[House Hearing, 110 Congress]
[From the U.S. Government Publishing Office]
DETENTION AND REMOVAL:
IMMIGRATION DETAINEE MEDICAL CARE
=======================================================================
HEARING
BEFORE THE
SUBCOMMITTEE ON IMMIGRATION,
CITIZENSHIP, REFUGEES, BORDER SECURITY,
AND INTERNATIONAL LAW
OF THE
COMMITTEE ON THE JUDICIARY
HOUSE OF REPRESENTATIVES
ONE HUNDRED TENTH CONGRESS
FIRST SESSION
__________
OCTOBER 4, 2007
__________
Serial No. 110-53
__________
Printed for the use of the Committee on the Judiciary
Available via the World Wide Web: http://judiciary.house.gov
______
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_____________________________________________________________________________
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COMMITTEE ON THE JUDICIARY
JOHN CONYERS, Jr., Michigan, Chairman
HOWARD L. BERMAN, California LAMAR SMITH, Texas
RICK BOUCHER, Virginia F. JAMES SENSENBRENNER, Jr.,
JERROLD NADLER, New York Wisconsin
ROBERT C. SCOTT, Virginia HOWARD COBLE, North Carolina
MELVIN L. WATT, North Carolina ELTON GALLEGLY, California
ZOE LOFGREN, California BOB GOODLATTE, Virginia
SHEILA JACKSON LEE, Texas STEVE CHABOT, Ohio
MAXINE WATERS, California DANIEL E. LUNGREN, California
WILLIAM D. DELAHUNT, Massachusetts CHRIS CANNON, Utah
ROBERT WEXLER, Florida RIC KELLER, Florida
LINDA T. SANCHEZ, California DARRELL ISSA, California
STEVE COHEN, Tennessee MIKE PENCE, Indiana
HANK JOHNSON, Georgia J. RANDY FORBES, Virginia
BETTY SUTTON, Ohio STEVE KING, Iowa
LUIS V. GUTIERREZ, Illinois TOM FEENEY, Florida
BRAD SHERMAN, California TRENT FRANKS, Arizona
TAMMY BALDWIN, Wisconsin LOUIE GOHMERT, Texas
ANTHONY D. WEINER, New York JIM JORDAN, Ohio
ADAM B. SCHIFF, California
ARTUR DAVIS, Alabama
DEBBIE WASSERMAN SCHULTZ, Florida
KEITH ELLISON, Minnesota
Perry Apelbaum, Staff Director and Chief Counsel
Joseph Gibson, Minority Chief Counsel
------
Subcommittee on Immigration, Citizenship, Refugees,
Border Security, and International Law
ZOE LOFGREN, California, Chairwoman
LUIS V. GUTIERREZ, Illinois STEVE KING, Iowa
HOWARD L. BERMAN, California ELTON GALLEGLY, California
SHEILA JACKSON LEE, Texas BOB GOODLATTE, Virginia
MAXINE WATERS, California DANIEL E. LUNGREN, California
WILLIAM D. DELAHUNT, Massachusetts J. RANDY FORBES, Virginia
LINDA T. SANCHEZ, California LOUIE GOHMERT, Texas
ARTUR DAVIS, Alabama
KEITH ELLISON, Minnesota
ANTHONY D. WEINER, New York
Ur Mendoza Jaddou, Chief Counsel
George Fishman, Minority Counsel
C O N T E N T S
----------
OCTOBER 4, 2007
Page
OPENING STATEMENTS
The Honorable Zoe Lofgren, a Representative in Congress from the
State of California, and Chairwoman, Subcommittee on
Immigration, Citizenship, Refugees, Border Security, and
International Law.............................................. 1
The Honorable Steve King, a Representative in Congress from the
State of Iowa, and Ranking Member, Subcommittee on Immigration,
Citizenship, Refugees, Border Security, and International Law.. 2
The Honorable John Conyers, Jr., a Representative in Congress
from the State of Michigan, and Chairman, Committee on the
Judiciary...................................................... 4
WITNESSES
Mr. Gary E. Mead, Assistant Director for Detention and Removal,
U.S. Immigration and Customs Enforcement, accompanied by
Timothy Shack, M.D., Medical Director, Immigrant Health
Services
Oral Testimony................................................. 5
Prepared Statement............................................. 7
Mr. Francisco Castaneda, former detainee
Oral Testimony................................................. 13
Prepared Statement............................................. 17
Ms. Edwidge Danticat, Author and Niece of Reverend Joseph
Danticat, deceased detainee
Oral Testimony................................................. 44
Prepared Statement............................................. 45
Ms. June Everett, sister of Sandra Kenley, deceased detainee
Oral Testimony................................................. 47
Prepared Statement............................................. 49
Mr. Tom Jawetz, Immigration Detention Staff Attorney, ACLU
National Prison Project
Oral Testimony................................................. 53
Prepared Statement............................................. 56
Mr. Allen S. Keller, M.D., Associate Professor of Medicine, New
York University School of Medicine
Oral Testimony................................................. 61
Prepared Statement............................................. 63
Ms. Cheryl Little, Executive Director, Florida Immigrant Advocacy
Center
Oral Testimony................................................. 68
Prepared Statement............................................. 71
APPENDIX
Material Submitted for the Hearing Record........................ 119
DETENTION AND REMOVAL:
IMMIGRATION DETAINEE MEDICAL CARE
----------
THURSDAY, OCTOBER 4, 2007
House of Representatives,
Subcommittee on Immigration, Citizenship, Refugees,
Border Security, and International Law
Committee on the Judiciary,
Washington, DC.
The Subcommittee met, pursuant to notice, at 1 p.m., in
Room 2141, Rayburn House Office Building, the Honorable Zoe
Lofgren (Chairwoman of the Subcommittee) presiding.
Present: Representatives Lofgren, Berman, Sanchez, Conyers,
and King.
Staff Present: Ur Mendoza Jaddou, Majority Chief Counsel;
David Shahoulian, Majority Counsel; Andrea Loving, Minority
Counsel; and Benjamin Staub, Professional Staff Member.
Ms. Lofgren. I would like to welcome the Subcommittee
Members, our witnesses, members of the public to the
Subcommittee's hearing on immigration detainee medical care.
According to the General Accountability Office, GAO, nearly
300,000 men, women and children were detained by Immigration
and Customs Enforcement, otherwise known as ICE, in 2006,
tripling the amount of 2001 when less than 100,000 were
detained.
With a large increase of detainees in ICE custody, it is
incumbent upon this Congress to ensure that ICE is properly
executing its responsibility of providing safe and humane
treatment of detainees in their custody.
Recent reports suggest that ICE is not doing its job. In
just the last few years, there have been several reports of
individuals detained by ICE that suggest unsafe and inhumane
treatment in ICE in contracted detention facilities.
For example, the Boston Globe recently reported the case of
a man who died in ICE custody due to epilepsy complications
despite the fact that his sister twice attempted to provide
necessary medication to detention officials, according to his
family. His sister says she was turned away both times.
Another reported case involves Victoria Arellano, who was
taken off HIV drugs while in custody and subsequently died
after serious complications and lack of appropriate medical
care for several months. Reports indicate that fellow inmates
tended to as much care as they could possibly provide on their
own and repeatedly informed detention officials of Arellano's
illness.
These and other cases have spawned questions from several
Members of Congress, but so far few answers have been provided.
There are two critical questions I hope we can address
today. First, are the medical care standards employed by ICE
satisfactory so as to create an environment that supports safe
and humane treatment of individuals in ICE custody? Second, if
those standards are adequate, are they being implemented in an
appropriate manner?
After a preliminary review of the standards and the various
reports on the administration of medical care, it appears we
could have problems on both levels.
The DIHS Medical Dental Detainee Coverage Services Packet
specifically states that medical care in ICE detention
facilities is to be provided primarily for emergency care. Care
for, and I quote, ``accidental or traumatic injuries incurred
while in the custody and acute illnesses is not required but
simply reviewed for appropriate care. Care for other illnesses,
including pre-existing illnesses that are serious but not life
threatening, is also not automatic but simply reviewable for
appropriate care.''
Furthermore, these reviews are conducted in Washington,
D.C. by nurses, not physicians, who are away from the patients
and simply reviewing paperwork submitted by other health care
professionals recommending such care.
With this policy, it is no wonder there are reports of
unsafe and inhumane medical treatment in ICE custody. This
policy fails to recognize a fundamental principle of medical
care in detention. The patient is detained and there is no
other option but care authorized by ICE. Yet the policy only
ensures emergency care and considers other care even in serious
cases on a case-by-case basis.
