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Our Request: Discipline Physicians at Dilley Children Jail.

The letter is below,

October 1, 2015

By E-mail and First Class Mail

Texas Medical Board

333 Guadalupe

Tower 3, Suite 610

RE: Request To Discipline Dr. Rochelle Flynn, MD (License No. N3643); Dr. Rosa Colon, MD( License No. BP10045161) Dr. Adolfo Carvajal, MD (License No. J8497); Dr. Luis Ortega, MD (None in Texas); and Dr. Benjamin Aguilar, PhD (License No. 33718) for inflicting severe physical and mental harm on their detained 12-year-old patient.

Dear Sir or Madam:

 

I am the attorney for the above-referenced12 year old child and write this complaint on his behalf.

The above-referenced physicians and psychologist used their licenses to practice medicine to authorize their employer, Immigration and Customs Enforcement (ICE), to detain our 12-year-old client despite the incontrovertible evidence that it was causing him extreme mental and physical pain and suffering.

Each physician that treated our client affirmatively represented that he was “medically cleared for custody” when he should have never been cleared for custody given that he is a child.

In the account follows, time and time again the physicians were obligated to recommend the child’s release from detention with his mother as part of a treatment plan for his health. They never did. This is a horrifying story of what happens when a physician abandons their duty to advocate for the best health interests of their client by choosing to obey the interests of an employer—ICE—to detain children for as long as necessary even if it results in serious harm to the child’s health.

The Physicians

Dr. Flynn and Dr. Carvajal are pediatricians licensed to practice medicine the State of Texas. Dr. Rosa Colon’s license to practice medicine in Texas was terminated on July 29, 2012. Dr. Luis Ortega is not licensed to practice medicine in the State of Texas. Dr. Benjamin Aguilar is a licensed to practice psychology in the State of Texas.

All of the healthcare professionals subject to this complaint work for Immigration and Customs Enforcement under the direct supervision of the “ICE Health Service Corps” (IHSC) at the South Texas Family Residential Center (STFRC), a sprawling detention camp that detains over 2000 undocumented mothers and children. The sole purpose of STFRC is to enable ICE to deport as many mothers and children as possible

Dr. Jon Robert Krohmer, MD (License No. D75335) licensed to practice medicine in the State of Maryland, is IHSC’s Chief physician. The mission statement of IHSC—“We protect America by providing health care and public services in the support of immigration law enforcement.”—inherently contradicts the duty of physicians to advocate for the best health interests of their patients: [1]

  1. The Child’s Diagnosis of Posttraumatic Stress Disorder and Anxiety

Our client is a 12-year-old boy who fled his native country due to severe persecution, torture, suffered by himself and his mother He was transferred to STFRC on May 24, 2015, and seen for a screening that same day.

One week later, Georgia L Cameron, LCSW, evaluated him for a wellness check and noted that: “This resident is not doing well. His mother states that he witnessed DV but did not discuss further. Resident was crying, clinging to his mother, picking at this [sic] fingers and appeared to be traumatized and frightened. Mother says he is eating but not sleeping and has nightmares.”

On June 5, the child Posttraumatic stress disorder , 309.81(Primary) (PTSD) by Dr. Benjamin Aguilar, PhD, whose notes read, in part: “…that ex partner held her without allowing her to leave, at times tying her to a chair which resident witnessed.” He concluded that the abuse he experienced and witnessed caused “him to feel anxious about his safety, be tearful throughout the day, and have disrupted sleep.” In a follow up interview with our office, we discovered that the child’s mother was tied to the chair so that the ex partner could cut the hands of the child and make her powerless to protect her own son.

Dr. Aguilar’s did not recommend that the child be released from custody as part of his written treatment plan.

On June 10, 2015, Dr. Rosa Colon, MD, evaluated the child due to, in part, a jittering incident that his mother believed was caused by anxiety. Dr. Colon wrote at the end of her note, “Medically cleared for custody, follow up visit scheduled.”

