Since the beginning of the last decade, 23 immigrants have died in detention centers as a result of poor medical care. A systemic failure has led to deaths that could have been prevented with timely, quality medical treatment. As an increasing number of immigrants, including children, are being detained for longer stretches of time, health professionals and policy makers have a responsibility to address the problem of substandard care in detention centers across the country.
There are many factors that have caused the systemic breakdown of medical care in detention centers, including insufficient staffing and ignoring a patient in need of care.
“What is more common is systemic problems with the quality of care, including use of licensed vocational nurses to assess and diagnose symptoms that require the attention of more highly trained practitioners,” wrote Clara Long, JD, MSc, MA, a senior researcher at the Human Rights Watch, and Rie Ohta, a JD candidate at the University of California, Los Angeles School of Law, in an article published in the AMA Journal of Ethics.
Many times, wrote Ms Long, nurses are asked to offer medical advice that is outside of their scope of experience, which can lead to unintentional patient harm. The authors shared the example of a 65-year-old male patient who had congestive heart failure. Rather than refer the patient to a clinician who could treat him, the nurse increased his fluids intake, exacerbating the problem.
Because of understaffing issues, many times correctional officers feel pressured not to leave their post because they might not have someone available to take over their shift. If a patient asks to go to the hospital, the correctional officer has to consider the risk involved.
In some instances, patients who ask for medical care are ignored or their symptoms go untreated for so long that it is too late to help. In one case, a patient died after repeatedly asking to be taken to the hospital, reporting, among other symptoms, shortness of breath. The patient was not taken to the hospital until after he coughed up blood all over his bed. At that point, it was too late to help.
There are many ways that healthcare professionals can get involved. Ms Long and Ms Ohta shared some thoughts on how:
“Harm caused by these conditions and detention itself should be enough to prompt clinicians to insist that the government enable provision of care consistent with generally accepted standards,” the authors wrote. “State licensing boards can be an effective avenue for ensuring quality of care, particularly with respect to disciplinary proceedings against clinicians who practice outside the scope of their license…. Clinicians can also seek to join medical-legal partnerships to find opportunities to help individual detained people.”
Ohta R, Long C. How should health professionals and policy makers respond to substandard care of detained immigrants? AMA J Ethics. 2019;21(1):E113-E118.