I hope that today's hearing will help us further understand
and clarify the problems that exist in providing medical care
to those in ICE custody so that we may begin to find solutions
to what appears to be a very serious problem.
I would now recognize our distinguished Ranking Member,
Congressman Steve King, for his opening statement.
Mr. King. Thank you. First, I want to tell you and thank
you on your willingness to work together and to ensure that
U.S. Immigration and Customs Enforcement has the opportunity to
give its side of the story at the same time as the statements
made by the other witnesses are made here and an opportunity to
respond and rebut if necessary.
Earlier this week I was concerned that ICE wouldn't get
that opportunity, but they will have today, and I appreciate
that.
We all agree that when a person is in Government custody,
he or she should receive adequate medical care. The issue
before us today is whether or not ICE detainees are receiving
that adequate medical care. Since American taxpayers pay over
72 million each year for ICE detainee health care, we should
ensure that the care is cost effective and that it is
competent.
Much has been made in media reports about the number of
detainee deaths while in ICE custody. And so I began to ask
some questions about that, and I think it has been reported
that 25 deaths in ICE custody for the fiscal year 2004, 16
deaths in the fiscal year 2005, 17 deaths under ICE custody in
2006 and 11 in fiscal year 2007, although that may go up
because I don't think we actually have the final number on
that. But when you look at the total number of ICE detainees in
those years, it means the chance of death in 2004 while under
ICE custody was one in 8,196.
And in 2005 it was one in 12,912. In 2006 it was one in
13,288 and so far in 2007 the chance of death while in ICE
custody one in 23,146.
Those numbers don't mean very much, Madam Chair, until you
compare them then to the death rate in our Federal Bureau of
Prisons, which is one in 603 for 2006, one in 761 in 2007. The
State prison death rate was one in 466 in 2005 and one in 464
in 2004, one in 459 in 2003.
But finally the death rate in local prisons was as high as
one in 1,519 in 2005, one in 1,376 in 2004 and one in 1,425 in
2003.
And so I will recognize that this is a total number of
inmates that have passed through these institutions during
these periods of time. And I will recognize that there is a
faster turnover during ICE incarceration than certainly our
Federal penitentiary and certainly for our local institutions,
but, regardless, when you make adjustments for that, it appears
that the fatalities under ICE are--if they are atypical of that
under other institutions, they appear that they are lower. And
so those odds of death are safer in ICE institutions, by these
statistics at least.
And in December of 2006, DHS Inspector General issued a
report in which he found instances of noncompliance with ICE
detention medical standards at four of the five detention
facilities that were studied.
After that, ICE convened a working group to review the
national standards and detention management control worksheets.
The working group made several recommendations with ICE, and--
that ICE is continuing to implement. Many of the ICE detention
centers have more than adequate medical facilities. I have a
couple of posters that will be on display down here that show
the type of facilities at some of these centers. They seem to
have updated equipment and respectable personnel.
I would just like to mention one additional point. The
death rates for ICE detainees do not even come close to the
accidental and illness death rates of those serving in the
active duty U.S. Military. For instance, in 2006, one in 2,004
military personnel died by accident or illness. And in 2005,
that was one in 1,509. And in 2004, it was one in 1,614.
So I think we need to take an objective look at this. Yes,
we have a responsibility, as this Congress has accepted
sometime well over 100 years ago, to provide quality health
care for the inmates in all of our institutions, including the
ICE detention centers, and I just ask that we want to see ICE
meet those standards, meet their own guidelines, have a system
in place to have that check on services that are provided, and
then put it in the perspective of the fact that people don't
live forever and they die in some places, and if there are
reasons for that for a single individual, we ought to look into
that, but I don't see at this point that the statistics support
the idea that there is an endemic flaw in the ICE health care.
So I am interested in the testimony, and Madam Chair, I
appreciate this hearing, and I would yield back the balance of
my time.
Ms. Lofgren. I would now like to recognize the Chairman of
the Committee, Mr. Conyers, for his opening statement.
Mr. Conyers. Thank you, Madam Chairwoman.
This is an important hearing. I am still complaining about
the fact that immigration ended up in the Department of
Homeland Security, but I am trying to give it up with some
grace.
I am drawn to this hearing not only by the fact that
immigration detention deaths are being examined out of the
Immigration Customs Enforcement, but the fact that we have a
Haitian presence here today. I am really pleased that we have
got attorney Cheryl Little, who has been working in this area
and is the head of the Florida Immigrant Advocacy Center for so
many years.
When I first began going to Haiti, I was in touch with the
lawyers and other leaders that were working with her on the
Haitian immigration crisis. Today, we have the pleasure of
having her before us and also to have the distinguished writer,
Ms. Edwidge Danticat, a Haitian of great distinction in terms
of our literary contributions. I am very pleased that she is
here as well.
Now for me, this coincides perfectly because I am going to
Haiti this weekend, and I will be joining Dr. Ron Daniels of
New York and many others there. This plays into an issue, and
hovering in this background is this double standard on
immigration policy with reference to Haitians that come to this
country.
There are two policies: There is a standard and then there
is the Haitian policy. And counsel for Ms. Lofgren advises me
that we are putting together a very close examination of what
these two different policies are and what they mean.
This hearing is important to me for all of those reasons,
and I will ask unanimous consent to put my written remarks into
the record.
And thank you.
Ms. Lofgren. Without objection, so ordered.
If the Ranking Member of the full Committee comes, he would
certainly also be permitted to submit his statement.
We have been called away to votes on the floor of the
House, and so we are going to go and comply with our obligation
there.
I would just like to note that under the rules of this
Committee, testimony is due to the Committee 48 hours in
advance. Sometimes people are a little bit late but I will note
that what the Government handed me was still hot when I got it
coming in here, and I recall when Jim Sensenbrenner chaired the
Immigration, chaired the Judiciary Committee and the head of
then INS came and did the same thing, he refused to let him
testify.
Now there has been a discussion. The minority is saying are
we going to allow this. My inclination would be to allow it,
but to note that this really falls way below what we expect of
our witnesses and especially the Government with all of the
resources.
So we are going to sort this out. We will have our staffs
discuss it and make sure we are all on the same wavelength.
We are going to recess the hearing until a certain time so
people can go get a cup of coffee or something, not just sit in
the room, and we will try and be back here about 2:30, and so
we will see you all then.
And we are in recess until 2:30.
[Whereupon, at 1:20 p.m., the Subcommittee was in recess,
to reconvene at 2:30 p.m., this same day.]
[2:40 p.m.]
Ms. Sanchez. [Presiding.] In the interest of time, I want
to apologize to our witnesses, we have no control over the vote
schedule. But I appreciate your patience. And because of our
busy schedules and the fact that more votes are likely to be
called, I would ask that other Members submit their written
statements for the record.
Without objection, all opening statements will be placed
into the record.
Without objection, the Chair is authorized to declare a
recess of the hearing at any point.
We have two distinguished panels of witnesses here today to
help us consider the important issues before us. I am pleased
to welcome Gary Mead, the assistant director of management in
the Office of Detention and Removal Operations at Immigrations
and Customs Enforcement. Prior to joining ICE in 2006, Mr. Mead
served with the U.S. Marshal Service. He worked as the
associate director for administration, the associate director
for operations support, and the assistant director for
management and budget. He holds his bachelor's degree from the
State University of New York, a master's from Bowling Green
State University, and graduated from the management program of
the National Defense University here in Washington. Welcome,
Mr. Mead.
Mr. Mead is joined by Dr. Timothy Shack, medical director
at the Immigrant Health Services to assist in responding to any
questions that we may have for Mr. Mead.
Mr. Mead and Dr. Shack, again, thank you for joining us. We
have just gotten a bell, but I am going to ask you to go ahead
and begin your testimony because I think we should be able to
accommodate your testimony before we head across for votes.
At this time I would invite you to give us your oral
testimony.
TESTIMONY OF GARY E. MEAD, ASSISTANT DIRECTOR FOR DETENTION AND
REMOVAL, U.S. IMMIGRATION AND CUSTOMS ENFORCEMENT, ACCOMPANIED
BY TIMOTHY SHACK, M.D., MEDICAL DIRECTOR, IMMIGRANT HEALTH
SERVICES
Mr. Mead. Thank you, Madam Chairman and distinguished
Members of the Subcommittee, it is my privilege to appear
before you to discuss the medical care of immigration
detainees.
DRO's core mission is the apprehension, detention, and
removal of deportable aliens. In carrying out our mission, one
of our highest priorities is to provide the best possible
health care to those in our custody.
DRO partners with the U.S. Public Health Service's Division
of Immigration Health Services to provide detainee health care.
