The (Lack of) Medical Treatment Received By ICE Detainees

by Cara on May 23, 2008

in bigotry, class and economics, discrimination, human rights, immigration, media, race and racism

Last week, Miss Sarajevo left a comment with a link to this series of articles in The Washington Post, and I’m just finally getting around to writing about it. The series, “Careless Detention,” is about the terrifying, unethical and downright inhumane medical treatment of immigrants imprisoned by ICE, generally while fighting or awaiting deportation for infractions that are usually non-violent and in fact so mild as to verge on the ridiculous. Since 9/11, Bush and his buddies have really stepped up anti-immigrant measures (which were already largely poor and in place), broadened definitions of who could be deported, increased raids and decided that those seeking asylum must do so while behind bars. Our government is imprisoning both documented and undocumented men and women (and though not mentioned in this series, also children), often without due process, and then, quite simply, killing them with medical neglect, or otherwise abusing/torturing them with inappropriate or an outright lack of medical treatment.

If you think that the medical treatment of some immigrants who are not in trouble with ICE is appalling (and it is), be prepared to learn a new definition of the word.

Excerpts from the articles after the jump.

Part 1: “System of Neglect” focuses on those who have died custody due to profound medical indifference:

The most vulnerable detainees, the physically sick and the mentally ill, are sometimes denied the proper treatment to which they are entitled by law and regulation. They are locked in a world of slow care, poor care and no care, with panic and coverups among employees watching it happen, according to a Post investigation.

The investigation found a hidden world of flawed medical judgments, faulty administrative practices, neglectful guards, ill-trained technicians, sloppy record-keeping, lost medical files and dangerous staff shortages. It is also a world increasingly run by high-priced private contractors. There is evidence that infectious diseases, including tuberculosis and chicken pox, are spreading inside the centers.

Federal officials who oversee immigration detention said last week that they are “committed to ensuring the safety and well-being” of everyone in their custody.

Some 83 detainees have died in, or soon after, custody during the past five years. The deaths are the loudest alarms about a system teetering on collapse. Actions taken — or not taken — by medical staff members may have contributed to 30 of those deaths, according to confidential internal reviews and the opinions of medical experts who reviewed some death files for The Post.

According to an analysis by The Post, most of the people who died were young. Thirty-two of the detainees were younger than 40, and only six were 70 or older. The deaths took place at dozens of sites across the country. The most at one location was six at the San Pedro compound near Los Angeles.

[. . .]

Doctors express concerns about violating medical ethics and fear lawsuits. In July, Esther Hui at Otay Mesa sent a memo to DIHS medical director Timothy T. Shack, saying her colleagues were worried that they might be sued because of the substandard care they were giving detainees. The agency’s mission of “keeping the detainee medically ready for deportation” often conflicts with the standards of care in the wider medical community, Hui wrote. “I know in my gut that I am exposing myself to the US legal standard of care argument. … Do we need to get personal liability insurance?”

Nurses who work on the front lines see the problems up close. “Dogs get better care in the dog pound,” said Catherine Rouse, a contract nurse at an Arizona detention center who quit after two months last year because she saw what she regarded as “scary medicine” in the prison: patients taken off medications they needed and nurses doing tasks they were not qualified to do. “You don’t treat people like that. There has to be some kind of moral fiber,” Rouse said.

Part 2: “In Custody, In Pain” focuses on a detainee who is severely ill and waiting desperately for any kind of treatment for her most likely life-threatening condition(s), which probably could have been easily controlled with early intervention:

Whether the gaps in Harvill’s treatment are by accident or by design is difficult to discern. Yet it is clear that the obscure federal agency that oversees detainees’ medical care, the Division of Immigration Health Services (DIHS), operates with a top priority of limiting care and saving money. Its medical mission is only to keep people healthy enough to be deported.

At Harvill’s jail, and everywhere else immigration detainees are held, doctors and nurses must get permission from the agency’s headquarters before treating patients. Except in emergencies or for the most routine care, they must send written requests to Washington, where, for the entire system of 33,000 detainees across the country, four managed-care nurses in a downtown office building decide what treatments to allow.

These care managers rule on what are known in the bureaucratic lexicon as treatment authorization requests, or TARs. In a recent month, they had to rule on 3,000 requests. They work five days a week, not on weekends, and are unavailable to handle requests that come in later than 4 p.m. Washington time, even though many large detention centers are in other time zones.

The agency touts this as an efficient form of managed care, similar to health plans familiar to patients in the outside world. But a 36-page manual that describes the “detainee covered services package” underscores how unusual it is, with rules designed to prevent people from getting too much help.

