Kids to the doctor. It was horrible. And the reason im sharing my story because i dont want to have it happen to any other person. They shouldnt be separated from their family or be scared to go to the doctor when we are supposed to be able to trust them. Thank you. Senator osoff thank you. That concludes the first Witness Panel at todays hearing. We will take a brief recess and welcome the second panel to the witness table. Thank you all for your attendance governor. Senator osoff we will call our second panel, dr. Stuart stewart smith, dr. Pamela hearn and honorable Joseph Cuffari as the office of Inspector General. Custom to swear in all witnesses. I would ask you to please stand and raise your right hands. Do you swear that the testimony you are about to give before this subcommittee is the truth, whole truth so help you god. We will be using a timing system. Your written testimonies will be put in the record and limit your speech to five minutes. Dr. Smith, you may begin. Would you mind moving that microphone a little bit closer. Mr. Smith you for the opportunity top appear before you today. We are committed to providing Health Care Services in accordance with nationally recognized standards. The work force has 1700 Health Care Provider positions comprised of Civil Servants and Commission Corps officers and contractors. These positions represent a wide array of Health Care Officials throughout the United States including physicians, advanced practice providers, registered nurses, psychiatrists, psychologists, social workers, pharmacists. We provide direct medical care to diverse population. Each is staffed by medical care professionals, 24 hours a day seven days a week. In fiscal year 2022, we provided care to noncitizens housed in failts throughout the nation. And oversaw compliance with detention standards for health care for over 120,000 housed in 163 noni. C. T. Facilities. There are the staff work diligently to improve health care and see yilensy through evidencebased treatment. The care detainees receive is the first professional medical care they ever received. It is common for initial health care screenings to identify chronic and health care conditions previously undiagnosed. To deliver Quality Health care. They receive medical, dental and Mental Health intake screenings within 24 hours upon arrival. They receive a comprehensive Health Assessment including physical examination and Mental Health screen by a qualified Health Care Professional within 14 days. Detained noncitizen identified as high risk are taken in for higher level care immediately. I. C. Has Health Care Delivery and undergoes extraordinary scrutiny. It oughts regular reviews and when needed, implements corrective implementation plans and subject to levels of independent oversight inspections by the d. H. S. Office of the Inspector General, the i. C. E. Oversight office and d. H. S. Ombudsman. I. C. E. Learned of forced medical procedures provided by a provider serving the Irwin County Detention Center through a whistle ploar complaint. We take these allegations and all allegations of medical mistreatment seriously. In october of 2022, following a whistle ploar complaint, i. C. E. Discontinued sending to this offsite provider and to pursue alternate providers. On november 25, 2020, a icdc and on september, 2021, i. C. E. Creased operations. And while providers are not contracted to provide services with i. C. E. Or the detention facility, they are licensed medical professionals and licensed by county boards. We are improving oversight by providing guidelines and instituting a National Review process, an initiative. I. C. E. Is committed to ensure that people are treated with respect and dignity and to fully cooperating and complying with request from oversight bodies. We continue to fully participate in all investigations of medical mistreatment at icdc. Thank you for the opportunity to speak with you today and i look forward to your questions. Senator osoff dr. Hearn, you may offer your Opening Statement. Dr. Hearn members of the subcommittee, thank you for arranging this hearing for the opportunity to provide testimony concerning detainee mistreatment. Im dr. Pamela hearn and medical director and overseen at the Irwin County Detention Center in georgia since january, 2020. Im responsible for the medical operations and deployment of Health Resources to support a number of medical facilities and the Irwin County Detention Center medical department. Im involved in improving initiatives for the patient we serve. I communicate with i. C. E. On accomplish procedures and protocols and annualize results and ensure that they meet the standard. The limited role in the provision of outside medical services. Was founded in 199 to address overcrowding in staterun detention facilities. We manage these facilities in four states. Partners with local municipalities to provide Facility Management and Operational Services while providing economic stability to these areas. It was led by a Corporate Management team. It has professionally experience in detention administration, criminal justice and public service. Guyeded by this leadership, it demonstrates a