Medicine at Brown: Moral Authority
This article features Government Accountability Project clients, Drs. Scott Allen and Pam McPherson, and was originally published here.
Two physicians with a record of calling out medical wrongdoing question why more doctors don’t.
In 2014, internist Scott Allen MD’91 RES’94 was working as a consultant for the Office for Civil Rights and Civil Liberties, part of the Department of Homeland Security. Charged with investigating complaints filed by the public regarding DHS actions, CRCL had recruited Allen to conduct inspections of its adult immigration detention facilities.
That summer, when the Obama administration began detaining asylum-seeking mothers and children in a facility in Artesia, NM, as part of a plan to deter immigrants from Central America, complaints came flooding in. CRCL sent Allen and Pamela McPherson, MD, a child and adolescent psychiatrist from Louisiana who was also a government contractor, to investigate.
What they found was deeply troubling.
In addition to widespread weight loss among the children, they discovered a 16-month-old baby who had lost one-third of his weight due to a diarrheal illness. For more than a week the child’s mother had sought medical attention but had not been offered appropriate treatment—despite the fact that a 10-percent weight loss would normally trigger emergency measures, including administration of IV fluids. In the absence of adequate pediatric care, the infant’s condition had gone unnoticed. The baby was on the verge of dying of dehydration.
“We were disturbed by how dangerous this place was,” Allen says. “We said, ‘You almost lost a baby. You gotta shut this place down.’” Within two weeks, DHS quietly closed the Artesia facility. (Two more facilities were built soon after, in Texas.)
Through the final years of the Obama administration, Allen and McPherson carried out 10 more inspections of immigration family detention centers and filed detailed internal reports to DHS on each one, documenting myriad harms to children, from receiving adult doses of vaccines to having their fingers crushed by heavy spring-loaded doors. But once Donald Trump took office in 2017, Allen recalls, “the phones stopped ringing.” The two experts assumed they wouldn’t be called on again.
Then, in June 2018, audio that had been secretly recorded inside a US Customs and Border Protection facility was released to the public. The recording consisted of eight excruciating minutes of the cries and howls of children separated from their parents as a result of the Trump administration’s “zero-tolerance” immigration policy. Faced with almost universal condemnation, the administration changed course, announcing that it would expand family detention instead. But in addition to the well-documented harms caused to children by detention itself, Allen and McPherson’s inspections had shown that family detention facilities failed to meet their standards of medical and mental health care for children. They were impelled to take action again—and this time, to take it further.
Davids V. Goliath
They turned to the Government Accountability Project, a whistleblower protection and advocacy group established in 1977 that until then had dealt mostly with issues like food integrity, chemical pollution, climate science censorship, and national security. “We promote government and corporate accountability by working with whistleblowers, protecting them from retaliation and seeking justice if they suffer that,” Dana Gold, the group’s attorney who took their case, says. “But we also ensure that their disclosures make a difference.”
The doctors learned that whistleblowing is not about disagreeing with a policy; it’s about exposing waste, fraud, abuse, or a threat to public safety. “Dana told us we checked all the boxes,” Allen says.
Gold (who had until then mostly worked on complaints against nuclear weapons facilities) further explained that their whistleblower status superseded the nondisclosure agreements they had signed with DHS. “We framed their speech as protected whistleblowing,” she says, “wrapping them in their rights.”
Likening the whistleblowing process to a chess game, she carefully laid out what steps they should take and in what order. They first filed a disclosure with DHS’s Office of the Inspector General, charged with oversight of government programs, asking them to investigate the hasty deployment of expanded family detention that they believed would put children at imminent risk of mental health and medical harm. Next, they wrote a letter to the head of CRCL strongly opposing the expansion of family detention, warning that, based on their findings from their own past investigations, a population surge would put children at risk. Finally, having exhausted internal mechanisms, they worked with Government Accountability Project attorneys to carefully craft a legal, protected disclosure to Congress, which they submitted to the Senate Whistleblowing Caucus. They expressed their position starkly: “Detention of innocent children should never occur in a civilized society … because the risk of harm to children simply cannot be justified.” They had officially put their government on notice.
