You may already know Scott A. Allen, MD, FACP, from his appearances on CNN and 60 Minutes, speaking about the poor conditions in migrant detention centers.
For nearly 40 years, he has worked with refugee, immigrant, and incarcerated populations, and for the past five years, he has been a medical subject matter expert with the U.S. Department of Homeland Security's Office of Civil Rights and Civil Liberties. When inspecting the first family detention facilities at the southern border in 2014, Dr. Allen saw some of the worst conditions at a facility in Artesia, N.M.
“That one was so bad, we recommended on the on-site visit that they shut it down immediately, and they did,” he said. “So to those who say, ‘We didn't hear about you until the Trump administration,’ we were objecting since 2014. But the key difference was in 2014, they listened to us, and ‘zero tolerance’ hadn't started.”
Last summer, Dr. Allen and his psychiatrist colleague Pamela McPherson, MD, decided to object more publicly to the problems they'd seen. In July 2018, the physicians wrote a letter to the Senate Whistleblower Protection Caucus chairs warning about serious compliance issues compromising care that they witnessed in the course of conducting 10 investigations of family detention facilities—the Karnes and Dilley detention centers in Texas, the Berks detention center in Pennsylvania, and the since-closed facility in Artesia, N.M. They said that expanded detention would exacerbate those problems and pose a risk of imminent and foreseeable harm to children.
Later that month, ACP and 13 other national medical associations issued a statement urging members of Congress to hold hearings to investigate the situation. “But that was not the first letter. The first letter of support on the public record was from the ACP, and it was the best letter,” said Dr. Allen, who is also medical director of Borrego Health's Access Clinic in Riverside County, Calif., and professor emeritus of clinical medicine at the University of California Riverside School of Medicine.
ACP Hospitalist recently spoke with Dr. Allen, who is still under contract with Homeland Security, about his experiences at the border.
Q: How does an internist come to be an expert in assessing family detention centers?
A: I work for the Office for Civil Rights and Civil Liberties within the Department of Homeland Security and I'm proud of their process. These facilities get inspected by just about everyone, all the time, but we are among the most thorough . . . They didn't have any pediatricians as experts on contract, and the federal contracting process is not a quick thing. So they reached out to me, and I said, “Yeah, I'll do the best I can.” . . . I was medical director of the state correctional facility, I've worked in refugee camps, I've worked with immigration before. I literally know how the operation works. I know where to look to find problems.
Q: Can you describe the problems you saw at these facilities?
A: I spent the weeks before talking to pediatricians saying, “I'm an internist, what should I look for?” And more than a few people said that adult doctors taking care of kids often don't focus enough on weights. . . . I would say the case that shut Artesia down was that baby we found that had lost a third of its body weight. . . . About 7% or 8% of the population had significant weight loss because they weren't giving the kids foods that they were familiar with. And no one noticed it. At that point, we said, “This is the problem with family detention,” and we said that “If you continue to detain children, you run the real risk of losing a child in your custody.”
The Karnes and Dilley facilities were certainly better than Artesia, and with multiple visits to those, we identified problems and helped them try to craft solutions. We found that they continued to have trouble retaining adequate pediatricians; language access is another issue, and there would always be new problems that we'd find. . . . Karnes had been built by a private company as a men's medium-security prison. Sure enough, I started seeing a lot of reports of send-outs to ER for finger injuries, and they were in young kids. The facility has spring-loaded, heavy prison cell doors, and they were crushing kids' fingers. There were lacerations, complicated fractures, probably lifelong deforming injuries. And there's a lot of them. . . . In contrast, Dilley wasn't built out of an old prison. It has its own problems, but it has regular doors, and I haven't seen a single finger injury there.
Q: What led you to become a whistleblower last summer?
A: First of all, the separation of children, which really was alarming to a lot of us because that was such a traumatizing thing to do. As physicians, you look at that and go, “That's unconscionable.” And rapidly following that, the announcement of expanded family detention. Dr. McPherson and I were in a unique position to know that this created an imminent threat of harm. What we knew going in, and we were able to demonstrate with real examples, is that detaining children and keeping them safe is really hard to do, and that's why we don't generally recommend doing it. You create all sorts of risks to their health and safety. When medical professionals and physicians are faced with unique knowledge of an imminent threat of harm, we have a professional duty to sound the alarm.
We contacted the Government Accountability Project, a whistleblower protection and advocacy organization, to understand our rights to report serious abuses and safety threats. They helped us assess the risks of raising concerns and how to exercise our rights to do so effectively under the whistleblower law that protects federal contractors. So we notified Congress. . . . I think how the government responded to our disclosures was enhanced greatly by the fact that in addition to being wrapped in a layer of protection by top-level legal representation, simultaneously, the ACP and other professional organizations wrapped us in the envelope of professionalism.
Q: Why were the conditions so poor in these facilities?
A: I can't say for sure why, but I have some thoughts. First, they placed these detention facilities in remote locations because that's what the modern correctional world does. It's usually contracted out, these are usually corporations, and they love going into these scarcely populated areas where real estate costs nothing, and then the local labor pool is cheap. The problem they run into is when they then need professionals. Professionals don't want to move and live there. I think the second barrier has been these places have become so notorious, a lot of pediatricians are thinking twice about whether they want to support them or be involved with them. Third, the facilities are not adequate to house populations they have. Not as severe as the border holding facilities, but the same kinds of problems. They at times get overwhelmed with numbers, and some of them are poorly designed.
Q: What can be done to improve the situation?
A: Since 2014, I've been looking into the eyes of young mothers and their young children, and I see human beings. In fact, I see traumatized human beings and vulnerable human beings. Forget about your politics, I think anyone placed in front of these people would have a sympathetic and humane response to them and would want to try to help them, comfort them, provide them with care. . . . As long as they continue to unnecessarily detain children when there are alternative ways to address the immigration process, I'm not done pressing the government to stop doing it. I think organized medicine needs to go further than they have. Having praised the ACP for being so good with their letter, I do want to challenge the ACP and all of organized medicine because I think they have not yet fully leveraged their influence and moral authority to press the government to abandon this inhumane practice. I think putting out a statement is where you start; it's not where you end.