deep understanding and ongoing commitment to the health and wellbeing to those entrusted in our care. We are committed with the highest level of decency and humanity while providing safe, secure and humane surroundings for our staff and those in our custody. Including owen county, georgia. It is the policy to ensure that all detainees have access to appropriate medical care by qualified personnel who are licensed, registered or certified with applicable federal and state requirements. Provides Health Care Services to patients with stringent standards known as the 2011. Frequent independent audits met or exceeded these standards. In addition, i. C. E. Has provided consistent guidance in the form of interim reference sheets and the Pandemic Response requirements. Again, independent reviews substantiate the fact that we met or exceeded standards. At no point was involved in the monitoring of outside providers or the translation of services on behalf of patients nor would we have done so governing our involvement at Irwin County Detention Center. The i. C. E. Credentialing department is i. C. E. Was to monitor. Our limited role respecting outside medical care was to ensure outside medical providers were available and provide transportation of the patient to and from those providers. At all times, we partner with the federal government and the agencies to provide excellent medical care and exceed the relevant i. C. E. Standards. Senator osoff thank you, dr. Hearn. Honorable cuffari, you may offer your statement. Hon. Cuffari thank you for discussing the oversight work. Our mission is to provide objective oversight of d. H. S. This is i that i and my professionals and my team take seriously. It is an honor to discuss our oversight of medical care in i. C. E. Detention facilities. Im grateful for the continued bipartisan support we have received from congress. This includes year over year increases in appropriations. As i said in my confirmation hearing i have used the expanded investment in our work to augment our detention oversight with contract medical professionals. Between f. Y. 2020 and 2022, we conducted inspections. In nine of those inspections, teams of medical professionals, a nurse and a doctor review detainee medical files, medical staffing levels, training curriculum, medical protocols to determine whether the medical care complied with federal detention standards and with covid protocols. In 7eleven reports we should from 2020 to 2022 we found deficiencies. We made 69 recommendations, 230 of which are improving detainee medical care. In september of 2020, we received a complaint about the Irwin County Detention Center. We forwarded the office of investigations and whistle ploar retaliation complaint to our whistle ploar unit and initiated an inspection of october of 2020. I personally visited that facility in july of 2021. We interviewed i. C. E. Personnel. We also reviewed video surveillance. Our medical experts conducted a virtual tour of the unit and medical records. Our investigation met our detention standards. However the chronic care, continuity care and procedures to be inadequate. Our medical team found the quality of Peoples Health care to be adequate based on records reviewed, but noted that offsite providers did not consistently share information with the facility. The facility generally complied with covid19 guidelines, but faced challenges facing those protocols. Detainees communication with i. C. E. Deportation officers was limited. We published a report and made five recommendations to improve the medical operations. I. C. E. Concurred with one implementation. I. C. E. Did not concur with four recommendations since may in 2021, the secretary announced d. H. S. Plan to discontinue the use of the facility. I. C. E. No longer detains detainees at irwin. At my direction, d. H. S. I. G. , in october of 2021, we should a fiveyear review of the use of administrative and disciplinary segregation in detention. This is the practice of holding individuals in isolation. In a separate review on medical vacancies across all detention facilities, i. C. E. Has challenges in recruiting and hiring. We ordered an audit across all detention facilities to ascertain the rigor for invasive surgical procedures. Whether through individual reviews, we continue to demonstrate to the department, our commitment to quality oversight. This concludes my testimony and i will answer questions that you or the subcommittee may have. Senator osoff thank you for our panel. Dr. Smith, i would like to, you lead the i. H. S. F. Y. 2020 report states quote, the assistant director is responsible for operational for the Health Care System and consequently all activities related to the health care. This is you, correct . Is your microphone on . Mr. Smith thats correct. Senator osoff you are responsible for overseeing the system and any activities related to the health care of individuals in i. C. E. Mr. Smith that is correct. Senator osoff i. C. E. And your own manual guidelines require that individuals under your custody must be provided with adequate medical care, is that correct . Mr. Smith thats correct. Senator osoff you are responsible