So how did it happen that repeatedly, as you heard from the medical experts, the underlying condition was treated with a course of treatment that was not appropriate for the underlying condition?

The experience that Ms. Cisneros Preciado just related to us is by no means unique.

OK. Please tell me more about the balance of responsibilities between LaSalle and the Federal Government.

We found that the relevant provider had been sued by the Federal Government and the State government for excessive and unnecessary billing practices.

My question is why did your agency fail? How did you allow this to happen?

Did you maintain any process for detecting whether or not providers working for DHS, working for IHSC, were performing extraordinarily high numbers of certain procedures, which can be a classic signature, for example, of fraudulent billing?

Our findings are deeply disturbing.

You were not aware. Were you aware, from 2017 to 2020--that is the relevant period here--that despite only seeing 6.5 percent of all OB/GYN patients, he was performing 95 percent of all laparoscopies and dilation and curettage surgeries?

Why were you not aware? Why were you not aware that one doctor was performing 9/10th of gynecological procedures?

Seven months away from your newborn daughter.

Thank you, Dr. Smith.

Let me reiterate our bipartisan findings. Excessive, invasive, and often unnecessary gynecological procedures.

How could a 3-day review have possibly been sufficient for LaSalle to draw any firm conclusions about what happened here?

The data was warning you, but you were not looking at it, and a lot of people got hurt.

What I am trying to understand, Dr. Smith, is this has been a bipartisan, 18-month, U.S. Senate investigation, and the bipartisan conclusions of our investigation are that women whose care you are responsible for were subjected to…

It is the bipartisan finding of the Subcommittee that they were not appropriate.

Do they accept the outside provider's recommendation without any review, without any question?

Those, I think, would have at least been warning signs to watch a little more carefully.

So they are using their best judgment. What does that mean?

You began the review because they were concerning. They certainly were concerning.

They do not exercise any discretion and they approve or refer 100 percent.

I cannot think of much of anything worse than this, unnecessary surgeries performed on prisoners. Give me a break. It is an abject failure, Dr. Smith. It is a disgrace to the Federal Government.

These are bipartisan findings of the U.S. Senate's preeminent investigative subcommittee that women ICE detainees were subject consistently to unnecessary, invasive, and often non-consensual gynecological surgical procedures.

You were taken from her.

Your testimony is that it is entirely the responsibility of IHSC to assess the propriety of the proposed intervention.