Suicides Point to Gaps in Treatment

The case of Junior Bannister, a detainee from Barbados, indicates that problems remain, as evidenced by another e-mail exchange.

When Bannister arrived at Pearsall in August, he told immigration officials that he had been taking Celexa, an antidepressant, for five years, since his young daughter died. When he was taken into custody, a top mental health official recommended continuing his medication, but his notes did not get scanned into Bannister's file.

Without his medication, he began having "auditory hallucinations." He complained often, and staff sent the concerns to Johnson, who never signed off on the prescription.

In January, a lawyer working with Bannister inquired about the delay, setting off a heated exchange between Johnson and his bosses, who discovered that the medical staff had seen Bannister 22 times.

Jay Sparks, officer in charge at Pearsall, sent a curt e-mail to Johnson on Jan. 11 after examining Bannister's medical records. "Now I am further puzzled. While I understand a shortage of medical staff, we evidently were staffed well enough to see this person 22 times, but in the course of all of this unable to get him the medication that had been recommended -- why would this be?"

Johnson replied 90 minutes later. "I could not get to him," he wrote. ". . . There are many things we are not able to get to."

Sparks e-mailed up the chain of command. "I believe this case illustrates that we need something more efficient," he wrote. ". . . If we need more medical staff, then they need to be deployed, but regardless of what the solution is, it needs to occur rather quickly, as access to adequate medical care for our detainees is a rather critical issue."

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Graphic: Deaths at ICE FacilitiesAt look at where deaths occurred in ICE facilities between 2003 and 2008.
SIDEBARDuring the past five years, 15 immigration detainees have committed suicide, making it the most common cause of death. Here are selected cases from medical files and other internal documents obtained by The Post.
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In a recent telephone interview, Bannister said he would try to get Johnson's attention whenever he saw him, without success. Johnson, he said, would dismissively "just wave his arms" every time. After eight months of asking, Bannister recently received his medication.

Isaias Vasquez was not as lucky. Three mental health workers at Pearsall misdiagnosed him and refused to allow him to continue taking medications that he had been prescribed much of his life. Immigration officials declined to comment, citing pending litigation.

Vasquez had come from Mexico to the United States legally with his family when he was 2 years old. He served in the Army for two years until psychiatric problems ended his military career. Years later, when he was convicted on a drug-possession charge, he served the 1 1/2-year sentence at a Texas state psychiatric hospital. The government said the crime made him deportable, and immigration officers picked him up from the hospital and sent him to one detention center, then another. Records chronicle his paranoid delusions and auditory hallucinations.

He had been diagnosed with chronic paranoid schizophrenia in the early 1990s and had been hospitalized 18 times before he landed in Pearsall. But the staff ruled that he was not schizophrenic and cut off his medication.

Instead, on Nov. 29, 2005, they diagnosed him with an "unspecified personality disorder." Vasquez "insisted throughout session he was paranoid schizophrenic and needed medication," a social worker wrote in his medical file. But the evaluation team concluded that "his thought process and content was normal, logical and coherent." They suspected he was faking to keep his Social Security disability benefits.

They decided to take him off a drug for schizophrenia, and another for depression, and cut his dose of a second antidepressant in half. The effects were swift. A week later Vasquez was placed on suicide observation. He "smeared feces throughout the suicide observation room," his medical chart shows. The next day, "he announced in the dormitory that either he killed himself or God would do it for him, and he took all of his clothes off. Then he got down onto the floor and licked it."

The staff's response: They eliminated the last of his psychotropic medicine. "Mental health visits will cease at present time," says a Dec. 15 note in his medical file.

Two months later, another note warned, "DO NOT PLACE YOURSELF WITHIN GRABBING OR SPITTING DISTANCE OF THIS DETAINEE."

After another month, he was found sitting on his bed with only a blanket around his waist, reading a Bible aloud and screaming, "The world is coming to an end, but not until I finish using my red tape!" He refused his other medications for diabetes, high blood pressure and suspected tuberculosis.

In mid-March, Johnson stuck a handwritten note on Vasquez's cell window: "If you keep refusing to take your . . . medicines . . . YOU put YOURSELF at risk of BLINDNESS, AMPUTATIONS, HEART ATTTACKS, KIDNEY FAILURE, STROKES and EARLY DEATH."

Vasquez "covered that area of the window with spit," Johnson wrote in his medical file. "I slid another copy under the door, and he turned it face down and slid it back out, and then he blocked the door with his clothing so I could not slide it under again."

On March 24, "[H]e had saved up 6 empty peanut butter jars and had some sort of yellowish liquid in them. . . . [T]he guards told him to give them up. He refused." The guards subdued him with tear gas.

They gassed him again two weeks later when he refused to give the guards the broken eyeglasses he had "tied to his head with an undershorts waistband. . . . When the room was repeatedly sprayed, he stood stoically."

Unable to persuade Vasquez to take his medicine, the staff discontinued it in late April. A final note on his behavior, from May 1, five days before his release, says he had "smeared feces on window to cell and threw water and feces under door of cell."

Even then, the staff did not reconsider its assessment that he was not schizophrenic or its decision to take away the psychotropic drugs. Their assessment of his problem: "Ineffective individual coping."

Vasquez had won his immigration case. When his common-law wife picked him up, she found him raving and gaunt. Gloria Armendariz drove him straight to the VA hospital. On the way, she recalled, "I had to cut the [car] speakers and put them in the trunk because he kept saying they . . . would listen and videotape him."

At the hospital, guards had to subdue him. He was admitted to the psychiatric ward, "which is where he needs to be," said his lawyer, Lee Teran. The next day, he was started on antipsychotics.