for ensuring the adequacy of this care for all detain ease in i. C. E. Care. Mr. Smith we do not monitor the direct patient senator osoff thats not my question. This is the correct from the annual report you are responsible for all administrative and operational elements of the Health Care System and that includes the provision of health care to detainees at privately administered facilities, correct . Mr. Smith correct. Senator osoff my understanding that the employees who are called Field Medical Coordinators and regional clinical directors approve referrals to offsite providers and the Regional Directors approve the procedures by those offsite providers such as dr. Amin in georgia, is that correct . Mr. Smith thats correct. Senator osoff and they report up the chain which you ever are the top. And that refer every surgical procedure that is provided by an offsite provider . Mr. Smith thats correct. Senator osoff i want you to respond to the facts of this matter. Your Opening Statement was quite broad. This is bipartisan findings of the u. S. Senates investigative subcommittee that women, i. C. E. Detainees were subjected consistently to unnecessary, invasive and often nonconsensual procedures. What is your response . Mr. Smith thank you for that question. We received the documented informed consent is the core preliminary of mid medical care and core tenant. It ensures that people understand the procedures they are going to go through and that they sign off on those and agree that they will go through those. We rely on those to obtain informed consent for any patient that receives care in the u. S. Health system. Senator osoff you say you rely on offsite providers. You, personally, and from documents, are responsible for all administrative and operational elements of the Health Care System and subsequently all activities related to the health of individuals in i. C. E. Custody. What im trying to understand, dr. Smith, is that this has been a bipartisan 18month u. S. Senate investigation and the bipartisan conclusions of our investigation are that women whose care you are responsible for were subjected to unnecessary invasive gynecology call procedures and surgeries that were not clinically indicated and had longterm risks to the women who were incarcerated at the time. Are you not shocked that this happened under your watch . Mr. Smith troubling to hear the testimony. We take the care of all detainees in i. C. E. Custody very seriously. I want to be clear that we dont have our own staff at these contracted facilities. They are contracted to provide that care. Our role is to provide that oversight through different audits so they were assured they comply with the detention standards of care. Our coordinators, when they conduct audits, they make sure they are complying with them and do an audit that the types of care that is being provided is in concert with those standards. Sen. Ossoff lets talk aboutut that oversight. Were you aware that dr. Amin, whom you contracted to provide care to detainees for whop you were responsible, for whom you were responsible, had previously been sued by the department of justice for performing unnecessary and excessive medical procedures . Mr. Smith when we became aware sen. Ossoff when did you become aware . Mr. Smith through the whistleblower process. Sen. Ossoff were you aware at the time you engaged his services hed been sued by the federal government notice state of georgia for doing what in the state of georgia for doing what it appears he did again working for you . Mr. Smith no, we were not aware. Sen. Ossoff you were not. Were you aware from 2017 to 2020, thats the relevant period here, that despite only seeing 6. 5 of all obgyn patients he was performing 95 of surgerys . These are intrucive gynecological surveys. Were you wear of that . Mr. Smith we became aware after the allegations were filed. Sen. Ossoff so you were not aware at the time . Mr. Smith no. Sen. Ossoff do you vet the doctors you hire . Mr. Smith we dont vet them sen. Ossoff you dont vet them . Mr. Smith let me finish if i may, sir. The process includes these providers are not contracted directly weufrpt c. E. I. C. E. They were not an employee of i. C. E. Theyre referred kwraufr site. Since these allegations, actually before, we have been sending out different letters of agreement with them that they will abide by different standards of care. But even if these things were to show up in a National Practitioner database as a red flag, it doesnt necessarily mean theyre not going to be licensed if theyre licensed in the state and theyve been provided credentialing and privileging in a different facility and we have not received any specific complaints on the physician, we will evaluate it further. In this particular case, in dr. Amins case, he was the only provider in the area that was willing to see these patients. However, we were not aware of all the particulars until the whistleblower allegation. Sen. Ossoff did you maintain any process for detecting whether or not providers working for d. H. S. , working for ihsc, were performing an extraordinarily high number of procedures which can be a classic signature