Ten Sue Feds Over Delays in Approval for Citizenship	June 6, 2008 Printable version
Helena Poleo
El Nuevo Herald Ten immigrants sued citizenship agencies and the FBI, saying they are having to wait an unreasonable time to become U.S. citizens. In the 2006 elections, Luciano Horna could not vote because he wasn't a U.S. citizen, but his wife and two grown daughters did because they became naturalized quickly. The entire family had sought U.S. citizenship in November 2005. In May the following year, Horna's wife and two daughters pledged allegiance to the United States. Horna continues to wait, but the 60-year-old Panamanian has had enough. He is among 10 South Florida immigrants who have filed a lawsuit against U.S. Citizenship and Immigration Services (USCIS), the Department of Homeland Security, the FBI and the Justice Department for having to endure an ''extraordinary'' wait to become a U.S. citizen. The plaintiffs include immigrants from Russia, Cuba, Panama, Guyana, Morocco, Pakistan and Bangladesh. Lawyers for the Florida Immigrant Advocacy Center, which is representing the 10, said Thursday that all are permanent U.S. residents and all passed their citizenship interviews. However, they've been waiting between two and four years for approval. ''All we want is for them to be given the rights they deserve,'' said Tania Galloni, a FIAC lawyer. U.S. law stipulates that every applicant should get word from the U.S. government about his or her citizenship petition within four months of an interview. It's been years for Horna and the other plaintiffs. ''They just keep saying that it's the name check'' that's causing the delay, said Horna, who has had a green card for nine years. The FBI checks are conducted to ensure that the names don't match anyone on a list of terrorists. That step began in 2002, after the Sept. 11, 2001 terrorist attacks. The process can take time, said Paul Bresson, an FBI spokesman in Washington, because in many cases the checks must be done manually, consulting paper files. The process has many critics, including the USCIS ombudsman. They say the checks are wasting resources and are unnecessary. Facing multiple complaints, USCIS and the FBI announced in April a plan meant to reduce the wait. According to the agencies, any name checks that have taken more than three years should have cleared by May. Though Bresson said he could not comment on a pending lawsuit, he said the agency had completed checks that were more than four years old. USCIS spokeswoman Ana Santiago also reiterated Bresson's timeline. ''As we had announced several months ago, all of these cases that were more than 4 years old were eliminated from the waiting list in May, as we specified in the elimination plan. Everything suggests that the names that have been waiting more than 3 years were also eliminated in May,'' Santiago said. Under the government's plan, the name checks should be up to date by 2009. But FIAC lawyers noted that they have cases of people who have waited for six years. ''In South Florida they don't seem to be meeting the parameters they announced,'' said Galloni. ``When we ask about their cases, they only get the same answer they have gotten for years: wait.'' FIAC Executive Director Cheryl Little said her office decided to file the suit because it has been bombarded with complaints about the long waits. ''This is the most effective way to help our clients,'' she said. ``We're sure that there are hundreds, if not thousands, of people in South Florida that could join this class-action lawsuit.'' Helena Poleo can be reached at hpoleo@elnuevoherald.com.
Back to top
Some Detainees Drugged For Deportation - Washington Post May 14, 2008	May 14, 2008 Printable version
Amy Goldstein and Dana Priest | Washington Post Staff Writers
Immigrants Sedated Without Medical Reason The U.S. government has injected hundreds of foreigners it has deported with dangerous psychotropic drugs against their will to keep them sedated during the trip back to their home country, according to medical records, internal documents and interviews with people who have been drugged. The government's forced use of anti psychotic drugs, in people who have no history of mental illness, includes dozens of cases in which the "pre-flight cocktail," as a document calls it, had such a potent effect that federal guards needed a wheelchair to move the slumped deportee onto an airplane. "Unsteady gait. Fell onto tarmac," says a medical note on the deportation of a 38-year-old woman to Costa Rica in late spring 2005. Another detainee was "dragged down the aisle in handcuffs, semi-comatose," according to an airline crew member's written account. Repeatedly, documents describe immigration guards "taking down" a reluctant deportee to be tranquilized before heading to an airport. 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. In the five years since its creation, ICE has stepped up arrests and removals of foreigners who are in the country illegally, have been turned down for asylum or have been convicted of a crime in the past. If the government wants a detainee to be sedated, a deportation officer asks for permission for a medical escort from the aviation medicine branch of the Division of Immigration Health Services (DIHS), the agency responsible for medical care for people in immigration custody. A mental health official in aviation medicine is supposed to assess the detainee's medical records, although some deportees' records contain no evidence of that happening. If the sedatives are approved, a U.S. public health nurse is assigned as the medical escort and given prescriptions for the drugs. After injecting the sedatives, the nurse travels with the deportee and immigration guards to their destination, usually giving more doses along the way. To recruit medical escorts, the government has sought to glamorize this work. "Do you ever dream of escaping to exotic, exciting locations?" said an item in an agency newsletter. "Want to get away from the office but are strapped for cash? Make your dreams come true by signing up as a Medical Escort for DIHS!" The nurses are required to fill out step-by-step medical logs for each trip. Hundreds of logs for the past five years, obtained by The Post, chronicle in vivid detail deviations from the government's sedation rules. An analysis by The Post of the known sedations during fiscal 2007, ending last October, found that 67 people who got medical escorts had no documented psychiatric reason. Of the 67, psychiatric drugs were given to 53, 48 of whom had no documented history of violence, though some had managed to thwart an earlier attempt to deport them. These figures do not include two detainees who immigration officials said were given sedatives for behavioral rather than psychiatric reasons before being deported on group charter flights, which are often used to return people to Mexico and Central America. Even some people who had been violent in the past proved peaceful the day they were sent home. "Dt calm at this time," says the first entry, using shorthand for "detainee," in the log for the January 2007 deportation of Yousif Nageib to his native Sudan. In requesting drugs for his deportation, an immigration officer had noted that Nageib, 40, had once fled to Canada to avoid an assault charge and had helped instigate a detainee uprising while in custody. But on the morning of his departure, the log says, he "is handcuffed and states he will do what we say." Still, he was injected in his right buttock with a three-drug cocktail. In one printout of Nageib's medical log, next to the entry saying he was calm, is a handwritten asterisk. It was put there by Timothy T. Shack, then medical director of the immigration health division, as he reviewed last year's sedation cases. Next to the asterisk, in his neat, looping handwriting, Shack placed a single word: "Problem." When he landed in Lagos, Nigeria, Afolabi Ade was unable to talk. "Every time I tried to force myself to speak, I couldn't, because my tongue was . . . twisted. . . . I thought I was going to swallow it," Ade, 33, recalled in an interview. "I was nauseous. I was dizzy." As he was being flown back to Africa, his American wife alerted his parents there that he was on his way. His father was waiting at the Lagos airport. It was the first time in three years that they had seen one another. Shocked by how woozy the young man was, his father decided not to take him home and frighten the rest of the family. Instead, he checked his son into a hotel. Ade was in the hotel for four days before the effects of the drugs began to abate. Part of a prominent Nigerian family, Ade asked The Post to identify him by only a portion of his name to protect their reputation. He had come to the United States as a college student in the mid-1990s. Five years later, he was in a car belonging to cousins when police found fraudulent checks in the trunk. He pleaded guilty. After finishing his sentence, Ade was living in Atlanta, and was two semesters away from a telecommunications degree at DeVry University, when immigration officers came looking for him one day in January 2003. They wanted to deport him for the old crime. He called his probation officer to ask whether he could wait to surrender until he took his upcoming final exams. But when he went to the probation office, immigration officers were there to arrest him. His records offer little explanation of why he was sedated. The one-page medical record in his file mentions one condition: chronic nasal allergy. The log of his trip does not mention mental illness; in the space to list current medical problems, a nurse wrote merely that Ade was anxious. His drugging, however, fits a pattern that emerges from the cases analyzed by The Post: The largest group of people who were sedated had resisted attempts to deport them at least once before. One summer day in 2003, deportation officers arrived at the rural Alabama jail where Ade was being held. Pack your bags, they told him. When they reached an immigration office in Atlanta, Ade recalled, half a dozen "big guys came to meet me and said I was there to be deported." "I can't be deported," he replied. "I have a wife I love very much." Besides, he told them, he was still appealing his immigration case. He shouldn't have to leave, he protested, until the judge had ruled. That day, he was returned to Alabama. But he said that immigration officers warned him, "We'll find a way to get you on a plane." A few weeks later, the officers came back and again took him to a holding cell in Atlanta. He was, the medical log says, becoming "increasingly anxious and non-cooperative per flt. to Nigeria." At 1:30 p.m., the log says, "Dt taken down by four" guards. Ade was being held down, he recalled, when he noticed a nurse "with a needle and a bottle with some kind of substance in it." He said he told the guards: "Okay, fine, fine. If it's going to be like this, don't inject me. I will go on my own free will." The nurse went ahead, the log shows, injecting him in the left shoulder with two milligrams of a powerful drug, Haldol, used to treat psychosis, and one milligram of an anti-anxiety drug, Ativan. He was injected with two more rounds, as well as a third drug, in progressively larger doses, during the trip. The Sedation Cocktail More than 250 foreigners without mental illness have been sedated for deportation during the past five years. Most of them have been injected with a cocktail consisting of two or three drugs, although a few were given different medications in the earlier years. During the 2007 fiscal year, ending in October, 53 people were sedated without a psychiatric