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Washington Post
Some Detainees Are Drugged For Deportation - Immigrants Sedated
Without Medical Reason
by Amy Goldstein and Dana Priest
The U.S. government has injected hundreds of foreigners it has
deported with dangerous psychotropic drugs against their will to keep
them sedated during the trip back to their home country, according to
medical records, internal documents and interviews with people who
have been drugged.

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.

"Unsteady gait. Fell onto tarmac," says a medical note on the
deportation of a 38-year-old woman to Costa Rica in late spring 2005.
Another detainee was "dragged down the aisle in handcuffs,
semi-comatose," according to an airline crew member's written account.
Repeatedly, documents describe immigration guards "taking down" a
reluctant deportee to be tranquilized before heading to an airport.

U.S. Government Forces Antipsychotic Drugs on Foreigners
In a Chicago holding cell early one evening in February 2006, five
guards piled on top of a 49-year-old man who was angry he was going
back to Ecuador, according to a nurse's account in his deportation
file. As they pinned him down so the nurse could punch a needle
through his coveralls into his right buttock, one officer stood over
him menacingly and taunted, "Nighty-night."

Such episodes are among more than 250 cases The Washington Post has
identified in which the government has, without medical reason, given
drugs meant to treat serious psychiatric disorders to people it has
shipped out of the United States since 2003 -- the year the Bush
administration handed the job of deportation to the Department of
Homeland Security's new Immigration and Customs Enforcement agency,
known as ICE.

Involuntary chemical restraint of detainees, unless there is a medical
justification, is a violation of some international human rights
codes. The practice is banned by several countries where, confidential
documents make clear, U.S. escorts have been unable to inject
deportees with extra doses of drugs during layovers en route to
faraway places.

Federal officials have seldom acknowledged publicly that they sedate
people for deportation. The few times officials have spoken of the
practice, they have understated it, portraying sedation as rare and
"an act of last resort." Neither is true, records and interviews
indicate.

Records show 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.

Stung by lawsuits over two sedation cases, the agency changed its
policy in June to require a court order before drugging any deportee
for behavioral rather than psychiatric reasons. In at least one
instance identified by The Post, the agency appears not to have
followed those rules.

In the five years since its creation, ICE has stepped up arrests and
removals of foreigners who are in the country illegally, have been
turned down for asylum or have been convicted of a crime in the past.

If the government wants a detainee to be sedated, a deportation
officer asks for permission for a medical escort from the aviation
medicine branch of the Division of Immigration Health Services (DIHS),
the agency responsible for medical care for people in immigration
custody. A mental health official in aviation medicine is supposed to
assess the detainee's medical records, although some deportees'
records contain no evidence of that happening. If the sedatives are
approved, a U.S. public health nurse is assigned as the medical escort
and given prescriptions for the drugs.

After injecting the sedatives, the nurse travels with the deportee and
immigration guards to their destination, usually giving more doses
along the way. To recruit medical escorts, the government has sought
to glamorize this work. "Do you ever dream of escaping to exotic,
exciting locations?" said an item in an agency newsletter. "Want to
get away from the office but are strapped for cash? Make your dreams
come true by signing up as a Medical Escort for DIHS!"

The nurses are required to fill out step-by-step medical logs for each
trip. Hundreds of logs for the past five years, obtained by The Post,
chronicle in vivid detail deviations from the government's sedation
rules.

An analysis by The Post of the known sedations during fiscal 2007,
ending last October, found that 67 people who got medical escorts had
no documented psychiatric reason. Of the 67, psychiatric drugs were
given to 53, 48 of whom had no documented history of violence, though
some had managed to thwart an earlier attempt to deport them. These
figures do not include two detainees who immigration officials said
were given sedatives for behavioral rather than psychiatric reasons
before being deported on group charter flights, which are often used
to return people to Mexico and Central America.

