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Trump administration must stop giving psychotropic drugs to migrant children without consent, judge rules

The Washington Post logoThe Washington Post 7/31/2018 Samantha Schmidt

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A federal judge on Monday found that U.S. government officials have been giving psychotropic medication to migrant children at a Texas facility without first seeking the consent of their parents or guardians, in violation of state child welfare laws.

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U.S. District Judge Dolly Gee in Los Angeles ordered the Trump administration to obtain consent or a court order before administering any psychotropic medications to migrant children, except in cases of dire emergencies. She also ordered that the government move all children out of a Texas facility, Shiloh Residential Treatment Center in Manvel, except for children deemed by a licensed professional to pose a “risk of harm” to themselves or others.

Staff members at Shiloh admitted to signing off on medications in lieu of a parent, relative or legal guardian, according to Gee’s ruling. Government officials defended this practice, saying they provided these drugs only on “an emergency basis” when a child’s “extreme psychiatric symptoms” became dangerous.

The judge didn’t buy this explanation, pointing to testimony from children who said they were given pills “every morning and every night.” Officials “could not have possibly” administered medications to children on an emergency basis every day, Gee wrote.

U.S. District Judge Dolly Gee ruled that the federal government must seek consent before giving migrant children medication. © NAPABA via AP/ U.S. District Judge Dolly Gee ruled that the federal government must seek consent before giving migrant children medication. Children testified in court filings that staff with the U.S. Office of Refugee Resettlement would sometimes not tell them what drugs they were being given or why. They recalled feeling side effects such as nausea, dizziness, depression and weight gain. Some reported being forcibly injected with drugs, and others said they felt that refusing medications would cause them to be detained longer.

“I witnessed staff members forcefully give medication four times,” one child held at Shiloh, identified as Isabella M., said. “. . . Two staff members pinned down the girl . . . and a doctor gave her one or two injections.”

Isabella was prescribed multiple psychotropic medications at Shiloh, including topiramate, without her mother’s consent, according to an April court filing. “Nobody asked me for permission to give medications to my daughter, even though the staff at Shiloh has always had my telephone number and address,” the mother testified.

The mother said Isabella’s anxiety medications were causing her to tremble and feel nervous. Isabella “tells me that she has fallen several times,” her mother testified, “because the medications were too powerful and she couldn’t walk.”

The Shiloh Residential Treatment Center, the judge ruled, violated a long-standing settlement that set strict standards for detaining immigrant children, including those who crossed the border unaccompanied and those who were separated from their parents. The 1997 Flores agreement requires the government to place children in the “least restrictive” setting appropriate to their age and any special needs.

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Plaintiffs on behalf of immigrant children showed Shiloh violated this standard in part because it is a locked facility with 24-hour surveillance and monitoring and engages in practices that are “not necessary for the protection of minors or others,” the judge wrote. Shiloh is one of many shelters contracted by the U.S. Office of Refugee Resettlement to house immigrant children.

There is evidence that several children were not allowed to have any private telephone calls at Shiloh, Gee wrote. One minor, identified as Julio Z., said Shiloh staff refused to let him and other children leave their living areas to get drinking water. When Julio tried to step out to get water on one occasion, a staff member allegedly threw him to the ground, injuring his elbow.

The judge ordered Shiloh to stop using any unessential security measures, such as denying children drinking water, and demanded officials allow children at Shiloh to speak privately over the phone.

Gee also said the government must explain to children in writing, in a language they understand and in a reasonable amount of time why they are being transferred to a secure facility, staff-secure facility or a residential treatment center. The judge also ruled officials cannot place children in a secure facility solely because they were allegedly affiliated with gangs.

Most immigrant children in U.S. custody are in nonsecure facilities. But others are in a range of higher-security facilities. A secure facility is the most restrictive option, with a physically secure structure and staff trained to control violent behavior — much like a juvenile detention center. A “staff-secure” facility may have a secure perimeter, such as a fence, and a higher staff-to-child ratio, but is not equipped with locked cells. Residential treatment centers are assigned to children who are determined to pose a danger to themselves or others.

Shiloh is a collection of trailers and small buildings that can house up to 44 children, 32 of them immigrants, according to the Center for Investigative Reporting, which has reported extensively on the facility. It has been contracted to house immigrant children deemed unaccompanied minors since 2013 and was also set to receive children separated from their parents under the Trump administration.

The facility also has a history of troubling practices, including allegations of child abuse, according to the Center for Investigative Reporting. A local congresswoman called for Shiloh to be shut down four years ago after the Houston Chronicle reported on long-running allegations of physical violence, excessive use of physical restraints and several deaths of children in custody.

A doctor at Shiloh who has signed off on many prescriptions for psychotropic drugs to immigrant children has practiced without board certification to treat children and adolescents for nearly a decade, the Center for Investigative Reporting found.

In a statement currently on its website, Shiloh said it has been visited, audited or investigated by authorities at the state and federal level in recent weeks. “All of the widely distributed allegations about Shiloh were found to be without merit,” the center wrote. “The children have been found to be properly cared for and treated. Shiloh Treatment Center has a specific treatment purpose within the federal system. It does not participate in border actions.”

Numerous sworn testimonies in court affidavits indicated children at Shiloh were regularly given psychotropic medication without the proper parental consent. Sometimes they were told these were vitamins.

In an April 16 court filing, lawyers wrote that “psychotropic drugs can seriously and permanently injure children.”

“The importance of oversight when giving psychotropic medications to children is well established,” the lawyers wrote. “Without it, the potential for abuse — including using drugs as ‘chemical straight-jackets’ to control children, rather than to treat actual mental health needs — is unacceptably high.”

Julio Z., another minor held at Shiloh, said he “never knew exactly what the pills were.” Court documents list Clonazepam, Divalproex, Duloxetine, Guanfacine, Latuda, Geodon, and Olanzapine among his medications.

“The staff threatened to throw me on the ground and force me to take the medication,” Julio Z testified. “I also saw staff throw another youth to the ground, pry his mouth open and force him to take the medicine. . . . They told me that if I did not take the medicine I could not leave, that the only way I could get out of Shiloh was if I took the pills.”

Lucas R., a 12-year-old boy from Guatemala who was detained in February, was transferred to Shiloh after he refused to take antidepressant Zoloft, which was causing him stomach pain, according to a separate court filing. Shiloh medical staff diagnosed Lucas with major depressive disorder and told him that officials would not release him until Shiloh medical personnel declared him psychologically sound.

His depression was in large part triggered by “being kept from family,” who had entered the country before him, according to court documents.

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