reason, according to a Washington Post analysis based on government records. Fifty of them were injected with Haldol. All those people also were given Ativan, and all but three were given Cogentin as well. Two deportees received Ativan alone, and one person's medications were not clear from the records. Here is a look at the major drugs in the government's sedation cocktail. The Most Potent Drug HALDOL (a.k.a. HALOPERIDOL) Antipsychotic medication Uses: Schizophrenia, psychosis induced by street drugs or any medical condition, persistent aggressiveness that may be a danger to patient or others, Tourette's syndrome, manic disorder. What it does: For people with severe psychiatric illness, can help them think more clearly, feel less nervous and prevent suicide in those who are likely to harm themselves. Can also reduce aggression and a desire to hurt others. Calming to psychotic people who hallucinate or are delusional. Produces a more "zombie-like" effect in non-psychotic people. Side effects: Dizziness, drowsiness, difficulty urinating, trouble sleeping, headache, anxiety and pain at the injection site. May cause muscle spasms or stiffness, tremors, restless- ness, masklike facial expression, drooling. Recommended daily doses: For aggressive behavior, 0.5 milligrams twice a day to 5 milligrams three times a day, although doses of up to 10 milligrams a day may be used in a hospital emergency room. The Other Drugs ATIVAN (a.k.a. LORAZEPAM) Benzodiazepine Uses: Anxiety, seizures, pre-surgery What it does: Produces a calming effect on the brain and the central nervous system Side effects: Dizziness, drowsiness, slurred speech, unsteadiness COGENTIN Anti-cholinergic agent that relaxes muscles by acting within the brain Uses: Parkinson's disease, involuntary movements due to side effects of some psychiatric drugs, including Haldol What it does: Helps decrease muscle stiffness, sweating and the saliva production, and helps improve walking ability in people with Parkinson's. Side effects: Blurred vision, constipation, decreased sweating, drowsiness, dry nose, dry throat, painful urination, nausea SOURCES: Medscape; WebMD; Philip Seeman, professor of psychiatry and pharmacology, University of Toronto The effects of those injections are what alarmed Ade's father after the plane landed in Lagos. Yet the medical log says Ade arrived "alert and oriented." His family's doctor, who visited him on each of the four days his father hid him in the hotel, had a different view. "He was groggy -- somebody under the influence of drugs or drunkenness, " recalled Olakunle Adigun, a general practitioner. He couldn't figure out what sedatives his patient had been given, so he tried to detoxify him with saline infusions. Ade's pulse was dangerously low, and when he tried to walk around the hotel room, "he leaned on the wall," Adigun said. "He was talking, but a slurred kind of speech." * * * Internal government records show that most sedated deportees, such as Ade, received a cocktail of three drugs that included Haldol, also known as haloperidol, a medication normally used to treat schizophrenia and other acute psychotic states. Of the 53 deportees without a mental illness who were drugged in 2007, The Post's analysis found, 50 were injected with Haldol, sometimes in large amounts. They were also given Ativan, used to control anxiety, and all but three were given Cogentin, a medication that is supposed to lessen Haldol's side effects of muscle spasms and rigidity. Two of the 53 deportees received Ativan alone. One person's medications were not specified. Haldol gained notoriety in the Soviet Union, where it was often given to political dissidents imprisoned in psychiatric hospitals. "In the history of oppression, using haloperidol is kind of like detaining people in Abu Ghraib," the infamous prison in Iraq, said Nigel Rodley, who teaches international human rights law at the University of Essex in Britain and is a former United Nations special investigator on torture. For people who are not psychotic, said Philip Seeman, a University of Toronto specialist in psychiatry and pharmacology, "prescribing Haldol . . . is medically and ethically wrong." Seeman studied the drug in the 1960s and later discovered the brain receptors on which several antipsychotic drugs work. The only circumstances in which small amounts of Haldol are appropriate for non-psychotic people, Seeman said, are when a person comes into a hospital emergency room violent and agitated from an overdose of a drug such as PCP, or when someone with severe dementia is delusional or combative. "You or I wouldn't get it if we were emotionally upset," he said. In addition, Seeman said, typical doses to help psychotic patients accustomed to the drug are perhaps five to 15 milligrams a day. Several deportees were given a total of 30 milligrams, which Seeman characterized as "really high," especially for people who have never taken the drug before. Even when used for its intended patients, people with psychosis, Haldol has drawn warnings from the U.S. government. In September, the Food and Drug Administration issued an alert citing "a number of case reports of sudden death" and other reports of dangerous changes in heart rhythm. It is, important, the FDA warned, to inject Haldol only into muscles, not veins, and to avoid doses that are too high. "Pharma non grata" is the way Emergency Medicine News magazine described the drug after the FDA alert. Beyond the specific drugs used, Rodley said, is a deeper question: "What is the least intrusive means of restraint consistent with the human dignity of the person? . . . I'd be very surprised if the injection of disabling chemicals against somebody's will that affect one's psychological well-being . . . is likely to be the least intrusive means." Asked to explain the reason for using Haldol and other psychotropic drugs with people who are not mentally ill, ICE responded, "The medications used by Aviation Medicine are widely used in psychiatry." Agency officials said that medical escorts administer "the lowest dose possible." Combining Haldol and Ativan "allows you [to] use less of each," they said, and produces a quicker and longer sedative effect. In the years before Ade was drugged, there had been an internal debate within the U.S. government over whether sedating deportees against their will is legal, according to confidential legal memos obtained by The Post. There was agreement that mentally ill people could be forced to take psychotropic medicine on their way out of the country. At dispute were cases in which the detainees were not mentally ill but combative -- known as "behavioral cases." Near the end of the Clinton administration, Health and Human Services lawyers sent around a memo that warned, "[U]sing chemical restraints in cases in which medication is not clinically indicated . . . may put the government at risk of potential liability." Another memo went further, concluding that it could be done only if a federal judge gave permission in advance. "[R]egarding detainees who are not mentally ill," the November 2000 document said, "involuntary medication of such persons for the sole purpose of subduing them during deportation, without a court order, is not supported by any legal authority and raises ethical issues, as well. "After the Sept. 11, 2001, attacks, and after the Bush administration assumed a tough new stance on immigration in its campaign against terrorism, the Justice Department still sounded wary about drugging deportees. In March 2002, a Justice lawyer laid out two options. One choice, he wrote, was to "seek a court order . . . in every case where the alien's medication is not therapeutically justified." The other choice was to create a regulation to grant immigration officials explicit permission to sedate deportees, perhaps including safeguards that would give people a warning that they might be medicated -- and a chance to object. Top immigration officials chose neither. Instead, in May 2003, just after ICE was created, they internally circulated a new policy: "[A]n ICE detainee with or without a diagnosed psychiatric condition who displays overt or threatening aggressive behavior . . . may be considered a combative detainee and can be sedated if appropriate under the circumstances." Under that policy, scores of people have been sedated every year since then, usually with heavy psychotropic drugs. Some countries forbid the practice. The medical files for several deportees recount disputes between U.S. officials, who wanted to inject a subject, and foreign officials, who would not allow it. Immigration guards and a public health nurse ran into trouble in May 2004, during a stopover on a trip from Colorado to Guinea. The deportee had been given the three-drug cocktail at the airport gate before leaving Denver, the nurse wrote in the log. Three "booster doses" followed. The last booster was given shortly before the plane landed in Belgium. "[N]o problem initially with Belgium security," the log says. "[T]hen approached and informed illegal to medicate detainee against their will in Belgium. Informed them pt wasn't medicated in Belgium airspace for which they replied that he is medicated in Belgium." In the end, the security officers let the deportation go ahead. Immigration guards and a nurse had more trouble during another deportation to Guinea in April 2006, as they escorted a 34-year-old man from Atlanta, with a stop in France. He had been given 15 milligrams of Haldol, as well as the two other drugs, by the time the flight reached Paris at 9:45 a.m. According to a nurse's report on the incident, the guards, nurse and deportee were met at the plane by French national police, who accompanied them to an airport police station to await the connecting flight to Africa later in the day. Once at the station, one of the guards asked a French officer "where we could inject the detainee when needed." First, they were shown into a private area. But five minutes later, the nurse's report says, "a superior French police officer approached and informed me that any type of involuntary injection was strictly forbidden in France, and that we would have to wait until we were in the aircraft if we were to inject our detainee." Six hours later, the entourage returned to the boarding area for the flight to Guinea. "When we arrived at the plane, the detainee became very argumentative, refusing to enter plane until [the guards] produced paperwork showing a final deportation order," the nurse wrote. The immigration officers tried to coax him onto the plane. He refused. "I asked the French police if the ramp on the gate would be an appropriate place to medicate," the nurse wrote. "The French police's reply was that it was strictly forbidden." The plane's captain came over to say that he would not allow the deportee onto the flight. The guards and the nurse flew him back to Atlanta. Five weeks later they tried again, and this time, they reached Guinea. By the time they arrived, a nurse had given the deportee nine injections of Haldol totaling 55 milligrams -- nearly four times as much as before. * * * Time in Custody Varies For Detained Immigrants Foreigners detained by immigration officials spent an average of 37 days in custody during fiscal 2007, according to Immigration and Customs Enforcement. Detainees, though, can be held for a much longer or much shorter time, depending on their circumstances. Under a practice that was expanded during the summer of 2006, undocumented immigrants caught within 100 miles of the Mexican border -- and within 14 days of their entry into the United States -- are deported swiftly under an "expedited removal" program. These immigrants usually do not have a hearing before a judge. On the other hand, some immigrants are detained for months or even years if they challenge their deportation in federal courts. Here is a breakdown of time in custody for fiscal 2006, the most recent information ICE could provide. The figures exclude nearly 5,800 detainees who are seeking asylum. Less than three months: 206,325 Three to six months: 10,828 Six to nine months: 2,644 Nine months to one year: 1,269 More than one year: 1,809 One deportee who was sedated last year had convictions for armed robbery and assault. Another kept telling immigration officers, "I am God." But many of those injected with psychotropic drugs, records show, are neither violent nor mentally ill. They simply do not want to go home. "[M]ild anxiety and agitation" is how a deportation log describes Remmy Semakula's state on the afternoon he was taken from his cell in the Middlesex County jail in New Jersey to be deported to Uganda in early April 2007. According to a memo from his deportation officer, he had said earlier that he would "fight with the officers and obstruct the operation of the airline" if guards tried to force him to go home. Semakula, 42, said that he had not tried to thwart his deportation and had not known it was imminent because his immigration case still was before a federal judge. "I never fought violently or physically," he said. "They just grabbed me and injected me with a sleeping drug." The first time immigration agents tried to deport Michel Shango, he slammed his head, hard, against the outside of the van that had come to pick him up at Atlanta's city jail. Instead of being driven to the airport, then flown to the Democratic Republic of Congo, he was brought back to the jail so his wound could be tended to. "I asked him why he feared being returned back to his country," an immigration officer wrote of the incident. Shango, now 42, replied that he had been a journalist and had written articles critical of the Congolese government. "Detainee stated . . . that he might as well die trying to avoid deportation," a second officer wrote, "because they will kill him as soon as he gets to the D.R. of the Congo." Until early 1996, Shango worked in Congo, ghostwriting articles and supplying information to foreign correspondents about the repressive administration of President Mobutu Sese Seko, he said in telephone interviews from locations in Congo, Gabon and Equatorial Guinea, where friends are now helping him hide. Eventually Shango was arrested, he and two of his lawyers said, but he escaped to Canada, then settled in North Carolina, where he started a limousine business with a cousin in Charlotte. He married an American, who at first offered to help him become a citizen. The marriage dissolved. He applied for political asylum. He was turned down. He was remarried to a Congolese woman by the time immigration officers came to his house at 4:30 one morning in May 2006. As his wife and their three American-born children cried at the frightening scene, the officers led him away at gunpoint. On Feb. 28, 2007, three months after the first deportation attempt was aborted because of the head-banging incident, seven guards arrived at the Atlanta jail to make a second attempt. Shango glanced at his watch and noted that it was 1:45 p.m. "They pushed me against the wall," he recalled. "They pulled my pants down." His medical log shows that he was given seven shots in his right buttock and right shoulder before he boarded the airplane. The log says his only psychological problem was "anxiety disorder." By the time Shango reached Congo, records show, he had been injected with 32.5 milligrams of Haldol and 7.5 milligrams of Ativan. As he was thrown into a prison after he got off the plane, and even as friends helped him escape, he was so disoriented, he said, that he did not fully know where he was. For two weeks, Shango said, "It was like I was dreaming. . . . I started crying, crying, crying all day long. . . . I was like crazy, because [of] the drugs, knocking me down." * * * Of all the detainees who have been forcibly drugged, only two have drawn much public attention. Neither, in the end, was deported. And compared with other deportees, neither got large doses of sedatives. But publicity about their cases sent shock waves through the immigration bureaucracy. Raymond Soeoth, a Christian minister from Indonesia, had tried and failed to win asylum in the United States. While in custody at an immigration compound near Los Angeles, his medical log notes, Soeoth, now 39, he said he would kill himself if deported -- a statement his lawyers say he never made. On Dec. 7, 2004, he was injected in the left buttock with five milligrams of Haldol and four milligrams of Cogentin before being taken to the airport. As it turned out, his deportation was canceled before takeoff because immigration officials had not alerted airline security in Singapore, a stopover point. Amadou Diouf came to the United States from Senegal as a student in 1996 and got a degree in information systems from California State University at Northridge. He married a U.S. citizen and was trying to change his immigration status when, in March 2005, he was arrested and brought to the same compound as Soeoth. Eleven months later, as he was still appealing his case and, according to his lawyers, had a court order blocking his deportation, immigration officers came for him and took him to the airport for the trip back to Senegal. At first, records show, Diouf, now 32, was calm. He was already sitting in a window seat, 4A, when he demanded to speak to the plane's captain. He "became more agitated, anxious and loud in his dialogue," according to the medical log. A nurse said he would be given "some calming medicine," but when Diouf saw the needle, he lunged. Guards "proceeded to take down the detainee to the ground" in the plane's galley, and the nurse injected him with five milligrams of Haldol, two milligrams of Ativan and two milligrams of Cogentin. At that point, the guards and nurse called off the trip. Diouf was returned to his cell. In early May 2007, a lawyer for the American Civil Liberties Union of Southern California was drafting a lawsuit on behalf of Soeoth and Diouf and told a local newspaper, the Los Angeles Daily Journal, about their sedations. Across the continent, inside the immigration health division's headquarters in downtown Washington, the publicity's effect was electric. The next day, the chief of psychiatry for the division's aviation medicine branch dispatched a memo. "I have stopped all planned non-psychiatric behavioral escorts, of which 10 are currently planned," he wrote, until government lawyers "have formalized policy in regards to this type of escort activity." A month and a half later, the medical escort rules were changed. Except in psychiatric cases, according to a confidential June 21 memo from ICE, the health division "must have a court order to assist. . . . [ICE in] removal of problematic detainees." In January, the language was made even stronger: "DIHS may only involuntarily sedate an alien to facilitate removal where the government has obtained a court order. There are no exceptions to this policy." The newest rules were issued less than three weeks before the government tentatively settled the lawsuit with Soeoth and Diouf, who are now out of custody. The government is no longer trying to deport Soeoth; Diouf is still fighting to remain in the country. How well the government is following its new rules is unclear. Asked how many court orders the government has sought, immigration officials said that none "have been issued to involuntarily sedate an alien for removal purposes," but they declined to discuss whether any requests are pending. In one known case in which government lawyers sought a court order, they withdrew the request after a congressman intervened. On Oct. 1, a federal judge in Texas was asked for permission to sedate Rrustem Neza. Immigration officers had canceled their first attempt to deport him to Albania because he created a scene at the Dallas/Fort Worth International Airport, screaming, "I am not a terrorist." One week after the government filed its motion, Rep. Louie Gohmert (R-Tex.), a former judge, wrote to the court, saying he had "grave concerns" about the government's desire to medicate his constituent to deport him. "Mr. Neza fled Albania after telling a crowd in Tropoje the names of the men who were seen killing Azem Hajdari, who organized a student movement against the Communist Party. Mr. Neza's cousins were fatally shot while fleeing with him," the congressman wrote. "[S]edating Mr. Neza amounts to a death sentence for an innocent man." Last March, after Gohmert had spoken about Neza's case with Secretary of State Condoleezza Rice, and after he had introduced legislation to block Neza's deportation, the issue was dropped. * * * In at least one instance since the rules were changed, the government apparently drugged a deportee without permission from a judge. Maher Ayoub, now 44, was sent back to Egypt last August. A month later, immigration officials told Congress that they had not yet asked for a court order in any case. Ayoub had thwarted the first attempt to deport him, a few months earlier, by sitting in a van and demanding all the paperwork in his immigration file. He said he spent the next three months in segregation in an Elizabeth, N.J., detention center. The next time they tried to send him home, immigration officers were determined to make sure he would go quietly. His record offers contradictory evidence about whether there was psychiatric justification for the drugs he got, though it seems to suggest that there was not. A one-page "patient summary" for Ayoub says "Med/Psych Alert Documents: None." His medical escort log labels him a mental health case and says he had a "depressed mood" and an "anxiety state." A handwritten note in his escort file, from a psychiatrist who saw him at the Elizabeth center, first says Ayoub was not likely to endanger himself or anyone else -- then, lower on the same page, says he might. On the next page of the file is another note, this one written two days before his flight, from the psychiatrist in charge of aviation medicine. It says that Ayoub's case is a "behavioral escort," not a psychiatric one, and that the nurse "is only to give medications to the patient if he agrees to take them. He will only use involuntary treatment if the patient is at imminent risk of hurting himself or others." That is not what happened. "Detainee tearful and wringing hands," his medical log begins. An hour later, it says: "Detainee increasingly agitated and resisting clothing change. Detainee is now crying and screaming" at two guards. A nurse at the Elizabeth detention center slid two milligrams of the anti-anxiety drug, Ativan, into his left shoulder. Immigration officials said his deportation was "consistent" with the June policy that allows medication only when a detainee "may be a risk to himself or others." "I was feeling my head was leaving my body," Ayoub remembers. "I was losing control over my body." He was groggy but awake when he arrived with guards and the nurse at New York's John F. Kennedy International Airport and boarded the nonstop flight to Egypt. Before the plane took off, he remembers, he called over a flight attendant and "asked them to tell the pilot I didn't want to leave." The nurse stuck a needle into his right arm this time. That injection put him to sleep. Staff researcher Julie Tate and database editor Sarah Cohen contributed to this report.