DIHS includes more than 600 doctors, nurses, and other health
care professionals. During fiscal year 2007, DRO spent almost
$100 million on detainee health care to ensure the highest
quality health care, DIHS medical facilities must be in
compliance with the applicable health care standards from the
American Correctional Association, the National Commission on
Correctional Health Care, the Joint Commission, and the ICE
National Detention Standards.
During fiscal year 2007, approximately 300,000 individuals
passed through ICE custody. Approximately 25 percent of these
detainees had chronic health care problems including
hypertension and diabetes. Many of these detainees first
learned of these conditions as a result of the health screening
and medical exams they received while being processed into
custody. They received the appropriate medical treatment for
their conditions that they would otherwise not likely have
received.
ICE health care policy requires that all detainees receive
an initial health screening upon arrival at a detention
facility to determine the appropriate medical, mental health,
or dental treatment that is needed. Included in this process is
either a chest x-ray or a skin test for TB. Immediate attention
is provided to those detainees who present a danger or
immediate risk to themselves or others, such as infectious
diseases, uncontrolled mental health disorders, or conditions
that would deteriorate if not immediately seen by medical
personnel.
Detainees also receive a physical examination within 14
days of arrival to identify medical conditions requiring
monitoring or treatment. A detainee with a medical condition
requiring followup treatment will be scheduled for as many
appointments as needed, including to outside medical providers
or facilities.
ICE standards also require that all detainees have access
to sick call. Procedures are in place to ensure that all sick
call slips are received by the health care service provider in
a timely manner. All facilities are required to have regularly
scheduled times when medical personnel will be available to see
detainees. In emergencies, medical staff or 911 are called
immediately.
During fiscal year 2007, as of June 30, DIHS completed more
than 518,000 total medical visits, including 138,000 intake
screenings, 12,000 dental visits, 16,000 mental health visits,
41,000 short stay unit visits, 134,000 chronic disease visits,
64,000 physical exams, 71,000 sick call visits. By July 31 of
last fiscal year, DIHS had filled more than 170,000
prescriptions and completed more than 427,000 pill line
distributions. By the end of August 2007, DIHS had completed
more than 124,000 x-rays.
The DIHS managed care program has a benefit package
described in the health care services available to all ICE
detainees. The services address imminent threats to life, limb,
hearing, or sight, rather than elective or nonemergency
conditions. Conditions that would cause suffering or
deterioration of a detainee's health are also covered. This
program has a network of more than 500 hospitals, 3,000
physicians, and 1,300 other health care facilities that provide
a wide range of medical services.
Detainees who require medical care beyond what can be
provided at the detention facility access that care through
treatment authorization requests. TARs are submitted to the
DIHS managed care program. More than 40,000 TARs are submitted
each year. The average turnaround time for a TAR is 1.4 days,
with 90 percent being approved. Specialized procedures
regularly approved through the TAR process include heart
surgery, cancer treatment, dialysis, and a variety of general
surgical procedures including gallbladder, appendicitis, and
orthopedics.
Before I conclude, I would like to make a few quick
comments regarding detainee deaths. During the past 4 years,
approximately 1 million people have passed through our custody.
Unfortunately, 66 have died. We are always saddened by the
death of a detainee. DRO reports all death to the Office of
Professional Responsibility, the DHS Office of the Inspector
General, local medical authorities or coroners who frequently
perform autopsies. DIHS also conducts an independent review of
all custody deaths.
I would like to thank you, Madam Chairman and Members of
the Subcommittee, for the opportunity to appear before you
today, and I look forward to answering any questions you may
have.
[The prepared statement of Mr. Mead follows:]
Prepared Statement of Gary E. Mead
Good afternoon, Chairwoman Lofgren and distinguished Members of the
Subcommittee. My name is Gary Mead, and I am the Assistant Director of
Detention and Removal Operations (DRO) at U.S. Immigration and Customs
Enforcement (ICE). It is my privilege to appear before you to discuss
the medical care and treatment of immigration detainees.
DRO's core mission is the apprehension, detention, and removal of
inadmissible and deportable aliens. In carrying out our mission, one of
our highest priorities is to provide the required health care to those
in our custody. We take this responsibility very seriously and have
created an outstanding detainee health care program, of which we are
very proud.
DRO partners with the U.S. Public Health Service's (PHS) Division
of Immigration Health Services (DIHS) to provide or arrange health care
for ICE DRO detainees. DIHS staff consists of more than 600 doctors,
nurses, and other health care professionals. During Fiscal Year 2007,
DRO spent almost $100 million on detainee health care.
To ensure the highest quality of health care delivery services,
DIHS medical facilities must be in compliance with applicable health
care standards from the American Correctional Association (ACA), the
National Commission on Correctional Health Care (NCCHC), the Joint
Commission, and the ICE National Detention Standards.
During Fiscal Year 2007, approximately 300,000 individuals passed
through ICE custody.
At a minimum, two examinations must be performed on every detainee.
It should be noted that approximately 25% of these detainees have
chronic health care problems, including hypertension and diabetes. Many
of these detainees first learn of these conditions as a result of the
health screening and medical examinations they receive while being
processed into custody. They then receive the appropriate treatment for
their condition that they would have otherwise not likely have
received.
ICE health care policy requires that all detainees receive an
initial health screening immediately upon arrival at a facility to
determine the appropriate medical, mental health, and/or dental
treatment that is needed. Included in this process is either a chest x-
ray or skin test for tuberculosis. Immediate attention is provided to
detainees who present a danger or an imminent risk to themselves or
others, such as infectious diseases, uncontrolled mental health
disorders, or conditions that would deteriorate if not addressed
immediately by medical personnel.
In addition to the initial health care screening, ICE policy also
requires that detainees receive a health appraisal and physical
examination within 14 days of arrival to identify medical conditions
that require monitoring or treatment. A detainee with a medical
condition requiring follow up treatment will be scheduled for as many
appointments as needed. Scheduled visits include appointments made in
advance for ambulatory care or specialty care clinics. Unscheduled
visits are performed as needed to attend to emergent or urgent
conditions.
During screenings, evaluations, and visits, a medical professional
assesses the detainee's health and treatment requirements and arranges
any medications, consultations, or other services needed. If language
difficulties prevent the health provider or officer from directly
communicating with a detainee for purposes of completing a medical
screening or health evaluation, the officer is required to obtain
translation assistance. ICE most commonly provides translation services
through our contracts with AT&T and Languages Services Associate, Inc.
In addition to the initial screening and medical evaluation, the
ICE standard on Medical Care requires that all detainees, regardless of
classification, have access to sick call. Detainees have the
opportunity to request health care services provided by a physician or
other qualified medical officer in a clinical setting. Procedures are
in place to ensure that all request slips are received by the health
service provider in a timely manner.
The sick call process allows detainees to access non-emergent
medical services, and all facilities are required to have regularly
scheduled times when medical personnel will be available to see
detainees who have requested services. For emergent or urgent medical
services, detainees may notify a correctional officer or other facility
personnel at any time that a problem occurs, and medical staff or 911
will be called immediately.
In Fiscal Year 2006, DIHS staff had more than 491,000 detainee
visits. These visits included 16,000 dental, 17,000 mental health,
28,000 short stay unit visits, 150,000 chronic disease visits, 54,000
physical exams, 61,000 sick call visits, and 327,000 pill line
distributions. DIHS also completed more than 103,000 chest x-rays
during intake screening.
As of June 30, 2007, DIHS showed an increase in total caseload with
more than 518,000 total visits, broken down as 138,000 intake
screenings, 12,000 dental, 16,000 mental health, 41,000 short stay unit
visits, 134,000 chronic disease visits, 64,000 physical exams, 71,000
sick call visits, and 427,000 pill line distributions.
Medical care provided at each detention facility also includes
access to necessary prescription medications. Prescriptions written for
detainees by the health service provider are filled either by an on-
site pharmacy or by a local community pharmacy. If a prescription
medication is not readily available and a detainee has a supply of the
medication needed or can obtain a supply of the medication from a
family member, that medication may be used as long as the facility's
medical staff can verify the validity of the medication to ensure it is
appropriate for the detainee to take and to prevent contraband from
entering a facility. By July 31, DIHS had filled more than 170,000
prescriptions, already exceeding the more than 136,000 prescriptions
filled in Fiscal Year 2006. By the end of August 2007, DIHS had
completed more than 124,000 chest x-rays.
The ICE Medical Program has an established covered benefits package
that delineates the health care services, medical products and
treatment options available to any and all detainees in ICE custody.
