Updated: June 10, 2019 1:30:22 pm
Written by Sheri Fink
Rom Rahimian, a medical student working at Banner-University Medical Center Tucson, was trying to help a 20-year-old Guatemalan woman who had been found late last year in the desert — dehydrated, pregnant and already in labour months before her due date. But the Border Patrol agents lingering in the room were making him uncomfortable.
The agents remained in the obstetrics ward night and day as physicians worked to halt her labour. They were present during her medical examinations, listened in on conversations with doctors and watched her ultrasounds, Rahimian said. They kept the television on loud, interfering with her sleep. When agents began pressing the medical staff to discharge the woman to an immigration detention facility, the doctors took action.
“It was a race against the clock to see if we can get her into any other situation,” Rahimian said. He called a lawyer and asked, “What can we do? What are her rights?”
As apprehensions of migrants climb at the southwest border, and dozens a day are taken to community hospitals, medical providers are challenging practices — by government agencies and their own hospitals — that they say are endangering patients and undermining recent pledges to improve health care for migrants.
The problems range from shackling patients to beds and not permitting them to use restrooms to pressuring doctors to discharge patients quickly and certify that they can be held in crowded detention facilities that immigration officials themselves say are unsafe. Physicians say that needed follow-up care for long-term detainees is often neglected and that they have been prevented from informing family members about the status of critically ill patients. Agency vehicles parked conspicuously near hospital entrances, health providers say, are also stoking fear and interfering with broader immigrant care.
Doctors typically do not know what rights they might have to challenge these practices. At Banner and several other hospital systems across the country, they have called on administrators to oppose and change security measures that they view as endangering health.
In many cases, doctors say, their patients are newly arrived asylum-seekers, like the Guatemalan woman in Tucson, who had fled violent abuse from her baby’s father back home. Such patients, who are in custody only because of their immigration status, are often subjected to security measures meant for prisoners charged with serious crimes. (In her case, medical staff at the hospital persuaded officials to allow her to be discharged to a volunteer-run respite center.)
“Doctors, who have a moral and ethical obligation and duty to care for patients, are actively being prevented from carrying out the practice of medicine as they’ve been trained to practice it,” said Kathryn Hampton, a program officer for Physicians for Human Rights, a nonprofit advocacy group. In a new report, the group documents a range of cases in which it said optimal health care was compromised by stepped-up immigration security.
Representatives for the two main agencies responsible for detaining migrants — Customs and Border Protection, on the border, and Immigration and Customs Enforcement, which oversees longer-term detention — declined to discuss the issue. They referred to their written standards for the supervision of detainees taken to community medical facilities. In CBP’s case, the standards state that at least one agent should accompany detainees and, if the patient is hospitalized, “follow their operational office’s policies and procedures.”
ICE has separate standards that require custodial officers to transport and remain with detainees during off-site medical treatment.
Health systems, too, maintain policies that doctors say are problematic. Banner Health, like some others, has a policy that applies equally to immigration detainees and prisoners. It disallows bathroom privileges, requires at least two limbs to be secured to beds unless medically inadvisable, gives agents discretion over whether mothers may visit newborns and obliges law enforcement officers to remain with patients.
In response to medical staff complaints, administrators at Banner-University Medical Center Tucson scheduled a meeting with the Border Patrol’s Tucson sector leaders this week to ensure that both the hospital and the agency “have policies in place that uphold the highest standards of patient care, safety and privacy,” Rebecca Armendariz, the Banner Health public relations director, said in an email.
Banner Health operates 28 hospitals in six states, and its custody policy applies to all of them. Elizabeth Kempshall, Banner Health’s senior director of security, wrote the policy; she said in a telephone interview that she planned to modify it “just to clarify things, but it’s not going to change a whole lot.”
Kempshall said she wanted to ensure a safe environment that never impeded medical care and that treated everyone in custody the same. “It’s a very delicate situation,” she said. “I have to be consistent across the board.”
Dr. Patricia Lebensohn, a family physician who has pressed for changes to the policy, said that constant supervision in a patient’s room “makes sense if you have a prisoner that’s convicted of murder, but this is a different population, especially the asylum-seekers.” She added, “They’re not criminals.”
