilation that youve heard about, a surgical procedure performed again in an operating room under anesthesia wears inserted into the regina and inserts are used to open it womans cervix obtaining access to the uterus. Once thats done a separate instrument is used to scrape the lining of the cavity to provide pathological specimen. Laparoscopy, surgical procedure in the operating room under general anesthesia where one or more small incision is made in the abdomen and the camera is introduced and different instruments are used to remove or repair tissue or organs. Additionally, several cases women had incorrect procedures performed by doctor amine. These resulted in number one, a woman and adequately treated for a cervical cancer. Number two, reproductive aged woman undergoing unnecessary removal of significant portion of her civics. Just examples. Due to incorrect procedures, both can expect to require further future procedures and monitoring, none of which was necessary have the appropriate procedures been done in the first place. All of these procedures involve risks. Risks are those directly treated to a procedure for example, injury to a portion of the intestine at the time of laparoscopic procedure and those downstream consequences. Preterm birth were labor following the procedure or infertility applications falling this. These were performed without adequate consent which means more than placing assigned consent form in a chart but documentation of appropriate discussion of less invasive options that might appropriate for the management of patient thus signifying meaningful shared decisionmaking discussion for her position. In the medical records but corroborated further by the stories youve heard from karina, it was identified a total absence of shared decisionmaking is the process between the patient and physician. Informed consent discussion should explore number one, the patients symptoms and the full range of treatment available for specific condition from least invasion, observation is appropriate as an example surgery and fee strategies. Importantly, if a patient has no symptoms or no father by her symptoms or particular surgery is on indicated, the integration exposes the patient to unwarranted risk that medical benefit. In many of these are magnified by the vulnerable nature of these women. As you have heard, they identified as, survivors. Several reports history of rape, sexual abuse or Sexual Assault. All incarcerated on able to choose a medical professional with whom they felt comfortable. In that, these women were forced to relinquish autonomy and their decision to participate in their own medical care. Autonomy is one ofe the four pillars of medical ethics and represent patients right to make decisions regarding her health care. Without medical providers trying to unduly influence her decisions, or simply stated, its the right to refuse or choose medical care without fear of retaliation. By nature of their incarceration, they did not have a choice in what providers they saw. Some were retaliated against when asked for a second opinion. The concerning pattern of care we identified the manner in which they were treated as they were subjected to aggressive unnecessary indicated incorrect procedures and surgeries often without benefit and usually without informed consent is unacceptable by any standard. It cannot be allowed to happen again. Thank you for your investigation and your time today. I look forward to your question. Thank you for your testimony. Doctor will be joining us remotely. The subcommittee on investigations, the university of vermont and o the departmentf gaetano g. I did send in tv. I have experience in improvement medical care and previously have been involved within the United States government as well as internationally including in a few years ago. Ill try not to be repetitive and everything doctor wheeler said was accurate coming from the quality side. I was asked to review the gynecological care within the United States immigration Customs Enforcement custody of the Detention Center. Medical records included the Detention Center from the hospital and provider records. Ill mention i wasnt involved in the election of the review and i dont have accessibility to the patient from the Detention Center. Ill move on to the summary of. The main concern in providing care is in hospital procedures for patient complaints regarding bleeding or pain. The cervix in the uterus, a dnc, exploratory laparoscopic in the abdomen, placing a camera in the abdomen to evaluate what is going on. Proceed with definitive patient care. The provider uses some of these diagnostic without adequate documentation. And these shots with the management of regular bleeding without allowing time for therapeutical prevention. Also budget ultrasound, the provide does not have a guideline for item performance or documentation proposed by the organization because of the ultrasound and medicine. During the surgery, providers often perform removal of benign lesions and its not been shown through the patients complaints. On a few occasions, it is not a recommended treatment. Of additional concern, a pap smear management outside of guidelines documentation as well as cervical skills as you have heard of your limited for several patients. These are essential within the acare essentially using magnifying glass better visualize abnormalities previously reported on a pap smear and surgical removal from the cervix to get pathologic l evaluation from the pap smear and hope to stop impression. Of importance, her patients within the review there no followup is documented where the treatment resulted in no answer and thats the way the surgery was performed with no useful tissue for evaluation on a diagnosis that could guide for the care and thats the whole reason for the procedure within the diagnostic care algorithm pap smears. Other concerns i can expand on if youd like, questioning on one section, intrauterine Device Management and works, diagnosis of endometriosis and documentation of both. Thank you for the opportunity to assess improvement of care. Thank you for your testimony and thank you again to both of you for the many hours of work youve invested helping theee subcommittee understand the records weve secured. We will turn to a first round of questions for our first panel of witnesses and ill be asking the first questions. I want to