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This story was originally published by Prism.

What happened to women detained at Georgia's Irwin County Detention Center (ICDC) is just as much a story about Immigration and Customs Enforcement (ICE) as it is about Mahendra Amin, the doctor alleged to have performed unnecessary gynecological procedures on detained women without their full and informed consent.

Congress has granted ICE billions of dollars to carry out enforcement and detain immigrants at facilities nationwide. "The number of people in immigration detention has increased under every presidential administration for more than 25 years," The Marshall Project reported—and there are no real successful mechanisms for oversight or accountability. This has created a deadly environment for immigrants, one in which widespread sexual assaultabusemedical neglectforced labor, and in-custody deaths are the everyday byproducts of the detention system. No one person can do the amount of damage Amin is alleged to have done to immigrant women without entire systems and chains of command coalescing—this is especially true in the detention system because of its reliance on a shady network of private, for-profit companies and other contractors who benefit every time someone is detained.

"This is bigger than [Amin]. It's a whole system in these small towns that let this happen. But if you've got a name and money like he does, you're at the top of the food chain."

But this is also a story about rural health care. 

In Douglas, Georgia, where Amin has practiced for decades, quality health care is hard to come by, especially for the region's low-income residents.

In 2017, 28 percent of Douglas residents had an income below the poverty level in a state where half the counties have no OB-GYN and some counties have no doctor at all, the Atlanta Journal-Constitution reported. According to women who spoke to Prism, Amin was a stop gap for Douglas residents and those who lived in surrounding areas, one of the only OB-GYNs in the area who allowed walk-ins and accepted Medicaid and Medicare. These facts alone mean that he saw scores of vulnerable, low-income women in the area, and word-of-mouth appeared to work in his favor. Friends referred other friends, family members referred other family members. It was not unusual for Amin to have provided care to multiple women in one family.

Sisters Christina Sumner and C.W. told Prism they cannot help but scroll through the Facebook page created in support of the doctor. C.W., who is using her initials because she still lives in the area, said it's upsetting to see women posting positively about Amin, offering their own experiences as evidence that he did not operate on detained women without their informed consent.

"It's a blessing for them that they had a good experience with him. But to me, it's a slap in the face," C.W. said in an interview with Prism.

See also: 'Abortion bans aren't just about abortion'—The fight for reproductive justice in the South

The sisters, both of whom were patients of Amin's, said the allegations against the doctor have been "a long time coming"—and it isn't just women detained at the Ocilla, Georgia, detention center that he harmed.

'Top of the food chain'

 Sumner told Prism that in small towns like Douglas, men with means are largely allowed to operate by a different set of rules.

"With these little towns—Douglas, Ocilla, Alma—if you don't know somebody, you're nobody. If your friends are cops or doctors, you'd be surprised what you can get away with in small, slow rural places in southeast Georgia," Sumner said. "This is bigger than [Amin]. It's a whole system in these small towns that let this happen. But if you've got a name and money like he does, you're at the top of the food chain."  

For decades, Amin has owned various businesses in Georgia and has been a powerful force in the local medical community. Though he is not a board-certified OB-GYN, Amin has served as the medical director for the labor and delivery department at Irwin County Hospital and has been in the process of opening the "Amin Surgery for Women." The doctor owns MGA Health Management, Inc., where he is listed as the company's secretary, chief executive officer, and chief financial officer. MGA has managed the Irwin County Hospital since 1996. According to court documents from a lawsuit, Amin is also part owner of Irwin County Hospital.

The allegations against Amin made by detained women and former Georgia patients overlap in significant ways, and the site of the alleged harm was almost always the Irwin County Hospital.

As part of a New York Times investigation published last month, five gynecologists reviewed medical records from Amin's patients who were detained at ICDC, finding that the OB-GYN "consistently overstated the size or risks associated with cysts or masses attached to his patients' reproductive organs." The investigation noted that "in some cases the medical files might not have been complete and that additional information could potentially shift their analyses," but based on the records the doctors reviewed, "Amin seemed to consistently recommend surgical intervention, even when it did not seem medically necessary at the time and nonsurgical treatment options were available."

This appears to be a pattern Amin replicated on Georgia residents who were his patients, inevitably funneling them to the Irwin County Hospital for gynecological procedures that appear to have been wholly unnecessary.