Back to top
Suicides Point to Gaps in Treatment - Washington Post May 13, 2008	May 13, 2008 Printable version
Amy Goldstein and Dana Priest | Washington Post Staff Writers
Errors in Psychiatric Diagnoses and Drugs Plague Strained Immigration System Peasant farmer Jose Lopez-Gregorio, 32, left his wife and five children behind in Guatemala with two bags of corn, barely enough food for one month, when he decided to find work in the United States. Detained crossing the Mexican border and held in an Arizona immigration center, he felt guilty, he told guards, eating three meals a day. Lopez had been inside one month and eight days when he strangled himself with a bedsheet. Five days earlier, the staff had placed him on suicide watch, only to be overruled within hours by the center's psychologist. Mexican Carlos Cortes Raudel, 22, hanged himself from a tree on the way to breakfast in a California compound. Korean Sung Soo Heo, 51, was on suicide watch, less than a week after leaving a psychiatric hospital, when he hanged himself from a ceiling vent in his New Jersey cell. Geovanny Garcia-Mejia, 27, a Honduran, wrote notes in blood on his Texas cell floor and hanged himself from a ventilation grate while supposedly under 15-minute checks around the clock. "It goes without saying that the incident could have been avoided," the Newton County sheriff noted in an internal review of Garcia's death. 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 Securitys 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. No one in the Division of Immigration Health Services (DIHS), the agency responsible for detainee medical care, has a firm grip on the number of mentally ill among the 33,000 detainees held on any given day, records show. But in confidential memos, officials estimate that about 15 percent -- about 4,500 -- are mentally ill, a number that is much higher than the public ICE estimate. The numbers are rising fast, memos reveal, as state mental institutions and prisons transfer more people into immigration detention. The influx is overwhelming the system, internal documents show. The ratio of staff to mentally ill detainees is out of balance, with far fewer staff members than in other prison settings, according to Dennis Slate, the top mental health official in the detainee system. In an e-mail to colleagues the morning of last May 31, Slate said the ratio in the Bureau of Prisons was 1 to 400. In prisons for the mentally ill, it was 1 to 10. But in the immigration detention centers, it was 1 to 1,142. Immigration authorities contract with a private facility in South Carolina to care for seriously mentally ill patients. They said they are considering several additional options for increasing care for such detainees. Along with the crisis in care, the records also show soul-searching among doctors, nurses and administrators. We need to stop looking for band-aid solutions for these problems, Slate wrote. Step back, take a deep breath . . . It wasnt just patients that Slate and his colleagues worried about. They also worried that trading financial savings for substandard health care would come back to haunt the government. Think about what we are trying to accomplish with limited financial and personnel resources we have, Slate wrote. The little money managed care may save in the short run is going to be dwarfed by the millions that will be paid out by ICE when the lawsuits roll in. None of these problems appeared overnight. When immigration became a national security issue after the terrorist attacks of Sept. 11, 2001, the administration decided to increase raids on workplaces for undocumented workers and to round up convicted felons who had served time but were now deportable, no matter how long they had lived in the United States. This, along with a new requirement that political asylum-seekers must wait out their cases behind bars, created a deluge that the system was unprepared to handle. A system set up for quick stays turned into a de facto long-term care center for the most troublesome patients, those whose countries of origin often refused to take them, Slate noted in a confidential e-mail. It was in this context that the basics of sound mental health care, such as proper supervision of suicidal detainees, were often overlooked. On the evening of March 21, 2005, Gene Migliaccio, then director of the immigration health services agency, sent a brief BlackBerry message to colleagues: DIHS is concerned that detainee committed suicide, in medical pod, after being assessed a suicide risk. Hassiba Belbachir, a 27-year-old woman from Algeria, had strangled herself with orange jail-issue socks, which she knotted together and wrapped twice around her neck. Five days before her suicide, Belbachir had a panic attack in her cell in an Illinois jail and was moved to a medical ward. The next day, internal records show, she told a social worker she was hearing parasites and radio waves and that she wanted to die. Death is dripping, drop by drop, she said. But she was not placed on suicide watch. Immigration officials declined to comment, citing ongoing litigation in the case. Belbachir had arrived eight days earlier at Chicagos OHare International Airport. The youngest of seven children, she loved books on religion and dancing the merengue. With a degree in Spanish, she thought of becoming a translator. She wanted to visit the world, said an older sister, Houaria Belbachir, who lives in France. Belbachir had gotten married, and her husband had brought her to Chicago to live. After a month, she learned he had another wife. She fled to Spain, but without a visa, she was turned away at the airport. She flew back to OHare, asked for political asylum and, by federal policy, was taken into custody while authorities considered her claim. Belbachir was sent to McHenry County Jail in the far suburbs of Chicago. The jail already had problems with its medical services: Detainees did not receive the required mental health screening, nor the standard screening for suicide risk, a recent review had found. Untrained staff members often did what screenings there were. During Belbachirs intake screening, jail records show, she said she had tried to commit suicide once by drinking soap. The social worker who interviewed her noted that she had a major depressive disorder and needed to see a psychiatrist for medication. Belbachir was given an appointment for 6 p.m. on March 18. By then, she had been dead for a day. Investigation reports say a guard glanced into her cell at 3:40 on the afternoon Belbachir died. She was lying face down on the floor, but the guard could see only her lower back and legs. He asked a co-worker whether she usually sleeps like that, and was told that she did. Half an hour later, when the guard returned to deliver dinner, he opened the cell door to discover Belbachir unconscious with the socks around her neck, her face purple, her mouth bloody. She left a five-page handwritten poem, in French, on a paper with Visa Waiver Program across the top. It began: Its good, the death. Inside the detainee mental health system, treatment decisions often revolve around money. There are frequent battles, with doctors and nurses in the field on one side and the managed-care administrators in Washington on the other, looking for ways not to spend. The battles often prompt Solomonic choices. One day, Slate and his colleagues engaged in an e-mail debate over a mentally ill detainee who was in the hospital but now well enough to leave. Should they send him to a detention center, where there was a bed available but no outpatient psychiatric care? Or should they keep him in the hospital, at greater cost, until space in a more appropriate immigration compound became available? We can not just leave these detainees in the hospital, insisted Linda Jo Belsito, the nurse in charge of managed-care decisions for DIHS. Dr. Slate is advising leaving these detainees in-patient but I do not agree. Reached by phone, Belsito declined to comment. Down the hall from Belsitos office at headquarters, Matt Kleiman, the head of behavioral health, strongly disagreed. Detainees such as these who are returned to the general prison population will in all likelihood decompensate quickly, he warned, using a term that means to deteriorate psychologically. Belsito and her managed-care associates were withholding treatment for many types of care, saving the agency millions of dollars. For mental health services, four denials for treatment of manic-depressive psychosis saved DIHS $18,145.36, according to an itemized record of the savings over a one-year period ending in August 2006. Two denials for care of unspecified psychosis saved an estimated $11,668.60. Nine denials for treatment of depressive disorder not elsewhere classified saved $43,158.57. An immigration spokeswoman said the vast majority of requests are ultimately approved and the denials are usually because of insufficient information. Money is not the only factor that determines the quality of care. Poor practices, records reveal, created a crisis situation at the South Texas Detention Complex at Pearsall, outside San Antonio. On June 15, Gustavo Cadavid, chief of psychiatry for DIHS, waved a red flag after discovering that Pearsalls clinical director, Erik Johnson, had close to 140 chart reviews pending, meaning 140 patients still needed care. Cadavid had complained to headquarters several times about Johnson. [I]t is becoming clear that there exist a crisis in the mental health care at Pearsall, he wrote in June. Two hours later, Slate gave Cadavid some advice. It is my suggestion that [medical director Timothy Shack] issue a clear order for Dr. Johnson to begin to provide treatment to mentally ill detainees, he wrote in an e-mail. If he fails to follow the order, then this behavior needs to be interpreted as insolence and insubordination and documented as such. Slate titled his e-mail Crisis in mental health care in Pearsall. He copied it to seven top ICE and DIHS administrators, including the interim director of DIHS, Neil Sampson. Immigration officials said the mental health care program at Pearsall meets national detention standards. Reached by phone, Johnson declined to comment. He is still at Pearsall. The case of Junior Bannister, a detainee from Barbados, indicates that problems remain, as evidenced by another e-mail exchange. When Bannister arrived at Pearsall in August, he told immigration officials that he had been taking Celexa, an antidepressant, for five years, since his young daughter died. When he was taken into custody, a top mental health official recommended continuing his medication, but his notes did not get scanned into Bannisters file. Without his medication, he began having auditory hallucinations. He complained often, and staff sent the concerns to Johnson, who never signed off on the prescription. In January, a lawyer working with Bannister inquired about the delay, setting off a heated exchange between Johnson and his bosses, who discovered that the medical staff had seen Bannister 22 times. Jay Sparks, officer in charge at Pearsall, sent a curt e-mail to Johnson on Jan. 11 after examining Bannister's medical records. Now I am further puzzled. While I understand a shortage of medical staff, we evidently were staffed well enough to see this person 22 times, but in the course of all of this unable to get him the medication that had been recommended -- why would this be?" Johnson replied 90 minutes later. "I could not get to him," he wrote. ". . . There are many things we are not able to get to." Sparks e-mailed up the chain of command. "I believe this case illustrates that we need something more efficient," he wrote. ". . . If we need more medical staff, then they need to be deployed, but regardless of what the solution is, it needs to occur rather quickly, as access to adequate medical care for our detainees is a rather critical issue." In a recent telephone interview, Bannister said he would try to get Johnson's attention whenever he saw him, without success. Johnson, he said, would dismissively "just wave his arms" every time. After eight months of asking, Bannister recently received his medication. Isaias Vasquez was not as lucky. Three mental health workers at Pearsall misdiagnosed him and refused to allow him to continue taking medications that he had been prescribed much of his life. Immigration officials declined to comment, citing pending litigation. Vasquez had come from Mexico to the United States legally with his family when he was 2 years old. He served in the Army for two years until psychiatric problems ended his military career. Years later, when he was convicted on a drug-possession charge, he served the 1 1/2-year sentence at a Texas state psychiatric hospital. The government said the crime made him deportable, and immigration officers picked