The July 17, 2018, disclosure received considerable media attention, including in the New York Times, and caused a “cascade” effect, according to Gold. Soon after, 14 medical organizations (including the American College of Physicians, the American Medical Association, the American Psychiatric Association, and the American Academy of Pediatrics) issued statements supporting the importance of the doctors’ disclosures and urging Congress to investigate. In November 2018, Allen and McPherson appeared in a harrowing 60 Minutes episode focused on the family separations of the previous summer.
Since Allen’s and McPherson’s 2018 disclosures, Gold’s portfolio of immigration-justice whistleblowers has ballooned from zero to 24. “Their whistleblowing added oxygen to advocacy efforts around preventing harm to immigrants,” she says. “It changed the immigration-justice space.”
Allen describes the family detention action as a “high-wire act.” But taking a stand for what’s right was not new to him.
In the early 2000s, as staff physician for the Rhode Island Department of Corrections, he and the medical program director, Anne Spaulding RES’92, MD, bucked protocol and began treating incarcerated patients for chronic hepatitis C—a practice that the National Institutes of Health considered too complicated. “We said, no one’s gonna treat our patients if it’s not us,” Allen recalls.
Around that time, in the RIDOC dispensary, Allen met the doctor who would become a lifelong colleague, comrade, and, most recently, fellow whistleblower. Infectious disease and addiction specialist Josiah “Jody” Rich, MD, MPH, professor of medicine and of epidemiology at Brown, had come to the state to address the HIV epidemic, including by taking care of incarcerated patients with HIV. Like Allen, he cared more about doing right by his patients than about preserving the status quo. Like Allen, he gravitated toward vulnerable, marginalized populations—individuals grappling with poverty, or substance use, or structural racism, or incarceration, or some combination of the above. “It’s all the same ball of wax,” he says.
When Rich learned that Allen had treated more than 90 patients for HCV, as the hepatitis C virus is called, he encouraged him to write it up and submit it to a journal. That paper, co-authored by Allen, Rich, and Spaulding and published in the Annals of Internal Medicine in 2003, caused a “big bang” in correctional medicine, Allen says. For several years after that, the doctors served as expert witnesses in federal lawsuits all over the country and lobbied the NIH to reverse its position. It did.
The two would continue to shine a light, in Allen’s words, on “failures of people in medicine … to do the ethical thing.” In 2004 Allen, who had become RIDOC’s medical program director, resigned that position to protest the mistreatment of one of his patients by prison staff. He went on to complete a Soros Physician Advocacy Fellowship (a program now based at Columbia University) and to serve as medical adviser on health in detention for Physicians for Human Rights, researching and writing reports on the role of health professionals in the management of hunger strikes, torture, and enhanced interrogation techniques.
Meanwhile, Rich pursued his work at The Miriam Hospital Immunology Center and RIDOC, conducting research and caring for patients. Through his scholarship (he has authored more than 300 journal papers and had continuous NIH research funding since 1995) and advocacy (he too was a Soros physician advocacy fellow), he has over the past three decades effectively reshaped the landscape of health care in the US carceral setting. He has also helped improve public health policy for people with addiction. His research and activism were instrumental in moving the needle, as it were, on the ability of people who use injection drugs to obtain sterile syringes; access was legalized in Rhode Island in 2000 and in Massachusetts six years later.
Following the 2014 death by overdose of his nephew, Rich became increasingly focused on overdose. His research documenting the benefits of medication for opioid use disorder (MOUD) for incarcerated individuals helped RIDOC become the first statewide correction system to make all three approved MOUDs (methadone, buprenorphine, and naltrexone) available to anyone incarcerated with opioid use disorder; many correctional facilities across the US have followed suit. Thanks to a contract between RIDOC and the Center for Health and Justice Transformation (which he and Allen co-founded in 2006, as the Center for Prisoner Health and Human Rights), Warren Alpert Medical School physicians now help provide primary care for incarcerated individuals in the state.