of, for example, fraudulent billing . Mr. Smith the process we had in place at the time, claims process, where we can actually see those claims when they come in, and if theres an overbilling thats occurring, we can catch it. Oftentimes because of the way the system was currently set up, we wouldnt see those until well after the fact. These providers have up to a year to submit their claims for processing and at the time that was the only process we had in place to see if there was these overbilling or debundling of services to overcharge and that sort of thing. Sen. Ossoff lets return to the vetting. What i heard you say is that you dont vet and even if you had vetted, it wouldnt catch this kind of thing is. That your testimony . Mr. Smith im saying based on the lack of any derogatory information that was in a National Practitioner database, specifically as to the type of care which we werent performing extensively at that time we were starting to, we wouldnt have we didnt have the ability to see that information other than through a claims process. Sen. Ossoff we found that information quite swiftly. We found that the relevant provide heir been sued by provider had been sued by the federal government and the State Government for excessive and unnecessary billing practices. He had been dropped by a major insurer formal practice claims. He was not board certified. Those would have at least been warning signs to watch more carefuly. And during the relevant period, hes performing, again, 90 plus of all of these gynecological surgery nationwide, despite only seeing 6 of obgyn patients in the country. Mr. Smith right. All of these procedures that were referred offsite were vetted through our regional clinical directors for appropriateness and again, since they having weve expanded our sen. Ossoff let me ask about that. They were vetted for appropriateness. How can that be when weve heard from medical experts who reviewed thousands and thousands of pages of records and its the bipartisan finding of the subcommittee that they werent appropriate . In fact, its not home that they werent pro ept, they were tkaeupbg appropriate, they were dangerous, they were wrong, they were poorly executed. Women had parts of their cervixes removinged they. Underwent transvaginal ultrasounds and pap smears with no clinical indication for it. They underwent microscopic surgery when there was no need. They had their uterine lining removed in part wouz medical indication and all of that was vetted and approved by your employees . Mr. Smith what im suggesting is when these referrals from the clinic came to our regional clinical directors to approve an offsite referral to see an obgyn physician, or a specialist, they approved that. They had no way of knowing exactly what was going to happen subsequent to that referral. Since then weve got guidelines so when our clinical directors see that heres the procedure thats going to be performed, we have an evidencebased protocol so we can take a look at. The clinical director looks at that offsite referral as far as the referral being appropriate and says either yes, we agree that it should be referred offsite to spaegsist for further evaluation specialist for further evaluation. What that evaluation may entail we dont know until after the fact. Sen. Ossoff im going to yield to my colleague, senator padilla. Sen. Padilla thank you, mr. Chair. Mr. Smith, i understand you have a lot of questions so far today. Ill give you a minute to catch your breath and address my first question to mr. Cue farry cuffari. You mentioned that following the complaints at irvin county detention center, you [indiscernible] audits across all d. H. S. Detention facilities. So during this audit, did you find examples in other i. C. E. Detention facilities of women being subjected to invasive medical procedures without their consent . Mr. Cuffari thank you for the question, senator. Good to see you and i look forward to visiting with you. I know our staff is accord faith in a visit coordinating a visit. That review is current lyon going and id currently ongoing and id be happy to share it with you as soon as the review has been completed. Sen. Padilla is there any evidence youve come across so far . Mr. Cuffari nothing that would warranty our immediate notification to the committee. Sen. Padilla you mentioned that facilities faced challenges in recruit the, the hiring and the residential of medical staff. So what ideas do you offer this committee on how i. C. E. Can improve practices so that medical care is more consistent across Detention Centers . Mr. Cuffari i believe in our review we found that recruitment of retention is a significant problem. We made a tphp of recommendations already we made a number recommendations already to shore up that, to strengthen their recruitment and retention efforts and we look forward to receiving word back from the department on exactly what their process is and how to strengthen it. Sen. Padilla eventually it comes to budget and resources which this committee and the senate and the congress as a whole needs to be involved. So please keep us posted. Mr. Smith. In july of last year i. C. E. Issued