him up from the hospital and sent him to one detention center, then another. Records chronicle his paranoid delusions and auditory hallucinations. He had been diagnosed with chronic paranoid schizophrenia in the early 1990s and had been hospitalized 18 times before he landed in Pearsall. But the staff ruled that he was not schizophrenic and cut off his medication. Instead, on Nov. 29, 2005, they diagnosed him with an "unspecified personality disorder." Vasquez "insisted throughout session he was paranoid schizophrenic and needed medication," a social worker wrote in his medical file. But the evaluation team concluded that "his thought process and content was normal, logical and coherent." They suspected he was faking to keep his Social Security disability benefits. They decided to take him off a drug for schizophrenia, and another for depression, and cut his dose of a second antidepressant in half. The effects were swift. A week later Vasquez was placed on suicide observation. He "smeared feces throughout the suicide observation room," his medical chart shows. The next day, "he announced in the dormitory that either he killed himself or God would do it for him, and he took all of his clothes off. Then he got down onto the floor and licked it." The staff's response: They eliminated the last of his psychotropic medicine. "Mental health visits will cease at present time," says a Dec. 15 note in his medical file. Two months later, another note warned, "DO NOT PLACE YOURSELF WITHIN GRABBING OR SPITTING DISTANCE OF THIS DETAINEE." After another month, he was found sitting on his bed with only a blanket around his waist, reading a Bible aloud and screaming, "The world is coming to an end, but not until I finish using my red tape!" He refused his other medications for diabetes, high blood pressure and suspected tuberculosis. In mid-March, Johnson stuck a handwritten note on Vasquez's cell window: "If you keep refusing to take your . . . medicines . . . YOU put YOURSELF at risk of BLINDNESS, AMPUTATIONS, HEART ATTTACKS, KIDNEY FAILURE, STROKES and EARLY DEATH." Vasquez "covered that area of the window with spit," Johnson wrote in his medical file. "I slid another copy under the door, and he turned it face down and slid it back out, and then he blocked the door with his clothing so I could not slide it under again." On March 24, "[H]e had saved up 6 empty peanut butter jars and had some sort of yellowish liquid in them. . . . [T]he guards told him to give them up. He refused." The guards subdued him with tear gas. They gassed him again two weeks later when he refused to give the guards the broken eyeglasses he had "tied to his head with an undershorts waistband. . . . When the room was repeatedly sprayed, he stood stoically." Unable to persuade Vasquez to take his medicine, the staff discontinued it in late April. A final note on his behavior, from May 1, five days before his release, says he had "smeared feces on window to cell and threw water and feces under door of cell." Even then, the staff did not reconsider its assessment that he was not schizophrenic or its decision to take away the psychotropic drugs. Their assessment of his problem: "Ineffective individual coping." Vasquez had won his immigration case. When his common-law wife picked him up, she found him raving and gaunt. Gloria Armendariz drove him straight to the VA hospital. On the way, she recalled, "I had to cut the [car] speakers and put them in the trunk because he kept saying they . . . would listen and videotape him." At the hospital, guards had to subdue him. He was admitted to the psychiatric ward, "which is where he needs to be," said his lawyer, Lee Teran. The next day, he was started on antipsychotics. Helped by his medicine and no longer facing deportation, Vasquez, now 49, did something that, in his nearly five decades in the country, he'd never bothered to do: He applied to become a citizen. At the citizenship ceremony last fall, he wore a jacket, a tie and a broad smile. While Vasquez had been denied crucial medicine, Amina Bookey Mudey had the opposite problem. Records show that she was diagnosed with psychosis she did not have and given medication she did not need. Alone and speaking little English, the Somali woman arrived at John F. Kennedy International Airport in New York on April 11, 2007, seeking political asylum. With no interpreter to question her, immigration agents shackled her ankles, wrists and waist, and put her in a van. Exhausted, hungry and frantic about being tied up, Mudey collapsed on the way to a windowless converted warehouse in Elizabeth, N.J., where she would remain for five months. The Elizabeth compound also had no interpreter. Nonetheless, an intake officer wrote in her medical records that Mudey said she was epileptic. A doctor there diagnosed her with post-traumatic stress disorder, depression and, incorrectly, with psychosis. He prescribed the potent antipsychotic Risperdal. Mudey, 30, was a member of an outcast Muslim clan and, according to her political asylum application, had been tormented by dominant groups throughout her life. When she was 10, she said, an old woman cut off her genitals with a razor blade. As a teenager, she was clubbed and beaten by girls with status. When she was 19, armed men shot and killed her father and two brothers at home. At 22, five men with guns gang-raped her mother and sister, who screamed so much the men killed her. Then they attacked Mudey with a knife and bashed her head with a gun butt. Soon after taking Risperdal at the Elizabeth detention center, she found herself in the throes of its worst side effects. Her arms and legs shook uncontrollably. Her tongue thickened and thrashed around in her mouth, which she was unable to close. She drooled constantly, vomited often and began to lactate. "I said, 'Maybe I am going mad,' " Mudey said. " 'Maybe I am going to die in here.' " When she lactated, her cellmates accused her of lying. " 'You must have killed your baby or had a late abortion,' they told me. 'You must be lying to us.' . . . Something was wrong. My breast was full of milk. They said to me, 'Are you sure you didn't leave a baby behind?'" Mudey's symptoms were classic side effects of Risperdal, said doctors consulted by The Post. But when she complained, the detainee doctor only increased the dose. ICE initially declined to comment because of privacy issues. Last night, after those issues were resolved, the agency said it did not have enough time to prepare a response. In her stupor, Mudey had her first court appearance. It did not go well. Her mind was a thick cloud; she was disoriented and unresponsive to questions. The judge was not impressed. In June, Mudey was introduced to Ann Schofield Baker, a Park Avenue lawyer who specializes in high-stakes intellectual-property litigation and had volunteered for pro bono duty. After much haranguing, Schofield Baker managed to get an interpreter, psychiatrist and gynecologist into the compound to examine her client. They determined she had been misdiagnosed, according to court affidavits. "She clearly has very severe PTSD and she is clearly depressed, but there is no evidence of psychosis," wrote Katherine Falk, the psychiatrist and a consultant for Physicians for Human Rights. The two doctors wanted Mudey off Risperdal. "They just drugged the crap out of her," Laurie Goldstein, the gynecologist, said in an interview. "They just kept her slogged." The doctors told her to refuse the pills. The compound's doctor scolded her when she did. She defied him. "I told him that the other doctors says this other medication has been hurting me. I am not going to take it," she recalled in an affidavit prepared for court. "The first day I stopped taking it, I noticed I stopped drooling. In two or three days I could close my mouth. I was not as dizzy and confused. My appetite came back. I started feeling almost normal." Her mind regained its focus. Her next testimony was clear and more convincing. But weeks later, Mudey experienced pain in her abdomen and back. She wrote notes to the doctor pleading for help. When she could no longer stand and lay balled up on her bed, her cellmates wrote notes for her. Weeks went by. She believed that the doctor was retaliating against her because she disobeyed him. On orders of the doctor, but without an exam, a nurse gave Mudey Diflucan for a yeast infection, as Goldstein discovered after reviewing the few medical records that immigration officials would give her. After several consultations with Mudey by phone, Goldstein concluded that she was suffering from an acute urinary tract infection, a kidney infection or pelvic inflammatory disease. She tried repeatedly to reach the Elizabeth center's physician, but he would not respond, she said. Schofield Baker prepared a legal injunction to force the Elizabeth compound to take Mudey to a hospital, and immigration officials relented. She got better quickly. She has no idea what was wrong with her or what drugs she was given; federal officials refused to give her the hospital records. On Sept. 18, Mudey won her political asylum case. A guard told Schofield Baker that she could wait for her client in the parking lot across from the compound. Hours later, at 11 at night, Mudey's tiny figure appeared. She wore the same flip-flops and fuzzy coat she had on the plane when she first arrived in the United States. "Seeing her walk out reminded me of a scene from the Holocaust," said Schofield Baker. "I was absolutely shocked and amazed we can treat human beings like this on our soil." Mudey got into her attorney's rented Lincoln Town Car. It carried her down a road lined with barbed wire, past rows of gritty warehouses and hundreds of hulking trucks. Having not seen the sun or a star in the sky in the five months she had waited inside the windowless compound, Mudey was overwhelmed by the lights and motion. She gasped. "My goodness, how beautiful America is!" Staff researcher Julie Tate contributed to this report.
Back to top
In Custody, In Pain - Washington Post May 12, 2008	May 12, 2008 Printable version
Amy Goldstein and Dana Priest | Washington Post Staff Writers
Beset by Medical Problems as She Fights Deportation, A U.S. Resident Struggles to Get the Treatment She Needs FLORENCE, Ariz. -- Underneath her baggy jail-issue pants, Yong Sun Harvill feels the soft lump just below her left knee. Sometimes it tingles. Sometimes it is numb. Like her cancer felt when it arrived behind the knee a few years ago. She noticed the lump under the thin, blue cotton in August, five months after federal immigration officers, to her amazement, took her into custody to try to deport her for buying stolen jewelry more than a decade ago. The lump grows slowly. It is now three inches across. And though she keeps asking, no one has done a test to see whether her sarcoma has come back. Her leg is painful and swollen from hip to foot, damaged by past surgeries and radiation treatments. Some nights, liquid seeps through cracks in her distended skin. Her left ankle is three times as big as her right. For years, she relied on a leg pump to boost her circulation and keep the swelling in check. But as an immigration detainee in this desert prison town, Harvill, 52, has been unable to persuade anyone to get her a pump, or to let her family back in Florida send hers from home. Nor has she gotten the biopsy that a doctor has told her she needs to determine whether the spots on her liver might be tumors. And it remains uncertain whether her frequent crying spells are part of bipolar disorder, as some records suggest, or a flare-up of old anxieties -- heightened now by chronic pain, bewildering medical problems, and the fact that, three decades after she arrived from South Korea as a teenage Army bride, she is in a jail far from home with the government trying to eject her from the United States. Harvill is one of 33,000 immigration detainees in the custody of the Department of Homeland Security's Immigration and Customs Enforcement agency, known as ICE, on any given day. They are locked up in a patchwork of out-of-the-way federal detention compounds, private prisons and local jails. This unnoticed prison system was built for a quick revolving door of detainees -- into custody, out of the country. But often, people linger in detention for months or years. These detainees, like other prisoners, are by law and regulation entitled to medical services if they are sick. But Harvill's journey through immigration detention provides a glimpse into a medical system that often fails those who need it most. It is an upside-down world where patients have no say, doctors and nurses on site have little power to administer timely treatment, and a managed-care system in Washington operates from a rulebook that emphasizes what is not covered rather than what is. Two months after ICE agents seized