The Office of Inspector General for the U.S. Department of Homeland Security (OIG) published a report last month finding that nearly one-third of medical procedures performed on immigrants in U.S. Immigration and Customs Enforcement (ICE) custody were not properly authorized.

The report found that ICE improperly authorized 32% of major surgeries performed on individuals in ICE detention without having gone through the proper procedure first. Due to ICE’s improper authorization, the OIG audit could not verify whether the surgeries were medically necessary. The report also suggests that the forced hysterectomies performed by medical staff to women detained at the Irwin Detention Center in Georgia were not isolated incidents.

One of the issues noted in the report was that approval for these medical procedures was not given by the appropriate medical staff. According to the report, the ICE Health Service Corp (IHSC), which provides medical services to people in ICE detention, requires major surgeries to be authorized by certain personnel with a specific level of training and expertise. They must have a medical degree or equivalent and at least three years of medical training leading to board eligibility or certification that distinguishes them from other medical practitioners.

The OIG’s review of a sample of 227 surgery reports found that in 72 of them, the surgeries were approved by the appropriate level of personnel, such as nurses or nurse practitioners.

The OIG report also describes the gaps in ICE’s record-keeping system that led to these systemic failures. For example, the IHSC did not have adequate protocols to authorize major surgeries. The IHSC developed a flow chart to obtain the required authorization, but the flow chart did not include a description of the steps to follow, leading to medical providers approving major surgeries via email or sometimes even verbally rather than the authorization being recorded in the electronic medical record system.

Back in 2020, reports surfaced that women at the Irwin Detention Center  faced forced and unnecessary hysterectomies. These reports were confirmed by an investigation from the Committee on Homeland Security and Governmental Affairs of the U.S. Senate in November 2022.

The new OIG report suggests that medically unnecessary hysterectomies also occurred at other facilities beyond the Irwin Detention Center. To investigate the adequacy of records on the medical necessity of major surgeries approved by IHSC, the OIG analyzed procedures within the field of obstetrics/gynecology (OB/GYN). OIG hired an independent OB/GYN doctor to review the medical files for the hysterectomies performed on women in ICE detention between fiscal years 2019 and 2021.The independent doctor reviewed the medical files of six procedures and found two cases  in which  “the detained noncitizens’ IHSC medical files did not demonstrate that a hysterectomy was the most appropriate course of treatment and was medically necessary.”

A footnote in the report states that the contracted physician could not review an additional case because the hysterectomy was conducted on a woman detained at the Irwin Detention Center, and it had been referred for a separate review by the Office of Investigations. This note suggests that the two hysterectomies for which there wasn’t documentation of medical necessity likely occurred at occurred at ICE detention facilities other than Irwin, indicating that the provision of unnecessary hysterectomies on detained women was not isolated to one problematic facility.

During its investigation, the OIG encountered the same problem transparency advocates have faced for years: the IHSC originally denied the OIG’s request for information and eventually disclosed limited data sets. ICE disputed the OIG’s assertion that it initially denied the request, claiming that ICE needed to extrapolate the data sought by OIG from a larger database that contained significantly more information because ICE did not have a data system explicitly dedicated to major surgeries. The OIG, however, affirmed its position that ICE’s initial rejection caused delays in the audit’s development.

Ultimately, the report admonished ICE to develop better protocols so that major surgeries for individuals in ICE detention are authorized by qualified medical professionals within the IHSC. Surprisingly, ICE agreed.

People in ICE detention all too often face atrocious conditions of confinement. This includes systematic substandard care and sanitary conditions that have been described as “unsafe” and “filthy” by DHS’ own oversight agency. It is appalling that immigrants in detention must also now endure the recovery from medical procedures deemed unnecessary or inappropriate.

In its response letter to the OIG report, ICE stated that it “strives to ensure detained noncitizens are housed in a safe, secure and humane manner.” Making sure that properly qualified medical professionals approve serious medical procedures, which can carry serious health risks, is but a small step to minimally improve conditions of confinement.

Further, ICE and DHS should do all they can to inform the public about how widespread this practice was and not pose barriers to oversight organizations and agencies investigating its practices. ICE should have learned this lesson from the forced hysterectomies at Irwin.

These steps are the bare minimum ICE must do so that it lives up to its purported mission and not relegate to a footnote the stories of people who suffered consequences from improper major surgeries.