On June 13, 2015, the child was treated for an emergency incident. Dr. Adolfo Carvajal, MD, and Albert Quinones, RN, saw him “…sitting in sofa breathing normally, talking when asked what was going on patient states his hands and feet feel numb…”He was assessed with Acute pain and Anxiety and told to drink more fluids.

Dr. Carvajal did not recommend that the child be release from custody as part of his written treatment plan.

On June 16, 2015, Dr. Rochelle Flynn diagnosed our client with “dizziness and giddiness; asthma; and Posttraumatic Stress disorder.” Her treatment plan for the PTSD was to notify Mental Health of his visit to her.

Dr. Flynn did not recommend that the child be released from custody as part of her written treatment plan.

On June 19, 2015, Dr. Benjamin Aguilar wrote extensive notes on proposed treatment: “Noted to mother and resident that his increased anxiety may be related to a worry about mother’s overall health, which was confirmed by resident who began to cry and noted that he worries that mother will die.”

Dr. Aguilar did not recommend as part of his written treatment that the child be released from custody.

On June 26, 2015, Dr. Benjamin Aguilar wrote, “Noted to mother and resident that resident’s anxiety may exacerbate existing breathing and allergy difficulties.” Dr. Aguilar plan of treatment for his patient included advice to “express his feeling via poems, writing, and drawings” but did not recommend release of the child from detention.

A week later, Dr. Aguilar’s own notes hint at the principal underlying cause—detention and the constant fear of return to past trauma that it invokes—of the child’s acute and potentially life-threatening symptoms stemming from his severe PTSD and Anxiety, describing the mother and boy as “much more hopeful and less stressed now that they received a positive outcome on their asylum interview.”

On July 8, 2015, Dr. Rochelle Flynn saw the child due to episodes of him feeling “dizzy and disoriented” followed by his legs and hand feeling numb. The mother noted that he had numerous lesions that have been denuded by scratching, all over extremities…He is very itchy…He was assessed with allergic rhinitis, extrinsic asthma, rash and other nonspecific eruption.

On July 17, 2015, Dr. Luis Ortega evaluated the child for “a fever, chills, and sore thought. The pain of swallowing was described as very painful, a 6-7 out of 10 on a pain scale. The child was diagnosed with acute pharyngitis, suspected strep, and he was immediately prescribed an antibiotic. Dr. Ortega affirmatively wrote that the child “medically cleared for custody.”

At 2:29 am on July 18, 2015, an emergency call was made “regarding spiking fever…if fever persists post 1 hour of Ibuprofen administration of 101 +, administer weight based acetaminophen, monitor for at least 1 hour for stabilizations and release to neighborhood once stabilized…”

His illness became worse. In the evening, he “woke up…choking…reported pain and numb feeling in his legs and could not walk to clinic. Medical went out to bring client in. Fever was stabilized, pain decreased to manageable, and client returned to general population.

In the same notes, Janinea Shelton, RN wrote on his fever: “variable will spike quickly, drop down then spike again.” His temperature was recorded as up to 104.8 degrees. The child’s mother stated that his fever reached 115. He was diagnosed with Acute Pain and Anxiety, Ineffective Thermoregulation, Risk for infection, Risk for fluid volume deficit, Risk for nutrition less than body requirement.

However, Ms. Shelton and her supervising physician, Dr. Flynn, wrote that the child was “medically cleared for custody with a follow up visit.”

His conditions did not improve hours later. The child reported the pain from his throat as 10 out of 10, and was vomiting some of the medication given to him. His strep throat test resulted in negative but he was continued with an anti-biotic.

In the afternoon of July 18, the child was sent to the center’s medical health unit due to his ongoing fever, which was recorded at 102.4 at the time of evaluation. He was assessed with Anxiety as well.

