Two Pediatricians Are Fighting Back After they Say Children's Medicine is Being Confiscated At the Border
More than 69,000 migrant children have been separated from their parents at the Mexico-United States border as of November 2019. These children are being detained at U.S. Customs and Border Protection (CBP) facilities in what those who have visited have described as inhumane conditions.
In a medical declaration, Dolly Lucio Sevier, M.D., said it's "worse than jail." Dr. Sevier, who examined the largest border patrol facility after a flu outbreak sent five infants to a neonatal intensive care unit, found that children were exposed to "cold temperatures, lights on 24 hours a day, no adequate access to medical care, basic sanitation, water, or adequate food."
But it gets worse. Many of these migrant children are also being placed in medically vulnerable situations as their medications are being confiscated, according to Noy R. Halevy-Mizrahi, M.D., and Ilana Harwayne-Gidansky, M.D., FAAP, two pediatricians at Stony Brook University Children's Hospital in Stony Brook, New York.
In a report published in Pediatrics in January, the physicians said these medications—such as insulin, steroids, and anti-seizure drugs—are critical for the management of chronic conditions and are being permanently removed from detainees without proper replacements. Not to mention, these facilities are overcrowded with infectious disease exposures, they added. This is leaving children vulnerable and causing unnecessary issues in medical facilities and for pediatricians across the U.S., the doctors say.
A Look Into Medication Confiscation
Dr. Halevy-Mizrahi and Dr. Harwayne-Gidansky began investigating after two children were admitted to the pediatric intensive care unit (PICU) at Stony Brook University Children's Hospital and reported that their medication had been taken away during the immigration process.
One of these patients, a school-aged girl, had her albuterol inhaler taken away from her at a detention center soon after crossing the border, and no replacement was reportedly provided. The other patient, a 7-year-old boy, was admitted to the PICU for severe asthma because his albuterol inhaler was confiscated at a detention center and a replacement was also not provided. Just two days after his release, he developed respiratory symptoms. His family brought him to the hospital a week later when his health rapidly declined.
The doctors say they can't estimate how many more children are affected by similar practices while at CBP facilities, but they believe instances are underreported.
The CBP stated in 2015 that detainees should validate their medication by a medical professional or be taken to a medical practitioner to obtain an equivalent U.S. prescription. According to the CBP, it is unsafe to allow individuals to maintain medications (or other substances) while in custody. The medication may eventually be given back to the individual.
"If the medication is determined to be valid, then CBP will hold the medication and dispense it in an appropriate, supervised manner," the CBP tells Parents.com. "If the medication is determined not to be valid, then CBP will facilitate the generation of an appropriate prescription, will obtain the medication, and will dispense it in an appropriate/supervised manner." And if the individual doesn't have the appropriate prescription needed, it is a medical practitioner's duty to obtain and distribute the medication to them.
"The reason for CBP policy not being properly implemented is unclear," says Dr. Halevy-Mizrahi.
Helping Vulnerable Migrant Children
There has been an influx of new migrant children since 2014—with the majority of undocumented children crossing through the southern border. "Immigrant children are already considered a vulnerable population. When their medication is confiscated and not replaced, they are at risk for decompensation and for a need of a higher level of care," says Dr. Halevy-Mizrahi. "This further places these children at risk of preventable morbidity and mortality."
Although there's little guidance available to pediatricians to deal with these cases, says Dr. Halevy-Mizrahi, it's important for them to step in. "Part of advocating for these patients includes investigating and understanding the process by which this happened and report it so that pediatricians understand what resources are available to them and to their patients," says Dr. Halevy-Mizrahi.
Dr. Halevy-Mizrahi and Dr. Harwayne-Gidansky reported the violations reported by their patients to the CBP, which responded by assigning a local special agent to investigate their case. There is yet to be an outcome.
The pediatricians encourage other doctors to also step up by contacting the Department of Homeland Security's (DHS) Office for Civil Rights and Civil Liberties and the DHS Office of Inspector General to report these incidences. Both offices investigate human rights violations that take place while in DHS custody.
Additionally, anyone concerned can work with representatives in congress and local districts that can take on this issue.
That's what congresswoman and former pediatrician, Kim Schrier, M.D., currently serving Washington's 8th congressional district, did when she wrote a letter to the DHS and the Department of Health and Human Services to demand answers and accountability. Representative Raul Ruiz serving California's 36th congressional district also proposed a bill which would ensure that a "detainee may not be denied the use of necessary and appropriate medication for the management of the detainee's illness." The bill passed in the House in July 2019 and is up for consideration by the Senate.
Dr. Halevy-Mizrahi and Dr. Harwayne-Gidansky hope for changes to help migrant children, especially those left without essential medications putting them at risk for worse health outcomes. "Children without access to necessary medications are at risk of facing more ED (emergency department) visits, hospitalizations, and risk critical illness as the patients in our specific cases did," says Dr. Halevy-Mizrahi.
But they point out this may also have effects that ripple into society. "The cost of providing these medications are so much lower than the cost to the health care system for hospitalizing these children," adds Dr. Halevy-Mizrahi. "As these children often lack health insurance, that cost may ultimately be transmitted back to the taxpayer."