Part 3: “Suicides Point to Gaps in Treatment” is about the astonishingly horrid treatment of the mentally ill in detention:

While tens of thousands of detainees inside immigration detention centers endure substandard medical care, people with mental illness are relegated to the darkest and most neglected corners of the system, according to interviews and thousands of internal documents, including e-mails, memos, autopsy reports and other medical records, obtained by The Washington Post.

Doctors and nurses who often have difficulty detecting and treating physical ailments are having even greater problems managing the nuances of mental illness, documents and interviews show. Treating mental illness is a challenge in any context, but inside this closed, overburdened world, some psychiatric patients undergo months and sometimes years of undermedication or overmedication, misdiagnosis or no diagnosis.

The records reveal failures of many kinds. Suicidal detainees can go undetected or unmonitored. Psychological problems are mistaken for physical maladies or a lack of coping skills. In some cases, detainees’ conditions severely deteriorate behind bars. Some get help only when cellmates force guards and medical staff to pay attention. And some are labeled psychotic when they are not; all they need are interpreters so they can explain themselves.

Suicide is the most common cause of death among detained immigrants. It accounts for 15 of 83 deaths since 2003, when the Department of Homeland Security’s Immigration and Customs Enforcement agency, known as ICE, took over facilities for foreigners whom the government is trying to deport. Inside these out-of-the-way compounds around the country, suicide attempts seem to be on the rise, according to internal documents: 16 in June, 21 in July, 20 in August.

Part 4: “Some Detainees Drugged for Deportation” is about the improper, dangerous and illegal use of tranquilizing antipsychotic drugs:

In a Chicago holding cell early one evening in February 2006, five guards piled on top of a 49-year-old man who was angry he was going back to Ecuador, according to a nurse’s account in his deportation file. As they pinned him down so the nurse could punch a needle through his coveralls into his right buttock, one officer stood over him menacingly and taunted, “Nighty-night.”

Such episodes are among more than 250 cases The Washington Post has identified in which the government has, without medical reason, given drugs meant to treat serious psychiatric disorders to people it has shipped out of the United States since 2003 — the year the Bush administration handed the job of deportation to the Department of Homeland Security’s new Immigration and Customs Enforcement agency, known as ICE.

Involuntary chemical restraint of detainees, unless there is a medical justification, is a violation of some international human rights codes. The practice is banned by several countries where, confidential documents make clear, U.S. escorts have been unable to inject deportees with extra doses of drugs during layovers en route to faraway places.

Federal officials have seldom acknowledged publicly that they sedate people for deportation. The few times officials have spoken of the practice, they have understated it, portraying sedation as rare and “an act of last resort.” Neither is true, records and interviews indicate.

Records show that the government has routinely ignored its own rules, which allow deportees to be sedated only if they have a mental illness requiring the drugs, or if they are so aggressive that they imperil themselves or people around them.

Stung by lawsuits over two sedation cases, the agency changed its policy in June to require a court order before drugging any deportee for behavioral rather than psychiatric reasons. In at least one instance identified by The Post, the agency appears not to have followed those rules.


The NY Times has recently published similar reports of mistreatment.

The Washington Post also published an op-ed by ICE assistant secretary Julie Meyers. Interestingly enough, it doesn’t really seem to deny much of anything, but simply argue that they’re making improvements. The piece also doesn’t seem to mention any disciplinary action that has been taken by ICE against those who are responsible for the acts discussed in the WaPo articles, let alone any action requested of law enforcement. But they’re still doing some frantic damage control.

Yesterday, Congress questioned Julie Meyers and Homeland Security Secretary Michael Chertoff on the allegations made with regards to medical neglect, and also on improper detention of U.S. citizens and permanent residents. You can support the Detainee Basic Medical Care Act of 2008, which is hardly a solution but, well, something (h/t).

I don’t really have anything intelligent to add; I think that the stories speak for themselves. And I can’t pretend to be any more knowledgeable on this issue than anyone else here. In many cases, I’m probably a lot less informed. You should seek out the words of those who work on and engage with the U.S. treatment of immigrants and detainees on a daily basis. And more bloggers than I can list have also written about this story.

Go read the full series. And then, let’s start talking about what can be done.

cross-posted from Feministe

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{ 7 comments }

1 sara May 23, 2008 at 5:46 pm

This is a great article. I will disagree with some of the smaller details while agreeing with the larger concept that this system is unethical and totally unacceptable.

Such episodes are among more than 250 cases The Washington Post has identified in which the government has, without medical reason, given drugs meant to treat serious psychiatric disorders to people it has shipped out of the United States since 2003

This snippet from the article was in reference to a detainee who was forced down and given an injection of some psychotropic substance. I disagree with the article that this was “without medical reason.” If the inmate was in fact severely agitated and harming himself or someone else, then its ABSOLUTELY appropriate to give them an injection of haldol or some other antipscyhotic to calm them down. We dont have enough details in the article to know for sure what happened, but on its face I cant fault the health workers decision in that particular instance.

