FINAL REPORT: ICE Major Surgeries Were Not Always Properly Reviewed and Approved for Medical Necessity

 In ICE Allowed Unnecessary Hysterectomies, DHS Watchdog Says for Law360, Britain Eakin reports that the U.S. Department of Homeland Security inspector general released a report (and here) yesterday that surgical procedures for noncitizens in government custody were not always properly approved, including two hysterectomies performed without documentation showing they were medically necessary.

Here is a summary of the report findings:

“What We Found

In fiscal years 2019 through 2021, U.S. Immigration and Customs Enforcement’s (ICE) Health Service Corps (IHSC) did not always properly process and authorize major surgical procedures for non- citizens in ICE custody. Per IHSC’s process, only designated Regional Clinical Directors (RCD) or Clinical Directors (CD) are qualified to review authorizations for medical necessity and approve major surgical procedures performed by off-site providers. We determined 72 of 227 major surgeries included in our statistical sample were not reviewed or approved by a RCD or CD, but instead were reviewed and approved by IHSC personnel such as nurses or nurse practitioners. This occurred because IHSC guidance was
vague and did not include clearly defined requirements for approving major surgical procedures in IHSC’s eClinicalWorks (eCW). Based on our universe of 553 major surgical procedures, we can infer with 95 percent confidence that between 137 and 214 major surgical procedures were not approved by the required IHSC RCDs or CDs in eCW from FYs 2019 through 2021. As a result, IHSC does not have assurance that all major surgeries conducted FY 2019 through FY 2021 were medically necessary.

Further, we contracted with an obstetrician/gynecologist (OB/GYN) to determine whether the documentation of medical necessity for major surgeries was adequate. In our judgmental sample, we limited our review to hysterectomies. 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.”

KJ