A Baltimore Sun story the next day said: "The impetus for the U.S. Justice Department report was a 1999 investigation by New York-based Human Rights Watch, an international human rights group. It found that hundreds of children were jailed in appalling conditions in Maryland, including the city detention center."

You also say that he was a top candidate for a juvenile services administrative job in the District, but that advocates in juvenile justice community did not want a corrections administrator and that was the reason he didn't get the job.

Post stories at the time and subsequent reporting for the series found that he did not get the job in part because of his troubled background. A statement by Justice for D.C. Youth, a coalition of advocates, was quoted by the Post as saying that Flanagan's "failed performance while overseeing the Baltimore city jail should be enough to eliminate him from consideration."

Post: "An entry-level emergency medical technician, with barely any training, had done Guevara's intake screening and physical assessment at the Otero County immigration compound in New Mexico. Under DIHS rules, those tasks are supposed to be done by a nurse."

ICE: The ICE National Detention Standards require that intake screening and physical assessments be conducted by trained personnel, including Emergency Medical Technicians (EMT).

Ombudsman: The Post has a copy of the memo that is quoted in the story criticizing the fact that Guevara was never seen by a doctor, nurse or "midlevel" medical provider. The exam was done by a beginning level EMT-B.

Post: "His wife, pregnant at the time with their second child, recalled that she rushed to the hospital, but ICE guards would not let her inside until the Mexican Consulate interceded. Guevara's mother waited five hours before they let her in. By then he was brain dead."

ICE: Otero County officers were providing security coverage during Mr. Guevara's hospitalization. ICE contacted Mr. Guevara's family so they could report to the hospital immediately to see their family member and to speak with the doctor regarding his condition. ICE was never made aware that there was a delay in their ability to see Mr. Guevara and we have no record of the Mexican Consulate interceding.

Ombudsman: This information came from interviews with Guevara's family.

Post: "The government's internal medical records say Dantica died of pancreatitis. A one-page death certificate in his file has "VOID" stamped across it. Two outside doctors who reviewed his medical records for The Post said he probably died of heart problems."

ICE: There is no space on the actual death certificate in which to enter the cause of death. This likely explains why Mr. Dantica's death certificate does not indicate the cause of death. The VOID mentioned in the article on the death certificate is a security feature to prevent forgery.

Ombudsman: No matter why the certificate is stamped void, medical records listed the cause of death as pancreatitis.

Post: "But internal documents and interviews reveal unsafe conditions that forced the agency to relocate all 404 detainees that month. An audit found 53 incidents of medication errors. A riot in August pushed federal officials to decrease the dangerously high numbers of detainees, many of them difficult mental health cases, and caused many health workers to quit. Finally, the facility lost its American Correctional Association accreditation."

ICE: San Pedro was temporarily closed because of the need to perform significant work on the fire suppression system and to replace the boiler. A decision was made that it would be a life safety issue to house the detainees there while the fire suppression system was offline while undergoing repairs. That would have placed the detainees in a potentially dangerous situation. We opted to relocate them.

In addition, and for clarification, San Pedro lost its ACA accreditation for not having been in compliance with one mandatory standard. That standard had to do with the manner in which caustic and toxic substances (like cleaning supplies, oil, gas, bleach, etc) are stored and inventoried. The facility immediately addressed the deficiency and were then in compliance with the standard again. Nonetheless, because the standard is mandatory, not having been in compliance with it was the cause for the loss of accreditation. According to ACA policy, ICE must wait two years before being eligible for accreditation regardless of the fact that the standard was immediately corrected.

Ombudsman: Internal documents and interviews revealed unsafe conditions at the San Pedro facility that forced all detainees to be moved. The facility lost its accreditation which is not contested. I reviewed the documents on San Pedro Medical Clinic and the documents were, to put it mildly, extremely critical. In six weeks, 53 medication errors were found. The clinic was unable to produce an accurate accounting of why the errors occurred.

