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JAMA Posts Job for ICE Detention Facility: A Concern for Dual Loyalty

by Jessica Hane, MD at University of Minnesota; Jennifer Arnold, MD at University of Minnesota; Kathleen Wilcox, MD at Hennepin Healthcare; Adnan Ahmed, MBBS at ResCare Minnesota; and Jonathan D. Kirsch, MD at University of Minnesota

“Philosophically committed to the objectives of the facility,” read the original job posting for a physician by The GEO Group in the prestigious Journal of the American Medical Association (JAMA). The GEO Group is a for-profit company that runs correctional facilities not just in the United States, but also in the United Kingdom, South Africa and Australia. It also operates several Immigration and Customs Enforcement (ICE) processing centers in the United States. The job listing was removed on July 23 due to a physician’s advocacy, but was posted on the JAMA Career Center for nearly a month.

As we learn about the deaths and human-rights violations occurring under The GEO Group, we ask that medical journals be more discerning in their job postings and for physicians to be wary of an employer’s requirement for philosophical compliance.

On their website, The GEO Group claims to be committed to the principles of diversity and inclusion. However, recent reports of overcrowding and lack of basic sanitation in the facilities they run tell a different story. The company is currently facing a class action lawsuit for breaking anti-slavery laws and only paying detainees $1 per day for their work in the facilities. There are also reports of threats of solitary confinement for detainees if they refuse to work. Under public pressure, several businesses have severed ties with The GEO Group due to ethical concerns.

As physicians, our ultimate duty is to the health and well-being of our patients — not to the priorities of a private company profiting from detainment. Asylum seekers in detention deserve quality medical care. However, physicians cannot ethically provide that care if they are also asked to philosophically comply with an employer that violates basic human rights. Physicians must first remain loyal to their patient, with a philosophical commitment to “providing competent medical care, with compassion and respect for human dignity and rights” (AMA). Health care providers can best deliver that care if they do not have a dual loyalty to private correctional facilities, and are instead affiliated with either non-profit humanitarian groups or federal oversight agencies that are aligned with the Hippocratic Oath.

At a time when so many citizens lack access to affordable, appropriate care, providing this care to detainees may seem challenging; however, there is precedent. During World War II, the US Public Health Service provided medical care to 19,000 individuals interned by the Immigration and Naturalization Service. As a third party, they had clinical independence to make decisions in the best interests of patients. These internees were afforded protection under the Geneva Prisoners of War Convention of 1929. Current detainees also deserve full protection.

Abiding by the Hippocratic Oath extends beyond the borders of our own hospitals and clinics. We call on JAMA to be more conscientious when giving corporations unfiltered access to its readership. We call on JAMA’s readers to hold organizations like The GEO group accountable for their disregard of basic human rights. Finally, we call on all health care providers to remain loyal to their patients and protect the sacred patient-physician relationship.

Author’s note: The authors would like to acknowledge Leah Stinson, Calla Brown, Karina Romo, Benjamin Katz, Saida Yassin and Maggie Eckerstorfer for their assistance with this manuscript.

Jennifer Arnold, MD Jennifer Arnold, MD (0 Posts)

Resident Physician Contributing Writer

University of Minnesota Medical School

Jennifer Arnold is a third-year internal medicine-pediatrics resident at the University of Minnesota. She studied human biology, psychology and Spanish at Michigan State University and went on to earn her medical degree from there as well. She is a member of the Global Health track as part of her residency and hopes to pursue a career working with underserved populations both locally and abroad. Outside of medicine she enjoys photography, running and paddleboarding.

Kathleen Wilcox, MD Kathleen Wilcox, MD (0 Posts)

Resident Physician Contributing Writer

Hennepin Healthcare

Kathleen Wilcox is an internal medicine resident at Hennepin Healthcare. After studying Medical Microbiology and Immunology at the University of Wisconsin-Madison, she spent time working at Epic. She completed medical school at the Medical College of Wisconsin. Outside of medicine she enjoys biking and reading. She can be found on Twitter @kwilcoxmd.

Adnan Ahmed, MBBS Adnan Ahmed, MBBS (0 Posts)

Attending Physician Guest Writer

ResCare Minnesota

Adnan is a community psychiatrist in Minneapolis. He provides services to a Forensic Assertive Community Treatment Team in Minneapolis. He is a graduate of the Forensic Psychiatry Fellowship program at the University of Minnesota. He also performs pro-bono asylum mental health evaluations for people in deportation proceedings.

Jonathan Kirsch Jonathan Kirsch (0 Posts)

Attending Physician Guest Writer

University of Minnesota Medical School

Jonathan Kirsch, MD is an assistant professor and an internist at the University of Minnesota Medical School. He practices and teaches hospital medicine at the University of Minnesota Medical School and is core faculty in Global Medicine. He served as a Fulbright Scholar from 2017-2018 in Cali, Colombia. He has been working with and advocating for migrant farmworkers for over 15 years. He has directed an inter-professional, community engaged rotation in Migrant health for 5 years. He has 3 children, loves travel, biking and has a dog and 12 chickens. He can be found on Twitter @j_kirsch.

Jessica Hane, MD Jessica Hane, MD (2 Posts)

Resident Physician Contributing Writer

University of Minnesota Medical School

Jessica Hane is a fourth-year internal medicine and pediatrics resident at the University of Minnesota. After studying biology and Spanish at Creighton University, she spent a year in Ecuador as a Fulbright Scholar. She completed medical school at the University of Iowa where she was involved in a student-run mobile clinic and the Global Medicine Society. Her interests include health equity, the intersection of homelessness and health, global health and medical education. In her free time, she enjoys reading and photography. She can be found on Twitter @jhanemd.