ICE failed to adequately document some major procedures, including hysterectomies, watchdog finds

Immigration and Customs Enforcement (ICE) had updated practices in light of a government investigation which found major surgeries for some detainees were not properly approved.

Immigration and Customs Enforcement (ICE) failed to adequately document the medical necessity of a number of major medical procedures — including at least two hysterectomies — a government watchdog found.

The Department of Homeland Security Office of Inspector General (OIG) launched the investigation after lawmakers raised concerns about whistleblower allegations of “mass hysterectomies” performed on detainees without consent.

That whistleblower’s claims, which sparked widespread outrage in 2020 when they were first made, accused one doctor of being a “uterus collector” and called one facility an “experimental concentration camp.”

The DHS OIG looked at 533 major surgical procedures conducted in fiscal years 2019 through 2021. 


When ICE facility staff determine the need for off-site care, they create an authorization referral, and if the provider recommends surgery, there is a separate authorization needed to be approved by an IHSC physician who is either a regional clinical director or a clinical director to ensure medical necessity. 

The watchdog found that between 137 and 214 procedures had not been approved by the required directors, meaning that the ICE’s Health Service Corps cannot be sure that all major surgeries were medically necessary.

Additionally, the OIG contracted with an obstetrician/gynecologist (OB/GYN) to determine the necessity of surgeries.

“Our contracted OB/GYN concluded that for two of six hysterectomies performed, the detained non-citizens’ IHSC medical files did not include documentation to support a conclusion that a hysterectomy was medically necessary,” the OIG found.

It stressed that the review was limited to six surgeries and that the conclusions “cannot be extrapolated to the population of major surgeries.”

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The investigation found that the surgeries were not always approved and reviewed, because guidance was vague and did not include clearly defined requirements — leading to some approvals being granted via email or verbally and not through the proper process. IHSC has since implemented a policy requiring that all procedures be reviewed and approved through the appropriate system, which had been recommended by the OIG.

In a statement to Fox, ICE said it “remains committed to ensuring all those in its custody receive appropriate medical care and are treated with respect and dignity.” 

It said it concurs with the report and noted the updated policies for the IHSC.

“IHSC current policies require Regional Clinical Directors and Clinical Directors to document their review and approval of major surgical procedures in IHSC’s electronic health records system. Specifically, planned major surgical procedures already require prior authorization review and approval documentation by either a Clinical Director, Regional Clinical Director, or their designee pursuant to directives published Dec. 19, 2022,” the spokesperson said.

The report comes as the U.S. continues to wrestle with a crisis at the southern border and a record 302,000 encounters in December. The administration is seeking more funding for ICE detention beds as part of a supplemental funding package. That deal is being held up as Republicans demand limits on asylum and the use of parole.

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