Washington Post Detainee Health Care Series -- Day 2

ICE:The Washington Post began a four part series on Sunday, May 11th on detention health care. The second article in the series focuses on the health care provided to Yong Harvill. If you are reading this series, you may also be interested in the following:

Post vs. ICE regarding the May 12, 2008, article:

Post: "Yong Harvill¿¿ She noticed the lump under the thin, blue cotton in August, five months after federal immigration officers, to her amazement, took her into custody to try to deport her for buying stolen jewelry more than a decade ago."

ICE: ICE is specifically prohibited by the Privacy Act from commenting on the medical records or treatment of an individual detainee. However, under the Immigration and Nationality Act, once an individual is convicted of any one of a number of crimes, that individual may be subject to removal. To ensure that individuals who have been convicted of a crime and who are amenable to removal are not released back into society at the conclusion of their sentence, ICE created the Criminal Alien Program. This program identifies individuals in federal, state and local jails and places them into removal proceedings at the conclusion of their incarceration.

Post: "The lump grows slowly. It is now three inches across. And though she keeps asking, no one has done a test to see whether her sarcoma has come back."

ICE: ICE is specifically prohibited by the Privacy Act from commenting on the medical records or treatment of an individual detainee; however, ICE detainee health care is equal to or better than that provided to U.S. citizens in custody. Each detainee is medically screened upon arrival and last year, 34 percent were diagnosed and treated for pre-existing chronic conditions. ICE routinely provides medical care for life threatening conditions, such as cardiac arrest, kidney disease, high risk pregnancies, HIV/AIDS, hypertension, and diabetes. ICE detainees also receive dental visits, physical exams, sick call visits, prescriptions and mental health visits.

Ombudsman: You said that you could not comment on the case of Ms. Harvill because of privacy restrictions and that you had not gotten a medical confidentiality waiver until after the series started. Goldstein and Priest have emails documenting that you received the waiver Friday, before the series began. I also saw an email from ICE, dated on Friday, containing answers to the questions that the reporters had asked about Ms. Harvill. ICE would not have provided the answers without a waiver in hand.

Post: "They are locked up in a patchwork of out-of-the-way federal detention compounds, private prisons and local jails. This unnoticed prison system was built for a quick revolving door of detainees -- into custody, out of the country. But often, people linger in detention for months or years."

ICE: It is important to note that the length of stay in an ICE detention facility is considerably shorter than that of a correctional facility. In 2007, ICE detainees spent an average of 37.5 days in detention. Decisions regarding detention are made on a case-by-case basis, taking into account a number of factors, including whether or not mandatory detention is required, whether the individual poses a threat to national security or public safety and whether he or she is a flight risk.

All individuals involved in the removal process have the right to full due process of law, such as a hearing before an Immigration Judge and the right to appeal before the Board of Immigration Appeals and the U.S. Circuit Court of Appeals. As such, some removal cases are lengthier than others, which can result in an individual being detained for longer periods of time.

Ombudsman: The average detainee "stay" is 37.5 days was a part of the graphic in the fourth story. I saw a DHS report to Congress for fiscal 2006 saying more than 16,000 detainees, who were not asylum seekers, had been in custody for three months or longer, including more than 1,800 who had been in detention for a year or longer. ICE public affairs confirmed that these figures were accurate and the most current that exist.

Post: "Two months after ICE agents seized Harvill in Florida, they transferred her to Arizona last May, saying a federal compound called the Florence Service Processing Center was better suited to handle her medical care. Four weeks later, they moved her, without explanation, a few miles down a cactus-lined highway to a county jail that hasn't had a full-time staff doctor since she arrived."

ICE: As a measure to ensure overcrowding does not exist at ICE facilities, ICE routinely moves detainees to other locations. In fact, oftentimes, when a facility reaches its capacity, we immediately take action to bring the population down to eliminate the strain of overcrowding. Further, a detainee may be moved to a facility that can better handle specific medical issues.

Ombudsman: You do not contest that Harvill was moved from Florida to an ICE-run facility in Arizona and then to a county jail. The story said she was first told that she was being moved to a center that was better suited for her medical care. But then she was moved to a jail with no full-time doctor ¿ and was not told why. She and her lawyers tried repeatedly to find out why she was moved and never got an explanation.

