When it comes to the mental health treatment of migrant children, the U.S. federal government does not require psychiatrists working with government-contracted detention centers to have specialized certification to treat children, according to a recent report.
Reveal from the Center for Investigative Reporting highlighted the case of Dr. Javier Ruíz-Nazario, a psychiatrist claiming to have specialized certification for treating children despite that certification lapsing in 2000; the doctor is named in several lawsuits.
Ruíz-Nazario’s name appears on various court documents that allege troubling practices at the Shiloh Treatment Center south of Houston, including affidavits in class-action settlement motions in which children claim they were tackled and injected and forced to take pills identified as vitamins that made them dizzy and drowsy.
Many of the records specifically name Ruíz-Nazario as the doctor who prescribed the medication.
Shiloh is categorized as a residential treatment center by the Office of Refugee Resettlement, gaining its first contract to house unaccompanied immigrant minors in 2013. Although the resettlement office previously had required board certification for grant applicants as part of a “culturally competent interdisciplinary team,” months before Shiloh received its first payment, the agency dropped that requirement.
Records reviewed by Reveal, however, show that government court filings state children at Shiloh are administered drugs by a psychiatrist board certified to treat them.
In a letter to attorneys in a lawsuit, dated April 2, 2018, an official with the federal resettlement agency makes three references to a “board certified” psychiatrist working at Shiloh. The federal Flores settlement, stemming from a lawsuit first filed in 1997, places certain requirements on the federal government regarding detention and treatment of unaccompanied immigrant children. Attorneys representing immigrant children filed motions in the case in April, asking a federal judge to halt the “continuum of trauma” that includes forcing children to take psychotropic medication at Shiloh.
“It is Shiloh’s policy that, in addition to monthly reviews of all their medication orders, on at least a quarterly basis, the board certified child and adolescent psychiatrists who contract with Shiloh to provide psychiatric care for (unaccompanied immigrant children and other residents) review current prescriptions of psychotropic medications,” states the letter sent to Flores counsel by James S. De La Cruz, senior federal field specialist supervisor with the Office of Refugee Resettlement’s division of children’s services.
The Shiloh residential treatment center is one of two facilities where migrant children are sent when they require a higher level of mental health care, which is determined by a doctor and reliant on behavioral cues.
In some cases, children are transferred among more than half a dozen shelters and can languish in the system for months and even years. One affidavit in the Flores case, from a child who came to the U.S. in 2014, states:
“ln Shiloh they gave me even more medicine. I took nine pills in the morning and seven in the evening. I don’t know what medications I was taking; no one ever told me that. I don’t know what my diagnosis or illness is. … Some of the staff at Shiloh would provoke the children there and make us angry intentionally. They made us act violently so then we had to be given shots. The staff would insult us and call us names like ‘son of a whore.’ They often did it in English but I understood some English so I would know what they were saying and get really angry.”
Complaints against Shiloh have been mounting for years, and in light of the most recent reports, Texas state Rep. Pete Olson has called for the facility to shut down all together.
“In light of this facility’s troubling history and current accusations, I recommend the closure of this facility and the removal of these children to a safer location until these accusations can be properly addressed. I have been in contact with local and state officials and stand ready to work with them to develop a safe resolution to protect these children. Regardless of where they come from, no child should be placed in physical danger,” said Olson, a Republican elected to Congress in 2009.
“Enough is enough. Since I have been in Congress, every time an issue arises concerning Shiloh’s poor care of undocumented children, Shiloh puts up a brick wall. Transparency and information is always put under lock and key. When I knocked on their door a few years ago, I was handed a slip of paper with a telephone number in Washington, D.C., to call to find out what is happening at Shiloh. With new allegations, the people of Texas (Congressional District) 22 are beyond their limits.”
“While I was not made aware of recent incidents until the media reported the alleged abuses, the details outlined in the lawsuit are very disturbing. Any facility in charge of the safety and well-being of children has a special responsibility to go above and beyond when caring for them.”