Sumner was a mother of four when she met her current husband and they decided to have children together. A cousin recommended Sumner go to Amin and on her first visit, the doctor allegedly told her she had an ovarian cyst that required surgery if she wanted to get pregnant.

In 1997, Amin performed surgery on Sumner to remove the cyst. Six months later she got pregnant, but had a miscarriage. Amin blamed her miscarriage on another cyst that he said needed to be removed. She believed her doctor, so she had the second operation in 1998, which she said took "months to recover" from.

Sumner, who now lives in Florida, told Prism she no longer has the medical records related to the operations she said took place more than 20 years ago, but she did sign a HIPAA release form and is currently working with Prism to obtain her records from Irwin County Hospital.

"He told me my baby had a 1 percent chance of surviving."

Prism consulted with an OB-GYN and a primary care physician with expertise in reproductive health for the purpose of this reporting. Both said that a common, benign cyst would not impact a person's ability to get pregnant and it's "highly unusual" for a doctor to immediately operate on a cyst that was not causing the patient any bleeding, pain, or other discomfort. The sources also said a common cyst would not cause a miscarriage and that it would be "usual" to take "months" to heal from having a cyst removed.

Sumner went on to have two more children in Georgia, the second of whom Amin delivered in 2001 at Irwin County Hospital. After giving birth with Amin, Sumner alleges she could barely walk for six months and that she sometimes felt so weak, her husband had to brush her hair. Amin was "extremely harsh" when delivering her daughter, Sumner said.

See also: Georgia tried to ban abortions. Telehealth offers a new alternative.

"Something wasn't right because after I had [my daughter], I went to the nursery to see her and when I stood up, blood literally gushed out of me," Sumner said. "I almost passed out and had to go back to my room. I bled that way for months after having her."

Sumner's sister C.W. also alleges she was mistreated by Amin, and the sisters corroborated the details of each other's stories in separate interviews.  

C.W. was a teenager when she began seeing the doctor. It was 1997 and she was 17 years old and pregnant with twins. She needed an OB-GYN and decided to give Amin a try, a decision she said she regrets.

The pregnancy was challenging and she regularly felt sick. C.W. said she conveyed her symptoms to Amin, but the doctor showed little concern. When C.W. was six months pregnant, something went wrong. She had excruciating abdominal pain for two days. She went to Amin's Douglas office and the doctor gave her a sonogram. During the appointment, Amin assured C.W. she was not in labor as she feared. He also told her that he only detected one heartbeat.

"He told me the other baby had died. He sent me home after that. He told me to come back a week later," C.W. said, noting that Amin showed her "no sympathy" when delivering the news.

The Douglas, Georgia, resident said she no longer had her medical records from 23 years ago and declined to work with Prism to obtain them because she has serious concerns about being identified in the small town. Medical records could lead to a different conclusion, but the physician and OB-GYN Prism consulted said that according to the information C.W. provided, the persistent pain she experienced should have been cause for serious concern. At the very least, C.W. should have been admitted to the hospital for observation.

"[Amin] kept saying, 'You'll be better in two weeks, you'll be better in two weeks,' but I wasn't getting better."

After Amin sent C.W. home, her pain persisted, so later that day she went to the Coffee Regional Medical Center in Douglas, another local hospital Amin is affiliated with. Hospital staff confirmed she was in labor, and this is when C.W. alleges she got into an argument with Amin.

"He told me my baby had a 1 percent chance of surviving," said C.W., explaining she felt very upset Amin would say that because she was already scared of giving birth prematurely.

C.W. was transferred more than two hours away to a Savannah hospital. She first gave birth to a stillborn baby weighing 5.9 ounces, followed by her daughter, who weighed less than 2 pounds and was born with cerebral palsy. Her daughter spent more than three months in the newborn intensive care unit.

"At 17 years old, you think your doctor knows what they're doing. I never questioned it until they told me in Savannah that my pregnancy could have been different," C.W. said. "People always [said] I should sue, but I just thought: What would it change? Who would listen?"