Post: "The day after she arrived, Harvill saw a nurse and a doctor for a checkup that all new detainees are supposed to have, but don't always get."

ICE: Nearly 1.5 million individuals have come through detention facilities since ICE was created in 2003 through fiscal year 2007. Another 345,000 are expected to pass through ICE detention in fiscal year 2008. Each of them received taxpayer-funded comprehensive medical screening and, for those remaining in ICE custody at least 14 days, a comprehensive physical examination. Each also received specific treatment, as medically necessary. Care management was provided by the Division of Immigration Health Services or local Intergovernmental Service Agreement (IGSA) contractors at a cost of more than $360 million.

Ombudsman: The story mentions -- and documents -- that all detainees do not get medical screening promptly. I saw a DIHS document that showed several did not get seen for 17 to 73 days.

Post: "Harvill gets shuttled back and forth to the hospital in Phoenix because the jail does not have a doctor on its staff." "According to internal government documents, one-third of the 29 medical positions at the Pinal County Jail were vacant as of February. The jail, the Florence compound and the large compound in nearby Eloy each had no full-time doctor."

ICE: According to ICE records, the Pinal County Detention Facility, ICE Medical Clinic is staffed with a Health Services Administrator (HSA), two Mid-Level Providers (MLPs) such as a Nurse Practitioner and Physician's Assistant, a Pharmacist, one Pharmacy Technician, six Registered Nurses (RNs), four Licensed Practical Nurses (LPNs), one Administrative Assistant and four Medical Records Technicians (MTRs). While not on site full time, there is also a Physician, a Psychiatrist and a Psychologist that provide services to the detainees at Pinal County on a regular basis. In addition, the Medical Clinic has full laboratory capabilities as well as a fully staffed pharmacy on site. Further, the facility does rely on specialists in the local area.

Ombudsman: While you detail the Pinal County Jail medical staff, documents show that as of February about one-third of the medical positions were vacant and that there was no full-time doctor there or at two nearby detention centers.

Post: "Whether the gaps in Harvill's treatment are by accident or by design is difficult to discern. Yet it is clear that the obscure federal agency that oversees detainees' medical care, the Division of Immigration Health Services (DIHS), operates with a top priority of limiting care and saving money. Its medical mission is only to keep people healthy enough to be deported."

ICE: The mission of DIHS is to provide appropriate medical care for ICE detainees. The DIHS Detainee medical care primarily provides health care services for emergency care. Accidental or traumatic injuries incurred while in the custody of ICE and acute illnesses will be reviewed for appropriate care. Other medical conditions which the physician believes, if left untreated during the period of ICE custody, would cause deterioration of the detainee's health or uncontrolled suffering affecting his/her deportation status will be assessed and evaluated for care. Each claim is reviewed by a medical professional on an individual basis for appropriateness and medical necessity.

Post: "Instead of listing, as most health plans do, the services available to patients, the manual specifies services that are "usually not covered" for allergies, heart problems and other illnesses. Cancer is not mentioned at all."

ICE: The DIHS benefit package, to include services available for detainees, is available on the DIHS website www.icehealth.org for public review.

Post: "Internal government documents obtained by The Post show that most requests are approved. But the documents also show that, when requests come in for people with serious problems, there can be pressure to cut costs." "One chart, covering October 2005 to September 2006 -- seven months before Harvill became an immigration detainee -- is labeled "TAR Cost Savings Based on Denials." The agency, the chart shows, saved $129,713 by denying 17 medical requests for people with HIV, $36,216 by denying seven requests for people with various forms of psychosis, $91,926 by denying 27 requests for people with chest pain and $9,545 by denying treatment for a case of blood in stool, one of the problems Harvill has had for months."

ICE: In fact, Treatment Authorization Requests (TAR), which are requests for off site medical care, are approved at a very high rate. However, a TAR may be denied because of available alternative procedures or the treatment is available on site. Thus, a TAR is not determined with an effort to cut costs.

Ombudsman: The story said the Division of Immigration Health Services operates with a priority of limited care and saving money and that its medical mission is to keep people healthy enough to deport. You say that the mission is to provide "appropriate" medical care. I have seen documents that show the amount of money saved by not doing various medical tests and procedures.