Even some people who had been violent in the past proved peaceful the
day they were sent home. "Dt calm at this time," says the first entry,
using shorthand for "detainee," in the log for the January 2007
deportation of Yousif Nageib to his native Sudan. In requesting drugs
for his deportation, an immigration officer had noted that Nageib, 40,
had once fled to Canada to avoid an assault charge and had helped
instigate a detainee uprising while in custody. But on the morning of
his departure, the log says, he "is handcuffed and states he will do
what we say." Still, he was injected in his right buttock with a
three-drug cocktail.

In one printout of Nageib's medical log, next to the entry saying he
was calm, is a handwritten asterisk. It was put there by Timothy T.
Shack, then medical director of the immigration health division, as he
reviewed last year's sedation cases. Next to the asterisk, in his
neat, looping handwriting, Shack placed a single word: "Problem."

When he landed in Lagos, Nigeria, Afolabi Ade was unable to talk.

"Every time I tried to force myself to speak, I couldn't, because my
tongue was . . . twisted. . . . I thought I was going to swallow it,"
Ade, 33, recalled in an interview. "I was nauseous. I was dizzy."

As he was being flown back to Africa, his American wife alerted his
parents there that he was on his way. His father was waiting at the
Lagos airport. It was the first time in three years that they had seen
one another. Shocked by how woozy the young man was, his father
decided not to take him home and frighten the rest of the family.
Instead, he checked his son into a hotel.

Ade was in the hotel for four days before the effects of the drugs
began to abate.

Part of a prominent Nigerian family, Ade asked The Post to identify
him by only a portion of his name to protect their reputation. He had
come to the United States as a college student in the mid-1990s. Five
years later, he was in a car belonging to cousins when police found
fraudulent checks in the trunk. He pleaded guilty.

After finishing his sentence, Ade was living in Atlanta, and was two
semesters away from a telecommunications degree at DeVry University,
when immigration officers came looking for him one day in January
2003. They wanted to deport him for the old crime. He called his
probation officer to ask whether he could wait to surrender until he
took his upcoming final exams. But when he went to the probation
office, immigration officers were there to arrest him.

His records offer little explanation of why he was sedated. The
one-page medical record in his file mentions one condition: chronic
nasal allergy. The log of his trip does not mention mental illness; in
the space to list current medical problems, a nurse wrote merely that
Ade was anxious.

His drugging, however, fits a pattern that emerges from the cases
analyzed by The Post: The largest group of people who were sedated had
resisted attempts to deport them at least once before.

One summer day in 2003, deportation officers arrived at the rural
Alabama jail where Ade was being held. Pack your bags, they told him.
When they reached an immigration office in Atlanta, Ade recalled, half
a dozen "big guys came to meet me and said I was there to be
deported."

"I can't be deported," he replied. "I have a wife I love very much."
Besides, he told them, he was still appealing his immigration case. He
shouldn't have to leave, he protested, until the judge had ruled. That
day, he was returned to Alabama. But he said that immigration officers
warned him, "We'll find a way to get you on a plane."

A few weeks later, the officers came back and again took him to a
holding cell in Atlanta. He was, the medical log says, becoming
"increasingly anxious and non-cooperative per flt. to Nigeria." At
1:30 p.m., the log says, "Dt taken down by four" guards.

Ade was being held down, he recalled, when he noticed a nurse "with a
needle and a bottle with some kind of substance in it." He said he
told the guards: "Okay, fine, fine. If it's going to be like this,
don't inject me. I will go on my own free will."

The nurse went ahead, the log shows, injecting him in the left
shoulder with two milligrams of a powerful drug, Haldol, used to treat
psychosis, and one milligram of an anti-anxiety drug, Ativan. He was
injected with two more rounds, as well as a third drug, in
progressively larger doses, during the trip.

The effects of those injections are what alarmed Ade's father after
the plane landed in Lagos. Yet the medical log says Ade arrived "alert
and oriented."

His family's doctor, who visited him on each of the four days his
father hid him in the hotel, had a different view. "He was groggy --
somebody under the influence of drugs or drunkenness," recalled
Olakunle Adigun, a general practitioner. He couldn't figure out what
sedatives his patient had been given, so he tried to detoxify him with
saline infusions.

