Unpacking allegations of forced hysterectomies at immigrant detention centers. – Slate

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Allegations surfaced late Monday that—among other alleged abuses of detained immigrants at the Irwin County Detention Center in Georgia—female detainees are being given forced hysterectomies without their consent. The allegation comes from a complaint filed on behalf of a nurse who worked in the detention center, by the nonprofit Project South, along with three other nonprofits, Georgia Detention Watch, Georgia Latino Alliance for Human Rights, and South Georgia Immigrant Support Network. The allegations in the complaint, which was directed at the inspector general of the Department of Homeland Security, are shocking and disturbing. Dawn Wooten, the whistleblower and a former nurse at ICDC, said that she was concerned that many women had received the procedure without being spoken to in their native language or being told why they were getting the surgery. The story elicited calls for investigation, due to the horror of the allegations and the limited corroboration for the claims that immigrants had indeed received the hysterectomies without proper process.

The complaint was first reported by LawandCrime.com, a website run by attorney and television personality Dan Abrams. That report is entirely sourced from the filed complaint and mostly focuses on the lack of proper COVID-19 protocols, but the LawandCrime.com headline focused on the alleged sterilizations—“ ‘Like an Experimental Concentration Camp’: Whistleblower Complaint Alleges Mass Hysterectomies at ICE Detention Center.” The story was widely shared on Monday night, and as of Tuesday, multiple other news outlets covered the allegations. Thus far, no one has obtained direct corroboration from women who allege they were forced into a hysterectomy. On Tuesday night, the Intercept published a story on the allegations around the hysterectomies that quoted several anonymous women staying at ICDC who shared stories about how they felt they had been pressured into having a hysterectomy, and who noted that they were frequently forced to go without an interpreter, but it was unclear if they had gone through with the procedure.

In the complaint, the allegation about the high rate of hysterectomies is listed as part of the fourth section detailing the “general lack of medical care,” following three sections that mostly focused on lack of proper COVID-19 protocols. The complaint does not directly quote women who experienced a hysterectomy but relies on the testimony of a detained woman who said she had spoken to many women who had had hysterectomies and that many of those women seemed confused about the procedure. The complaint also includes testimony from Wooten, who said she was concerned about what she perceived as a high rate for the procedure at ICDC and the problematic circumstances that seemed to surround the procedure. Wooten tells the story of a young woman who was supposed to have a cyst removed from her left ovary, but the doctor accidentally removed the right ovary. The woman had to go back to have the left ovary removed, which meant she “wound up with a total hysterectomy.” Wooten gave a statement in which she claimed that there is a doctor treating the detained women who she described as “the uterus collector,” saying, “Everybody he sees, he’s taking all their uteruses out or he’s taken their tubes out.” The organization’s legal and advocacy director, Azadeh Shahshahani, told Vox that though the group knew the identity of the doctor in question, it had decided not to release his name publicly yet.

There are very good reasons to proceed cautiously, given the current level of sourcing. At the same time, the cases in Georgia would not be unprecedented if proven true.

In a statement issued on Monday evening to the Atlanta Journal-Constitution, Immigration and Customs Enforcement refuted many of the claims in the account, stating that “ICE epidemiologists have been tracking the outbreak, regularly updating infection prevention and control protocols, and issuing guidance to ICE Health Service Corps (IHSC) staff for the screening and management of potential exposure among detainees.” ICE further responded to the Law and Crime story by saying that it does not comment on matters referred to its inspector general but that “in general, anonymous, unproven allegations, made without any fact-checkable specifics, should be treated with the appropriate skepticism they deserve.” But the point of the whistleblower complaint is not to prove the allegations themselves. The point is to sound the alarm and raise questions—in fact, Wooten’s complaint urges “a prompt and thorough investigation into these practices at ICDC as well as all other LaSalle operated facilities.” The Office of the Inspector General has not said whether it will open a probe, but Speaker of the House Nancy Pelosi issued a statement Tuesday calling for immediate investigation, noting that if the allegations are true, they represent “a staggering abuse of human rights.”

Further investigation is clearly warranted; the key question here seems to be how likely it is that the allegations are true. There are very good reasons to proceed cautiously, given the current level of sourcing. At the same time, the cases in Georgia would not be unprecedented if proven true. It’s difficult not to layer the prospect of forced sterilizations against the long, troubling history of mandatory forced sterilizations that were blessed in 1927 by the Supreme Court in Buck v. Bell. That case featured Oliver Wendell Holmes’ now infamous assertion that, “three generations of imbeciles are enough.” At least technically, America’s experimentation with eugenic sterilization culminated in the U.S. Supreme Court’s 1942 decision in Skinner v. Oklahoma, when the high court finally rejected eugenic sterilization as a legitimate state goal and recognized that procreation “involves one of the basic civil rights of man.”

But it hardly stopped there. Allegations of forced sterilization are often complicated to prove, as the procedure is often connected to other medical procedures and it can be difficult to determine whether it was medically required and whether consent was acquired ethically. From this perspective, America has a long history of forced sterilization directed at different ethnic and racial groups depending on the time and region of the country, even after Skinner v. Oklahoma. To understand the oft fraught circumstances surrounding these scenarios, and the barriers women face in attempting to get legal redress, it’s useful to look at Madrigal v. Quilligan, a case on mandatory sterilizations that were performed on poor and minority women in the 1970s. The case was unpublished (any decision can be), but San Francisco School of Law professor Maya Manian has contributed some shocking and must-read scholarship on the case. From Manian:

In 1973, twenty-three-year-old Consuelo Hermosillo arrived at the Los Angeles County USC Medical Center in the midst of labor. In an effort to persuade her to sign a consent form for sterilization, medical staff claimed that she was “high risk” and could die from another pregnancy. While enduring labor pains and waiting for a cesarean section to be performed, a nurse told Hermosillo that her cesarean surgery would not proceed until she consented in writing to a tubal ligation. Fearing that her baby might die if she did not consent and unable to stand the pain any longer, Hermosillo signed the consent form. She was so upset about signing the form that she “said a bad word.” Years later, Hermosillo described herself as “a bird who wants to fly and has had its wings cut.”