a new policy on pregnant, postpartum and nursing individuals. This policy sta euplt states such individuals kpbtd be detained cannot be detained unless their release is prohibited by law or exceptional circumstances exist. Theres also a requirement that i. C. E. Help services, must maintain information on all detainees who are pregnant, postpartum and nursing and report this information to the i. C. E. Enforcement and removal operations. Since your office is charged with collecting this information, can you tell us whether the number of pregnant postpartum and nursing women in i. C. E. Detention has dropped since the policy went into effect a year ago . Mr. Smith yes, sir, it has. [indiscernible] sen. Padilla ok. Ill look forward to the underlying data behind that response. Followup is what procedures are in place for i. C. E. Officers to ascertain whether an individual fits this criteria . For example, are they asking individuals to take a pregnancy test or asking if theyre nursing at the time of arrests . Mr. Smith yes. So we have [indiscernible] female officers [indiscernible] sorry. We do have a female Health Services directive that outlines all the different unique care we provide to the female population. They are screened for pregnancy as part of the intake process. And sen. Padilla as in tested or questioned . Mr. Smith urine test. So we can have a confirmtory whether they are or not. This directive also addresses elective abortions, contraception, emergency contraception, restrictive housing of female pregnant, postpartum, breastfeeding and all of those types of things. So unless there is a compelling reason outside of what we would have to retain to detain this person, our recommendation is always to release. Sen. Padilla im glad you bring up the question of care beyond the test. As you know, in july of this year, following the Dobbs Decision by the supreme court, it was reported an internal i. C. E. Memo was going to be sent from the director to e. R. O. Reiterating that pregnant women detained in i. C. E. Custody have access to full Reproductive Health care. And that it may be necessary to transfer detainees to another area of responsibility to ensure such access. I. C. E. s own 2011 standards state that women have the right to access abortion and that i. C. E. Will fund the cost if the mother was raped or is carrying the fetus would be detrimental to her health. Women can also request an abortion in other situations. What is i. C. E. Doing to ensure individuals in i. C. E. Detention are informed about their right to an abortion . Mr. Smith as part of the intake process, we do explain this to all the women in our custody. We provide counseling, clinical staff schedule and coordinate any transfers for a woman that decides she wants to take that route. If particular state theyre in does not allow that based upon that dobbs ruling, we recommend transport to a state that would allow that. We support that and we make sure that those that would do the transfer are aware of that and we give our recommendation. Sen. Padilla and the last question. How many individuals have been transferred to other facilities to ensure they can receive an abortion if they need or choose and can you tell us which states theyve been transferred from or to . Do you keep that level of data . Mr. Smith ill take that as a getback. I dont have that with me today. Sen. Padilla please at your earliest opportunity. Thank you, mr. Chair. Thank you, senator. Picking up where we left off, please, dr. Smith. Weve established that you personally are responsible for, and i quote, from again your agencys documents, all activities related to health care of individuals in i. C. E. Custody. Let me reiterate our bipartisan findings. Excessive, invasive and often unnecessary tkpwaoeupblg khropblg cal gynecological procedures. Repeated failures to secure informed consent. I. C. E. Did not conduct oversight of offsite medical procedures. Do you take responsible . Mr. Smith yes, sir, ultimately i do. Im responsible party, to make sure that the right processes and procedures are in place. If we see things not going in the proper direction, to take the proper course of action to fix those. Sen. Ossoff why did your agency fail . Mr. Smith well, again, i believe that we provide the policies, the procedures, and we make sure our clinicians understand what those procedures are and we dont have direct knowledge at the time of some of these procedures happening. Were working on putting systems in place to do that through the guidelines of our clinical directors and those that approve these procedures. A template that they can use based on evidencebased standards. So they can be morin formed on more informed on whether to approving an offsite procedure or not based on those standards. Sen. Ossoff you say youre taking those steps now. My question is why did your agency fail . How did you allow this to happen . How did you allow dozens if not hundreds of women to be subjected to unnecessary gynecological surgery . How did that happen . Mr. Smith we werent aware of these complaints. Until we werent aware of them until we received those the whistleblower complaint. So