The ICE covered services package emphasizes that benefits are provided
for conditions that pose an imminent threat to life, limb, hearing or
sight, rather than to elective or non-emergent conditions. Medical
conditions which the local treating physician believes would cause
suffering or deterioration of a detainee's health are also assessed and
evaluated through the DIHS Managed Care Program. The DIHS Managed Care
Program has a network of more than 500 hospitals, 3000 physicians, and
1300 other health care facilities that provide a wide range of medical
care and services.
Detainees who require medical care beyond what can be provided at
their detention facility, access that care through Treatment
Authorization Requests (TARs), which are submitted to the DIHS Managed
Care Program. More than 40,000 TARs are submitted each year. The
average turnaround time for a TAR is 1.4 days with 90 percent of
requests being approved. Specialized procedures regularly approved
through the TAR process include heart surgery, cancer treatment,
dialysis, and a variety of general surgical procedures including gall
bladder, appendicitis, and orthopedics. In fiscal year 2006, there were
465 hospital admissions.
Before I conclude, I would like to make a few comments regarding
ICE detainee deaths. During the past four years approximately 1 million
persons have passed through our custody. Unfortunately, 64 have died.
We are always saddened by the death of a detainee in our custody.
DRO reports all detainee deaths to the ICE Office of Professional
Responsibility (OPR) and the DHS Office of the Inspector General (OIG)
so that they have an opportunity to determine if an investigation into
the circumstances of the detainee's passing is warranted. Deaths are
also routinely referred to the local medical examiner or coroner's
office who will conduct an autopsy if required. DIHS also conducts an
independent review of all in-custody deaths.
While a single death of an ICE detainee is serious matter, the ICE
Detainee Health Program has an overall death rate that is well below
those in comparable detention or correctional settings. ICE detainee
death rate per 100,000 detainees, based on the number of detainees
booked into custody per Fiscal Year, was ten deaths in Fiscal Year
2004; seven deaths in Fiscal Year 2005; and seven deaths in Fiscal Year
2006. The comparatively low death rate among ICE detainees is
remarkable, given that many of the ICE detainees have a history of poor
or no health care before coming into ICE's custody.
In conclusion, our comprehensive detainee health program is based
on state of the art medical care, sound management, continuous review
and process improvement. DIHS staff consists of highly motivated
correctional health care professionals who are dedicated to providing
high quality services. The scope of ICE's medical services and
operational processes is continually monitored by both internal and
external healthcare experts with the ultimate goal of providing the
best possible health care to those in our custody. As I mentioned at
the start of my statement, the well being of our detainees is among our
highest priorities and we take this responsibility very seriously.
I would like to thank you, Ms. Chairwoman and Members of the
Subcommittee, for the opportunity to appear before you today, and I
look forward to answering any questions you may have.
Ms. Sanchez. Thank you for your testimony, Mr. Mead.
Unfortunately, the bells beckon and we have votes on the floor.
I think this is a natural point in time to take a break to head
over for votes. When we come back, we will begin with
questioning, and we appreciate that both of you will be
available for that. Again, I beg your indulgence and I
recognize your patience, and we will be back from voting as
quickly as possible.
We stand in recess.
[Recess.]
Ms. Lofgren. [Presiding.] The Subcommittee will come back
into order.
At this point I understand that the testimony has been
concluded, and we will go into questions for our witnesses; and
I would turn first to the Ranking Member, Mr. King, for his 5
minutes of questions.
Mr. King. Thank you, Madam Chair.
And, Mr. Mead, thanks for your testimony.
As I look through some of the material that you provided
preliminarily to your testimony being submitted, I notice here
that of the--in this material, it says 27,500. I think you
testified 30,000 would be the number of beds that are available
in a given year. So that would be the snapshot of the number of
inmates that you could max out at.
I am presuming that. I will let you define that more
precisely in a moment.
But as I also look at this information, it says 65 percent
are located in State and local prison jail facilities, 19
percent are in commercial contract facilities and 14 percent
are in ICE-owned service processing centers; that leaves
another 2 percent there for the Federal Bureau of Prisons.
My question is, of these fatalities that are the subject of
this hearing, how many of those fatalities took place in the
State and local prisons that are--represent the 65 percent of
the overall inmates; how many took place in ICE commercial--in
the commercial facilities; how many took place in ICE
facilities? Can you break that down?
Also, I would presume that the medical care in those State
and local-run facilities--at 65 percent, I would presume that
medical care would be identical to that of the other inmates
that are incarcerated in the same facilities.
Could you shed some light on those components as part of
the question that I have asked you?
Mr. Mead. Yes.
Off the top of my head, I can't break down those 66 between
State and local contract or Government-owned and operated, but
the 66 were the total deaths from everyone in our custody.
The State and local facilities in most cases come under the
same accreditation requirements as the Federal facilities do,
and they answer to State authorities, county authorities; and
many, as I said, have exactly the same accreditation as ours.
In addition, when it comes to housing our detainees, they
must be in compliance with our ICE detention standards; and
those detention standards are applied to our own facilities,
our contract facilities, and the State and local facilities.
So you are correct that the care received across the board
is relatively consistent.
Mr. King. Do those health care practitioners, though, in
our State and those that--of that 65 percent, say, primarily in
our State institutions and the local, are they the same health
care providers in most instances as they are for the other
inmates in the same institution?
Mr. Mead. Yes. Whatever health care program county inmates,
for example, are afforded and whoever is providing that health
care--our detainees are ICE detainees--get the same medical
program.
Mr. King. Then if there is an issue here of, I will say, an
unusual number of deaths, which I don't know that the
statistics support--if there is an issue here, wouldn't it be
an issue then that cast that same question for the balance of
the inmates within those facilities that two-thirds of the ICE
inmates are incarcerated in?
Mr. Mead. Yes. If there were an aberration there, it would
be applied across the same or the entire population at that
county facility, because our detainees do not get special
health care while in there.
However, if there is health care required beyond what the
county jail can provide, we do manage that centrally through
DIHS, and we can remove them from that facility and provide
health care elsewhere. And it is not a reflection on the
county; it is just a reflection on what their----
Mr. King. I will submit at least one question to be
answered after this hearing, at least one, and that one will be
the question that asks you to break down those deaths into
those categories which are ICE facilities and those which are
ICE-approved facilities.
Within those actually four different categories, I ask you,
do those deaths include suicides or homicides?
Mr. Mead. They include suicides; and during the past 4
years, we have not had a homicide.
Mr. King. Can you tell me how many are suicides out of the
66?
Mr. Mead. I would say it is approximately 13 over the past
4 years. I can confirm that after the fact, but I would say it
is about 13.
Mr. King. Thirteen of 66. And then the numbers that show
the deaths for 2007 shows 11 with the data that I have. Is that
a current number and does that complete the fiscal year?
Mr. Mead. As far as I know, that completes the fiscal year.
Mr. King. So that would indicate the numbers that trend--I
shouldn't say ``trend'' because we only have a 4-year snapshot
for me, 16, 17 and then one number larger than that down to 11.
If one could draw a trend, that would indicate that it is going
at least in a positive direction.
Mr. Mead. Yes, sir.
Mr. King. I would make that point.
And then, as you transition, you have also written
information here that shows a number, about 254,000 total, that
were processed by ICE, and your testimony says 300,000.
What is the right number?
Mr. Mead. Hopefully, the 254 would have either been the
last fiscal year or a year-to-date number. Our 2007 number in
terms of passing through our custody is approximately 300,000.
Mr. King. And these inmates are being processed through--it
takes time to process them. If you could process them more
quickly, would that have an effect on the number of inmate
deaths that you have?
Mr. Mead. Conceivably, the average length of stay in our
custody would be a factor, certainly on illnesses that are,
what, related to longer term care.
Mr. King. Mr. Mead, I would just ask you to reflect upon--
you heard my opening statement with regard to the number of
deaths in our U.S. military, nonrelated to hostilities, and
those numbers being higher than the numbers of the inmates in
ICE care; and the balance of the statistics that were part of
that opening statement that I made, how do you explain that--
that, apparently, if your interest is to improve the
statistical odds of your survival, joining the military in a
time not of war seems to be statistically, or being a part of
a--let me just say that compared to being an ICE inmate--I
would like to hear you respond to that.
Mr. Mead. I am not in a position to comment on the military
issue, but the ICE health care program is an extremely robust
program.
We do a lot of screening. As I mentioned in my opening
statement, last year DIHS completed over 500,000 medical visits
for the detainees in our custody. Many of our detainees receive
almost daily attention.
So it is an aggressive program, and we do everything
possible to maintain the best quality of life for the detainees
in our custody.
Mr. King. Thank you.
Madam Chair, I yield back.