One hour later Dr. Rochelle Flynn discontinued the prescription of antibiotics due to strep test being negative, diagnosing him now with an unspecified viral infection. She noted that “he is the same presentation as numerous others with viral infection” and that

“Patient has a very significant history of anxiety and PTSD, hyperventilating episodes, numbness in hands/feet/legs. Currently with viral syndrome that is going around with HA, fever, S, body aches. He is x2 today with fever but will not walk, shaking with anxiety, talking fast and upset. Given all of his very uncomfortable anxiety episodes, I think he would benefit greatly from SSRI treatment. He also would benefit from frequent coping skills and counseling, if not already.”

Dr. Flynn did not recommend that he would benefit from being released from detention.

On July 19, Dr. Flynn medically cleared the child for custody and release into the general population of STFRC. Dr. Flynn discharged him from the Medical Health unit at 9 am with “no further recommendations” other than plenty off fluids and counseling with Dr. Aguilar regarding his PTSD.

It is important to point out that Dr. Flynn cleared the child for release from isolation in the STFRC’s Medical Health Unit to general population despite only a day earlier finding him at risk of further infection.

His last medical record comes from Dr. Aguilar, who concluded in his treatment plan on July 21, 2015 that: “Mother reported that they will likely be released this week, which has caused her and resident to feel more hopeful and euthymic.

Dr. Aguilar did not recommend that the child be released as part of his written treatment plan.

  1. Complicity in Inflicting Severe Mental and Physical Pain On Patient

The extensive medical records show the treating physicians knew that the only treatment plan that would effectively address our client’s symptoms of physical paralysis, pain, and acute infection caused and exacerbated, respectively, by the real and constant threat of a return to the severe trauma he experienced in his native country was that the child be released from detention.

Yet at no point did any medical professional recommend that the child be released from detention. Instead, the physicians were desperate to satisfy the goals of their employer, ICE, which was and remains to create the illusion of adequate medical care by acting as a paramedic to maintain a patient in critical condition.

If any of the physicians had affirmatively stated to their employer that the child was not cleared for custody, ICE would have been obligated to release the child under the law, including the U.S. Constitution.[2]

Children are extraordinarily vulnerable to harm in detention given that they are just children. In a letter to DHS Secretary Jeh Johnson, the President of the American Academy of Pediatrics, that the academy was “concerned…that the continued detainment of any children and mothers in existing facilities puts them at greater risk for physical and mental health problems and unnecessarily exposes children and mothers to additional psychological trauma.” She continued by stating “the act of detention or incarceration itself is associated with poorer health outcomes, higher rates of psychological distress, and suicidality making the situation for already vulnerable children even worse.”[3]

In the United States, children in the custody of their parents or others are entitled to be provided with adequate medical care. If a parent or other custodian repeatedly fail to provide adequate medical care, they will lose custody of the child.

The physicians at STFRC should be barred from treating children in the custody of their employer for the same reason: they are committing neglect by enabling ICE to detain children which is concretely harmful to their physical and mental health. Our client’s case is a damning example.

Dr. Flynn’s desperation to fulfill her employer’s goals was reflected by her recommendation that the child be administered “SSRIs”, or Selective Serotonin reuptake inhibitors, which are commonly known as anti-depressant drugs with names like Prozac, Lexapro, Celea, Luvox, or Zoloft , to slow down the constant terror that the child experienced every day in detention. The rash jump to prescribing such powerful drugs in lieu of an available and better alternative—freedom—could have had drastic consequences: numerous studies have found that children who take SSRI’s are at a higher risk of suicidal tendencies than adults.

Dr. Flynn also acknowledged that his anxiety and PTSD were exacerbating the symptoms associated with his viral infection.

If a child suffers from a life-threatening fever, a reasonable parent would immediately bring that child to an pediatric hospital emergency room, if available.

The physicians at STFRC acted far below the standard of professional care by transferring the child to a clinic setting overseen by non-physicians for monitoring. At most developed hospital settings, there is always a physician on premises in the event of acute cases that become life threatening. Our client’s fever was life threatening. He had lost the ability thermoregulate. Based on the medical records and our client’s mother’s statement, the child’s fever peaked at 115.