we just didnt have access to that information. Sen. Ossoff why were you not aware that one doctor was performing 9 10 of gynecological procedures but only seeing 6 of patients . Mr. Smith we didnt have the proper systems in place to detect that information. We started putting that process in place, those systems in place, well in advance of this. We just havent got those completely implemented at this point. Sen. Ossoff what would you say to the women who went through this . Mr. Smith its disheartening. Sen. Ossoff disheartening . Mr. Smith its very disturbing. Its very disturbing. Any responsibility we have we take very seriously and we want to fix this system so it doesnt happen again. Sen. Ossoff dr. Smith, you have full responsibility. Weve established that. And this is worse than disheartening. Dr. Smith yes, sir. Sen. Ossoff its hard for me to think of anything worse, really, dr. Smith. Age that the federal government than the federal government subjecting women to unnecessary gynecological surgeries. Its the most appalling thing this committee has seen in the last two years. Dr. Hearn. I understand that you want to clarify and you sought to do so in your Opening Statement where you believe the lines of responsibility between the federal government and the contractor are. Id like to give you an opportunity to do that, please. Dr. Hearn we provide onsite care, primary care, and any care that is deemed more advanced is referred to a specialist, an outside specialist. This specialist must be approved by ihsc in order for us to make an appointment sen. Ossoff let me start there. I appreciate that. The specialist must be approved by ihsc. Dr. Smith, how during the period of 2020 to 2020 2017 to 2020 did you go about approving that special assist what was the process . Dr. Smith the process was that these specialists were referred these patients were referred offsite and we made sure we had a letter of understanding in place within that they would accept the proper medicare rates, would be first thing. And if they were credentialed or hrpblsed in the if a licensed in the facility or in the state, then they were deemed as competent enough to provide those services. Sen. Ossoff so the only Due Diligence was to see if there was a valid medical license in that jurisdiction . That was the extent . Dr. Smith and if they had any adverse things that were had outstanding as far as direct patient care complaints through the National Practitioner database. Which we began toeufrpl the during that time to implement during that time. Sen. Ossoff for this provider, 2005, Major Medical insurer tkropls him because of excessive malpractice claims. 2013, federal government initiatance investigation of alleged billing fraud. One year later, you hire him. D. O. J. , state of georgia and the doctor settle in 2017. For five years, with apparently no vetting and no oversight, hes treating the patients for whom you have responsibility. Agency level responsibility. As weve established, personal responsibility. Doctor, did you have the opportunity to hear the first panel . Did you listen to the testimony from our first panel of witnesses . Yeah. He stated to the subcommittee that it appeared this doctor was operating with no oversight at all. Is that accurate . Had mr. Cuffari again, the only type of oversight when he in place were an kwraufr site provider at the time, was going to be through the medical claims process. Dr. Smith we didnt have any utilization management, utilization review. Part of our Modernization Program is to put those things in place so we can detect those types of things before they happen. Were in the process of doing that. Sen. Ossoff thank you, dr. Smith. Dr. Hearn, forgiving my interruption. You had begun to explain how responsibility is shared between lasalle and the federal government. You notessed that ihsc makes determinations with respect to who the offsite providers are and approves the referrals. Is that correct . Dr. Hearn that is correct. Sen. Ossoff please tell me more about the balance of responsibilities between la salle and the federal government. Dr. Hearn once the provider onsite determined a specialty appointment was made, it was presented through a medfar authorization and once thed me far was approved the medvedevfar was approved medfar was approved, then the mechanism existed where the approval was transmitted to the unit and the unit then scheduled the appointment with the approved provider. Sen. Ossoff thank you, dr. Hearn. So again turning to you, dr. Smith, describe the approval process whereby your agency approves the surgeries and procedures requested through the referral from the private operator. Dr. Smith so all those referrals, surgical referrals, are referred to our regional clinical director and they review those. Sen. Ossoff what does that review consist of . Dr. Smith looking at what that patient is being redue srao ud or being referred for. At the time we didnt have the specific evidencebased guidelines in place so they were using their best judgment on those things as a clinician. Since that time, sen. Ossoff these are doctors making these determinations . So theyre using their best