Today, as you read this article, human rights abuses are occurring in the United States of America. Lack of access to vital acute, chronic, and preventative healthcare has resulted in suffering and death of children and adults under the eye of the U.S. government. Many of us do not see these horrors happening in our day-to-day life, as they are taking place out of public sight in the shadows of a complex and controversial immigration system. However, they are happening every day, and healthcare professionals, including pharmacists, must speak up against these atrocities.
What are immigration detention centers?
Immigration detention centers are places of confinement, similar to jails or prisons, where immigrants are held if they submit a claim for asylum, are being deported, or have unlawfully entered into the U.S. These centers are overseen by the Immigration and Customs Enforcement (ICE) agency, and are often outsourced to public and private prisons.
It would be incorrect to assume that this is a geographically limited issue that only impacts states like Texas or Arizona. There are over 200 immigration detention centers in the U.S., with at least two in every state. In 2016, it was reported that nearly 360,000 individuals were detained in these centers across the U.S.
People may be detained for different periods of time in these centers. Seventy percent of individuals are held for one month or less, with many being released the same day they were detained (often meaning they were immediately deported). Since 1997, children have different rules due to the Flores Settlement, a court agreement that set a nationwide policy of a 20-day limit for holding children. However, some adults are held for months, or even years.
Why does this matter to the profession of pharmacy?
Unfortunately, for years, there have been consistent reports of human rights and medical abuses that are occurring in immigrant detention centers. These abuses have a direct tie to the values and ethics that members of the profession of pharmacy pledge themselves to uphold. In particular, the Oath of a Pharmacist states, “I will consider the welfare of humanity and relief of suffering my primary concerns.” In October 2019, the American Pharmacists Association (APhA) came out with a statement of concern regarding care provided within migrant detention centers. In addition to the disturbing reports of medical abuses, recent analysis has shown that there are economic consequences as a result of trauma to children and adolescents in detention centers.
As the professional whose duty it is to oversee the appropriate utilization and administration of medications, several categories of these abuses directly relate to the profession of pharmacy. These include: forced administration of unnecessary medications, lack of access to medications and vaccines, lack of access to tools and environment to prevent disease, and forced unnecessary surgeries.
Forced administration of unnecessary medications
Over the years, there have been many reports of inappropriate medical care being provided in detention centers. Legislation has been introduced in the past to address these issues, but has yet to be signed into law. In the past several years, reports have begun to resurface from prominent news organizations and have seemed to increase in frequency. During the summer of 2018, there were many reports of the forced administration of antipsychotics to children without parental or guardian consent in order to sedate them. A jarring quote on the abuses came from an outside physician, who said, “These children tend to be overmedicated with combinations of meds that are really not indicated for children with PTSD [post-traumatic stress disorder], particularly small children. The purpose of that medication is not really to treat an illness, but to tranquilize them. It’s not a tool of therapy, it’s a tool of control.” Federal judges have since ruled against the use of antipsychotic medications in children without appropriate consent, however, additional abuses have continued.
Lack of access to medications and vaccines
There have been repeated reports of detained individuals not having access to acute and chronic medications. Examples of types of medications that have been withheld from detainees include anticoagulants, antihypertensives, antiepileptics, antipsychotics, and more. In one instance of clear patient harm from this practice, a detained man was not allowed to access his anticoagulant, which resulted in a blood clot in his leg.
There has been discussion and attempts to eliminate the Flores Settlement, which would lift the 20-day limit for holding migrant children in immigration detention centers. In addition to resulting in longer periods of time where children may have limited access to their medications, they may also have limited access to vital preventative healthcare, such as vaccines. The Department of Homeland Security (DHS) has a policy against administering the influenza vaccines to detainees, despite multiple migrant children having died from the flu in the past several years.
Lack of access to tools and environment to prevent disease
During the coronavirus pandemic, medical and healthcare abuses have continued. In addition to there being limited access to medications and preventative care, such as vaccines, there have been reports that there is a higher risk of infection as a result of how individuals are detained. As of September 17th, there have been nearly 5,900 confirmed cases of COVID-19 in immigrant detention centers. On June 4th it was reported that tests of immigrants in detention centers were resulting in a 50% positive rate, indicating that ICE was dramatically under-testing the detained population. When only symptomatic individuals are tested, isolation and treatment to prevent further spread of the virus, in already suboptimal conditions, becomes nearly impossible.
In addition to being confined in close quarters with inadequate testing, individuals that are detained have limited access to commonplace antiseptics like soap. Washing hands and surfaces with soap is one of the top recommendations by the Centers for Disease Control and Prevention (CDC) for preventing further spread of the virus. As a result of this lack of access to soap, individuals that were detained were forced to go on a hunger strike in order to receive appropriate preventative measures to decrease the spread of COVID-19.
Forced unnecessary surgeries
The most recent reports of abuses have come to light after a nurse’s whistleblower complaint alleging multiple forced unnecessary hysterectomies. Multiple women have come forward with these complaints, unable to explain why they had the surgery, and some are comparing it to the medical experimentation that occurred in the concentration camps of Nazi Germany. ICE has responded that they are investigating the claims, and over 170 members of Congress are requesting immediate investigation. Further inquiry will be necessary to determine the veracity of the whistleblower complaint and if additional details surface regarding inadequate care being provided both pre- and post-op.
How can you take action?
Regardless of the results of the most recent investigation into healthcare abuses, one can feel confident that this trend of inappropriate access to and administration of healthcare will continue unless further legislative and regulatory action is taken. A Grassroots Pharmacist team member published an article in the Journal of the American Pharmacists Association regarding this issue which includes information on current legislation to advocate for and a letter template to send to members of Congress. In addition to sending letters and scheduling visits with our elected leaders, an important role of the healthcare professional is in educating our community members. Discussing this and other social issues with our friends and family is vital to helping others to understand the importance of this issue. Discuss this on social media, with your patients, coworkers, and students. This is not a partisan issue. This is a healthcare issue, and as pharmacists held to our oath and ethics, it is our duty to advocate for the appropriate administration of healthcare.
Along with the action that we can take as individuals, the organizations/businesses that we are associated with can take action as well. As we continue to discuss social issues that impact pharmacists, students, and our patients, we have recognized that a statement or press release is insufficient. These injustices are happening and will continue to happen unless legislative and regulatory action is taken. The profession of pharmacy, including state and national professional associations, employers, and academic institutions must allocate resources to advocate and support legislative and regulatory change to promote healthcare equity and eliminate human rights abuses.
If we want to be healthcare providers, this comes with the territory. We cannot simply focus on issues that impact pharmacy. We cannot remain blissfully ignorant of the horrible injustices resulting in the pain and suffering of human beings within our country. We must prioritize issues that impact the people we care for. We must take action.