Harvill in Florida, they transferred her to Arizona last May, saying a federal compound called the Florence Service Processing Center was better suited to handle her medical care. Four weeks later, they moved her, without explanation, a few miles down a cactus-lined highway to a county jail that hasn't had a full-time staff doctor since she arrived. At Pinal County Jail, Harvill is 2,132 miles from her family outside Tampa, and even farther from her Miami lawyers. To see her, they crowd around a closed-circuit TV in an immigration courtroom in Miami, where the judge to whom her case is assigned convenes "video hearings" about once a month. Seated at a scuffed oak table in a small courtroom in Florence for one recent hearing, facing a television screen with a video camera on top, Harvill looked older than her age. Her thick, long hair was streaked heavily with gray. Her brown eyes, sparkling in a 1999 wedding photo, were now dull. Arthritis had bent her fingertips. On days when her hands are too stiff, Harvill dictates as other detainees write her entries in the journal that her lawyers have asked her to keep, as best she can, with the five pieces of paper the jail doles out each week. The entries tell of her leg pain, of missing her husband and her Florida cancer doctors, of wondering whether God still loves her. One entry tells of a dream in which she peered into a coffin and saw herself inside. Her medical records, inches thick, document countless visits to jail nurses and to a public hospital in Phoenix. But many of the visits have been frustrating and unproductive. One morning in late February, she was led from her cell at 5:15 a.m. and driven the 66 miles to the hospital to have an operation to remove polyps that were causing bleeding in her uterus. When she arrived, three workers in green scrubs told her that the doctor couldn't perform the surgery because the hospital was out of hot water. Even with hot water, they said, she couldn't have had the procedure that day: As usual, no one at the jail had told her ahead of time that she would be having a medical appointment, so she didn't get the instructions not to eat or drink after midnight the day of surgery. When the guards woke her at 5 a.m., she ate a honey bun, a treat she had been saving from the jail canteen. In response to questions from The Washington Post, ICE officials said last week that, "based on standard medical protocols," Harvill's records document that she has been "appropriately diagnosed and treated." "I feel like I'm on a merry-go-round, round and round and you don't really get nothing done," Harvill said, her voice husky with just a trace of an Asian accent, during one of three interviews she gave The Post by telephone and in person, without the knowledge of federal officials. "I feel like an animal in a cage here. Sometimes I'm afraid I'm not going to wake up." At night, to anyone driving southeast from Phoenix through the dark Sonoran Desert, the sky over Florence glows white with prison floodlights. This county seat, once a center of copper mining and cotton, greets motorists today with road signs that say "State prison. Do not stop for hitchhikers." Every February, motorcyclists roar through town for the Hells Angels Florence Prison Run. And the first business along Butte Avenue, the main street leading into the small downtown, is E&E Outfitters, with its "UNIFORM" sign in the window and, inside, racks of guards' outfits in khaki, black and olive green. "Detention polo shirts from $28.50," says the sale sign over one circular rack. Of the 25,500 people who live in Florence, about 17,000 are behind bars. The incarcerated included an average of more than 700 immigration detainees in fiscal 2007, divided among a federal compound, two private prisons and the county jail. An additional 1,500 were housed nearby in a compound outside the town of Eloy, giving Pinal County the largest concentration of foreign detainees in the nation. At the town's northern edge, just beyond an RV park for retirees, rows of concertina wire surround the federal Florence Service Processing Center. During World War II, it was the site of a prison camp for Italian and German POWs. Now it is a tidy brown-brick compound with cactuses and giant crests of the Department of Homeland Security out front. This is where Harvill arrived last May after a flight from Florida, panicky, her nose bleeding, her stomach upset, an officer on each side. The day after she arrived, Harvill saw a nurse and a doctor for a checkup that all new detainees are supposed to have, but don't always get. "Numerous issues," they wrote in her medical chart. History of sarcoma. Hepatitis C. High blood pressure. The nosebleeds. Panic attacks. "Borderline bipolar." And lymphedema, painful fluid buildup in her left leg. Elizabeth Fleming, a lieutenant commander in the U.S. Public Health Service who was Florence's clinical director, showed concern about Harvill. She noted that Harvill needed a leg pump -- a compression device that inflates and deflates -- to help the circulation in her leg. She also requested records from Harvill's longtime cancer doctors in Tampa. And she managed to persuade administrators in Washington to let Harvill have three outside consultations at Maricopa Medical Center, the public hospital in Phoenix. "Will likely need to order . . . pump and may require transfer to [another immigration detention center] with infirmary," the doctor wrote in her patient's chart. The pump never arrived. Still, Fleming saw Harvill a dozen times over the next month, records show. By mid-June, the doctor wrote, her patient was "smiling, cheerful," and her nausea and leg pain were "much improved." Harvill did not know that would be the last time Fleming would treat her. The next day, Harvill was moved down the road to the county jail. The government never explained the move, although she and her lawyers have asked repeatedly. Last week, ICE officials told The Post: "Florence is not well equipped to provide long term medical care for female detainees. Female detainees are transferred from Florence to Pinal because of its better capability to provide long-term medical care to women. Ms. Harvill received appropriate medical care at Pinal with physician oversight." Harvill lives in Cell 323 in Pod E300, part of a wing built for an eventual 600 detainees whom the federal government pays the county to house. Her isolation at the county jail is almost complete. Her lawyers cannot call. Family members, if they came to visit, would not be allowed to see her in person, not even through plexiglass. The jail allows only "video visits," with visitor and detainee in separate parts of the building. Harvill, while longing for her family, has told them it is not worth the trip. She hasn't seen her husband in a year. Most of her moments outside come when immigration officers take her in a white van on a three-minute ride to a little courtroom at the Florence federal compound for video hearings with her Miami immigration judge, and when they take her to the public hospital, an hour and 20 minutes away, where, as likely as not, little will get done. Harvill gets shuttled back and forth to the hospital in Phoenix because the jail does not have a doctor on its staff. There is no hospital within 30 miles of Florence, despite its thousands of prisoners. The Central Arizona Medical Center, on the city's outskirts, has been closed since 1999, and the small hospital building is empty. On a white sign out front, the blue lettering that says "clinic" has almost faded away. One morning last summer, Harvill was taken up the road to the Florence compound for a repeat session to take photographs and fingerprints that immigration officers told her had gotten lost. Before she went inside, she later put in her journal, she noticed Fleming, the doctor who had treated her when she first arrived, going by "in a little golf cart." I was glad to see her I had so much to ask her. Nurse here says that she is still my doctor and that all that happens to me goes to her. . . . I asked to talk to her for a minute. She told me that she was very busy, that she would try to talk to me later. I knew she wouldn't talk to me because she has not seen me for the last 2 months I was so sad. . . . Actually I felt as though she was angry with me. I stood there with tears in my eyes, but I had to go with the officer to get my fingerprints done. The fleeting encounter with Fleming disturbed Harvill. The closest thing to a doctor she has seen at the jail during her 11 months there -- apart from a psychiatrist who has prescribed lithium and other drugs, but has not really diagnosed her -- was a physician assistant. Fleming resigned days later. According to internal government documents, one-third of the 29 medical positions at the Pinal County Jail were vacant as of February. The jail, the Florence compound and the large compound in nearby Eloy each had no full-time doctor. In such an environment, complaints sometimes surface about the shortages and their effects. Last summer, two Eloy nurses sent a memo to headquarters in Washington, laying out the working conditions that were leading them to resign. The checkups required for all arriving detainees were "never staffed with enough people," wrote the nurses, Catherine Rouse and Patricia O'Brien. Nurses would be told to expect five new arrivals, "but that could easily change to greater than 100 non-English speaking sick and injured frightened people," they wrote. The nursing shortage was particularly severe on nights and weekends. And one pharmacist and an assistant "process over 4,000 prescriptions a month. They try their best to have thing[s] complete before they leave on Friday. However, serving 1,500 people is an impossible task." Last year, the Arizona State Board of Nursing heard that nurses at Eloy were being required, without enough training, to take the chest X-rays that new detainees are supposed to get to check for tuberculosis. The board sent ICE a terse, two-sentence letter. "Nurses are not radiologists," it said. "Taking X-rays is out of the scope of practice for a nurse, and a nurse who does so is violating the Nurse Practice Act and will be subject to discipline on his/her license." The response from Washington: "Nurses working in federal government facilities are not subject to state licensing requirements." At first, Harvill would get excited on the mornings of her trips to Maricopa Medical Center, but she learned soon that the visits usually were disappointments. On July 26, she rode in the van to the hospital's cancer clinic. That same day, by coincidence, a doctor from the H. Lee Moffitt Cancer Center in Tampa, where she had been treated for more than a decade, wrote a letter at the request of Harvill's lawyers, warning that she "will need continued care at a facility familiar with [her] types of tumors, as they will continue to recur and progress. If not treated properly, they can become life-threatening." It was from the Moffitt Center that Fleming had gotten records of Harvill's three previous episodes of cancer and her treatment. But no one had sent copies to Maricopa Medical Center. Starting from scratch, a doctor there ordered a CAT scan of her pelvis and her swollen left leg. The test, according to a radiology report, found a mass in an ovary and a cyst on her cervix, but there is no indication that her leg was scanned. By late July, her records show, another Maricopa doctor had ordered a biopsy to determine whether unexplained "densities" on her liver might be tumors. But when Harvill went for the procedure a few weeks later, the records show, someone in the radiology department did an ultrasound as a first step and, when he saw cysts on her liver, canceled the biopsy. "Liver Biopsy report received. . . . Biopsy not done," says a notation from a few days later in her jail records. A month later, when Harvill saw the doctor who had ordered the biopsy, he asked whether it had been done. I told him no because they told me it was just a cyst not a tumor. He was upset. . . . He still wanted a biopsy, she wrote in her journal. By now, the soft lump had begun to grow under her knee, and her abdomen had started to swell and become hard. As an officer drove her to the hospital one day in mid-August, she hoped the appointment would address one of those problems. As it turned out, she was there to see a gynecologist, who wanted to do a Pap smear. Harvill pointed out that she'd had one a month before. I showed him my stomache, he told me he could not take care of that, that I needed to see a GI doctor. I told him about my leg swollen, and also he told me I had to see another doctor for that. Still another runaround began when a different doctor said Harvill urgently needed a biopsy of her uterus lining to find out why, well after menopause, she was bleeding heavily. In early