what does that mean . What criteria are they accountable to . What guidance did you give them . Whats the policy . Dr. Smith the guidance is if they were being referred offsite because the clinic didnt have the expertise to provide it. Obviously the right thing to do is not to keep them at the clinic. And try to provide care for them there. We needed to get them offsite and so they would make sure that yes, theyre going offsite to a provide that are has those types of qualifications. Dr. Amin was that provider that was willing to see our female patient population. Sen. Ossoff and are these individuals, these physicians, making these determinations as part of your agency, are they specialists in the relevant field or are they generalists . What are their specialties typically . Dr. Smith they have specialty internal medicine, family medicine, those types of things. Which have a certain degree of o. B. Specialty. I might say knowledge, enough knowledge to know that when theyre being referred to an o. B. Physician that thats the right place for them to go to be seen. Sen. Ossoff do these physicians look at the nature of the complaint and assess whether or not the treatment thats being requested is collinically indicated . Clinically indicated . Dr. Smith to the best of their knowledge with the information they have at the time, yes. Sen. Ossoff how did it happen that repeatedly the underlying condition was treated with a course of treatment that was not appropriate . W t underlying condition . Appropriate with the underlying condition . Dr. Smith i have no way of specifically knowing what they knew at that time when they referred them. Sen. Ossoff you have asked them . Dr. Smith we have asked them. They said based upon the information they had through the referral process, that they thought it was the appropriate thing to refer them offsite to a higher level of specialty care. Sen. Ossoff dr. Hearn, you statessed in your testimony when these allegations became public that you undertook a review. Is that correct . Dr. Hearn that is correct. Sen. Ossoff why did you do that . Dr. Hearn the allegations were extremely concerning to la salle and to myself. So we immediately began a review, an internal review at that time. Sen. Ossoff you began a review because they were concerning. They certainly were concerning. Were you advised by corporate leadership to undertake that review . What was the decision make prague ses to launch that review . Process to launch that review . Dr. Hearn the discussion between myself and the c. E. O. Concerning the allegations. Sen. Ossoff how long did that review take . Dr. Hearn that review started day after my discussion with the c. E. O. And it had continued throughout until this very day. Sen. Ossoff thats a little bit different from what we heard from the company previously. We understood and we can refer to the relevant party, there was a threeday review. What does that refer to . Dr. Hearn that was to go onsite and review documents at the facility, discussions with the medical leadership and with the unit leadership. Sen. Ossoff what did you find . Dr. Hearn i reviewed medical charts and i reviewed discussion with the leadership and at that point sen. Ossoff forgive me. Medical charts and discussion with leadership. Heres what im trying to understand. It took a team of professional investigators from both Political Parties here in the senate 18 months and consultation with a significant number of outside medical experts to go through tens of thousands of pages of medical records in order for us to arrive at these conclusions. So how could a threeday review have possibly been sufficient for la salle to draw any firm conclusions about what happened here . Dr. Hearn my review involved the process of referral. The process of referral at the unit and the appropriateness of the referral and the approval process that the referrals were approved. Sen. Ossoff ok, lets talk about that referral process. As weve heard from our medical experts, there was a consistent pattern, a course of treatment that this provider consistently undertook and generally speaking it began with imaging or examination procedures that were not clinically indicated by the underlying complaint. Then a statement by the physician that the first intervention would be a shot, a contraceptive injection. And then on the basis of, for example, imaging, a transvaginal ultrasound that may have been performed, a determination that there were cysts present. And statement by the nags if it didnt resolve by the physician that if it didnt resolve in a number of weeks they might proceed to some surgical intervention and in many cases the doctor did cut these patients, range of procedures. You said that when you make that referral, are you assessing, are your medical professionals assessing whether the course of treatment that is proposed by the offsite provider is clinically appropriate given the underlying complaint . Dr. Hearn the medical provider is reliant on expertise of the specialist. Sen. Ossoff medical provider meaning your employee onsite . Dr. Hearn the onsite medical provider is dependent upon the expertise of the outside medical