At the earliest sign of the child’s convalescence from his viral infection, Dr. Flynn discharged him back into a community environment shared by thousands of young children and mothers. Given the shared living environment and his recovering immune system, he was exposed to an extraordinary risk of re-infection.

iii. Convicted Felons in Texas Treated Better Than Children at STFRC.

Long-term detention of children on such a massive scale for the purposes of their deportation is unprecedented in Texas, and as such there is a regulatory black hole. The closest equivalent to compare is the correctional early-release statute for individuals convicted of serious crimes.

Section 508.146 of Title 4, Subtitle G of the Texas State Code, provides for early release under supervision for inmates who are elderly, physically disabled, mentally ill, terminally ill, or mentally retarded or having a condition requiring long-term care, as long as the parole board determines that the inmate does not pose a risk to the public.[4]

There is no statute or regulation that regulates an orderly procedure for release of children detained in the custody of ICE. If there were, every child would qualify for release given that their status as children makes them in need of specialized care—freedom from constant fear and infections that pervade the STFRC.

The Physicians Who Used Their Medical Licenses to Inflict Harm on Our client Must Be Disciplined and Directed To Recommend Release from Custody of all Children at STFRC Or Have Their Licenses Immediately Suspended

Physicians are supposed to improve the health of their patients. The physicians at the STFRC are worsening the health of their children patients by stating to ICE and the world that they are medically cleared for detention. Children can never be medically cleared for detention. In our client’s case, actions of the doctors were so far below the standard of adequate medical care that it resulted in the child suffering extreme physical and mental pain for nearly 3 months.

The politics or policy of immigration law, refugees, or asylum seekers has no bearing whatsoever on the duty of a physician to advocate for the best health interests of their patient. It is black and white. As such, I urge you to take immediate disciplinary action against the physicians Dr. Rochelle Flynn, MD; Dr. Adolfo Carvajal, MD; Dr. Rosa Dubon, MD; Dr. Luis Ortega, MD; and Dr. Benjamin Aguilar, PhD.[5]

Please find attached evidence in support of this complaint:

  1. Copy of child’s medical records while in ICE custody;
  2. Copy of Letter From American Academy of Pediatricians;
  3. Copy of Affidavit of Dr. Luis Zayas, PhD; and
  4. Copy of New York Times News Article.

Thank you for your attention to this urgent matter. If you should have any questions, please do not hesitate to contact me at

Very Truly Yours,

Bryan S. Johnson, Esq.

CC:

Texas State Board of Examiners of Psychologists

333 Guadalupe, Suite 2-450

Austin, Texas 78701

Maryland Board of Physicians

INTAKE UNIT

4201 Patterson Avenue

Baltimore, MD 21215

[1] Physicians for Human Rights, Dual Loyalties in U.S. Immigration Detention, March 28, 2011. http://physiciansforhumanrights.org/asylum/dual-loyalties-immigration-detention.html?referrer=https://www.google.com/

[2] Julia Preston, U.S. Judge Increases Pressure on U.S. to Release Migrant Families, August 22, 2015, http://www.nytimes.com/2015/08/23/us/judge-increases-pressure-on-us-to-release-migrant-families.html?_r=0

[3] See https://www.aap.org/en-us/advocacy-and-policy/federal-advocacy/Documents/AAP%20Letter%20to%20Secretary%20Johnson%20Family%20Detention%20Final.pdf; and affidavit of Dr. Luis H. Zayas, Phd, the Dean of the School of Social Work at the University of Texas at Austin, who interviewed several children at the family detention center located in Karnes City, Texas, https://lofgren.house.gov/uploadedfiles/declaration_of_luis_zayas.pdf

[4] http://www.statutes.legis.state.tx.us/Docs/GV/htm/GV.508.htm

[5] A copy of this complaint has been concurrently sent to Texas State Board of Examiners of Psychologists

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