Ade's pulse was dangerously low, and when he tried to walk around the
hotel room, "he leaned on the wall," Adigun said. "He was talking, but
a slurred kind of speech."

* * *

Internal government records show that most sedated deportees, such as
Ade, received a cocktail of three drugs that included Haldol, also
known as haloperidol, a medication normally used to treat
schizophrenia and other acute psychotic states. Of the 53 deportees
without a mental illness who were drugged in 2007, The Post's analysis
found, 50 were injected with Haldol, sometimes in large amounts.

They were also given Ativan, used to control anxiety, and all but
three were given Cogentin, a medication that is supposed to lessen
Haldol's side effects of muscle spasms and rigidity. Two of the 53
deportees received Ativan alone. One person's medications were not
specified.

Haldol gained notoriety in the Soviet Union, where it was often given
to political dissidents imprisoned in psychiatric hospitals. "In the
history of oppression, using haloperidol is kind of like detaining
people in Abu Ghraib," the infamous prison in Iraq, said Nigel Rodley,
who teaches international human rights law at the University of Essex
in Britain and is a former United Nations special investigator on
torture.

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. "You or I wouldn't get it if we were
emotionally upset," he said.

In addition, Seeman said, typical doses to help psychotic patients
accustomed to the drug are perhaps five to 15 milligrams a day.
Several deportees were given a total of 30 milligrams, which Seeman
characterized as "really high," especially for people who have never
taken the drug before.

Even when used for its intended patients, people with psychosis,
Haldol has drawn warnings from the U.S. government. In September, the
Food and Drug Administration issued an alert citing "a number of case
reports of sudden death" and other reports of dangerous changes in
heart rhythm. It is, important, the FDA warned, to inject Haldol only
into muscles, not veins, and to avoid doses that are too high.

"Pharma non grata" is the way Emergency Medicine News magazine
described the drug after the FDA alert.

Beyond the specific drugs used, Rodley said, is a deeper question:
"What is the least intrusive means of restraint consistent with the
human dignity of the person? . . . I'd be very surprised if the
injection of disabling chemicals against somebody's will that affect
one's psychological well-being . . . is likely to be the least
intrusive means."

Asked to explain the reason for using Haldol and other psychotropic
drugs with people who are not mentally ill, ICE responded, "The
medications used by Aviation Medicine are widely used in psychiatry."
Agency officials said that medical escorts administer "the lowest dose
possible." Combining Haldol and Ativan "allows you [to] use less of
each," they said, and produces a quicker and longer sedative effect.

In the years before Ade was drugged, there had been an internal debate
within the U.S. government over whether sedating deportees against
their will is legal, according to confidential legal memos obtained by
The Post. There was agreement that mentally ill people could be forced
to take psychotropic medicine on their way out of the country. At
dispute were cases in which the detainees were not mentally ill but
combative -- known as "behavioral cases."

Near the end of the Clinton administration, Health and Human Services
lawyers sent around a memo that warned, "[U]sing chemical restraints
in cases in which medication is not clinically indicated . . . may put
the government at risk of potential liability."

Another memo went further, concluding that it could be done only if a
federal judge gave permission in advance. "[R]egarding detainees who
are not mentally ill," the November 2000 document said, "involuntary
medication of such persons for the sole purpose of subduing them
during deportation, without a court order, is not supported by any
legal authority and raises ethical issues, as well.

"After the Sept. 11, 2001, attacks, and after the Bush administration
assumed a tough new stance on immigration in its campaign against
terrorism, the Justice Department still sounded wary about drugging
deportees. In March 2002, a Justice lawyer laid out two options. One
choice, he wrote, was to "seek a court order . . . in every case where
the alien's medication is not therapeutically justified." The other
choice was to create a regulation to grant immigration officials
explicit permission to sedate deportees, perhaps including safeguards
that would give people a warning that they might be medicated -- and a
chance to object.

