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WASHINGTON, DC, May 8, 2017 – New evidence has emerged of dangerously subpar medical care in United States immigration detention at a time when the Trump administration is seeking to increase its use, Human Rights Watch and Community Initiatives for Visiting Immigrants in Confinement (CIVIC), a group seeking to end immigration detention, said in a report released today.
The 104-page report, “Systemic Indifference: Dangerous & Substandard Medical Care in Immigration Detention,” reveals systemic failures, such as unreasonable delays in care and unqualified medical staff, that are likely to expose a record number of people to dangerous conditions under President Donald Trump’s ramped-up deportation and detention plans.
“The data reveals that people in immigration detention died needlessly under the Obama administration, even with its attempts at reform,” said Grace Meng, senior US researcher at Human Rights Watch. “The Trump administration has already announced its intent to roll back key reforms while detaining even more immigrants, which would likely mean more people will die needless and preventable deaths.”
The report is based on independent medical experts’ analyses of records from US Immigration and Customs Enforcement’s own investigations into 18 deaths in detention from 2012 to 2015, and the medical records of 12 additional people from 10 privately and publicly operated facilities across the country. Human Rights Watch also interviewed more than 90 people who are or were detained, as well as family members, attorneys, immigration advocates, and correctional health experts.
The medical experts found numerous incidents of substandard and dangerous medical care, including failure to follow up on symptoms that required attention; medical personnel apparently practicing beyond the scope of their licenses and expertise; severely inadequate mental health care; the misuse of solitary confinement for people with mental health conditions; and sluggish emergency responses. The experts agreed that such subpar care contributed to seven of the 18 deaths.
Among them was Raul Ernesto Morales Ramos, who died of organ failure with signs of widespread cancer in 2015, after being detained at Adelanto Detention Center in California. The two experts who reviewed the records from his death investigation found that there had been symptoms of widespread cancer two years earlier, but that they essentially went unaddressed until a month before he died. Throughout this time, Morales-Ramos repeatedly begged for care.
Tiombe Carlos, detained at York County Prison in Pennsylvania, died in 2013, in her second suicide attempt in the two-and-a-half years she was detained. Staff knew she had a mental health condition requiring substantial support, but failed to create a mental health treatment plan. One expert called the mental health care she received “woefully inadequate.”
ICE officials at Hudson County Correctional Facility in New Jersey told Human Rights Watch that registered nurses review requests for care and that everyone is seen within 24 hours. But the medical records of one man indicated that when he sought care for abdominal pain so strong that he wrote, “I cannot walk with the pain,” he was only seen a month later.
The experts emphasized that in several instances there was evidence of substandard medical practices that could put people throughout entire facilities at risk of serious harm, even if it did not necessarily contribute to the person’s death. In the case of one man who died in 2014, the ICE investigation found a licensed vocational nurse was attempting to record vital signs four weeks after the fact “from memory.”
“The sheer number and consistency of cases involving inadequate medical care point to a crisis that warrants immediate action,” said Christina Fialho, an attorney and the co-executive director of CIVIC. “The medical experts’ analyses confirm what we have been hearing from detained immigrants for years. It’s past time to put an end to the substandard medical practices that harm many people in immigration detention each year.”
Human Rights Watch and CIVIC concluded that the US government lacks effective means to monitor and correct these problems in facilities under its control. An audit of Eloy Detention Center in Arizona by ICE Enforcement and Removal Operations prior to a string of suicides stated there was appropriate policy and procedure for suicide intervention. However, successive death investigations conducted by the ICE Office of Detention Oversight after the suicides flagged the lack of a suicide prevention plan.
In addition, according to its annual report to Congress, the Department of Homeland Security’s Office of Civil Rights and Civil Liberties, an oversight body, sent ICE 49 recommendations to improve conditions at an unnamed facility in Arizona that is clearly Eloy. It took ICE two years to respond, and the civil rights office concluded that it had not responded appropriately to 30 of the recommendations. Dr. Marc Stern, a correctional health expert who reviewed all the documents in this report, concluded, “From the evidence that I saw in the cases that I reviewed, we have a system that is broken for detainee health care, and adding more detainees to that system can only make it worse.”
Other experts who reviewed records for Human Rights Watch are Dr. Allan Keller, an expert in access to health care for prisoners, and Dr. Palav Babaria, chief administrative officer of ambulatory services at Alameda Health System in Oakland, California.
The US currently detains about 40,000 people a day, or more than 400,000 per year, at an annual cost of US$2 billion. Many people in detention are blocked under US law from having a bond hearing to determine whether their detention is necessary. The Trump administration’s recent request for supplemental funding had included a request for $1.2 billion for increased detention capacity from the 34,000 beds to an unprecedented 45,700. It is likely some of the $1.5 billion for border security in the reported appropriation deal will be used for increased deportation and detention, and more funds are likely to be requested for the final fiscal year 2018 budget.
In California, which detains more immigrants than any state except Texas, a bill is pending that could improve conditions. Senate Bill 29, Dignity Not Detention, would require localities that hold immigrants in detention for the federal government to adhere to the 2011 Performance-Based National Detention Standards and make these standards enforceable by the California Attorney General’s Office and local district and city attorneys.
“The detention system was sprawling and bloated, with oversight mechanisms that had no teeth even before President Trump was elected,” Meng said. “True reform to protect the rights of the men, women, and children in immigration detention should include an overhaul of laws that often require detention for no good reason.”