In 2015, as the opioid crisis was raging, then-Gov. Gina Raimondo asked Rich to be a medical adviser to her Overdose Prevention and Intervention Taskforce. Elected to the National Academy of Medicine in 2018, today he is the principal investigator on three grants related to substance abuse and director of the $11.8 million COBRE Center on Opioids and Overdose at Rhode Island Hospital.
Although an avid researcher, teacher, and public health advocate, for Rich it all starts with clinical care. “I wouldn’t know what to research if I didn’t have my patients,” he says. “If I have an idea, which I typically get from my clinical interactions, I run it by my patients and they tell me, ‘No, you shouldn’t do that,’ or ‘Yeah, you should do that.’ I get so much more from talking to my patients than reading the medical literature or sitting through conferences. They’re what’s really driven my career.”
Allen moved west in 2011 to become a founding faculty member of the new University of California Riverside School of Medicine, where he served as professor and chair of medicine. (His wife, Emma Simmons MD’91 RES’94 MPH’04, is also a founding professor and dean of student affairs. They were recruited together by G. Richard Olds, MD, Riverside’s founding dean, a former professor at Brown, and inaugural director of its International Health Institute.) Yet despite being on opposite coasts, Allen’s collaboration with Rich has not waned. “There’s nothing I do where [Jody’s] not whispering advice in my ear,” Allen says. “We are very close confidants in the work we do.”
Rich attentively followed his colleague’s work as a whistleblower and, in late 2019, agreed to join him as a medical expert for CRCL. The following February, not long after his DHS authorization had gone through and just days before the World Health Organization declared COVID-19 a pandemic, he had an epiphany. It was Allen’s number that he dialed.
“This is going to be a major problem in corrections,” Rich told him, referring to the 10 million individuals cycling in and out of US prisons and jails, all breathing the same air, with no opportunity for social distancing. “We need to sound the alarm.”
Over the months that followed, the two kept up a steady drumbeat of warnings to the US government. In March, with infections popping up in New York’s Rikers Island and an ICE detention facility in Ohio, they submitted letters to Congress, again with legal representation from Gold, laying out the health threats posed by the virus, calling the potential for transmission from detention facilities to their surrounding communities a “tinderbox scenario.” With Mavis Nimoh, MPA, associate professor of the practice of health services, policy, and practice at Brown’s School of Public Health and the new executive director of the Center for Health and Justice Transformation, they published an opinion piece in the Washington Post calling for the immediate release of low-risk prisoners from prisons and jails; failing to do so, they argued, would likely result in a public health crisis. Cannily, they consistently targeted the public’s self-interest by underscoring the risks to correctional staff, their families, and the general community: “Each severely ill patient coming from corrections who occupies an ICU bed will mean others may die for inability to obtain care,” they wrote.
In April, Rich and others penned an essay in the New England Journal of Medicine urging selective decarceration as a way of “flattening the curve” of coronavirus infections. (That same month, the US Attorney’s Office for the Northern District of Alabama issued a press release alleging that the conditions in Alabama men’s prisons violate the Eighth Amendment of the Constitution, which prohibits “cruel and unusual punishments” of prisoners; Rich had contributed to the investigation that led to the allegation.) In June, Allen testified before the US Senate Judiciary Committee on best practices for incarceration and detention during the pandemic, calling correctional health “the tip of the spear in public health.” In his testimony he urged the committee to support aggressive testing in detention and correctional facilities, careful release of detainees and prisoners, and inclusion of detention and correctional facilities in all levels of the country’s COVID response plans. In an opinion piece in The Hill, Allen and Rich urged the Biden administration to apply its vaccine effort to ICE detainees, and in USA Today they joined with McPherson to oppose family detention in the context of COVID.
In addition to this outreach, Rich’s former postdoctoral trainee Lauren Brinkley-Rubinstein, PhD, an associate professor of population health sciences at Duke University, formed the COVID Prison Project, a public-facing database providing data on the state of infections behind bars. The project documented that 90 of the 100 largest outbreaks in the country were in correctional facilities. In 2021 Rich also published a study showing the feasibility of implementing a vaccine campaign among sentenced individuals and correctional staff, based on the success of the program he oversaw at RIDOC.