Amin's attorney, Scott R. Grubman, told Prism Amin is "legally prohibited" by HIPAA from responding to allegations from former patients unless they sign a HIPAA release form. C.W. declined, but Sumner signed a waiver permitting Amin to discuss her treatment with Prism. Neither Grubman or Amin have responded to questions about Sumner's care. Prism also contacted the Irwin County Hospital for comment multiple times and has not received a response.  

'Hurting in an ungodly way'

The doctor is not just accused of performing unnecessary operations. According to former patients, Amin was also very rough.

The New York Times reportedthat in 2018, a detained woman named Nancy Gonzalez Hidalgo was "left shaken" after several appointments with Amin, during which she said "he performed rough vaginal ultrasounds and ignored her when she cried out in pain." In an email from Gonzalez Hidalgo's attorney to ICDC's warden, the attorney explained that Gonzalez Hidalgo was hesitant to seek medical attention because her last experience with Amin "was so painful and traumatic that she did not want to be sent back to him."

When describing their treatment during appointments, Amin's former patients often began by saying Amin "had no bedside manner," explaining that he was "rough."

Based on the surgeries she received, Sumner said she believes Amin didn't really care about her or his other patients; he was "just out to make a dollar." She estimates there are large numbers of former patients in rural Georgia who were mistreated and unnecessarily "cut open" by Amin—women she says may be afraid to speak out or who are struggling to wrap their heads around the mistreatment they experienced.

See also: Reproductive justice wins in Tennessee aren't just about abortion

Shannon Tatum is another former patient speaking out for the first time. The details of her story were corroborated by her husband when she first spoke to Prism on Sept. 20.

Tatum comes from a family of women who were operated on by Amin. Her experience with the OB-GYN began in 2014. She was at work at a Georgia sheriff's department when an ovarian cyst ruptured. At the recommendation of one of her sisters, Tatum went to Amin.

The Waycross, Georgia, resident told Prism that not only did she want a hysterectomy, but that she was "looking forward to it." She already had children and had long been "troubled with problems" related to endometriosis. Amin told Tatum the September 22, 2014 surgery would take "an hour or two." Tatum said it took closer to four.

"I woke up hurting in an ungodly way," said Tatum, who alleges she was in such severe pain that she couldn't stand up straight for weeks.

Before her two-week checkup, Tatum had to return to the Irwin County Hospital for a blood transfusion. Tatum describes the facility as "old timey," with crank-style beds and IV poles, long removed from modern hospitals.

"[Amin] kept saying, 'You'll be better in two weeks, you'll be better in two weeks,' but I wasn't getting better," Tatum said. "My skin was gray and I couldn't get my blood pressure to stay up because I was losing so much blood. I'm a person who can deal with pain, but it hurt so bad to pee that I would sit on the toilet and cry."

According to the OB-GYN Prism consulted for this reporting, Tatum's need for a blood transfusion was "unusual" and suggests there was some type of "unrecognized complication" that caused her to bleed after the surgery. Tatum's need for a blood transfusion should have led Amin to admit Tatum and evaluate her to better understand the cause of the bleeding.

If it wasn't for a nurse friend who visited Tatum at her home and saw the state she was in, Tatum says she is unsure if she would be alive today. The nurse urged Tatum's husband to take her to the emergency room. This is how she eventually found her way to obstetrics and gynecology specialist Dr. Dan Lott. Tatum appeared at Lott's practice complaining of persistent pelvic pain and urinary frequency, including leaking. According to medical records from Lott's office, Tatum had a fever and a CT scan revealed a mass in her abdomen. The OB-GYN Prism consulted with reviewed Tatum's medical records and said the mass was not related to endometriosis, but "more likely a complication related to her surgery" with Amin.

"When I kept going back to him, he acted like I was lying to him about the pain."

Tatum was placed on an antibiotic for two months before Lott performed surgery on her in December 2014, finding an intra-abdominal wall mass that extended to her bladder. The OB-GYN who consulted with Prism said this mass likely developed as a complication of Tatum's hysterectomy.

Tatum alleges that Amin did not take her symptoms or her pain seriously, even though she said she could barely walk for weeks.

"He lacks empathy and sympathy," Tatum said. "After I had my hysterectomy, the way he examined me—it's like you're not there, it's like you're a thing without feelings. When I kept going back to him, he acted like I was lying to him about the pain."