Top immigration officials chose neither. Instead, in May 2003, just
after ICE was created, they internally circulated a new policy: "[A]n
ICE detainee with or without a diagnosed psychiatric condition who
displays overt or threatening aggressive behavior . . . may be
considered a combative detainee and can be sedated if appropriate
under the circumstances."

Under that policy, scores of people have been sedated every year since
then, usually with heavy psychotropic drugs.
Some countries forbid the practice. The medical files for several
deportees recount disputes between U.S. officials, who wanted to
inject a subject, and foreign officials, who would not allow it.

Immigration guards and a public health nurse ran into trouble in May
2004, during a stopover on a trip from Colorado to Guinea. The
deportee had been given the three-drug cocktail at the airport gate
before leaving Denver, the nurse wrote in the log. Three "booster
doses" followed.

The last booster was given shortly before the plane landed in Belgium.
"[N]o problem initially with Belgium security," the log says. "[T]hen
approached and informed illegal to medicate detainee against their
will in Belgium. Informed them pt wasn't medicated in Belgium airspace
for which they replied that he is medicated in Belgium." In the end,
the security officers let the deportation go ahead.

Immigration guards and a nurse had more trouble during another
deportation to Guinea in April 2006, as they escorted a 34-year-old
man from Atlanta, with a stop in France.

He had been given 15 milligrams of Haldol, as well as the two other
drugs, by the time the flight reached Paris at 9:45 a.m. According to
a nurse's report on the incident, the guards, nurse and deportee were
met at the plane by French national police, who accompanied them to an
airport police station to await the connecting flight to Africa later
in the day.

Once at the station, one of the guards asked a French officer "where
we could inject the detainee when needed." First, they were shown into
a private area. But five minutes later, the nurse's report says, "a
superior French police officer approached and informed me that any
type of involuntary injection was strictly forbidden in France, and
that we would have to wait until we were in the aircraft if we were to
inject our detainee."

Six hours later, the entourage returned to the boarding area for the
flight to Guinea. "When we arrived at the plane, the detainee became
very argumentative, refusing to enter plane until [the guards]
produced paperwork showing a final deportation order," the nurse
wrote. The immigration officers tried to coax him onto the plane. He
refused.

"I asked the French police if the ramp on the gate would be an
appropriate place to medicate," the nurse wrote. "The French police's
reply was that it was strictly forbidden." The plane's captain came
over to say that he would not allow the deportee onto the flight. The
guards and the nurse flew him back to Atlanta.

Five weeks later they tried again, and this time, they reached Guinea.
By the time they arrived, a nurse had given the deportee nine
injections of Haldol totaling 55 milligrams -- nearly four times as
much as before.

One deportee who was sedated last year had convictions for armed
robbery and assault. Another kept telling immigration officers, "I am
God." But many of those injected with psychotropic drugs, records
show, are neither violent nor mentally ill. They simply do not want to
go home.

"[M]ild anxiety and agitation" is how a deportation log describes
Remmy Semakula's state on the afternoon he was taken from his cell in
the Middlesex County jail in New Jersey to be deported to Uganda in
early April 2007. According to a memo from his deportation officer, he
had said earlier that he would "fight with the officers and obstruct
the operation of the airline" if guards tried to force him to go home.
Semakula, 42, said that he had not tried to thwart his deportation and
had not known it was imminent because his immigration case still was
before a federal judge. "I never fought violently or physically," he
said. "They just grabbed me and injected me with a sleeping drug."

The first time immigration agents tried to deport Michel Shango, he
slammed his head, hard, against the outside of the van that had come
to pick him up at Atlanta's city jail. Instead of being driven to the
airport, then flown to the Democratic Republic of Congo, he was
brought back to the jail so his wound could be tended to.

"I asked him why he feared being returned back to his country," an
immigration officer wrote of the incident. Shango, now 42, replied
that he had been a journalist and had written articles critical of the
Congolese government. "Detainee stated . . . that he might as well die
trying to avoid deportation," a second officer wrote, "because they
will kill him as soon as he gets to the D.R. of the Congo."

