New Report Highlights Conflicts of Interest for Medical Professionals in Immigration Detention Centers

Physicians for Human Rights (PHR) today released a report onthe difficulty of providing quality health care to detainees in the United States immigration detention system. The report, Dual Loyalties: The Challenges of Providing Professional Health Care to Immigration Detainees, highlights the conflicts that arise when health professionals are torn between their duties to their patients and their obligations to an employer, government, insurer, or the military – a common problem in immigration detention centers, prisons, and other secure environments.

The consequences of dual loyalties can be devastating for patients. The report chronicles the story of one immigrant from Ecuador who sought medical help for persistent headaches that lasted more than a month while in detention. After only receiving Tylenol from medical staff and no other treatment or screening, she fell from a bunk bed and was taken to a local hospital. At the hospital she was diagnosed with an infection of the brain that is common among Latin American immigrants, and died shortly after. A simple screening might have prevented her untimely death, but for reasons that remain unclear, the medical staff never ordered one for her.

“Loyalty to patients is the basis of all medical ethics and should be every medical professional’s first priority,” said Frank Donaghue, CEO of Physicians for Human Rights. “However, when a physician is forced to choose between the needs of their employer and the patient, someone is going to lose.”

The US immigration system detains approximately 400,000 people each year, including elderly, mentally ill, and disabled people. The detainees include asylum seekers and other survivors of human rights violations who often spend months and sometimes years in detention.

In the report, Dr. Susan McNamara, who spent four days assessing provision of health care at the Willacy Detention Facility in Texas in February of 2010, points out a number of shortcomings in the detention centers which intensify the dual loyalty conflicts.

“A lack of communication within the detention centers means health professionals do not know whom they should consult when dual loyalty conflicts arise,” said McNamara. “With no one to talk to about the conflicts they are facing, physicians become further isolated and end up making unethical choices about patient care.”

The report makes a number of recommendations including:

• Require health care professionals to report to health organizations, such as the Department of Health and Human Services, to maintain clinical independence.
• Address chronic staffing shortages.
• Ensure clear lines of accountability.
• Create an independent oversight organization.
• Create an ombudsman office to which detainees may easily report grievances regarding access to medical care.
• Make the Performance Based National Detentions Standards (PBNDS) legally enforceable in all facilities that house immigration detainees.
• Revise PBNDS so that they are based on an administrative model of temporary custody rather than the current penal, corrective, model.

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