[Ppnews] Some Detainees Are Drugged For Deportation
Political Prisoner News
ppnews at freedomarchives.org
Fri May 16 12:06:49 EDT 2008
http://www.washingtonpost.com/wp-srv/nation/specials/immigration/cwc_d4p1.html
Some Detainees Are Drugged For Deportation
Immigrants Sedated Without Medical Reason
by Amy Goldstein and Dana Priest | Washington Post Staff Writers
Page A1; May 14, 2008
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 antipsychotic
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 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.
* * *
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.
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