Helped by his medicine and no longer facing deportation, Vasquez, now 49, did something that, in his nearly five decades in the country, he'd never bothered to do: He applied to become a citizen. At the citizenship ceremony last fall, he wore a jacket, a tie and a broad smile.

While Vasquez had been denied crucial medicine, Amina Bookey Mudey had the opposite problem. Records show that she was diagnosed with psychosis she did not have and given medication she did not need.

Alone and speaking little English, the Somali woman arrived at John F. Kennedy International Airport in New York on April 11, 2007, seeking political asylum. With no interpreter to question her, immigration agents shackled her ankles, wrists and waist, and put her in a van.

Exhausted, hungry and frantic about being tied up, Mudey collapsed on the way to a windowless converted warehouse in Elizabeth, N.J., where she would remain for five months.

The Elizabeth compound also had no interpreter. Nonetheless, an intake officer wrote in her medical records that Mudey said she was epileptic. A doctor there diagnosed her with post-traumatic stress disorder, depression and, incorrectly, with psychosis. He prescribed the potent antipsychotic Risperdal.

Mudey, 30, was a member of an outcast Muslim clan and, according to her political asylum application, had been tormented by dominant groups throughout her life. When she was 10, she said, an old woman cut off her genitals with a razor blade. As a teenager, she was clubbed and beaten by girls with status. When she was 19, armed men shot and killed her father and two brothers at home. At 22, five men with guns gang-raped her mother and sister, who screamed so much the men killed her. Then they attacked Mudey with a knife and bashed her head with a gun butt.

Soon after taking Risperdal at the Elizabeth detention center, she found herself in the throes of its worst side effects. Her arms and legs shook uncontrollably. Her tongue thickened and thrashed around in her mouth, which she was unable to close. She drooled constantly, vomited often and began to lactate. "I said, 'Maybe I am going mad,' " Mudey said. " 'Maybe I am going to die in here.' "

When she lactated, her cellmates accused her of lying. " 'You must have killed your baby or had a late abortion,' they told me. 'You must be lying to us.' . . . Something was wrong. My breast was full of milk. They said to me, 'Are you sure you didn't leave a baby behind?'"

Mudey's symptoms were classic side effects of Risperdal, said doctors consulted by The Post. But when she complained, the detainee doctor only increased the dose. ICE initially declined to comment because of privacy issues. Last night, after those issues were resolved, the agency said it did not have enough time to prepare a response.

In her stupor, Mudey had her first court appearance. It did not go well. Her mind was a thick cloud; she was disoriented and unresponsive to questions. The judge was not impressed.

In June, Mudey was introduced to Ann Schofield Baker, a Park Avenue lawyer who specializes in high-stakes intellectual-property litigation and had volunteered for pro bono duty. After much haranguing, Schofield Baker managed to get an interpreter, psychiatrist and gynecologist into the compound to examine her client. They determined she had been misdiagnosed, according to court affidavits.

"She clearly has very severe PTSD and she is clearly depressed, but there is no evidence of psychosis," wrote Katherine Falk, the psychiatrist and a consultant for Physicians for Human Rights.

The two doctors wanted Mudey off Risperdal. "They just drugged the crap out of her," Laurie Goldstein, the gynecologist, said in an interview. "They just kept her slogged."

The doctors told her to refuse the pills. The compound's doctor scolded her when she did. She defied him.

"I told him that the other doctors says this other medication has been hurting me. I am not going to take it," she recalled in an affidavit prepared for court. "The first day I stopped taking it, I noticed I stopped drooling. In two or three days I could close my mouth. I was not as dizzy and confused. My appetite came back. I started feeling almost normal." Her mind regained its focus. Her next testimony was clear and more convincing.

But weeks later, Mudey experienced pain in her abdomen and back. She wrote notes to the doctor pleading for help. When she could no longer stand and lay balled up on her bed, her cellmates wrote notes for her. Weeks went by. She believed that the doctor was retaliating against her because she disobeyed him.

On orders of the doctor, but without an exam, a nurse gave Mudey Diflucan for a yeast infection, as Goldstein discovered after reviewing the few medical records that immigration officials would give her. After several consultations with Mudey by phone, Goldstein concluded that she was suffering from an acute urinary tract infection, a kidney infection or pelvic inflammatory disease. She tried repeatedly to reach the Elizabeth center's physician, but he would not respond, she said.

Schofield Baker prepared a legal injunction to force the Elizabeth compound to take Mudey to a hospital, and immigration officials relented. She got better quickly. She has no idea what was wrong with her or what drugs she was given; federal officials refused to give her the hospital records.

On Sept. 18, Mudey won her political asylum case. A guard told Schofield Baker that she could wait for her client in the parking lot across from the compound. Hours later, at 11 at night, Mudey's tiny figure appeared. She wore the same flip-flops and fuzzy coat she had on the plane when she first arrived in the United States.

"Seeing her walk out reminded me of a scene from the Holocaust," said Schofield Baker. "I was absolutely shocked and amazed we can treat human beings like this on our soil."

Mudey got into her attorney's rented Lincoln Town Car. It carried her down a road lined with barbed wire, past rows of gritty warehouses and hundreds of hulking trucks. Having not seen the sun or a star in the sky in the five months she had waited inside the windowless compound, Mudey was overwhelmed by the lights and motion. She gasped. "My goodness, how beautiful America is!"

Staff researcher Julie Tate contributed to this report.

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Glossary

Key terms and acronyms from the Careless Detention series.

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Document Archive

Read the original government documents related to the people and cases detailed in this story.

Mapping Deaths at ICE Detention Facilities

A Closer Look At 83 Deaths

Based on confidential medical records and other sources, The Washington Post identified 83 deaths of immigration detainees between March 2003, when the federal Immigration and Customs Enforcement agency was created, and March 2008.

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