Today in the Washington Post there is a front page story aboutabout immigrant medical care in facilities designed to hold immigrants pending review of their immigration status. Not only is the story truly disgusting in it's description of how detainees are cared for, but it represents a problem of this country's healthcare system as a whole. The title of this diary is the title of Carl Rogers' famous book about humanistic psychology and how we should act and treat others.
The required brief disclosure here. Many here should be familiar with my comments and feelings about illegal immigrants. I do not share the views of many here that we should let these immigrants in. Here though I will probably join with most here in decrying the total inhumane treatment of these detainees, which is even less then the treatment afforded detainees at Gittmo. I also have in the past worked in Corrections over thirteen years and am a Registered Nurse.
Previously, the courts have ruled that when we take custody and incarcerate an individual, the government assumes the burden of care for that individual which includes food, clothing, sheltor and adequate medical care. According to the Post's article it would seem that should you be an illegal immigrant, these standards don't apply.
The medical neglect they endure is part of the hidden human cost of increasingly strict policies in the post-Sept. 11 United States and a lack of preparation for the impact of those policies. The detainees have less access to lawyers than convicted murderers in maximum-security prisons and some have fewer comforts than al-Qaeda terrorism suspects held at Guantanamo Bay, Cuba.
But they are not terrorists. Most are working-class men and women or indigent laborers who made mistakes that seem to pose no threat to national security: a Salvadoran who bought drugs in his 20th year of poverty in Los Angeles; a U.S. legal U.S. resident from Mexico who took $50 for driving two undocumented day laborers into a border city. Or they are waiting for political asylum from danger in their own countries: a Somalian without a valid visa trying to prove she would be killed had she remained in her village; a journalist who fled Congo out of fear for his life, worked as a limousine driver and fathered six American children, but never was able to get the asylum he sought.
The most vulnerable detainees, the physically sick and the mentally ill, are sometimes denied the proper treatment to which they are entitled by law and regulation. They are locked in a world of slow care, poor care and no care, with panic and coverups among employees watching it happen, according to a Post investigation.
The investigation found a hidden world of flawed medical judgments, faulty administrative practices, neglectful guards, ill-trained technicians, sloppy record-keeping, lost medical files and dangerous staff shortages. It is also a world increasingly run by high-priced private contractors. There is evidence that infectious diseases, including tuberculosis and chicken pox, are spreading inside the centers.
To fix the problem, the Bush Administration hired a new Director of the Division of Immigration Health Services after two interum Directors resigned. The new Director had a very impressive resume as cited by the Post article.
Neil Sampson, who ran the DIHS as interim director most of last year, left that job with serious questions about the government's commitment. Sampson said in an interview that ICE treated detainee health care "as an afterthought," reflecting what he called a failure of leadership and management at the Homeland Security Department. "They do not have a clear idea or philosophy of their approach to health care [for detainees]," he said. "It's a system failure, not a failure of individuals."
A new director for health services arrived six months ago, following a stretch when the agency was run first by Sampson and then by a second interim director. The new boss is LaMont W. Flanagan, who brought with him the credential of having been fired in 2003 by the state of Maryland for bad management and spending practices supervising detention and pretrial services. An audit found that Flanagan had signed off on payments of $145,000 for employee entertainment and other ill-advised expenditures. His reputation was such that the District of Columbia would not hire him for a juvenile-justice position.
The response from health care providers?
"We are putting ourselves and our patients at risk," another official said.
Doctors express concerns about violating medical ethics and fear lawsuits. In July, Esther Hui at Otay Mesa sent a memo to DIHS medical director Timothy T. Shack, saying her colleagues were worried that they might be sued because of the substandard care they were giving detainees. The agency's mission of "keeping the detainee medically ready for deportation" often conflicts with the standards of care in the wider medical community, Hui wrote. "I know in my gut that I am exposing myself to the US legal standard of care argument. ... Do we need to get personal liability insurance?"
Nurses who work on the front lines see the problems up close. "Dogs get better care in the dog pound," said Catherine Rouse, a contract nurse at an Arizona detention center who quit after two months last year because she saw what she regarded as "scary medicine" in the prison: patients taken off medications they needed and nurses doing tasks they were not qualified to do.
Public Health staff are designated to oversee the care in these facilities, and by law are responsible for the identification, treatment and containment of infectious diseases. However Administrators and the whims of correctional officers whom have no medical training, or licenses direct policies and medical proceedures that should they do so in the public sector, they would be jailed for.
The overcrowding has created a petri dish for the spread of diseases. One mission of the Public Health Service is to detect infectious diseases and contain them before they spread, but last summer, the gigantic Willacy center was hit by a chicken pox outbreak.