provider. Sen. Ossoff so do they accept the outside providers recommendation without any review, without any question . Dr. Hearn there is a review of the medical documents that are presented, but they are very limited oftentimes. From the outside provider. Sen. Ossoff and why does why do la salle personnel undertake that review . Stphp why do the clinicians onsite at your Facilities Review the underlying documentation submitted by specialist to determine whether or not the procedure is appropriate . Why do you do that . Dr. Hearn the onsite providers do not have the clinical expertise or knowledge of the specialists referral. But youre looking to see and seek approval for the treatment that has been recommended by the clinician, the outside clinician. Osaka say the last part again. Youre sen. Ossoff say the last part again. Youre looking to see what . Dr. Hearn youre looking to see the treatment that was recommended by the outside provider and then that goes into an approval process with ihsc because any followup appointments are approved by ihsc. Sen. Ossoff right. So im not getting clarity on whether or not your personnel onsite, the clinicians onsite are making a determination about the pro bright of the proposed pro bright of the pro pryity of the proposed course of treatment. This rejust rubber stamping it or looking at the record and making an assessment as to whether it is an appropriate course of treatment. Dr. Hearn theyre not making an assessment. Sen. Ossoff theyre just referring it to ihsc . Dr. Hearn yes. Sen. Ossoff so they approving 100 . Dr. Hearn theyre referring all recommendations to ihsc. Sen. Ossoff so your testimony is that it is entirely the responsibility of ihsc to assess the pro pryity of the proposed intervention . Pro brighty of the proposed intervention . Dr. Hearn any referral or followup appointment procedure is approved by ihsc. Sen. Ossoff you said your review is ongoing to this day. What steps you have taken subsequent to those initial three days and why you have taken them . Dr. Hearn well, with the subpoena that was issued, i personally reviewed page after page of medical records that were on paper until september, 2017. Then we had Electronic Health records and we pulled an Electronic Health records to maintain and be able to comply with the request from subpoenas. Sen. Ossoff for clarity, what you mean when you say the review is continued to this day is you have complied with this subcommittees and perhaps other agencies processes for securing information but youve not undertaken any additional review yourself of the underlying records, the propriety of the treatment . Is that correct . Dr. Hearn during my document production, there were some review that goes along with document production as well. Sen. Ossoff i see. So in the course of providing us another and other potential agencies with those documents, you looked at them is what youre saying. Dr. Hearn yes. Sen. Ossoff thank you, doctor. I know that the office of the Inspector General is currently engaged in its own review of this matter. When can we expect you to complete that . Mr. Cuffari senator, in an open setting i would be remiss because were touching on other agencies within the executive branch that have equities in the matter youre asking about. And i dont have the timeline to give you in an opening setting. Sen. Ossoff what steps can the office of the Inspector General take to ensure that these grotesque failures and abuses never happen again . Mr. Cuffari to continue our vigorous and objective oversight of the department of Homeland Security and mr. Issa detention, i. C. E. Detention, to include c. B. P. Detention as well. Sen. Ossoff thank you. This will conclude the questioning for todays hearing. The record will remain open for 15 days for submissions. I got to just say, this is such an appalling case. Im remeeting myself but repeating my self, but as i said earlier, i cant think of anything much worse than this. Unnecessary surgeries performed on prisoners, give me a break. It is an abject failure, dr. Smith. Its a disgrace to the federal government. And what weve heard today is that there was no real vetting, your assessment appears to be that if youd undertaken vetting, you wouldnt have found anything. Well, that suggests youre not thinking creatively enough about how to vet these providers because there were red flags that should have provided the basis for more careful monitoring of this physician. And basically there were no processes in place. No Due Diligence, no review, no way to monitor for red flags. The data was warning you but you werpbts look at it werpbts looking at it werent looking at it and a lot of people got hurt. Well have followup questions, dr. Smith and hearn, and Inspector General cuffari. Look forward to the conclusion of your ongoing work related to this matter. I thank you all for your presence today. I, without objection, will introduce this full report into the record and adjourn the hearing. [captioning performed by the national captioning institute, which is responsible for its caption content and accuracy. Visit ncicap. Org] [captions Copyright National cable satellite corp. 2022]