Last week, a nurse at a privately run immigration-detention facility in Irwin County, Georgia, filed a whistle-blower complaint alleging that women at the facility were undergoing hysterectomies without their informed consent. The whistle-blower, Dawn Wooten, filed her complaint to the office of the Department of Homeland Security’s inspector general, which is now investigating the claims; Immigration and Customs Enforcement has responded by saying that there are only records of two hysterectomies performed in the past two years on women at the facility, which is run by LaSalle Corrections. Several women have come forward to complain about their experiences of gynecological exams and procedures while at Irwin, and some have hired lawyers. Wooten’s complaint also states that the facility’s operators did not take proper safety measures for COVID-19; this was the subject of a separate complaint, made in July by another whistle-blower, about a LaSalle facility in Louisiana.
To discuss the whistle-blower complaint, and what we know about the Irwin County facility and ICE detention centers more broadly, I spoke by phone with Eunice Cho, a senior staff attorney at the A.C.L.U.’s National Prison Project. In 2016, she wrote a report for the Southern Poverty Law Center about ICE detention facilities across the South, which singled out Irwin for the low quality of its medical care. During our conversation, which has been edited for length and clarity, we discussed the greatest dangers that immigrant women face at poorly run facilities, how language barriers make detention and medical care even worse, and the ways in which the Trump Administration has exacerbated the already dire circumstances of ICE detainees across the country.
What do we know about ICE detention facilities, especially the ones that are contracted out, and especially in the South, if you think that considering these things in regional terms is helpful?
In the South, in particular, these facilities are known for harsh conditions and their remote nature. Recently, we put together a report at the A.C.L.U. called Justice Free Zones. It looks at the expansion of immigration detention under the Trump Administration. And the vast majority of that has happened in the rural South, in jails that have been emptied out by criminal-justice reform. So these are beds that are now empty, because of the decrease in the numbers of people in mass incarceration, and they’re now being filled with immigrant detainees. And the thing about these detention facilities, particularly in the South, is that they are notable for the fact that they’re incredibly remote, often hours away from the nearest metropolitan area. That means detainees are remotely located from friends, family, and any infrastructure of support, including legal support and other advocacy that can help support detainees in what they are facing in these facilities.
The fact that most, if not all, of these facilities are run by private-prison companies through contracts with local counties also reflects something about the economics. Many small counties have basically hitched their ride to mass incarceration. And they have now become dependent on ICE to fill those beds—and they see that as an economic engine for local economies, because the per diem in the South tends to be much lower. Basically, it takes much less to sustain these Southern facilities in general, across the board. The per diem is paid by ICE. It is a rate of payment per day for each person housed in a detention center. It usually covers the costs of housing, food, security, and onsite medical care. On average, the per diem for an ICE detainee is around two hundred dollars per day. But at contract facilities in the South, the per diem rate is regularly much lower than the national average, sometimes forty-five or sixty dollars per day. But what we see is very poor standards of care across the country with respect to ICE detention. There are even more corners being cut in these facilities because profit margins are even smaller.
Why did ICE begin subcontracting these facilities? Just to save money?
The expansion of ICE’s detention facilities basically hinges on the private-prison industry. So as of January, 2020, we found that eighty per cent of people in immigration-detention beds are in facilities that are either owned or operated by private-prison companies. And if you look at the number of detention beds that have been added under Trump, ninety per cent of those beds are owned or operated by private-prison companies. When I say owned or operated, that means that it can follow two models. One is, ICE will contract directly with a private-prison company like G.E.O. or CoreCivic, or it will contract with a local county that then turns around and contracts with a private-prison company, and takes a tiny bit off the top for the county.
What does medical care often look like at these facilities?
I think that medical care within ICE facilities raises concern across the board, whether they’re in metropolitan areas or whether they’re in a rural area, because what happens inside a facility is really subject to the problems that plague many correctional institutions in terms of poor medical care—under-staffing, lack of responsiveness to people with chronic-care issues, all of the things that happen in correctional and detention facilities nationwide. The problem for rural facilities, in particular, is that they’re located so far away from any medical infrastructure, including emergency care and trauma care, that when there’s a need for that sort of thing, it is going to be too late, or you are in a place where you have very underdeveloped medical resources in general. So there’s less ability to provide the necessary specialized care to people in detention.
How were you able to learn about the care at these facilities?
For those reports, the process is really going into the facilities and getting permission from ICE to do a tour. Members of the public and nonprofit organizations and legal groups may request the ability to tour the facilities and hold stakeholder interviews with people who are in detention. So what we have done is schedule those and go in and really be able to see what’s going on inside the facilities. The access that we have is, of course, not quite the same as if we were litigating against ICE, where the court is mandating that you are able to see documents and depose employees and that sort of thing, but it does give you a good sense of what is happening. Detainees always tell us, “The food is way better today. They’ve repainted the whole facility. They’ve cleaned everything up in advance of your visit.” But even given those cosmetic improvements, very serious violations and very serious issues with respect to conditions of confinement are usually visible.
What are some of the conditions you have found in your reports?
So in terms of medical care, what we’re finding is actually not very different from what the government inspectors have also found themselves. For example, at Irwin, the Office of Detention Oversight arm of ICE conducted reviews of the facilities. And what is notable about the government inspections is that they have actually been criticized widely, even by the office of the inspector general [O.I.G.] and the Government Accountability Office, for basically rubber-stamping and giving a free pass to many of these potential facilities. Because, as part of the appropriation framework, if a facility receives two failing grades on an inspection, the contract can be pulled. And ever since that provision was added, in 2009, only one out of a hundred facilities have failed inspections [according to a 2015 finding].