Ms. Lofgren. I will be very brief because I know we have
another panel that has been waiting all afternoon. I just want
to make one comment, and I will have one question.
Before I was in Congress, I served on the Board of
Supervisors in Santa Clara County, the fourth largest county in
California, and one of my jobs was to oversee the county jail,
then one of the largest jails in America. And a major focus was
the medical care that needed to be provided because once you
have somebody in custody, it is all on you. They can't go to
another doctor.
You take up whether they are charged with murder or
jaywalking, you have the same obligation for their care. And I
would just note that when I was in charge of that, we didn't
have to call Washington, D.C., to get permission for treatment
of an inmate in the county jail as the--as is the case for ICE
detainees.
So to say the two populations are being treated the same,
simply is incorrect and I think very misleading. I would also
like to note some skepticism that I have about your testimony.
On page 6 you note that the DRO reports all detainee deaths
to the ICE Office of Professional Responsibility and the DHS
Office of the Inspector General. However, we have a letter from
the Inspector General of DHS to Senator Dayton, just last year,
1 year ago, where he pointed out--and I won't mention the
woman's name because I don't know whether there is a privacy
issue--but Ms. X had died, but we were unaware of her death
until the complaint was received from the complainant some
number of months later. So I guess it makes me skeptical about
the testimony that you have given to us.
And finally, I have this question: For the deaths that are
reported, does it include individuals who are released and then
expire for the lack of treatment they received in custody or
only those who die while they are actually in your facilities?
Mr. Mead. Well, not necessarily in our facilities. They
could still be in our custody and at a hospital, but those who
die later are not included.
Ms. Lofgren. And the stories that we have, it is not years
later; it seems to be a direct cause of the neglect received in
the facility.
At this point--my time has not expired, but it is already
3:30, and there are no other Members to ask, I would thank you
for being here for your testimony. Note that the record is open
for 5 days and additional questions may be forthcoming, and if
they are, we would ask that you answer them promptly.
Thank you very much. I thank all of you for your
willingness to be here today and for your patience for all of
the votes that we had on the floor.
We will now call the next panel.
Seated first on the panel, we would like to extend a warm
welcome to Francisco Castaneda, a former ICE detainee. Mr.
Castaneda immigrated to the United States from El Salvador with
his family in 1982 at the age of 10 to escape that nation's
civil war.
His family moved to Los Angeles where he went the school
and began working at the age of 17.
Mr. Castaneda has a 14-year-old daughter, who is with us
here today, and has celebrated his 12th anniversary with his
girlfriend, Cynthia.
He entered ICE's custody in March of 2006 and will tell us
about it.
Next, we are joined by Edwidge Danticat, the renowned
American author and niece of the Reverend Joseph Danticat, a
deceased detainee. She was born in Haiti and moved to the
United States to join her family at the age of 12.
She has written several critically acclaimed books
including Breath, Eyes, Memory, an Oprah Book Club section;
Krik!Krak!, a National Book Award finalist; and the Farming of
Bones, an American Book Award winner. She earned her bachelor's
degree from Barnard College and her MFA from Brown University.
I would like to extend a welcome to June Everett, the
sister of Sandra Kenley, a deceased ICE detainee. Ms. Everett
and her sister grew up in Barbados. Ms. Kenley raised Ms.
Everett and her two other siblings while their mother worked to
provide for their family.
Ms. Everett, a U.S. Citizen, currently resides outside of
Washington in New Carrollton, Maryland, and has become an
advocate for ICE detainee family members since her sister's
death.
Next, I am pleased to introduce Tom Jawetz, an immigration
detention staff attorney with the American Civil Liberties
Union.
Prior to his work as an immigration detention staff
attorney, Mr. Jawetz worked on the ACLU's National Prison
fellowship and the Immigrant and Refugee Rights Project at the
Washington Lawyers Committee for Civil Rights and Urban
Affairs. He clerks for U.S. District Court Judge Kimba Wood of
New York and served as an AmeriCorps member in South Carolina.
Mr. Jawetz graduated with honors from both Dartmouth
College and the Yale University School of Law.
I am also pleased to welcome Dr. Allen Keller, an Associate
Professor of Medicine at the New York University School of
Medicine and Director of the Bellevue/NYU Program for Survivors
of Torture.
Dr. Keller also directs NYU's School of Medicine Center for
Health and Human Rights, chairs the policy committee of the
National Consortium of Torture Treatment Programs and served on
the American College of Physicians Ethics and Human Rights
Committee. He additionally worked as a source advocacy fellow
with Human Rights First and led a study on asylum seekers at
the request of the U.S. Commission on International Religious
Freedom.
He completed his medical education and residency at NYU and
served as the hospital's Chief Resident in the early 1990's.
And finally we would like to welcome Cheryl Little,
the Cofounder and Executive Director of Florida Immigrant
Advocacy Center, or FIAC. FIAC, based in Miami, provides free
legal assistance to immigrants of all nationalities.
Ms. Little began her career in immigration law with the
Haitian Refugee Center after graduating with her bachelor's
degree from Florida International University and her law degree
with honors from the University of Miami's School of Law.
Well, thank you all for your willingness to tell us your
stories and to give us your information and share your
expertise. Each of your written statements will be made part of
the record in its entirety.
We would ask that you summarize your testimony in about 5
minutes, and there is a machine that is not--it is hidden but
when 4 minutes have gone by, a yellow light will go on. That
means you have got 1 minute more. When the red light goes on,
it means your time is up; and we would ask, if at all possible,
you summarize so we can hear the other witnesses. And then we
will have questions.
So we will start, if we could, with Mr. Castaneda for your
5 minutes of testimony.
TESTIMONY OF FRANCISCO CASTANEDA, FORMER DETAINEE
Mr. Castaneda. Good afternoon. Thank you to the Chairwoman
Lofgren for inviting me to----
Ms. Lofgren. Could we move the mike?
Mr. Castaneda. Thank you to the Chairwoman Lofgren for
inviting me and to the Immigration Subcommittee for holding
this hearing.
My name is Francisco Castaneda. I was held in immigration
detention over 2 months and was just released this past
February, due to my medical condition, after many letters from
the ACLU were sent on my behalf.
First, I would like to tell you a little bit about myself.
I am 35 years old. I came to the United States from El
Salvador with my mother and siblings when I was 13 years old to
escape from the civil war. My family moved to Los Angeles where
I went to school and began working at the age of 17. My mother
died of cancer when I was pretty young before she was able to
get us legal immigrant status.
After my mom died, I looked to my community for support and
found myself wrapped up in drugs instead, which today I deeply
regret. I worked doing construction up until I went to prison
on a drug charge, where I spent just 4 months before I was
transferred into ICE detention.
When I entered ICE custody at the San Diego Correctional
Facility in March 2006, I immediately told them I had a very
painful lesion on my penis. After a day or two, Dr. Walker
examined me and recognized that the lesion was a problem. He
said he would request that I see a specialist right away. But
instead of sending me directly to a specialist, I was forced to
wait and wait and wait.
All the while, my pain got worse. I started to bleed even
more and it smelled really bad. I also had discharge coming out
of it. Dr. Walker submitted a request to the Division of
Immigration and Health Service. After more than a month, it was
finally granted.
When I saw an oncologist, he told me it might be cancer; I
needed a biopsy. He offered to admit me to a hospital. He
admitted me for the biopsy, but ICE refused to permit a biopsy
and told the oncologist that they wanted to try a more cost-
effective treatment.
I was then referred to a urologist, but I only got to see
the urologist 2\1/2\ months later, after I filed a request and
a grievance with ICE. The urologist said I needed an incision
to remove the lesion and stop the pain and bleeding, and also
said I needed biopsy to figure out if I had cancer. ICE and the
Division of Immigration Health Services never did either of
those things. They said that it was ``elective surgery.''
My pain was getting worse day by day. When you are in
detention, you can't help yourself. I tried to get medical help
every day. Sometimes I would show the guards my underwear, the
blood on it, to get them to take me to medical; but they would
say they couldn't help me for nothing.
Several more requests for biopsy were denied. They told me
in writing that I couldn't get the surgery after--they told me
I could get the surgery after I left the facility and was
deported.
In late November 2006, I was transferred from San Diego to
San Pedro Service Processing Center. When I got there, I
immediately filed sick call slips about my problem. After a few
days I saw a doctor. I told him about my pain and showed them
the blood in my boxer shorts and asked them to examine my
penis. They didn't even look at it. One of them said I couldn't
be helped because I needed elective surgery.
In the middle of December, I noticed a lump in my groin. It
hurt a lot. It was a little bit smaller than a fist, so I filed
a sick call slip about it. I never got any treatment for it. I
later found out it was a tumor; the cancer had already spread.