Hermosillo was one of 10 women who eventually filed a lawsuit alleging that medical personnel at the L.A. County USC Medical Center, which operated a busy maternity ward serving low-income and immigrant populations, systematically coerced similarly situated Mexican American women into submitting to sterilization. Antonia Hernández, a recent UCLA law school graduate, and Charles Nabarrete, two Mexican American attorneys at the nearby Model Cities Center for Law and Justice, took on the case, interviewing, as Hernández later said, almost a hundred women. During these interviews, Hernández was forced to ask, “Do you know you were sterilized?” She further said that “some of them knew, but they all had the misconception that their tubes were tied but could be untied.”

These women’s stories demonstrate the complicated nature of gaining appropriate consent for these procedures, and the complicated nature of proving the abuse.

Eventually the so-called Madrigal Ten brought suit, alleging that doctors at the medical center coercively sterilized each of them between June 1971 and March 1974. As Manian writes, “all of the ten cases involved women whose primary language was Spanish; each of the women underwent a tubal ligation after childbirth by cesarean section. Nurses and physicians exploited the fact that the women had limited English language skills and were seeking medical care for childbirth in several ways.” Further, the 10 women had all been “approached for consent to sterilization while in the midst of labor, some after being heavily medicated, and pressured into signing English language consent forms that they could not understand.” Moreover, “most of the women had to resist multiple requests by multiple staff to submit to sterilization.” One plaintiff, Georgina Hernández, refused to sign the consent even though a doctor told her “the Mexican people were very poor and that she should not have any more children because she could not support them.” She signed a consent solely for a cesarean operation, but before going inside the operating room, the doctor claimed she had agreed to be sterilized. Georgina Hernández later recalled: “And this lady came, I don’t remember seeing her face, I just remember her voice telling me, ‘Mijita, you better sign those papers or your baby could probably die here.’ ” Hernández learned that she had been permanently sterilized three weeks later at her post-delivery examination.

These women’s stories demonstrate the complicated nature of gaining appropriate consent for these procedures, and the complicated nature of proving the abuse. Imbalances of power, authority, language barriers, and the fact that signatories may be under duress all complicate the claims. Some of the women in the Madrigal Ten never signed any consent form to be sterilized; their doctors simply waived consent based on asserted exigent circumstances. The Madrigal Ten filed their suit in 1975, and as Manion notes, the case “galvanized Chicana feminist activism in ways that highlighted tensions between mainstream white feminists and women of color.” As she writes, “in the 1960s and 1970s, white feminist groups focusing on reproductive rights emphasized the right not to become a parent, but women of color during this same time period began fighting for a broader conception of reproductive justice. While white feminist activists argued for unimpeded access to sterilization, contraception, and abortion, women of color sought to change the conversation on reproductive rights to include their concerns about abusive practices designed to restrict racial minority women’s reproduction.”

Eventually the trial judge, U.S. District Judge E. Avery Crary, granted a preliminary injunction against the California Department of Health, ordering state health officials to rewrite Spanish language sterilization consent forms to a sixth-grade reading level (they had been written at a 12th-grade reading level). State regulations were later amended to add a 72-hour waiting period prior to sterilization procedures. While the case was pending, the U.S. Department of Health, Education, and Welfare also issued new guidelines requiring any hospitals receiving federal funds to have bilingual consent forms and a monitoring program to ensure compliance with the new regulations.

The second phase of litigation involved compensation for the victims. Crary died in 1978, and the case was transferred to Judge Jesse W. Curtis. After extensive evidence of abuse was presented at trial, Curtis ruled against the Madrigal Ten. In his opinion, he said that he failed to see how the case as a whole exposed a broader pattern of abuse at the medical center based on gender, race, and class. He refused to find a discriminatory pattern and opted to view the case as 10 distinct random occurrences, in which each woman’s story was explained away because the attending physician believed that the patient “consented based simply on a signed consent form or other medical documentation.” Curtis summarized the case as “essentially the result of a breakdown in communications between the patients and the doctors.” He found that:

There is no doubt that these women have suffered severe emotional and physical stress because of these operations. One can sympathize with them for their inability to communicate clearly, but one can hardly blame the doctors for relying on these indicia of consent which appeared to be unequivocal on their face and which are in constant use in the Medical Center.

The 9th U.S. Circuit Court of Appeal’s decision denying the women’s request for redress is also unpublished. It was not until 2003 that the state of California finally apologized for its history of coercive sterilization, although it did not award any reparations. Almost 40 years after the litigation, historian Virginia Espino and documentary filmmaker Renee Tajima-Peña spoke to the women for the 2016 film No Más Bebés. Some of their lives were irreparably ruined. And of course, the tragedy hardly ended even there. As Manian notes in her article, “only ten years after California’s official apology for abusive sterilization practices, an independent investigation found that the state’s prison system had sterilized almost one hundred and fifty female inmates—most of whom were low-income women and women of color— without proper approval.” In other words, the allegations from Georgia, while not yet fully investigated or corroborated, are horrific, and they are most certainly not without ample precedent.

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