Until early 1996, Shango worked in Congo, ghostwriting articles and
supplying information to foreign correspondents about the repressive
administration of President Mobutu Sese Seko, he said in telephone
interviews from locations in Congo, Gabon and Equatorial Guinea, where
friends are now helping him hide. Eventually Shango was arrested, he
and two of his lawyers said, but he escaped to Canada, then settled in
North Carolina, where he started a limousine business with a cousin in
Charlotte. He married an American, who at first offered to help him
become a citizen. The marriage dissolved. He applied for political
asylum. He was turned down.

He was remarried to a Congolese woman by the time immigration officers
came to his house at 4:30 one morning in May 2006. As his wife and
their three American-born children cried at the frightening scene, the
officers led him away at gunpoint.

On Feb. 28, 2007, three months after the first deportation attempt was
aborted because of the head-banging incident, seven guards arrived at
the Atlanta jail to make a second attempt. Shango glanced at his watch
and noted that it was 1:45 p.m. "They pushed me against the wall," he
recalled. "They pulled my pants down." His medical log shows that he
was given seven shots in his right buttock and right shoulder before
he boarded the airplane.
The log says his only psychological problem was "anxiety disorder."

By the time Shango reached Congo, records show, he had been injected
with 32.5 milligrams of Haldol and 7.5 milligrams of Ativan. As he was
thrown into a prison after he got off the plane, and even as friends
helped him escape, he was so disoriented, he said, that he did not
fully know where he was. For two weeks, Shango said, "It was like I
was dreaming. . . . I started crying, crying, crying all day long. . .
. I was like crazy, because [of] the drugs, knocking me down."

* * *

Of all the detainees who have been forcibly drugged, only two have
drawn much public attention. Neither, in the end, was deported. And
compared with other deportees, neither got large doses of sedatives.
But publicity about their cases sent shock waves through the
immigration bureaucracy. Raymond Soeoth, a Christian minister from
Indonesia, had tried and failed to win asylum in the United States.
While in custody at an immigration compound near Los Angeles, his
medical log notes, Soeoth, now 39, he said he would kill himself if
deported -- a statement his lawyers say he never made.

On Dec. 7, 2004, he was injected in the left buttock with five
milligrams of Haldol and four milligrams of Cogentin before being
taken to the airport. As it turned out, his deportation was canceled
before takeoff because immigration officials had not alerted airline
security in Singapore, a stopover point.

Amadou Diouf came to the United States from Senegal as a student in
1996 and got a degree in information systems from California State
University at Northridge. He married a U.S. citizen and was trying to
change his immigration status when, in March 2005, he was arrested and
brought to the same compound as Soeoth.

Eleven months later, as he was still appealing his case and, according
to his lawyers, had a court order blocking his deportation,
immigration officers came for him and took him to the airport for the
trip back to Senegal.

At first, records show, Diouf, now 32, was calm. He was already
sitting in a window seat, 4A, when he demanded to speak to the plane's
captain. He "became more agitated, anxious and loud in his dialogue,"
according to the medical log. A nurse said he would be given "some
calming medicine," but when Diouf saw the needle, he lunged. Guards
"proceeded to take down the detainee to the ground" in the plane's
galley, and the nurse injected him with five milligrams of Haldol, two
milligrams of Ativan and two milligrams of Cogentin.

At that point, the guards and nurse called off the trip. Diouf was
returned to his cell. In early May 2007, a lawyer for the American
Civil Liberties Union of Southern California was drafting a lawsuit on
behalf of Soeoth and Diouf and told a local newspaper, the Los Angeles
Daily Journal, about their sedations. Across the continent, inside the
immigration health division's headquarters in downtown Washington, the
publicity's effect was electric.

The next day, the chief of psychiatry for the division's aviation
medicine branch dispatched a memo. "I have stopped all planned
non-psychiatric behavioral escorts, of which 10 are currently
planned," he wrote, until government lawyers "have formalized policy
in regards to this type of escort activity."