October, when an immigration officer took her back to the hospital for that test, a receptionist said it had been canceled and rescheduled for a month later. The officer, Harvill put in her journal, was stunned and told the receptionist that he "had the order for today." Instead, hospital workers did a CAT scan of her uterus. She had already had a CAT scan of her uterus. I told them I had a lump on my knee, if they could do a scan on that and they said they didn't have an order for that. . . . We got out of hospital and the ICE officer said he felt bad for me, because he has taken me to the hospital 4 or 5 times and they never do anything for me. It was early November when Harvill had the biopsy of her uterus, three months after it was ordered. She was told to come back for the results in two weeks, although the lab report was ready the next day, according to her medical records. Yet it wasn't until late January that she learned what was wrong: The bleeding was being caused by polyps that needed to be removed. The surgery, she was told, would be within two or three weeks. Four months later, it has not been done. Late last week, after her attorneys gave them authorization to talk about her case, Maricopa hospital officials said that medical privacy law prohibited them from even confirming, without Harvill's personal consent, that she has been a patient. But she could not give consent because neither her attorneys nor anyone else is allowed to telephone her in the jail. Over a weekend in mid-April, Harvill was told not to eat solid food for two days in preparation for a colonoscopy to try to find out why she had blood in her stool. First thing that Monday, she again boarded the van for the 66-mile drive to the hospital, where she was told that the procedure had been rescheduled. Ten days later, she went to the hospital and had the test. It found a growth in her colon. The doctor said there was a chance it is cancerous and sent a sample for a biopsy. She does not know the result. The liver biopsy still has not taken place. And no one has tested the lump below her knee. 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. The health services division, the manual says, allows treatment mainly for emergencies that are "threatening to life, limb, hearing or sight." If a detainee has medical problems that "would cause deterioration of the detainee's health or uncontrolled suffering affecting his/her deportation status," treatment is not guaranteed. Instead, the manual says, the detainee "will be assessed and evaluated for care." Instead of listing, as most health plans do, the services available to patients, the manual specifies services that are "usually not covered" for allergies, heart problems and other illnesses. Cancer is not mentioned at all. Internal government documents obtained by The Post show that most requests are approved. But the documents also show that, when requests come in for people with serious problems, there can be pressure to cut costs. One chart, covering October 2005 to September 2006 -- seven months before Harvill became an immigration detainee -- is labeled "TAR Cost Savings Based on Denials." The agency, the chart shows, saved $129,713 by denying 17 medical requests for people with HIV, $36,216 by denying seven requests for people with various forms of psychosis, $91,926 by denying 27 requests for people with chest pain and $9,545 by denying treatment for a case of blood in stool, one of the problems Harvill has had for months. Asked about the chart, an immigration spokeswoman said that the vast majority of medical requests eventually are granted. Usually, she said, denials are "due to lack of information." The supervisor of the managed-care nurses who rule on treatment requests sent a note once to a senior official about a 33-year-old detainee seen at a Nashville hospital for a recurrence of sarcoma, the same kind of cancer Harvill has had. "The process of re-diagnosis and treatment will be extensive and costly," that nurse wrote. She said she seconded the idea of releasing the detainee so the government would not have to pay for his care. These sorts of machinations prompted the deputy warden at York County Prison in Pennsylvania, which houses many immigrant detainees, to fire off an angry letter about the health services division. "[I]n my opinion, they have set up an elaborate system that is primarily interested in delaying and/or denying medical care to detainees," the warden, Roger Thomas, wrote in late 2005. "There is nothing easy about working with DIHS. If something can be delayed, it is delayed. If it can be denied, it is denied. If it can be difficult, it is made difficult. Most importantly, if there is some bureaucratic procedure that will delay/deny treatment to a detainee . . . you can be assured that DIHS will do it." Harvill's lawyers have tried to find out how many requests for treatment have been sent from Pinal County Jail on her behalf and how Washington has ruled on each one. They filed a Freedom of Information Act request last summer and, after two months, got an incomplete answer. In January, they left a phone message for the division's medical director. No one has called back. But one page in Harvill's thick medical file hints at an answer. In late August, slightly more than a month before she would arrive at the hospital for a biopsy, only to be told it had been rescheduled, a jail nurse wrote this note: "TARs not approved for endometrial biopsy and lab draws. . . . Will continue to work on approvals and provide additional documentation as needed." Finally, in early February, Harvill had a big week, riding in the van to the hospital three mornings in a row. A cancer doctor told her, yet again, that she needed a biopsy on her liver and one on the growing lump beneath her knee. A gynecologist talked with her about the surgery she needs on her uterus. A gastroenterologist spoke with her about the colonoscopy she should have. Yet, after many months in immigration custody, Harvill understood that doctors' orders do not automatically produce tests. "It doesn't matter what the doctor says," she said in an interview. Back at the jail after her three hospital trips, she asked a nurse what would be done with the doctors' requests. "She said she is going to send it up" to Washington, Harvill recounted at her next court hearing. "But she doesn't know when or how it is going to get approved. She doesn't know if it is going to get approved. She just said, 'Let's hope for the best.' " * * * Leon Harvill sat at his mother's kitchen table in Plant City, Fla., on a Sunday night, cradling the phone to his ear. "Baby, don't cry," he said softly into the receiver. "Come on, baby. Quit crying, all right?" He had gone to an evening service at the Church on the Rock, the first time he had been in months. He hadn't felt much like reading the Bible lately. "I just don't understand it right now," he said. "I just can't understand things that are going on that are hard to believe. Her medical care -- I just can't understand that." The thing that makes perhaps the least sense to him is that his wife is covered under a good health insurance policy that he gets through his union, the International Brotherhood of Boilermakers, and she and her lawyers have asked whether she could use that policy to pay for her treatment by private doctors while she is detained. They have been told no. One more problem in a life full of them. Yong Sun Harvill's immigration troubles began in March 2007, as she was finishing 13 months in prison on a drug-possession charge. One day, a prison official summoned her to his office and handed her a phone. On the line was a man who worked in Orlando for Immigration and Customs Enforcement. She would not be going home, he told her. She would be handed over to ICE agents, who planned to send her back to South Korea, a place she had not seen for 32 years. Harvill had been barely 19 when she came to the United States in 1975, the new wife of an American soldier who had been stationed in Seoul. Within a year, she had a baby son and her first cancer diagnosis. She divorced her first husband -- who hit her sometimes when he drank, according to Harvill, her lawyers, two friends and her medical records -- and then her second one, who hit her sometimes when he was high on drugs. Nine years ago, she married Leon Harvill, a childhood friend of her second husband. He isn't much of a talker. She is loud and chatty. She felt protected by him. He loved how she cared for children and how her smile lighted up a room. After all her years in Florida, she would still drive to Tampa once a month to buy rice at a Korean grocery, but she also loved collard greens and black-eyed peas, was a die-hard Tampa Bay Buccaneers fan, and knew the lyrics to all of Brooks & Dunn's country tunes. In 2004, while she was riding with a friend, police stopped them for driving with expired tags. The car belonged to her friend, but the marijuana and methamphetamine on the floor were Harvill's. She pleaded guilty to drug possession and served her time. Ordinarily, that would have been that. But ICE had begun scouring jails and prisons nationwide for people it might be able to deport, and a check of Harvill's criminal history turned up a decade-old felony conviction for buying stolen jewelry. Her lawyer insisted she'd had no idea it was stolen. A judge suspended the sentence and put her on probation, which was terminated early for good behavior. A 1996 law had given the government new leverage to deport foreigners, including people living in the country legally as U.S. residents, if they had committed a crime at any time in the past, and the Bush administration was wielding that power aggressively. The law expanded the list of crimes defined as "aggravated felonies" that are grounds for deportation. It also for the first time required people to be locked up during their deportation cases -- including permanent legal residents such as Harvill, who is not a citizen but has had a green card ever since she came to the United States. On March 22, 2007, instead of going home, Harvill was handed an orange uniform at the Palm Beach County jail to await deportation. Her parents are dead. She lost track of her sisters long ago. She has no idea where or how she would live in South Korea, particularly because she has not held a job for years because she cannot put weight on her leg for too long. She has been fighting the deportation with the help of Cheryl Little and Kelleen Corrigan, lawyers at the Florida Immigrant Advocacy Center in Miami. They have applied for a visa available to foreigners with firsthand knowledge of crimes -- in Harvill's case, the abuse by her first two husbands. Meanwhile, they have repeatedly asked federal officials to let Harvill go home on bond because she is so ill. Corrigan has a postcard on her office door with the words "Free Yong!" over a photo of a younger, happier-looking Harvill. At church that Sunday night, Leon Harvill did not open the prayer book. But during the silent prayer, he leaned forward, his hands resting on the pew in front of him, and closed his eyes. He prayed for his wife to get medical treatment, to find peace, to come back. He raced home after church, knowing she would call. At 9:14 p.m. the kitchen phone rang. "I love you, too, baby," her husband said. "Things are going to get better. Come on, baby. Something is going to happen soon." Before dawn the next morning, he would leave the house of his mother, Margaret Kersey, with whom he had been staying to save money, for the Tampa airport and a flight to Hawaii, where he had found a welding job with better pay. It had been hard lately to save, with work scarce in central Florida and money flowing out for his wife's phone cards and canteen treats, and for the "Free Yong!" postcards he'd printed so friends could mail them to the government. Most of all, he thought, he needed to save money so he would have some to send her if someday she were deported to South Korea. Deportation had been on Yong Sun Harvill's mind, too. Sometimes, she is so depressed that she thinks about quitting her fight and signing the papers that would let the government send her out of the country. And she has been missing the one real friend she made in a jail, a younger Korean woman who would rub menthol ointment, when she could get some, on Harvill's swollen leg and write the journal entries when Harvill's hands stiffened too much. A few weeks before this January night, her friend was deported. But on this night, Harvill listened to her husband describe the path he would take to Hawaii the next day. "I have a layover in Phoenix," Leon Harvill said into the phone. She told him to look at the desert as he landed. "I'll get a look at it tomorrow," he told her. "We'll be that close." Staff researcher Julie Tate contributed to this report.