In beginning of January, they put me in handcuffs and leg
shackles and drove me to the emergency room. When I got there,
the officer tried to find someone to see me. But he was told I
would have to wait in line like everybody else. After about an
hour over the following time, all chained up, they took me back
to San Pedro, and I never got to see no one.
Back when I was in San Diego, another detainee give me the
phone number from the ACLU and said, They might be able to help
you. I called them and spoke with them and told them about my
story and about how much pain I was in. When I got to San
Pedro, he sent letters and called the people at the facility to
try to help me get medical care.
Finally, around the end of January, Immigration agreed to
let me get a biopsy. They made an appointment with the doctor.
But just before the surgery, they released me from custody. A
doctor actually walked me out of San Pedro and told me I was
released because of my serious medical condition. The first
thing I did was call a doctor to see whether I could still get
my biopsy; the secretary told me I had canceled it.
I then went back to emergency room at Harbor-UCLA on my own
and I waited to see the doctor and finally got my biopsy. A few
days later, the doctor told me I had cancer, I would have to
have a surgery right away to remove my penis. They said if I
didn't have the surgery, I would be dead in less than 1 year.
On February 14th, Valentine's Day, after I was released
from custody, I had the surgery to remove my penis. Since then
I have been through five aggressive week-long rounds of
chemotherapy. The doctor said my cancer spreads very fast--it
had already spread to my lymph nodes.
I am sure you can imagine how this feels. I am a 35-year
old man with my life on the line. I have a young daughter,
Vanessa, who is only 14. She is here with me today because she
wanted to support me and because I want her to see her father
do something for the really good so that she would have that
memory of me. The thought that her pain and mine could have
been avoided almost makes this too much to bear.
I have to be here today because I am not the only one who
didn't get the medical care I needed. It was routine for the
detainees to have to wait weeks or months to get basic care.
Who knows how many tragedies can be avoided if ICE only
remembers that regardless of why a person is in detention and
regardless of where they will end up, they are still humans and
they deserve basic care, humane medical care.
In many ways, it is too late for me; short of a miracle,
the most I can hope for are for some good days with Vanessa and
some justice. My doctors are working on my good days; and
thankfully, my attorneys at Public Justice here in Washington,
Mr. Conal Doyle in California, and the ACLU are working on the
justice not just for me but for many others who are suffering
and who will never get the help unless ICE is forced to make
major changes in the medical care provided to immigrant
detainees.
I am here to ask each of you, the Members of the Congress,
to bring an end to the unnecessary suffering that I and too
many others have been forced to endure in ICE detention.
Thank you for your time.
Ms. Lofgren. Thank you. Thank you, Mr. Castaneda for your
willingness to be here and to explain your tragic experience.
[The prepared statement of Mr. Castaneda follows:]
Prepared Statement of Francisco Castaneda
ATTACHMENT
Ms. Lofgren. Ms. Danticat.
TESTIMONY OF EDWIDGE DANTICAT, AUTHOR AND NIECE OF REVEREND
JOSEPH DANTICAT, DECEASED DETAINEE
Ms. Danticat. Madam Chair, Members of the Subcommittee. I
thank you very much for the opportunity to appear before you.
I come today not in my own name, but in the name and in the
stead of a loved one who died while in the custody of the
Department of Homeland Security and ICE officials in the Krome
Detention Center in Miami. His name was Joseph Danticat and he
was 81 years old.
He had been living in the same neighborhood in Haiti for
more than 50 years, but on October 24th, 2004, United Nations
troops and Haitian police forces launched a military operation
there. Their goal was to oust armed neighborhood gangs.
However, during the clash that followed, they used his roof to
fire and kill more than a dozen of his neighbors.
After these forces left the neighborhood, because of the
shots had been fired from his roof, the gangs threatened his
life, and so he fled and eventually traveled to the United
States where he had been a very frequent visitor for more than
30 years.
He had a passport and a valid visa when he arrived at Miami
International Airport. However, because he requested asylum, he
was arrested and taken to the Krome Detention Center where the
medications he was taking for high blood pressure and an
inflamed prostate were taken away from him.
A few days later, on the morning of his credible fear
hearing, he became ill and began to vomit. Vomit was shooting
out of his mouth, his nose as well as the tracheotomy hole he
had in his neck that he had for cancer surgery. Still, when a
medic arrived at the scene, the medic accused him of faking his
illness. I am not just saying this; it was in an OIG report
that we got through FOIA.
Later that morning, his condition was worse and with
shackles on his feet, he was transported to Miami's Jackson
Memorial Hospital. He arrived in the emergency room there at 1
p.m. And was transferred to the prison Ward D where he was
first seen by a physician 24 hours after he arrived. Later that
evening, he was sweating profusely and complained of weakness,
and soon after, he was found dead by an immigration guard.
There are certainly many heartbreaking elements to my
uncle's death. However, there are certainly very crucial
moments where the medical system in detention failed him.
First of all, the fact that his medication, which he had
been taking for many years in a careful balance that took into
consideration his high blood pressure and his status as a
cancer survivor, that was taken away and that was one.
Secondly, the fact that he was not taken seriously when he
became ill at a public hearing; and having been accused of
faking his illness was certainly another.
Furthermore, the fact that he was not seen by a physician
when he was brought to an emergency room was surely
detrimental. And finally, the fact that he was not permitted by
criminal officials and Homeland Security officials to see his
loved ones during his final hours must have left him feeling
less than human at best.
After my uncle died--and by the way, his death was not
reported until it was in the press contrary to these things--
the Department of Homeland Security simply gave my family a
corpse, a cadaver, and a cause of death, which they said was
acute and chronic pancreatitis, which my uncle had never shown
any symptoms of before he became ill at Krome and for which he
was never screened, tested, diagnosed or treated while he was
either at Krome or Jackson Memorial.
We were given no further explanations or clarification
concerning his last days, and in order to receive his medical
records, we had to file those FOIA requests that I mentioned.
Recently, in an article entitled New Scrutiny As Immigrants
Die in Custody, Nina Bernstein, a New York Times reporter,
quoted Jamie Zuieback, a spokesman for the Department of
Homeland Security as saying, quote, that ``Anybody who violates
our immigration laws is going to get the same treatment by ICE
regardless of their medical condition.''
It is worth noting that my uncle and many others who have
died and are dying in the custody of the Department of Homeland
Security and ICE officials did not violate any immigration
laws. All my uncle did was request asylum, which I believe is
an internationally acknowledged human right.
Furthermore, if it is the intention of the Department of
Homeland Security and ICE official to criminalize the right of
a person to seek asylum and then see that lack of medical
attention given to that person as part of the punishment, then
more and more people will continue to die.
Today, our loved ones are being referred to in this hearing
as ``detainees.'' But when they enter the system they are in
sick, we quickly learn that they are prisoners; as family
members, we quickly learn that. But even prisoners deserve to
be treated fairly, decently and humanely.
Death in custody will continue to increase if we neglect to
care for people who have already suffered great traumas before
getting here and are dying, hurt and uncared for, in
immigration jails.
Many people like my uncle, who in spite of the designation
that he was given as Alien No. 2704199, was a father, a
grandfather, a brother, an uncle, a friend who is missed and
treasured every day by those of us who loved him.
Thank you.
Ms. Lofgren. Thank you very much, Ms. Danticat.
[The prepared statement of Ms. Danticat follows:]
Prepared Statement of Edwidge Danticat
Madame Chairwoman and Members of the Committee and Subcommittee:
I thank you very for the opportunity to submit for the record this
testimony concerning immigration detainees and medical care.
I write today not in my own name, but in the name--and stead--of a
loved one who died while in the custody of Department of Homeland
Security and Immigration and Customs Enforcement officials, and the
Krome Detention Center in Miami. His name was Joseph Nosius Dantica and
he was 81 years old. He was the patriarch, the head, of our family. He
was a father of two and grandfather of fifteen, an uncle to nearly two
dozen of us, a brother, a friend, and even, after having survived
throat cancer, which took away his voice, a minister to a small flock
in Port-au-Prince, Haiti. He had been living in the same impoverished
neighborhood in Haiti for more than fifty years when on October 24,
2004, United Nations troops and Haitian police forces launched a
military operation there. Their goal was to oust armed neighborhood
gangs. However, during the clash that followed, they used the roof of
his church to fire at and kill more than a dozen of his neighbors.