The Georgia resident said she considered suing, but alleges that after her surgery with Lott, she went to Amin's office to request her medical records and was told by his office that they were "lost." Federal law generally requires a medical provider to provide a patient with their medical records.

Tatum signed a HIPAA release form in an attempt to work with Prism to obtain any existing records from the Irwin County Hospital, however she declined to provide release to Amin's attorney so that the doctor could respond to her allegations. Grubman has not responded to Prism's request for comment regarding the broader allegations against Amin, including his rough treatment of patients and his practice of performing unnecessary procedures.

Given all of the reporting that has emerged, Tatum told Prism she can't understand why people in the community continue to defend Amin. Some are even purchasing T-shirts that say, "I stand with Mahendra Amin."

See also: Georgia rushed to reopen, but the COVID-19 crisis is worse than before: 'I'm scared of more than just dying'

The Georgia resident said that she first learned Amin was being accused of operating on detained women without their consent when she saw Prism's article circulating on Facebook. The framing of the piece, which outlined reproductive injustices in the detention system that have occurred under the Trump administration, made Tatum hesitant to reach out. She and other women interviewed for this story identify as Trump supporters, and they say the poor treatment they received at the hands of Amin had nothing to do with President Donald Trump.

These women are right, and so is Tatum's assessment that Amin has "left a trail" for years.

A history of harm

A number of lawsuits have been brought against Amin, including one related to a 21-year-old woman who went to the doctor on July 3, 2000 "complaining of abdominal pain and early labor." According to court documents, Amin admitted her into the Irwin County Hospital, but three days later gave orders to release the woman "despite life threatening abnormal lab values." Over the next 48 hours, the woman's condition worsened and on July 8, 2000, she was admitted to Coffee Regional Hospital with elevated blood pressure, vaginal bleeding, "pitting edema," and a fetal heart rate that was "significantly deteriorated." She died shortly after receiving an emergency cesarean section. The case was settled for $75,000.

In another lawsuit reported by the Daily Beast, Amin settled with a mother "who claimed the doctor and nurses at the Irwin County Hospital did not respond quickly enough when her baby's heart rate plummeted during delivery, causing him to die of lack of oxygen. An attorney for the mother said it is common for an OB-GYN to face such suits, and that Amin's conduct on this instance was 'not anything that would go to any egregious behavior.'"

In a third, previously unreported lawsuit filed in 1995, a man unsuccessfully sued Amin and a pharmaceutical company on behalf of his deceased wife, alleging that their combined negligence caused her death at the age of 25. According to court records, she was a patient of Amin's when she gave birth to a daughter. After the delivery, Amin prescribed the drug Parlodel in order to dry up her breast milk. About seven weeks after giving birth on October 3, 1992, the woman died unexpectedly. Her husband alleged that the ingestion of Parlodel was the cause of death and that Amin failed to fully inform his wife of the drug's side effects.

In a now widely publicized case, Amin and other doctors at the Irwin County Hospital paid the federal government $520,000 in 2015 after the Department of Justice accused them of fraudulently billing Medicare and Medicaid. According to the complaint, Amin and others billed the government for procedures as if they had performed them themselves, when they were actually performed by nurses and technicians. The hospital is also said to have inflated the costs of procedures, performed unnecessary tests, tacked on fees to operating room bills, and retaliated against whistleblowers. The complaint also outlined a kickback scheme in which Amin and other doctors directed patients to the Irwin County Hospital. Because of Amin's part ownership of the hospital, he profited from every referral.

The three former patients who spoke to Prism said they wanted the public to know that Amin's circle of harm extends far beyond the detention center. Some of these women have former patients in their families that they are now urging to come forward.

Tatum said she doesn't "want anyone's pity"; she just wants to see Amin held accountable for what he's done.

"I believe in karma and I always told myself, 'What goes around comes around.' I knew he would get his," Tatum said. "It may not be by me, but I believed this moment would come. I'm glad I lived to see it."

Prism is a BIPOC-led nonprofit news outlet that centers the people, places, and issues currently underreported by our national media. Publishing original reporting, analysis, and commentary, Prism challenges dominant, toxic narratives perpetuated by the mainstream press and works to build a full and accurate record of what's happening in our democracy.