I've reviewed government policy documents that say what will not be covered and also say that "traumatic injuries" or conditions that would cause "deterioration of the detainee's health or uncontrolled suffering" will only be "reviewed." A review on your Web site of the DIHS benefit package backs up what the stories say.

The story says that most requests for treatment are approved. But it also says that there is pressure to cut costs. You say: "a TAR (Treatment Authorization Request) is not determined with an effort to cut costs." Yet the reporters have a document I read which is labeled "TAR Cost Savings based on Denials" that has 329 denials, "saving" $1,372,887.09.

Post: "These sorts of machinations prompted the deputy warden at York County Prison in Pennsylvania, which houses many immigrant detainees, to fire off an angry letter about the health services division. "[I]n my opinion, they have set up an elaborate system that is primarily interested in delaying and/or denying medical care to detainees," the warden, Roger Thomas, wrote in late 2005. "There is nothing easy about working with DIHS. If something can be delayed, it is delayed. If it can be denied, it is denied. If it can be difficult, it is made difficult. Most importantly, if there is some bureaucratic procedure that will delay/deny treatment to a detainee . . . you can be assured that DIHS will do it." Harvill's lawyers have tried to find out how many requests for treatment have been sent from Pinal County Jail on her behalf and how Washington has ruled on each one. They filed a Freedom of Information Act request last summer and, after two months, got an incomplete answer. In January, they left a phone message for the division's medical director. No one has called back."

ICE: Without speaking specifically to Ms. Harvill's case, each detainee is given the highest level of care. DIHS treats each TAR case on an individual basis and at times may request more information to make an informed medical decision.

Ombudsman: You say that "each detainee is given the highest level of care." The angry letter from the deputy warden at York County Prison is a powerful documentation of problems in health care for detainees in 2005. The reporters contacted the deputy warden to see if the situation had changed, but were not given an interview.

Post: "The thing that makes perhaps the least sense to him is that his wife is covered under a good health insurance policy that he gets through his union, the International Brotherhood of Boilermakers, and she and her lawyers have asked whether she could use that policy to pay for her treatment by private doctors while she is detained. They have been told no."

ICE: A decision on appropriate medical care is made between the patient and the physician. If necessary ICE will transport a detainee to an approved specialists to obtain appropriate and necessary medical care. DIHS uses a similar standard in determining the appropriate procedures for an individual as any other healthcare provider¿appropriateness and medical necessity.

Ombudsman: Your statement is not a denial of the facts in the story: Ms. Harvill was not permitted to use her husband's private medical insurance.

Washington Post Detainee Health Care Series -- Day 3

ICE:The Washington Post began a four part series on Sunday, May 11th, on detention health care. The third article in the series focuses on the treatment of mental illness among immigrant detainees, with an emphasis on suicide.

If you are reading this series, you may also be interested in the following:

Post vs. ICE regarding the May 13, 2008, article:

Post: "While tens of thousands of detainees inside immigration detention centers endure substandard medical care, people with mental illness are relegated to the darkest and most neglected corners of the system."

ICE: In fiscal year (FY) 2007, DIHS psychologists and social workers have provided 31,697 different types of psychological services and/or patient contacts that impact detainees in a positive manner.

In the last 12 months, DIHS psychologists and social workers have been successful in managing a daily population of between 1,350 to 2,160 detainees with serious mental illnesses. In that time frame, there have been no suicides.

Ombudsman: That defense does not mean that the problems in the story were not true. Nothing in your responses refutes the cases mentioned in the story and the problems with ICE mental health personnel documented by the reporting and interviews.

Post: "Suicide is the most common cause of death among detained immigrants. It accounts for 15 of 83 deaths since 2003, when the Department of Homeland Security's Immigration and Customs Enforcement agency, known as ICE, took over facilities for foreigners whom the government is trying to deport."