Back to top
Detention in America - 60 Minutes CBS News - May 11, 2008	May 11, 2008 Printable version
Scott Pelley
(CBS) Since 9/11 there have been a lot of changes in how the United States deals with immigrants. One of the biggest is the explosive growth of a system of immigrant detention centers that few Americans know anything about. Immigrants who come into the country illegally, or refugees who apply for political asylum, often go into detention, some for many months. Before 9/11, about 100,000 detainees went though the system each year. Today, with stricter immigration rules, that number has tripled to more than 300,000. The surge appears to have overwhelmed the medical care provided to the immigrants. Now, a Washington Post investigation, joined by 60 Minutes correspondent Scott Pelley, has found evidence that immigrants are suffering from neglect and some don't survive detention in America. ________________________________________ In 2004, United Nations troops were fighting militant gangs in the streets of Haiti. Eighty-one-year-old Reverend Joseph Dantica, a Baptist minister, saw his church ransacked during the unrest, so he fled to the United States and asked for political asylum. His niece, Edwidge Danticat (her last name is spelled differently than her uncle's) says he was taken straight to a U.S. immigration detention center. "He was essentially arrested?" Pelley asks. "Yes. I consider it an arrest," Danticat says. "Because . . . he had to ask for special relief for him not to be handcuffed. And they did allow him that, but told him that if he ran, they would shoot him." Rev. Dantica raised Edwidge in Haiti; she moved to the U.S. at the age of 12 and grew up to become a prize-winning author. Danticat's recent book, "Brother, I'm Dying," recounts her uncle's ordeal. She was waiting for him in Miami. Asked what she was thinking when she heard her uncle had been detained, Danticat tells Pelley, "Well, I was horrified. Eighty one years old and, after the ordeal that he had been through in Haiti, I worried about his ability to handle that." Records show that two days later, during an asylum hearing, he became violently ill and collapsed. A detention center physician's assistant failed to recognize that Dantica was in serious trouble. "Help me understand from the records that you've seen precisely what the medic said about your uncle and his condition," Pelley asks. "It appears that he said,'I think he's faking,' or something to that effect," Danticat says. It took four hours to get Rev. Dantica to an outside hospital. His family wasn't allowed to see him. In a day and a half, Rev. Dantica was dead. The medical examiner said it was pancreatitis. Asked what she was thinking in that moment, Danticat says, "Just a series of things.” Crying, she continues, "Of course, you know, a great deal of sadness because he died so alone." "He died without his family," Pelley remarks. "Yeah. And after being treated like an animal," Danticat says. "Someone who was just trying to escape horrible things, who was so old and sick. Just had to die that way." But in one sense, Rev. Dantica was not alone: he's among hundreds of sick or dying detainees inside 22 detention centers, plus some 350 state and local jails. The federal lock-ups range from a former warehouse in New Jersey that houses 325 people, to a desert facility near the Mexican border. The centers are run by U.S. Immigration and Customs Enforcement, known by its initials "ICE." Inside the detention centers, medical care is provided by another federal agency, the Division of Immigration Health Services, or DIHS. Reporters Dana Priest and Amy Goldstein of The Washington Post have been investigating DIHS. "This is not just some deaths or just some sick people anecdotally. If you take them all together, they show poor medical judgments, faulty administrative practices, sloppy paperwork, lost medical records and very dangerous staffing levels," Priest explains. Priest, who contributes to 60 Minutes, and Goldstein have obtained thousands of internal DIHS documents. They include investigations, e-mails, autopsy reports and complaints. What sort of a picture did the documents paint of how DIHS is working? "They show a bureaucracy that offers many immigrants no care or slow care or poor care," Priest says. "And they also show that the employees inside are panicked about this." For example last year, 21-year-old detainee Juan Guevara was complaining of severe headaches. Soon he had died of a brain aneurysm. A staff member wrote in an e-mail "the detainee was prescribed Tylenol. The detainee was not seen or evaluated by an RN, midlevel (physician's assistant) or physician." This internal report from 2007 was written after another detainee died of a contagious infection: "the clinical staff at all levels failed to recognize early signs and symptoms of meningitis." This memo from 2007 sounds an alarm over staffing shortages in Buffalo, written in all caps, "CRITICAL STAFFING SITUATION OCCURRING, SITE IS DOWN TO ONLY 3 FULL TIME NURSES." In Arizona, "CRITICAL STAFFING levels. Site has reached a 48% nursing vacancy rate." While the number of immigrants in detention has tripled since 9/11, the health services budget has grown only by 65 percent. Priest reads from an email from the acting director of DIHS to a senior ICE official in August 2007: “We're facing critical staffing shortages at most every site. While we developed, executed and achieved major successes in our recruitment efforts, we've been unable to meet the demand." One immigrant detained in 2007 was Amina Mudey. She fled Somalia after her father, brothers and sister were murdered. Amina landed in New York and requested political asylum. "The medical treatment that Amina received was absolutely deplorable. Substandard, sanction-able, and flat out malpractice," says Ann Schofield Baker, Amina's lawyer. Schofield Baker says Amina was detained in the former New Jersey warehouse facility and almost immediately was prescribed a powerful anti-psychotic drug called "Risperdal." "How did she come to be on Risperdal to begin with? I mean, was she psychotic?" Pelley asks. "Not even remotely psychotic," Schofield Baker says. "When Amina first arrived at the detention center she hadn't slept in two or three days. She hadn't eaten. She'd never been on a plane before. She was disoriented. They brought her to the facility shackled. She was absolutely petrified. And she collapsed and had a panic attack. From that, someone concluded that she was psychotic." Schofield Baker says on Risperdal, Amina was dazed, drooling and helpless. A human rights group asked her to represent Amina. She got her own doctors, who took Amina off the drug. And Amina was granted asylum. Now Amina is studying computers and English. "What was it like when you walked out of there?" Pelley asks. "Outside was beautiful," Amina says, with the help of a translator. "It was a tough start for you," Pelley remarks. "America is wonderful place. I like it, New York," Amina answers in English. Amina's alleged misdiagnosis isn't an isolated case according to an internal memo from last year, written by the head of mental health at the Division of Immigration Health Services. "The top psychologist worried about mental health,” Priest says, as she quotes from an email he wrote: 'We need to stop looking for Band-Aid solutions for these problems.” "The little money managed care may save in the short run is going to be dwarfed by the millions that will be paid out by ICE when the lawsuits roll in.There have been just a handful of lawsuits so far. But they know they're sitting on a powder keg." DIHS is being sued in the case of 35-year-old Francisco Castaneda, who testified in a deposition some three weeks before he died. By that time, he was bedridden and the cancer had spread to his lungs. His voice barely rose above a whisper. Castaneda told of coming to the U.S. illegally from El Salvador at the age of ten. In 2004, he was sentenced to a few months in jail after a conviction on possession of methamphetamine, and later was sent to a detention center for deportation. "When you look back on how he was treated at the detention center over those months, what do you think?" Pelley asks Castaneda's sister Yanira. "I'm mad, sad," she says. Yanira says her brother went into the detention center with a bleeding lesion on his genitals. There was concern it was cancer, but the DIHS turned down requests for a biopsy. "How long do you believe the DIHS staff in the detention center knew or had a reasonable reason to suspect that he had cancer?" Pelley asks Conal Doyle, who, along with Adele Kimmel of the non-profit group Public Justice, represents the Castaneda family. "The second day he entered the facility, of March 28th, 2006, a physician's assistant, Lieutenant Walker, specifically documented that he needed a urology consult and a biopsy to rule out cancer," Doyle says. But Doyle says Castaneda never got that biopsy during his detention. Castaneda filed grievances with the Division of Immigration Health Services. He wrote, "I am in a considerable amount of pain and I am in desperate need of medical attention." DIHS said the surgery was elective and the government wouldn't pay for it. His request was denied for 10 months. Then, for reasons that aren't clear, he was released. "They released him on February 5th, 2007. And he sought care on his own outside the facility. And had that biopsy on February 8th. Cancer was discovered, his penis was amputated on February 14th," Doyle says. But the cancer had spread and Castaneda died a year later. "The judge in this case in federal district court has entered an order describing the care received by Castaneda as transcending negligence by miles. And, being beyond cruel and unusual," Doyle says. Immigration and Customs Enforcement declined an interview, but ICE did send 60 Minutes a letter which states in part, "The number of deaths per 100,000 is dramatically lower for ICE detainees than for U.S. prison and jail populations…." ICE goes on to say that the nation as a whole is "experiencing severe shortages of qualified health professionals." In October, Congress held hearings on immigrant healthcare. Gary Mead, a senior immigration official, told the Congress that ICE provides "state-of-the-art medical care," and "the best possible healthcare." "Last year DIHS completed over 500,000 medical visits for the detainees in our custody. Many of our detainees receive almost daily attention. So it is an aggressive program, and we do everything possible to maintain the best quality of life for the detainees in our custody," Mead said. ICE declined to talk about the detainees in mentioned in this story. In the case of Rev. Dantica, a government inspector general report said there was "no evidence of mistreatment or malfeasance" in his death. The Castaneda family is continuing its lawsuit in his case. "What does the DIHS owe prisoners like Francisco Castaneda?" Pelley asks. "Well, if the government's gonna detain someone, it's very clear. The Supreme Court has said that they are entitled to reasonable medical care. And that includes medical care for any serious medical need," Doyle says. "You know that there are people watching this interview who are saying to themselves, 'Castaneda was an illegal immigrant. He had a drug conviction. The people of the United States owed him nothing,'" Pelley remarks. "I'm sure there's people out there that think that," Doyle acknowledges. "But that's not what the law is. And that's not what a civilized society does. And you know, if it's true that you judge the degree of civilization in a society by entering its prisons, the United States has a long way to go on this particular issue." ________________________________________ Two weeks ago, DIHS admitted to a federal court that it was medically negligent in its treatment of Francisco Castaneda. Ten days ago Congress began considering a bill to set new standards for immigrant detainee healthcare. © MMVIII, CBS Interactive Inc. All Rights Reserved. ________________________________________
Back to top
System of Neglect - Washington Post May 11, 2008	May 11, 2008 Printable version
Dana Priest and Amy Goldstein | Washington Post Staff Writers
As Tighter Immigration Policies Strain Federal Agencies, The D