Yet, Medical Marijuana is a Federal crime.
http://www.wa****ngtonpost.com/wp-srv/nation/specials/immigration/cwc_d4p1.html
Some Detainees Are Drugged For De****tation
Immigrants Sedated Without Medical Reason
by Amy Goldstein and Dana Priest | Wa****ngton Post Staff Writers
Page A1; May 14, 2008
The U.S. government has injected hundreds of foreigners it has de****ted
with dangerous psychotropic drugs against their will to keep them
sedated during the trip back to their home country, according to medical
records, internal do***ents 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 do***ent calls it, had such a potent effect
that federal guards needed a wheelchair to move the slumped de****tee
onto an airplane.
"Unsteady gait. Fell onto tarmac," says a medical note on the
de****tation 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, do***ents describe immigration guards "taking down" a
reluctant de****tee to be tranquilized before heading to an air****t.
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 de****tation 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 Wa****ngton Post has
identified in which the government has, without medical reason, given
drugs meant to treat serious psychiatric disorders to people it has
****pped out of the United States since 2003 -- the year the Bush
administration handed the job of de****tation 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
do***ents make clear, U.S. escorts have been unable to inject de****tees
with extra doses of drugs during layovers en route to faraway places.
Federal officials have seldom acknowledged publicly that they sedate
people for de****tation. The few times officials have spoken of the
practice, they have understated it, ****traying 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 de****tees 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 de****tee 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 de****tation 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 *****s the
detainee's medical records, although some de****tees' 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 de****tee 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
do***ented psychiatric reason. Of the 67, psychiatric drugs were given
to 53, 48 of whom had no do***ented history of violence, though some had
managed to thwart an earlier attempt to de****t them. These figures do
not include two detainees who immigration officials said were given
sedatives for behavioral rather than psychiatric reasons before being
de****ted 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
de****tation of Yousif Nageib to his native Sudan. In requesting drugs
for his de****tation, 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 air****t. 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 ****tion 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 fini****ng 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 de****t 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 de****t them at least once before.
One summer day in 2003, de****tation 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 de****ted."
"I can't be de****ted," 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 de****tees, 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 de****tees 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 de****tees
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 Es*** 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 cir***stances 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
de****tees 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 re****ts of
sudden death" and other re****ts of dangerous changes in heart rhythm. It
is, im****tant, 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 de****tees 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 do***ent said, "involuntary
medication of such persons for the sole purpose of subduing them during
de****tation, without a court order, is not sup****ted 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
de****tees. 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 de****tees, 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 cir***stances."
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
de****tees 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 de****tee
had been given the three-drug cocktail at the air****t 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 de****tation go ahead.
Immigration guards and a nurse had more trouble during another
de****tation 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 re****t on the incident, the guards, nurse and de****tee were met
at the plane by French national police, who accompanied them to an
air****t 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 re****t 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 de****tation 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 de****tee 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 de****tee nine injections
of Haldol totaling 55 milligrams -- nearly four times as much as before.
* * *
One de****tee 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 de****tation log describes Remmy
Semakula's state on the afternoon he was taken from his cell in the
Middle*** County jail in New Jersey to be de****ted to Uganda in early
April 2007. According to a memo from his de****tation 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 de****tation 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 de****t 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
air****t, 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 de****tation," 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 de****tation 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 de****ted. And compared
with other de****tees, 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 de****ted -- 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 air****t. As it turned out, his de****tation was canceled before
takeoff because immigration officials had not alerted airline security
in Singa****e, 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 de****tation, immigration
officers came for him and took him to the air****t 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 Wa****ngton, 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 de****t 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 de****t him to
Albania because he created a scene at the Dallas/Fort Worth
International Air****t, 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
de****t 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 de****tation, the issue was dropped.
* * *
In at least one instance since the rules were changed, the government
apparently drugged a de****tee 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 de****t 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 Do***ents: 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 de****tation 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
Air****t 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 re****t.
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