At this point, in the fading months of the Bush's reign, I've cynically become accustomed to one saddening report after another about the mismanagement and malfeasance running through much of our government. However, coming across the Washington Post's four-day series, Careless Detention reignited my anger and indignation at the direction our country has taken over the past eight years. Specifically, I'm disgusted by today's story about alien detainees being drugged for deportation with the aid of doctors and nurses from the Division of Immigration Health Services. This story cuts particularly close to home as I've just attained my MD, and I will be working for the federal government after I finish residency.
After the jump, I'll get into specifics and discuss why I find this article's revelations so troubling in light of Abu Ghraib, our country's current torture policy, warrantless wiretapping, and other unchecked governmental power.
In brief, the WaPo article, by Amy Goldstein and Dana Priest, chronicles the past 8 years of INS and ICE legal opinion and behavior regarding the non-medical administration of Haldol, Ativan, and Cogentin to detainees. At least 250 detainees in the past 4 years have been medicated before and during their deportation flights. In 2007, ICE changed their policy to only give DIHS ability to medicate with a court order, making their policy consistent with the Clinton Administration's Dept. of Health & Human Services recommendations to INS in 2000. WaPo's site also hosts PDFs of many original memos by DHHS, INS, ICE, and DIHS. It's a well-done series, and I recommend the reading the entire thing.
The article goes into some detail about the administration of the drugs:
In a Chicago holding cell early one evening in February 2006, five guards piled on top of a 49-year-old man who was angry he was going back to Ecuador, according to a nurse's account in his deportation file. As they pinned him down so the nurse could punch a needle through his coveralls into his right buttock, one officer stood over him menacingly and taunted, "Nighty-night."
The taunting speaks volumes to the reasoning behind using these drugs.
And what are the drugs being used? Haldol, Ativan, and Cogent are familiar to me through my rotations in the emergency dept., psychiatric ER, psychiatric ward, surgery ward, and general medicine ward. They are probably familiar to most doctors and nurses. The article gives good lay-descriptions of each, but I'll quickly go over them here. Haldol is a very strong antipsychotic with some significant side effects. It's been around for 50 years, and was used much more frequently in the past than it is now. I've only seen it used a few times, and always in the case of violently psychotic individuals. Ativan is a benzodiazepine, and it is powerful to treat anxiety on a short-term basis. It also is a sedative, muscle relaxant, and anticonvulsant. I've personally used small doses of Ativan several times on patients nervous to go into an MRI scan, and it's used throughout medicine as part of the anesthetic cocktails before surgery and in patients with seizures. The last, Cogentin, is an anticholinergic drug used to treat some of the side-effects of Haldol.
The big problem the WaPo article lays out is in the dosing of these drugs. Specifically, the article mentions that of the 50 given Haldol in 2007, 38 received 10-29mg, 4 received 30-39mg, and 2 received 40mg. Haldol is very strong, and in my limited experience with psychotic ER patients threatening to kill all of us we would only give 10-15mg total. The psychotic patients in the psych ward would get even less, as they were on longer-term treatment. The article doesn't give a more detailed breakdown, but even being generous and assuming almost all of the 38 received only 10mg strikes me as overkill for non-psychotic passengers on a flight. The article confirms this when describing the detainees:
…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.
It's obvious that these drugs are being abused to make deportation easier. One simply needs to look at the case of of a 34-year-old man being sent to Guinea. On his first attempt at deportation, he was given 15mg of Haldol before he arrived in France to transfer planes. He asked for paperwork to prove his deportation order, ICE responded by attempting to drug him again but French authorities would not allow it. He was not allowed on the connecting flight and was brought back to the USA.
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.
I am not a legal expert, an immigration expert, an international law expert, and I've only very recently finished my training to become a doctor. But it seems clear to me that the DIHS doctors and nurses, at the behest of ICE, are acting unprofessionally and unethically. It angers and embarrasses me to know that members of the profession I have worked so hard to join are violating what seems obvious to me: the basic human right to control what goes into one's body. All medications have consequences, whether it's the commonly known side-effects of Haldol somewhat alleviated by Cogentin, or the rarer, and sometimes fatal, heart condition or neuroleptic malignant syndrome that can occur. These people, coming to America with whatever hopes and dreams our country's image has long promised all immigrants, are instead sent home abused and in a stupor. And for what? Convenience? A quieter flight for everyone else? In my opinion, it is immoral to force something like Haldol on someone if they are not an immediate danger to either themself or others around them.
And I'm not alone in that opinion. Back in 2000, the Dept. of Health and Human Services, under Clinton, looked into this issue. Their findings were unequivocal:
Regarding detainees who are not mentally ill, 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.
For whatever reason, after ICE's formation in 2003, it took two lawsuits and a letter of support by Rep. Louie Gohmert (R-TX1) to force the requirement of a court order before drugging a detainee in June of 2007. Even now, the WaPo article has found evidence that at least one detainee has been drugged without a court order since.
As I alluded to previously, the past eight years have made me quite cynical to the things our government has done and could be doing in secret. The revelation that the US government has been drugging illegal immigrants out of convenience during deportations is yet another disgusting low. From the abuses at Guantanamo Bay and Abu Ghraib, a war started on lies, torture, extraordinary rendition, illegal wiretaps, politicalization of the Justice Dept., and the countless areas where money is going to cronyism and waste, it's clear the last eight years have been full of corrupting, unchecked power. This new revelation is just one more symptom. Add to it the shameful response to Hurricane Katrina, the still-failed reconstruction of the Gulf Coast, our looming gas crisis this summer, a floundering economy, our failing infrastructure (the ASCE estimated $1.6 trillion needed over 5 years to improve beyond a "D" rating, back in 2005), and tens of millions either uninsured or underinsured, and it appears that the hasn't been much work on improving our lives either.
It makes me wonder what we can do here to change all that. I know change will be slow, hard, and rige with setbacks. Obviously, electing an inspiring Democratic President and ensuring a strong Democratic majority in Congress are paramount. And electing more and better Democrats at every level in every state is important too. But I'm not sure that it's enough. There needs to be a strong and clear message that unchecked power, whether under this current regime or a coming Democratic one, is unacceptable. An outcry that our government has been failing us where it should count the most. Our Congress and media have a job to be doing, they should be speaking to these issue, but a majority are failing at it. This site, and the progressive blogosphere in general, has shown signs of powerful success when we get behind issues as a group. Is there something we can do here to cut through the malaise and inaction?
I'm open to suggestions for action in the comments.