After these forces left the neighborhood, because the shots had been
fired from his roof, gang members came to my uncle's home and
threatened to kill him. He was able to flee and eventually travel to
the United States, where he has been a frequent visitor for more than
30 years. He had with him a passport and a valid multiple-entry visa,
which would have expired in 2008. However because he requested what he
termed ``temporary'' asylum, he was immediately arrested and taken to
the Krome Detention Center in Miami, where the medications he was
taking for his high blood pressure and inflamed prostate were taken
away from him. He made this known as much as he could, to his son, to
his lawyer, and to me on the phone, and to the medical staff at Krome
where he was held in the short stay medical unit. However his pleas
were ignored by those who had taken his medication away.
On the morning of his credible fear hearing, my uncle became ill as
a result of this. To those who saw him, including his lawyer, he
appeared to be having a seizure and he began to vomit. Vomit shot out
of his mouth, his nose, as well as the tracheotomy hole he had in his
neck as a result of the throat cancer operation. The vomit was spread
all over his face, from his forehead to his chin, down to the front of
his dark blue Krome issued overall.
According to a report prepared by the Office of the Inspector
General of the Department of Homeland Security, fifteen minutes passed
before help arrived. When a medic and nurse arrived at the scene, the
medic accused my uncle of faking his illness. To prove his point, the
medic grabbed my uncle's head and moved it up and down. It was rigid
rather than limp, he said. Besides, my uncle would open his eyes now
and then and seemed to be looking at him.
``You can't fake vomit,'' my uncle's lawyer, John Pratt shot back.
``This man is very sick and his medication shouldn't have been taken
away from him.''
The medications were indeed taken away, replied the medic, in
accordance with the facility's regulations, and substituted with
others.
Later that morning, my uncle's condition worsened and with manacles
on his ankles, he was transported to Miami's Jackson Memorial Hospital.
My uncle's medical records from Krome and from Jackson Memorial
Hospital indicate that he arrived in the emergency room at Jackson
Memorial Hospital around 1:00 PM with an intravenous drip in progress
from Krome. He was evaluated by a nurse practitioner at 1:10 PM.
At 4:00 PM, during a more thorough evaluation by the nurse
practitioner, he complained of acute abdominal pain, nausea and loss of
appetite. At 5 PM, he was transferred to the hospital's prison area,
Ward D. The records indicate that he was seen for the first time by a
physician at 1:00 PM the next day, exactly twenty-four hours after he'd
been brought to the emergency room. At 7:00 PM, after more than twenty
hours of no food and sugarless IV fluids, my uncle was sweating
profusely and complained of weakness. He was found to be hypoglycemic,
with a lower than normal sugar level of 42 mg/dl. At 7:55 PM, his heart
rate rose to 110 beats per minute. An electrocardiogram (EKG) was
performed at 8:16 PM. The next note on the chart shows that he was
found pulse-less and unresponsive by an immigration guard at 8:30 PM.
He was pronounced dead at 8:46 PM.
There are certainly many heartbreaking elements to my uncle's
death. However, there are certainly moments where the medical system in
detention failed him. First of all, the fact that his medication, which
he had been taking for many years in a careful balance that took into
consideration his high blood pressure and his status as a cancer
survivor, had been taken away was one. Secondly the fact that he had
not been taken seriously when he fell ill during the credible fear
hearing, had been accused of faking his illness, was another. The lack
of instant and serious response to his becoming ill at the credible
fear hearing implied that his symptoms might also not have been taken
seriously elsewhere away from the view of others. Furthermore, the fact
that he was not seen by a physician soon after he was brought to the
emergency room by Krome officials was also part of his continually sub
par medical attention. Also the fact that he was not permitted by
Homeland Security and Krome officials to see loved ones, who also
wanted to see him, during his final hours must have left him feeling
less than human, at best.
After my uncle died, the Department of Homeland Security simply
gave my family a corpse and a cause of death-acute and chronic
pancreatitis--which he'd never shown any symptoms of before he became
ill at Krome and for which he was never screened, tested, diagnosed, or
treated while he was at the Krome medical unit or at Jackson Memorial
Hospital. We were given no further explanations or clarification
concerning his last days. In order to receive his medical records, with
the help of the Florida Immigrant Advocacy Center, we had to file
Freedom of Information Act requests as well as a lawsuit. From the
perspective of a family member, this is a nightmare. Not only did we
tragically lose our loved one, but we had to fight a huge bureaucracy
to find out what happened to them.
Recently in an article entitled ``New Scrutiny as Immigrants Die in
Custody,'' Nina Bernstein, a New York Times reporter, quoted Jamie
Zuieback, a spokeswoman for The Department of Homeland Security, as
saying that ``Anybody who violates our national immigration law is
going to get the same treatment by I.C.E. regardless of their medical
condition.'' First of all, my uncle and many of the others who have
died, and are dying in the custody of the Department of Homeland
Security and I.C.E officials did not violate any immigration laws. All
many of them have done, was request asylum, which is an internationally
acknowledged human right. Furthermore, if this, as stated by Ms.
Zuieback to the New York Times, is the general attitude of and implied
policy of Department of Homeland Security and I.C.E officials--to
criminalize the right of a person to seek asylum and then see the lack
of medical attention and care given to them as part of the punishment--
then more people will continue to die in their care.
During our efforts to see my uncle in his last days, we were
consistently told that Department of Homeland Security Officials, I.C.E
and Krome officials had the right to make decisions in his medical
care. In that type of situation, this can mean that they literarily
have our loved ones' lives in their hands. Therefore, if our loved ones
are sick, they should be treated. If they need emergency care, they
should get it. They are called detainees, but really they are
prisoners. As family members we quickly learn that. But even prisoners
deserve to be treated fairly and decently and humanely. This is what we
consistently tell jailers of other countries. How about we practice
some of it here ourselves?
Immigration detention is one of the fastest growing forms of
incarceration in the United States. Deaths in custody will only
increase if we neglect to care for people who are withering away and
dying unheard and neglected. People like my uncle who was not just
Alien #27041999, but a father, a grandfather, a brother, and uncle, a
friend, a clergyman, who was extraordinarily loved and greatly
treasured and is missed every single day by those who loved him very
very much.
Ms. Lofgren. Ms. Everett, are you able to proceed now?
TESTIMONY OF JUNE EVERETT, SISTER OF SANDRA KENLEY, DECEASED
DETAINEE
Ms. Everett. I have to.
I would like to thank Congresswoman Lofgren and all of the
Members of the Subcommittee for inviting me to speak today.
My name is June Everett. My sister is Sandra Marina Kenley.
To find out after reading the papers recently that more than 62
immigrants have died and continue to die while in U.S. custody
since about the time of my sister's death is shocking and
disheartening.
My sister was one of those immigrants who died in jail on
the ICE supervision. I cannot tell you the stories of all of
these other deceased immigrants, but I can tell you my sister's
story.
Sandy came to America when she was 20 years old and lived
here for nearly 33 years.
My sister was not illegal but a legal permanent resident.
She was not a terrorist. She was a human being, one that made
mistakes like all of us. She was a--she was human enough to
turn her life around and to pursue her dreams. She became a
nurse, had just bought a new car and took custody over her
granddaughter. My sister worked in this country for at least 25
years before becoming disabled.
In 2005, Sandie visited Barbados to show off her
granddaughter, over whom she had custody. When she returned to
this country, she was stopped by an ICE officer and asked to
report to the immigration office for questions. When she did,
Sandie was asked to return without her granddaughter. When she
returned a few weeks later, she again brought her
granddaughter. She was the child's sole custodian.
The officer sent her away and told her to return without
her granddaughter. My sister again reported to the authorities
for questioning, as requested. Three times she went to Dulles
airport to answer immigration questions. This time she did not
return.
Her son, who is here today, and I were with her the day she
was taken into custody. Sandie was detained for an old
misdemeanor drug charge for which she hadn't even served any
jail time. She also had already fulfilled the court's
requirement for that charge. She completed her probation early
and never went back on drugs.
At the airport, we told the ICE officer of my sister's
medical condition. She was disabled. She had a bleeding fibroid
that needed surgery. She had a date set for that surgery. She
had high blood pressure and high cholesterol and took
medication for those conditions. Despite all of this, ICE
determined that she needed to be detained.
Sandie wasn't a threat to anyone, and she was not a flight
risk, proving that going back three times. She had her whole
family in this country and had just shown up for questions
three times.
Sandie was taken to the Pamunkey Regional Jail in Virginia.
I know she complained constantly about not getting her
medicine. When the prison officer finally gave her her pills
after many weeks, they were the wrong ones, not the ones we had
given the ICE official that day at Dulles airport.
Those pills made her very sick. She was hemorrhaging
nonstop. Blood pouring down her legs and spilling on the floor
of her cell. My sister was scared and suffering unnecessarily.