2 sara May 23, 2008 at 5:51 pm

doctors and nurses must get permission from the agency’s headquarters before treating patients. Except in emergencies or for the most routine care, they must send written requests to Washington, where, for the entire system of 33,000 detainees across the country, four managed-care nurses in a downtown office building decide what treatments to allow.

These care managers rule on what are known in the bureaucratic lexicon as treatment authorization requests, or TARs. In a recent month, they had to rule on 3,000 requests. They work five days a week, not on weekends, and are unavailable to handle requests that come in later than 4 p.m. Washington time, even though many large detention centers are in other time zones.

The agency touts this as an efficient form of managed care, similar to health plans familiar to patients in the outside world. But a 36-page manual that describes the “detainee covered services package” underscores how unusual it is, with rules designed to prevent people from getting too much help.

This part is particularly outrageous. No disrespect to nurses, but they have no business deciding which medications a patient gets or what kind of procedures are medically necessary. Thats a doctors judgment call.

Its true that HMOs use a scheme thats similar in some respects, however they always have doctors on staff to appeal decisions to if there’s a disagreement over patient care.

RNs dont have the authority to write prescriptions, so this government system is set up to have them guilty of practicing medicine without a license, since they are obviously deciding which meds patients get and/or what kind of procedures they get too.

3 Cara May 23, 2008 at 5:54 pm

Sara, WaPo acknowledges that there are cases where this would be appropriate, and that the rule is that there has to be a medical condition or the person has to be “so aggressive that they imperil themselves or people around them.” That isn’t what happened here. The nurse’s file said that they drugged him because he was angry, and a guard taunted him. If he was being violent, his file should have stated so. So there are three possibilities: 1. that there was no medical reason, 2. that there was a medical reason and it simply wasn’t noted in his file, which is still horrible and negligent and therefore deserves our criticism all the same and 3. that WaPo is simply lying about what is in the file. I find 3 to be pretty far fetched, and I’m leaning towards 1.

4 sara May 23, 2008 at 6:35 pm

I dont think the newspaper is lying, I think its likely that they dont have enough information to judge the situation, and that openly declaring that there was no “medical reason” is jumping to conclusions without enough facts at hand.

Medical records tend to be very scant anyways, its HIGHLY unlikley that there’s a detailed description about what happened. I agree that they should have documented better if thats the case.

If the guy was simply angry but otherwise posed no physical threat to himself or others, then obviously they were in the wrong to administer haldol (most likely drug of choice).

If, on the other hand, he was angry and ALSO banging his head against the wall, or being physically aggressive towards the staff, then they were absolutely justified in administering haldol.

5 Cara May 23, 2008 at 7:29 pm

Yeah, it’d be totally justified if there weren’t any other methods in existence for restraining people who are being violent. There are. Lots of them. If he was being physically aggressive or trying to harm himself, they should have tried other methods of restraining him physically. They transport prisoners all the time — including dangerous and violent ones — and all over the world without drugging them. Pumping serious drugs into a person’s system without their consent should always be a method of last resort. And in other circumstances, it’s quite frankly just plain violence.

6 bfp May 23, 2008 at 8:58 pm

plus, he’s not the only one that they’ve done this to. they regularly do this to people from Iraq/Afghanistan that have not been tried in a court of law and often times where there is NO evidence at all of their involvement in “terrorism”. They do it when they are transporting them from their native countries out to Guantanamo or to other holding cells that are outside the prisoner’s country of origin(an act that in and of itself is illegal, in my opinion–if you commit a “crime” in one country you should *stay* in that country to serve your time).

Pumping people up full of drugs is a *regular* thing–these are not isolated incidences. It is an invasion or penetration of body–a rape, IMO, and I don’t say that lightly. I think it’s also important to think about the connection between psychiatrists/psychologists and this practice–these drugs were created to treat “mental” problems and are now being used as a tool of control by the government. Are the drugs also being used to control patients in ways that are just as unethical and grossly violent? Which leads to the question–if these drugs are being used to control patients–which patients are being controlled?

on a side note–cara, I want to say thank you for how you are covering immigration lately–You’re getting some really important information out there and I really appreciate it.

7 Cara May 24, 2008 at 10:16 am

Hey BFP, thanks for stopping by. I very much appreciate it, but no need for thanks. I wanted to say that I’m really glad you seem to be back to blogging; as I’m sure you know, you’ve been greatly missed.

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