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Johns Hopkins professors argue ‘dual loyalty’ compromises health care in migrant detention facilities

A woman works in the Main Medical building at a U.S. Immigration and Customs Enforcement detention facility known as the South Texas Family Residential Center, which houses families who are pending disposition of their immigration cases on Aug. 23 in Dilley, Tex. (Jabin Botsford/The Washington Post)

EL PASO — The “dual loyalty” of health-care professionals who work in U.S. immigration detention facilities undermines the quality of care for migrants held there, according to an article by three professors from Johns Hopkins University published Friday in the Journal of the American Medical Association.

The professors argue that medical care for those detained under current Trump administration policies that are aimed at deterring migration to the United States create a conflict for doctors and nurses because those policies place the interests of the government over the patients in their care.

“Whatever the future of U.S. immigration policy, decent and humane treatment of children, as well as all other detainees, and preservation of independence of physicians and other health professionals to meet patients’ medical and psychological needs are essential,” said the opinion article written by Paul Spiegel, Nancy Kass and Leonard Rubenstein of Johns Hopkins School of Public Health.

In an interview, Spiegel said the article arose after the professors saw an advertisement from a privately run Immigration and Customs Enforcement detention center in Louisiana that sought a lead doctor who would be “philosophically committed to the objectives of the facility.”

That language was dropped after widespread criticism, but the company still continued to seek a doctor who would work “based on the company goals, objectives and philosophy” — rather than explicitly working to protect the best interests of their patients.

“Being a medical practitioner, the loyalty always has to be first and foremost to the patient,” said Spiegel, who is the director of the Center for Humanitarian Health at Johns Hopkins.

Spiegel was among of a group of doctors who recently sent a letter to Congress urging the Department of Homeland Security to improve its treatment of influenza in detention facilities, including providing flu vaccines to people when they are taken into custody.

Flu was rampant in many overcrowded detention facilities earlier this year, and at least three children died of the disease, according to autopsy reports.

Doctors urge probe of child migrants deaths: ‘Poor conditions’ at border increase risk of spreading flu

U.S. Customs and Border Protection officials said the agency will not administer vaccines because of the “complexities” of providing the shots and because migrants are supposed to be in their custody for three days or fewer, said Steven Bansbach, a CBP spokesman.

“It has never been a CBP practice to administer vaccines, and this is not a new policy,” Bansbach said.

DHS officials did not respond to requests for comment.

CBP’s refusal to provide flu vaccines is an example of dual loyalty, Spiegel said, something that forces health-care providers to follow agency mandates that run against what would be best for patients. He said flu vaccines are simple to administer and protect the detainees, government employees and the general population.

“What we’re talking about here of course is much bigger than the flu vaccine, but I think I’d say it’s an illustrative example,” Spiegel said. “It doesn’t make a difference if they’re staying for 72 hours, because the sooner someone gets the vaccine, the sooner they will be protected.”

An El Paso pediatrician who treats migrant children after they are released said the dual loyalty of contract health workers in detention facilities results in substandard medical care, with illnesses often going untreated.

“We’re still getting calls daily from the volunteers at the shelters that we have here in El Paso that there’s somebody with a blood pressure of 220 over 120, there’s a diabetic with a sugar of 500,” said Dr. Carlos Gutierrez, who has volunteered to treat migrant children for more than 30 years.

Gutierrez said government health-care providers do not provide records of treatment for detainees when they are released and have been told not to communicate with community providers.

“Whoever signs a contract like that, to care for those refugees with the understanding that they’re not going to be able to communicate with individuals on the outside to provide better continuity of care, that’s totally malpractice,” he said.

Gutierrez said that during another surge of Central American families and children to the U.S.-Mexico border in 2014, Border Patrol officials asked volunteer community health-care providers to enter detention facilities to examine and treat migrants.

He said doctors and other clinicians have volunteered to provide care in detention facilities during the past two years but have been rebuffed.

In the Journal article, Spiegel and his co-authors say health care in migrant detention facilities should be provided by independent medical associations or nongovernmental organizations that are “transparent and independent.” They also call for an independent oversight body to monitor health-care conditions in those detention facilities.

Spiegel said health-care providers should speak out loudly in the immigration debate but avoid the divisiveness that often plagues those discussions.

“We should be using evidence to make our points and stay away from the politics and any partisanship,” he said.