Walking The Tightrope
Both Allen and Rich say they are grateful to have suffered no retaliation for their efforts; on the contrary, Allen has received the Ridenhour Award for Truth-Telling, the Physicians for Human Rights Award, and the Neal Pike Award for his efforts. But they are aware that going public doesn’t always go well.
In 2020, nurse Dawn Wooten blew the whistle on her employer, the Irwin County Detention Center in Ocilla, GA. Her primary complaint was inadequate protection from COVID for staff and patients. But what seized the public’s attention was her claim that a local ob-gyn hired by ICE had performed invasive and often unnecessary gynecological procedures on dozens of immigrant women without their informed consent. In a hearing of the Senate investigation, which he led, US Sen. Jon Ossoff called the case “a catastrophic failure by the federal government to respect basic human rights.” Yet Wooten lost her job, spent time in hiding, and suffered from suicidal depression. Allen and Rich recognize that the fact that she is Black and a woman without an MD after her name most likely contributed to a very different outcome for her, but Gold is quick to underscore the importance of the doctors’ having sought expert legal advice before blowing the whistle, while Wooten did so after suffering retaliation.
Despite the risks, both believe that for medical professionals, raising the alarm on injustices committed against vulnerable populations is not an option, it’s a duty. This shared conviction has served as their moral compass for their entire careers. “Doctors in academia are good at placing their papers in peer-reviewed publications, but not so good at communicating their findings to policymakers or the public,” Allen says, adding, “We’re not only trying to push for policies and practices to improve. We’re also trying to nudge our very conservative, very cautious profession to leverage its moral authority on health care and public health.”
Rich agrees: “With that moral authority comes a megaphone. Our voice is louder than others’. There’s a responsibility to use that wisely.”
Having walked the whistleblowing tightrope, the two are eager to pass on lessons learned and provide a “toolbox” for current and future MDs. Last year, McPherson, Gold, and Allen published “The Physician’s Role in Confronting Humanitarian Challenges: A Guide for Action” in World Social Psychiatry. Among other things, the article outlines the constellation of efforts—from ethicists, legal experts, organized medicine, and the media—a physician needs in order to “take a stand against power” and effect change.
This desire to model effective advocacy is nothing new. Two decades ago, Francis Wolf ’02, MD, spent a year working as Rich’s research assistant and was deeply inspired by his “commitment to improving the lives of people no one else cares about … [and]by his belief that one person can change things.” According to Snigdha Vallabhaneni ’01 MD’06, MPH, a medical epidemiologist at the CDC whom Rich also mentored, “Jody exposed me to the fact that medicine and advocacy are political.” (Wolf and Vallabhaneni met working for Rich and ended up marrying. They have three kids; the middle name of their second child is Josiah.)
Allen traces his moral framework in part to the ethics instruction he received throughout his seven years at Brown, where “a hunger for social justice has long been the blood coursing through the system,” he says. “Brown has stated and set those goals, but it also recruits and retains students who are expecting that, who demand it.” (While the University discontinued its biomedical ethics concentration in the early 2000s, the Medical School weaves bioethics into its curriculum and offers a scholarly concentration in Medical Humanities and Ethics.)
“I blame Brown for making me a pain in the ass,” Allen says, all the while giving props to the place where he met his wife: he and Simmons married one month before their med school graduation. The daughter of a Mississippi civil rights leader, Simmons provided vital encouragement when Allen was weighing the risks to his family of blowing the whistle. She also shares his commitment to serving the underserved. In 2012 the two founded the Access Clinic, which provides primary care to adults with developmental disabilities (including their son, Miles, 28, who was born with a severe congenital abnormality).
Though the Biden administration ended family detention in 2021, news outlets reported in March of this year that Homeland Security is considering reinstating it. “What keeps Jody and me going,” Allen says, “is the understanding that on most days … the victories we’re aiming for might be unattainable, but the forces that are doing harm never sleep. So we can’t either.”