Doctors say that agents arriving with immigrants are typically kind and respectful. But one exception galvanized physicians in Texas last year. A cancer patient was admitted to a public hospital accompanied by two guards from the GEO Group, the private contractor for the immigration detention facility where he was being held. Doctors came to believe that guards were texting parts of their conversations with the patient to someone outside the hospital.
The patient told his doctors that he feared speaking in the earshot of the guards, who, unlike local police officers, refused to step outside during examinations. As the man lay shackled to his hospital bed by both wrists and ankles and at his waist, the skin on his back began to ulcerate. Doctors said they felt intimidated and powerless.
“His treatment by the guards limited and challenged the ethical care of a patient by the physicians,” Dr. Judy Levison said at a board meeting for the Harris Health System, which operates the Texas hospital where he was treated.
The GEO Group did not immediately respond to a request for comment.
Harris Health’s communications director, Bryan McLeod, said that a task force was reviewing the care of patients in law enforcement custody. Harris Health’s policy, like Banner’s, applies to both immigration detainees and prisoners.
Another Texas physician, Dr. Amelia Averyt, testified before the Texas Legislature about one of her patients — not a recent migrant, but an immigrant already living in Texas — who was so fearful of encountering immigration officials at a hospital that he delayed care for a stroke, missing the chance to receive medicine that could have prevented permanent brain damage.
Fears of immigration raids in medical institutions have led some immigrant advocates to organize training sessions, including one in Chicago that stresses disclosing patient information to immigration authorities only when required by a court order or warrant, and informing patients of their right to remain silent. Providers are encouraged not to record immigration statuses in medical records.
For migrants already in Border Patrol custody, medical providers are particularly concerned about minors. At Banner-University Medical Center Tucson, a medical student, Claire Lamneck, said she had seen an armed agent watching a teenage mother breast-feed her baby. “The agent was sitting across from her, just staring at her chest,” Lamneck said. He refused to leave the room until a physician persuaded him to give the 15-year-old privacy.
Many young migrants arrive at hospitals already traumatized from whatever they were fleeing. In another new report from Physicians for Human Rights, Weill Cornell Medicine experts analyzed more than 180 forensic evaluations conducted in the United States on young asylum-seekers. Most of the migrants reported having experienced physical violence, and nearly 1 out of 5 said they had suffered sexual violence. Health providers documented physical injuries and commonly found evidence of post-traumatic stress syndrome.
Sometimes, U.S. hospitals send immigrant patients who are not in custody to hospitals in their countries of origin. Known as medical deportation, the practice occurs because immigrants without documentation — and even some who are legally present in the country — are ineligible for most federally funded health insurance benefits. When these patients experience catastrophic injuries or illnesses and cannot afford long-term care or rehabilitation, hospitals incurring the expenses have limited options.
But doctors are finding solutions. When an immigrant at Banner-University Medical Center Tucson faced possible medical deportation last year, health providers, community members and the patient’s family raised funds and worked with administrators to ensure her care, said Dr. Samantha Varner, a founder of the Arizona Asylum Network, which conducts medical evaluations of immigrants requesting asylum.
As a resident in obstetrics and gynecology at the University of Arizona, Varner also regularly treats pregnant women in the custody of Border Patrol agents, who insist on a special discharge note stating “not only that the patient is discharged but that they’re healthy to be detained,” she said. She views this as akin to certifying the safety of detention conditions that she cannot control and that give her great concern.
Recently a pregnant woman was exposed to chickenpox in detention and required preventive treatment at Varner’s hospital. And last year, an 8-year-old boy, Felipe Alonzo Gomez, died of complications from influenza and sepsis after being treated at the Gerald Champion Regional Medical Center in Alamogordo, New Mexico, and released back to Border Patrol custody, before being returned hours later.
“They’re pressuring you to do something medically unethical, which is to say you give your medical approval to detain a person,” Varner said.
She drafted a template letter for her colleagues to use instead. It states that the patient is stable to be discharged but that the letter “should not be construed as any form of approval for detention.” The letter refers to a statement sent last year to a top Department of Homeland Security official from leaders of three major organizations representing pediatricians, obstetricians and family physicians. The letter concluded that “the conditions in DHS facilities are not appropriate for pregnant women or children.”
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