The illness spread because the facility did not have enough available isolation rooms and its large pods share recycled air, but also because security officers "lack education about the disease and keep moving around detainees from different units without taking into consideration if the unit has been isolated due to heavy exposure," noted the DIHS's top specialist on infectious diseases, Carlos Duchesne. The staff was forced to vaccinate the entire population in mid-July.
In one 2007 death, memos and confidential notes show how medical staff missed an infectious disease, meningitis, in their midst. Victor Alfonso Arellano, 23, a transgender Mexican detainee with AIDS, died in custody at the San Pedro center. The first three pages of Duchesne's internal review of the death leave the impression that Arellano's care was proper. But the last page, under the heading "Off the record observations and recommendations," takes a decidedly critical tone: "The clinical staff at all levels fails to recognize early signs and symptoms of meningitis. . . . Pt was evaluated multiple times and an effort to rule out those infections was not even mentioned."
Arellano was given a "completely useless" antibiotic, Duchesne wrote. Lab work that should have been performed immediately took 22 days because San Pedro's clinical director had ordered staff members to withhold lab work for new detainees until they had been in detention there "for more than 30 days," a violation of agency rules.
The maddness continues:
"I need medicine for pain. All my bones hurt. Thank you," wrote Mexico native Roberto Ledesma Guerrero, 72, three weeks before he died inside the Otay Mesa compound.
Delays persist throughout the system. In January, the detention center in Pearsall, Tex., an hour from San Antonio, had a backlog of 2,097 appointments.
Luis Dubegel-Paez, a 60-year-old Cuban, had filled out many sick call requests before he died on March 14. Detained at the Rolling Plains Detention Facility in the West Texas town of Haskell, he wrote on New Year's Day: "need to see doctor for Heart medication; and having chest pains for the past three days. Can't stand pain."
Ten days later he went to the clinic and became upset when he wasn't seen. He slugged the window, yelled, pointed at his wristwatch. He was escorted back to his cell.
Another of his sick call requests said: "Need to see a doctor. I have a lot of symptoms of sickness ... as soon as possible!" The next was more urgent: "I have a emergency to see the doctor about my heart problems ... for the last couple days and I been getting dizzy a lot."
The next day, Dubegel-Paez collapsed and died. His medical records do not show that he ever saw a doctor for his chest pains.
In another case, Francisc Castenadaa 35 year old Mexican immigrant died after being released from detention so that ICE could avoid paying for a biopsy of his penus, after denying the biopsy for 10 months claiming it was "an elective proceedure". The biopsy upon release revealed penal cancer. The family has sued over his death and when the government sought to have the suit dismissed, the judge ruled for the family and in one of the harshest rebukes from the bench I have ever been aware of, had this to say to the government;
U.S. District Judge Dean D. Pregerson denied a government request to dismiss the lawsuit brought on Castaneda's behalf. In his March 11 ruling, the judge said lawyers had "submitted powerful evidence that Defendants knew Castaneda needed a biopsy to rule out cancer, falsely stated that his doctors called the biopsy 'elective,' and let him suffer in extreme pain for almost one year while telling him to be 'patient' and treating him with Ibuprofen, antihistamines, and extra pairs of boxer shorts."
Pregerson added: "Defendants' own records bespeak of conduct that transcends negligence by miles. It bespeaks of conduct that, if true, should be taught to every law student as conduct for which the moniker 'cruel' is inadequate."
This is a rather long diary and I appreciate your patience. As a nurse over the years I have become alarmed at nursing homes, state government facilities that allow unlicensed staffers such as EMT's or CNA's who have had a couple of classess on giving medications to give patients dangerous drugs without the knowledge of assessment, contraindications for the medications, etc to do the tasked of a licensed and trained nurse. Healthcare is not an area where one may lower standards to save money. Healthcare involves human life, and for those practicing it, all should be aware of Carl Rogers afore mentioned book.
Healthcare involves not only medications and emergency treatment, but a standard of living that these facilities lack. As noted in the Post's article, the detainees are often left in cells, and have no place to engage in recreational activities at all. This is a direct violation of jail and prison standards, and has been proven to detroy one's mental health creating a condition not present before, which then calls for a life long medical monitoring of a condition induced by the state. There are 23 such facilities, 7 of which are built and operated by private prison contractors who get lucrative contracts to operate, yet short change those confined to their care as pointed out in an earlier diary by
ACLU.
Perhaps we need to truly re-examine those values we supposedly hold. I have maintained when I worked in Corrections we must hold ourselves to a higher standard, lest we the jailors become the inmates.