ICE: Since 2003, suicides have accounted for 18% of the deaths of detainees in custody. Compared to other correctional agencies that serve large populations (California Department of Corrections and the Federal Bureau of Prisons) the suicide rate for individuals detained in ICE custody is much lower. Over 1.5 million detainees have transited thru the ICE detention system in the last 5 years with a suicide rate lower than comparable-sized correctional systems and lower than the national average of 12 suicides per 100,000 people. ICE provides effective suicide screening, crisis response and has a strong suicide prevention program. The first suicide prevention program was instituted in 2000. It was revised again in late 2005, and the program is reviewed annually. The suicide prevention program includes guidelines for annual staff training, screening for suicide risk, identifying risk factors for suicide, suicide risk assessment procedures, the place and process of suicide watch and guiding principles in suicide prevention. Additionally, there has not been a suicide in more than 15 months.

Ombudsman: You dispute that suicide is the most common cause of death among detainees since 2003 when ICE was created. Yet that came from a Post analysis of DIHS' own death records. While the reporters could have used comparable prison or general population figures on suicide, it still does not take away from what they found.

Post: "Inside these out-of-the-way compounds around the country, suicide attempts seem to be on the rise, according to internal documents: 16 in June, 21 in July, 20 in August."

ICE: ICE detention facilities, not compounds, are not out of the way. They are strategically placed to support immigration law enforcement programs and/or to facilitate easier removal of detainees to Central American countries. There are detention facilities in or near every major city in the United States including New York, Philadelphia, Miami, Houston, Chicago, Phoenix, San Diego, Los Angeles, and Seattle.

ICE is concerned for the safety of all detainees. The first suicide prevention program was instituted in 2000. It was revised again in late 2005, and the program is reviewed annually. Detention facility staff is specially trained to recognize risk factors for suicide and manage suicidal detainees with appropriate supervision and sensitivity. Information gathered from internal documents is anecdotal and does not reflect scientific analysis or study and is a matter of speculation by outside sources. An increase in suicide attempts of less than one-tenth of 1 percent over 3 months does not suggest a sustained increase in suicide attempts over time. More importantly, as ICE continues to monitor its suicide prevention program, there have been no suicides in the past 15 months, during which ICE detention capacity has increased from 27,500 to 32,000.

Ombudsman: Many of the facilities mentioned are away from population centers and services. Others, such as the Elizabeth facility near New York City, are in a warehouse and industrial district.

While you say that you have suicide prevention programs in place, they obviously did not prevent the suicides in the story. You say that the increase in suicide attempts of "less than .1 of 1 percent" over three months does not suggest a sustained increase over time. I agree with that, but that does not mean that the figures should not have been reported. What should have been reported is that there have been no suicides in the last 15 months.

One suicide, that of a 27-year-old Algerian woman named Hassiba Belbachir, occurred in an Illinois jail where suicide prevention efforts had been found to have defects during a federal review several months before she arrived.

Post: "The ratio of staff to mentally ill detainees is out of balance, with far fewer staff members than in other prison settings, according to Dennis Slate, the top mental health official in the detainee system. In an e-mail to colleagues the morning of last May 31, Slate said the ratio in the Bureau of Prisons was 1 to 400. In prisons for the mentally ill, it was 1 to 10. But in the immigration detention centers, it was 1 to 1,142."

ICE: Since December of 2007, significant efforts have been made to increase staffing. Within the next 3 to 4 months ICE will have a mental health professional to detainee ratio similar to the Department of Justice's Bureau of Prisons. By the end of the fiscal year, ICE will evaluate the impact of its staffing increases. If more staff is needed, ICE will move decisively to hire additional mental health staff. ICE is actively working with the DHS Office of Health Affairs to make sure that DIHS has the appropriate number and type of medical providers.

Ombudsman: The story says the ratio of staff to mentally ill detainees is out of balance with far fewer than in other prison settings and quotes Dennis Slate, the top DIHS mental health official, as saying that in a memo. You say that significant efforts have been made to increase staffing and that detention facilities will be better staffed by the end of the fiscal year.

Post: "When immigration became a national security issue after the terrorist attacks of Sept. 11, 2001, the administration decided to increase raids on workplaces for undocumented workers and to round up convicted felons who had served time but were now deportable, no matter how long they had lived in the United States. This, along with a new requirement that political asylum-seekers must wait out their cases behind bars, created a deluge that the system was unprepared to handle."

