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Global health: Health in vulnerable communities
Unstable gynaecological patient with an ankle monitor: implications of US Immigration and Customs Enforcement’s Alternatives to Detention programme in the healthcare setting
  1. Anna Pancheshnikov1,
  2. Rohini Boddu1,
  3. Leonard S Rubenstein2 and
  4. C Nicholas Cuneo3,4
  1. 1 Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
  2. 2 Program on Human Rights, Health and Conflict, Center for Public Health and Human Rights; Center for Humanitarian Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
  3. 3 Departments of Pediatrics and Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
  4. 4 Program on Migrant Health and Human Rights, Center for Public Health and Human Rights; Center for Humanitarian Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
  1. Correspondence to Dr C Nicholas Cuneo; nick.cuneo{at}jhmi.edu

Abstract

We review the case of an unstable gynaecological patient in the USA who presented with profuse vaginal bleeding after spontaneous miscarriage and was ultimately diagnosed with a uterine arteriovenous malformation managed with interventional radiology embolisation of her uterine artery. Her case was complicated by the presence of an ankle monitoring device which had been placed by US Immigration and Customs Enforcement as part of the Alternatives to Detention programme in which she was enrolled during her immigration proceedings. The device prompted important considerations regarding the potential use of cautery, MRI compatibility and device-related trauma, in addition to causing significant anxiety for the patient, who was concerned about how the team’s actions could affect her immigration case. Discussion of her course and shared perspective highlights the unique clinical and medicolegal considerations presented by the expanded use of ankle monitoring devices for electronic surveillance (or ‘e-carceration’) of non-violent immigrants and others.

  • Anxiety disorders (including OCD and PTSD)
  • Migration and health
  • Obstetrics and gynaecology
  • Perioperative care
  • Global Health

http://dx.doi.org/10.1136/bcr-2021-246515

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    Footnotes

    • AP and RB are joint first authors.

    • Twitter @nickcuneo

    • Presented at North American Refugee Health Conference; June 25, 2022; Cleveland, Ohio, USA.

    • Contributors AP and RB cared for the patient directly, assisted in drafting the manuscript and served as joint first authors. LSR provided legal guidance/review for the manuscript and substantial contributions to the ethical analysis and framework for the case. CNC contributed significantly to case conceptualisation, assisted in drafting the manuscript, and served as senior and corresponding author.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.