A month and a half later, the medical escort rules were changed.
Except in psychiatric cases, according to a confidential June 21 memo
from ICE, the health division "must have a court order to assist. . .
. [ICE in] removal of problematic detainees." In January, the
language was made even stronger: "DIHS may only involuntarily sedate
an alien to facilitate removal where the government has obtained a
court order. There are no exceptions to this policy."

The newest rules were issued less than three weeks before the
government tentatively settled the lawsuit with Soeoth and Diouf, who
are now out of custody. The government is no longer trying to deport
Soeoth; Diouf is still fighting to remain in the country.

How well the government is following its new rules is unclear. Asked
how many court orders the government has sought, immigration officials
said that none "have been issued to involuntarily sedate an alien for
removal purposes," but they declined to discuss whether any requests
are pending.

In one known case in which government lawyers sought a court order,
they withdrew the request after a congressman intervened. On Oct. 1, a
federal judge in Texas was asked for permission to sedate Rrustem
Neza. Immigration officers had canceled their first attempt to deport
him to Albania because he created a scene at the Dallas/Fort Worth
International Airport, screaming, "I am not a terrorist."

One week after the government filed its motion, Rep. Louie Gohmert
(R-Tex.), a former judge, wrote to the court, saying he had "grave
concerns" about the government's desire to medicate his constituent to
deport him. "Mr. Neza fled Albania after telling a crowd in Tropoje
the names of the men who were seen killing Azem Hajdari, who organized
a student movement against the Communist Party. Mr. Neza's cousins
were fatally shot while fleeing with him," the congressman wrote.
"[S]edating Mr. Neza amounts to a death sentence for an innocent man."

Last March, after Gohmert had spoken about Neza's case with Secretary
of State Condoleezza Rice, and after he had introduced legislation to
block Neza's deportation, the issue was dropped.

* * *

In at least one instance since the rules were changed, the government
apparently drugged a deportee without permission from a judge. Maher
Ayoub, now 44, was sent back to Egypt last August. A month later,
immigration officials told Congress that they had not yet asked for a
court order in any case.

Ayoub had thwarted the first attempt to deport him, a few months
earlier, by sitting in a van and demanding all the paperwork in his
immigration file. He said he spent the next three months in
segregation in an Elizabeth, N.J., detention center. The next time
they tried to send him home, immigration officers were determined to
make sure he would go quietly.

His record offers contradictory evidence about whether there was
psychiatric justification for the drugs he got, though it seems to
suggest that there was not. A one-page "patient summary" for Ayoub
says "Med/Psych Alert Documents: None." His medical escort log labels
him a mental health case and says he had a "depressed mood" and an
"anxiety state."

A handwritten note in his escort file, from a psychiatrist who saw him
at the Elizabeth center, first says Ayoub was not likely to endanger
himself or anyone else -- then, lower on the same page, says he might.
On the next page of the file is another note, this one written two
days before his flight, from the psychiatrist in charge of aviation
medicine. It says that Ayoub's case is a "behavioral escort," not a
psychiatric one, and that the nurse "is only to give medications to
the patient if he agrees to take them. He will only use involuntary
treatment if the patient is at imminent risk of hurting himself or
others."

That is not what happened.

"Detainee tearful and wringing hands," his medical log begins. An hour
later, it says: "Detainee increasingly agitated and resisting clothing
change. Detainee is now crying and screaming" at two guards. A nurse
at the Elizabeth detention center slid two milligrams of the
anti-anxiety drug, Ativan, into his left shoulder.

Immigration officials said his deportation was "consistent" with the
June policy that allows medication only when a detainee "may be a risk
to himself or others."

"I was feeling my head was leaving my body," Ayoub remembers. "I was
losing control over my body." He was groggy but awake when he arrived
with guards and the nurse at New York's John F. Kennedy International
Airport and boarded the nonstop flight to Egypt.

Before the plane took off, he remembers, he called over a flight
attendant and "asked them to tell the pilot I didn't want to leave."
The nurse stuck a needle into his right arm this time. That injection
put him to sleep.

Link:
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