What's a nurse thinking while injecting substantial doses of haloperidol (Haldol) and lorazepam (Ativan) into someone who hasn't been diagnosed with a mental illness? Some nurses who've been recruited as medical escorts find themselves doing just that. The U.S. Department of Homeland Security's Division of Immigration Health Services (DIHS) Web site describes its medical escorts as "Certified Flight Nurses who provide in-flight medical support for removal of sick or dangerous deportees." But according to a May 14, 2008, article in the Washington Post, the logs some medical escorts filled out describe performing actions that were neither medical nor supportive on detainees who were neither sick nor dangerous.
The Post report was based partly on hundreds of medical logs from deportation trips since 2003, obtained through a Freedom of Information Act request. The logs show use just before and during transit of psychotropic medications-a "three-drug cocktail" of haloperidol, lorazepam, and benztropine mesylate (Cogentin).
The Post described deportees arriving in their home countries semiconscious, groggy, and thick tongued. In one case it took four days for the drugs' effects to clear. Although some logs document deportees' combative behavior, many describe anxious men and women simply asking questions or loudly stating their desire to remain in the United States. Why didn't these nurses question the choice or doses of medications used? A medical escort giving potent sedative- hypnotic medications to anxious, agitated deportees is not the same as an ED nurse sedating a combative, undiagnosed patient.
Are these nurse escorts specialists in mental health or emergency care? If so, they should be aware of less toxic prescription drugs and nonpharmacologic interventions that are also effective in stressful situations. Are these nurses correctional health services specialists? If so, they should know to ask the prescriber about the use and misuse of all psychotropic drugs to be administered.
Maybe these nurses were hired without regard to specialty; even so, they should remember the obligation to "first, do no harm": to use medication only when indicated and to question inappropriate medication orders. Perhaps the national frenzy over homeland security after 9/11 and the resultant xenophobia caused these nurses to heedlessly assist U.S. Immigration and Customs Enforcement (ICE), the agency responsible for deportation, in clearing out the unwanted.
In one online discussion at http://allnurses.com, about the issue of drugging deportees, I was disturbed to see that the first three responses could be summarized as "Right on, nurse," although four others questioned the clinical ethics of these practices.
Perhaps the first time the nurse escorts were directed to use psychotropic drugs inappropriately they expressed concerns, and perhaps the accompanying ICE guards dismissed them by describing violent deportees and the need for self-protection. But it could be that ensuring human rights and good nursing weren't uppermost in anyone's mind. At the DIHS, health care is secondary to national security. The DIHS recruits medical escorts by publishing articles about the job in their newsletter, luring nurses with promises of travel to "exotic, exciting locations" and performing care in a "unique environment."
I don't know what the nurse escorts were thinking or whether the more than 250 deportees identified by the Post who were wrongly sedated are an aberration or the norm. But I do know that the nurses involved are members of our profession. We should work with them to be certain that no nurse takes part in actions that abuse human rights.