But what these oversight inspections have revealed is that medical care provided to detainees is substandard, and that people can go for weeks, if not months, with life-threatening conditions, without getting the proper medical care. People are typically told to take a Tylenol, or aspirin, or drink more water as the standard recommendation or response for any illness. It is very challenging to have a specialist’s care approved. And, in general, many detainees have reported that they are actually unaware of what is happening to them in detention because of poor translation in these medical appointments. We’ve had detainees tell us that they have no idea what’s happening. We’ve had many people who were detained say that they have been pulled in to come translate for other detained people in their medical care provided by ICE facilities, because the medical staff could not speak the person’s language, which obviously raises many issues regarding patient confidentiality. Even where there’s no bilingual staff, detention staff is supposed to be able to use telephone language lines, but that’s either not used or not actually very effective in terms of providing care sufficient for informed consent.
What is your view, broadly speaking, of the people who work at ICE facilities? Are these problems about resources and people being stuck in a bad position? Or is there really poor care and sadistic behavior going on?
I think that, at the end of the day, immigration detention is a system that’s set up to fail people’s medical needs, and their needs more broadly. These are institutions that are structured to pack in many people in crowded situations. The incentive is to provide people with the cheapest amount of care. And it’s a system predicated on vulnerability, on people who have very little agency and have very little recourse to hold any institution accountable. And when you have those types of conditions, it is bound to foster abuse. I think there are people who work at ICE detention facilities who are guards or who are medical staff who may not have very many other options for employment. And I think the psychology of working in a detention facility is very much like working at any other correctional or institutional facility, where there is a change that happens for people. Shane Bauer’s book, “American Prison,” is a very good example about what happens. That facility is actually now an immigration-detention facility owned by LaSalle, the same company that owns Irwin. [Bauer wrote about a private prison in Winnfield, Louisiana, called Winn Correctional Center; it now holds ICE detainees.]
Has there been any change in the culture of these places over the past four years, or since Trump’s election? Obviously some of your reports talk about conditions under the Obama Administration, when it was far from perfect, but has the culture change at the top had an effect?
Yes, for sure. I think it’s notable that this year has had the highest number of deaths in immigration detention since 2006, and the numbers of people who are dying as a result of suicide or alleged suicide is particularly disturbing. There’s a lack of mental-health care that is happening. But the most basic change, in addition to the fact that the Trump Administration has expanded the system so greatly in these rural areas, is the continued erosion of oversight and accountability of these facilities. The Trump Administration, last year, released a new set of detention standards that walked back protections and gave facilities much more leeway in terms of how detainees should be treated. We’ve seen oversight mechanisms, including facility inspections and the office of inspector general, become very much under the sway of Trump political appointees. ICE’s inspectors are not even going into the facilities to conduct their annual evaluations of the facilities. They’re just depending on papers that are provided by the facilities themselves. All of this shows a profound lack of interest or oversight in terms of the conditions of confinement at the facilities.
ICE has said that there were only two hysterectomies at Irwin in the last few years. What do we know about the record of Homeland Security to investigate these things generally? How much faith or trust do you have in that process?
I had some concern when I saw that it was only the O.I.G. that was conducting inspections of this situation. The O.I.G. has obviously come under fire recently for having been under the sway of political appointees that are quite in line with the Trump agenda. The latest reports that we’ve seen come out of the O.I.G. have lacked rigor, and, in terms of their findings, they have watered them down considerably. And what we know of the agency is that prior inspectors who have been able to really hold the agency accountable have now found it much more difficult to do their work.
The whistle-blower complaint also mentioned coronavirus, and another complaint accuses the same subcontractor of taking insufficient precautions against the virus at a separate facility back in July. What is it that we’ve seen at ICE facilities in terms of coronavirus generally?
Well, in the A.C.L.U., I’ve been litigating a number of cases. We’ve filed over fifty cases nationwide with respect to ICE’s handling of COVID-19 in ICE detention facilities nationwide. And what we are finding in that litigation and from reports across the country with respect to COVID-19, is that ICE has consistently either ignored the problem or denied the problem, and basically endangered people’s lives, whether it is detainees or people who are working in these facilities, as well as the surrounding communities. From the very beginning, there has been verifiable information that ICE had tests on hand to see who at the facilities had COVID-19. But ICE has actively discouraged employees from conducting those tests on detainees, so that it could avoid complications in terms of transfer logistics or reporting positive COVID cases in their facilities, bucking local public-health officials’ requests and internal-operation requests as well.
We’ve seen that ICE has willfully transferred people between facilities, knowing that they are positive for the coronavirus and that they are spreading COVID-19 across the country. The whistle-blower complaint substantiates that this also happened as the Irwin detention facility, where the warden and ICE officers were aware of people who tested positive, and despite that either transferred people or put them on a plane for deportation. It is simply impossible for people to practice the six feet of social distancing when they’re held in ICE custody, and all of these measures place people, especially those who are medically vulnerable, in great danger. [ICE did not respond to a request for comment about conditions at the Irwin facility.]
I don’t want to go beyond what we know, but is there anything that you feel we’ve definitively learned from what’s come out about this Irwin case so far?
I think what is happening at Irwin regarding the allegations of a high number of hysterectomies or other procedures that might inhibit reproductive capacity raises serious concern. And I think further investigation should really look at what the women who have had these procedures actually experienced. Why did they ask for medical care, and did the reasons that they needed medical care actually meet what happened to them? And did they understand what would be happening to them? And, at any point, did they feel that they could actually refuse treatment? I think what the whistle-blowers’ accounts reflect is the clear vulnerability, lack of agency, and ability to exercise full and knowing consent. People who come to the United States expect refuge or safety. And instead, if these allegations are true, they’re walking out of detention robbed of their ability to bear children, and they’re going to have to live with that for the rest of their lives.
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