ICE: In response to the terrorist attacks of Sept. 11, 2001, when the administration placed greater priority on worksite enforcement, the Criminal Alien Program and ending the practice of "Catch and Release", ICE's staffing levels and bed space funds increased to support the demand. Between 2004 and 2008, ICE has increased its on-board staffing levels for the Office of Detention and Removal Operations (DRO) from approximately 4,000 to 6,300 full time employees. During the same time period, funded bed space levels grew from 19,444 to 32,000. Adequate preparation for the increase in activity and the efficient management of this bed space allowed for over 311,213 individuals to move through ICE custody in FY07. Since October 2007 more than 200 new DIHS staff have entered on duty and more than 200 applicants are in the hiring pipeline.

Ombudsman: You say that your agency staffed up significantly to handle post 9/11 cases, but there are many memos and e-mails in the story from doctors, nurses and administrators who say that inadequate staffing is a problem.

Post: "Belbachir was sent to McHenry County Jail in the far suburbs of Chicago. The jail already had problems with its medical services: Detainees did not receive the required mental health screening, nor the standard screening for suicide risk, a recent review had found. Untrained staff members often did what screenings there were."

ICE: ICE detention standards require that detainees undergo a health screening within the first 24 hours of admission to an ICE detention facility. However, on rare occasions beyond ICE's control, like an unanticipated number of arrests, these standards may not be met for a very short period of time. In those situations, every effort is made to provide the screenings and examinations as quickly as possible. This screening includes evaluation of the individual's medical, dental and mental health status. A health history is taken through an interpreter, if needed. Each ICE detainee also receives a more detailed physical examination within 14 days of admission to an ICE detention facility.

Ombudsman: A detainee (Hassiba Belbachir) was sent to a Chicago suburban jail that already had problems with medical services. You say that health screenings are usually done within 24 hours except when there is a large number of unanticipated arrests. Your response does not refute the reporting on Belbachir.

A draft inspector general's report, from the Department of Homeland Security, relating to detainee deaths, said DIHS had trouble giving timely medical exams and was experiencing staff shortages. In several instances, in just one detention facility, detainees waited from 17 to 73 days for an intake exam.

Post: "Belsito and her managed-care associates were withholding treatment for many types of care, saving the agency millions of dollars. For mental health services, four denials for treatment of manic-depressive psychosis saved DIHS $18,145.36, according to an itemized record of the savings over a one-year period ending in August 2006. Two denials for care of "unspecified psychosis" saved an estimated $11,668.60. Nine denials for treatment of "depressive disorder not elsewhere classified" saved $43,158.57."

ICE: The Washington Post has consistently mischaracterized the managed care program. Requests for specialized care, including mental health services are approved at a rate of 90 percent. Just like in any managed care program serving U.S. citizens, there is an obligation to make sure that the care is needed and that the costs being charged are reasonable and customary. DIHS does not deny care for the purpose of saving money. Managed care is a system implemented to assure payment of claims for all off site medical, dental, mental health and inpatient hospitalizations for detainees in ICE's custody. The detainee benefits package covers both emergency and routine care for those in custody of ICE. The Managed Care Team Case Managers, do not withhold treatment. Requests for care are received through a Treatment Authorization Request (TAR) web system. All requests are reviewed on a case-by-case basis by weighing several factors. The cost savings reflect the change in payment of claims, not denials or withholding treatment. The TAR process is used to approve payment only, and allocation of government funds for off site medical care. The cost savings reflect a savings based on Medicare rates mandated by Congress. Denials for payment may be for administrative reasons, due to the fact that the detainee is not in ICE custody, or the case managers were never notified of any need for care.

Ombudsman: Many health care providers the reporters interviewed cited problems with managed care and several of the cases went deeper into the problems.

The TAR cost-savings document ¿ headlined "TAR Cost Savings based on Denials" ¿ in their possession lists $1.37 million saved from Oct. 1, 2005 to Sept. 30, 2006. It seems pretty self-explanatory.

Post: "The Elizabeth compound also had no interpreter."

ICE: ICE Detention and Removal employees are required to pass Spanish language training at the Federal Law Enforcement Training Center. For languages other than Spanish, ICE does have available interpreter services 24 hours a day, 7 days a week, which are utilized by facilities across the country. Again, ICE detention facilities, are not compounds. They are full-service facilities subject to building, fire and health and safety codes and regulations. There are inspected annually and continually maintained.

Ombudsman: The story said the Elizabeth facility had no interpreter available to Amina Mudey, a Somali woman. She and her lawyer said she was routinely examined without an interpreter. They also offered to bring in an outside interpreter, and ICE refused.

Washington Post Detainee Health Care Series -- Day 4

ICE:The Washington Post began a four part series on Sunday, May 11th on detention health care. The fourth article in the series focuses on the practice of chemically sedating deportees.

If you are reading this series, you may also be interested in the following:

Post vs. ICE regarding the May 14, 2008, article:

(The ombudsman's response is at the bottom of this section)

Post: The article's discussion regarding the scope of the use of chemical sedation. ICE has injected more than 250 cases without medical reason since 2003. In the article, the practice is described as a human rights violation, comparing the practice to the Soviet Union's use of Haldol on political prisoners.

ICE: Prior to June 2007, the involuntary sedation of detainees for removal purposes was authorized only after consultation with medical professionals and in cases where the detainees posed a threat to themselves, the passengers, the crew and the transporting officers. Voluntary sedation was also allowed in certain circumstances if a detainee requested medication in order to stay calm on a flight and under the care of a medical professional.

In June of 2007 and again in January 2008, ICE issued policy requiring a Federal court order in order to utilize involuntary sedation as part of the removal process. Under both the June 2007 and January 2008 policy, medication administered consistent with treatment of a diagnosed mental condition is appropriate.

Post: "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."

ICE: The policies for DIHS Aviation Medicine reflect the intent to protect the detainee and those doing the escort at all times. The aviation medicine providers are trained to use de-escalation techniques and use the administration of medication safely, and as a last resort. It is well established that by combining two medications, augmentation of the desired effect can be obtained with a lower dose of each.

Post: The article's discussion of ICE's policy/procedures for sedating deportees on the flight. Repeatedly, documents describe immigration guards "taking down" a reluctant deportee to be tranquilized before heading to an airport.

ICE: When an alien has exhausted all legal challenges, ICE is required to carry out his removal. The vast majority of individuals are removed from the United States without issue. A small number of individuals, however, attempt to affirmatively physically obstruct their removal. In these very few cases, ICE policy permits its officers, in conjunction with the Department of Justice, to seek a court order to involuntarily sedate an individual to facilitate removal.

Post: The article's discussion of traditional medical uses, and the inference that ICE goes against such use. 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.

ICE: The medications used by Aviation Medicine are widely used in psychiatry and their use is in compliance with the DIHS "Practice Guidelines for the Management of Combative Detainees".

Post: The article's discussion of the litigation surrounding this issue. 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. In at least one instance identified by The Post, the agency appears not to have followed those rules.

ICE: As of June 2007, ICE policy requires that a Federal court order will be obtained before an individual is involuntary sedated. Prior to January 2008, the policy allowed an emergency exception when the individual represented a threat to self or others. Since January 2008, the policy requires a court order without exception. Under both the June 2007 and January 2008 policy, medication administered consistent with treatment of a diagnosed mental condition is appropriate.

The Post's choice of rhetoric and specific language misleads the reader into believing 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." It is in the next sentence that The Post then states that "In at least one instance identified by The Post, the agency appears not to have followed those rules". There have been no violations of the government's policy as written. In fact, The Post made no reference to the January 2008 policy, again misleading the viewer into believing that the government uses involuntary sedation without a court order.

Ombudsman: The 250 cases mentioned in the story all involved detainees who had no psychiatric reason for their sedation. The series documented many cases where ICE did not follow its own former policies on sedation. It gave ICE's view of the drug protocol. The series also noted the change in policy about the court order, but it should have been higher in the story.

In some cases the reporters cite in the story, the deportee was calm at the time they were sedated. In other instances, de-escalation attempts were not tried before drugs were administered, so sedation was not a last resort.