My sister did everything she could to get help, but no one
would do anything. Then, on December 18, 2005, I received a
call saying my sister had died in jail.
I have so many questions about Sandie's death, and ICE has
made it so very difficult for me to learn what happened. There
needs to be some transparency, some oversight, and ultimately
some accountability.
Sandie died trying to do the right thing. She died because
the American system failed her--a system we believed in, a
system that needs fixing before more lives are lost
unnecessarily. What am I supposed to tell my grandniece,
Nakita, about her grandmother's death? What am I supposed to
tell Nakita about American principles?
I am here because I believe that what happened to my sister
ought not happen to anyone else. I urge you to conduct the
necessary oversight over my sister's tragic and preventible
death and fix the problem of inadequate medical care in
immigration detention centers that has resulted in too many
avoidable deaths.
Sandie's death was one that was avoidable from the onset.
I thank you for your time.
Ms. Lofgren. Thank you, Ms. Everett.
[The prepared statement of Ms. Everett follows:]
Prepared Statement of June Everett
Ms. Lofgren. Mr. Jawetz.
TESTIMONY OF TOM JAWETZ, IMMIGRATION DETENTION STAFF ATTORNEY,
ACLU NATIONAL PRISON PROJECT
Mr. Jawetz. My name is Tom Jawetz. I am the immigration
detention staff attorney for the National Prison Project of the
American Civil Liberties Union.
The ACLU is currently involved in a class action lawsuit
regarding inadequate medical care for immigration detainees at
the San Diego Correctional Facility. I would like to thank
Chairwoman Lofgren and Members of the Subcommittee for inviting
me here today to speak about a serious and growing problem in
immigration detention--horribly inadequate medical care that
leads to unnecessary suffering and death.
This issue lies at the center of one of our country's most
basic principles: that everyone is entitled to fair and humane
treatment.
Today, the ACLU requests that this Committee do the
following four things:
One, eliminate the procedural hurdles that prevent on-site,
treating clinicians from providing necessary medical care to
detained immigrants;
Two, fix the serious substantive deficiencies in the DIHS
Covered Services Package to ensure that detainees receive
adequate and appropriate medical care;
Three, require immigration authorities to publicly report
every death; and
Four, codify improved and binding detention standards,
including legislation prohibiting retaliatory transfers of
detainees who complain about poor medical care and conditions
of confinement.
ICE detains nearly 300,000 people each year; approximately
one-quarter are identified as suffering from some chronic
health condition. Detainees are scattered across the country in
hundreds of county jails and in a handful of facilities run by
ICE or private prison companies. Some are detained for weeks,
many are detained for months or years.
Recent reports from the DHS Office of Inspector General and
the Government Accountability Office confirm that there are
nationwide problems with medical care and detention. The
policies that were testified to today are not being followed,
and these reports demonstrate that.
The system for providing necessary medical care suffers
from several fatal flaws:
First, detainees may not receive specialty services such as
a biopsy or an MRI unless on-site medical personnel obtain
authorization from off-site managed care coordinators with the
Division of Immigration Health Services in Washington, D.C.
This results in unreasonable delays in medical care and
unjustifiable refusals to provide authorization.
My statement is based not only on my experience and the
experience of the ACLU with our clients, but also on the
criticisms of jail officials whose hands are often tied by the
DIHS bureaucracy. In York County, Pennsylvania, where detainees
have been housed for years, the deputy warden wrote in a letter
to a local ICE officer that DIHS had, quote, ``set up an
elaborate system that is primarily interested in delaying and
or denying medical care to detainees. There is nothing easy
about working with DIHS. If something can be delayed, it is
delayed. If it can be denied, it is denied. If something can be
made difficult, it is made difficult.''
Second, the treatment authorization decisions made by those
managed care coordinators, who are the nurses, not doctors--and
there are three of them in D.C. for the entire country--are
made in accordance with deeply flawed policies. Those policies
emphasize that detainees primarily receive emergency care only
literally when life or limb is at stake. This policy is
blatantly inconsistent with established principles of
constitutional law and basic notions of decency.
The terrible consequence of poor medical care for ICE
detainees is that it can result in death. Recently, ICE
revealed that 62 people have died in their custody since 2004.
Since that announcement, at least three other detainees have
died.
In their written testimony, they say 62 and in--64, rather;
64, I think it is; in the oral testimony today it was 66. I
don't really know what the right answer is, what the right
number is.
Since that announcement, at least three others have died.
Some of these deaths were undoubtedly the result of poor health
care, yet ICE appears to have no legal obligation to publicly
report deaths that take place in their custody and concedes
that not every in-custody death is investigated.
Congress must rectify this problem to ensure some amount of
transparency and accountability.
Two and a half months ago, Victoria Arellano passed away
after spending 8 weeks in detention. Ms. Arellano was a
transgender, HIV-positive detainee who, by all appearances, had
her disease well under control before she entered ICE custody.
In detention, she was taken off of the HIV medication she
required to fend off opportunistic infections and her health
quickly began to deteriorate. She developed a high fever,
complained of severe pain, nausea, stomach cramps, and began
vomiting blood and suffering from diarrhea. Nevertheless, it
was fellow detainees and not qualified medical personnel who
took care of her in the weeks preceding her death.
After Ms. Arellano's death became public, detainees quoted
in the press about her lack of care were transferred to
facilities across the country, as far as away as Texas. Such
transfers have taken place following other deaths. They appear
retaliatory, they hinder investigations, and they intimidate
other detainees into silence.
The ACLU has called on the Department of Homeland Security
Office of Inspector General to investigate Ms. Arellano's death
and the suspicious transfer of these detainees.
Congress ought to pass legislation requiring the detainees
receive adequate treatment. This grossly deficient care is
inexcusable and immoral, but is often common and often
unchecked. While ICE has issued standards for the treatment of
detainees, they are not enforceable regulations. Comprehensive
immigration reform may have stalled in the Senate, but Congress
cannot remain idle while innocent people detained by the
Federal Government continue to suffer unnecessary pain and
death.
I applaud the efforts of the Chairwoman and Members of the
Subcommittee to perform the oversight that the executives is
either unable or unwilling to perform, and I urge this
Committee to reform a broken health care delivery system that
allows people to die.
Congress should fix the procedural and substantive barriers
that now prevent detainees from receiving adequate care, and
require immigration authorities to publicly report every
detainee death. Congress should also pass legislation to codify
and improve binding immigration detention standards.
On behalf of the ACLU, I would like to thank the
Subcommittee for taking the time to explore this important
issue, and I look forward to the opportunity to answer your
questions.
Ms. Lofgren. Thank you very much.
[The prepared statement of Mr. Jawetz follows:]
Prepared Statement of Tom Jawetz
Ms. Lofgren. Doctor.
TESTIMONY OF ALLEN S. KELLER, M.D., ASSOCIATE PROFESSOR OF
MEDICINE, NEW YORK UNIVERSITY SCHOOL OF MEDICINE
Dr. Keller. Thank you for the opportunity to testify here
today.
I am here on behalf of the Bellevue/NYU Program for
Survivors of Torture and Physicians for Human Rights. I am here
as a physician who has cared for many immigrants and refugees,
including many who have been in immigration detention. I am
also here as a scientist who conducted a study looking at the
health of asylum seekers in immigration detention.
In this study, done in June 2003, more than 4 years ago--
that is when it was released--we documented high levels of
psychological distress that worsened the longer that
individuals were in detention. We also documented inadequate
access to mental health services as well as inadequate medical
and dental services.
Unfortunately, recent reports demonstrate that the problems
we identified more than 4 years ago remain uncorrected; and I
think it is crucial to remember there is a lot more to
suffering and morbidity than death. Clearly, that is an
important thing to look at, but there is a lot more to the
picture.
It is important to remember that like other immigration
detainees, asylum seekers are civil detainees, not criminal
detainees; and repeatedly we heard from the individuals we
interviewed that never did they think when they came to this
country, seeking safety and to build a better life, that they
would be treated like criminals, placed in facilities such as
the Elizabeth Detention Center, a windowless converted
warehouse. And these harsh prison conditions were confirmed in
a study we conducted with the U.S. Commission on International
Religious Freedom for which I serve as an expert.
Access to mental health services was woefully lacking.
Furthermore, there were clear disincentives for individuals to
report depressive symptoms such as suicidal thoughts because
detainees believed, and rightfully so, that if they did, they
would be held in solitary confinement if they informed their
jailers of these thoughts; and this issue remains a concern
today.
In addition to inadequate mental health services, more than
half of the individuals we interviewed reported having serious
health problems for which they had significant difficulty
accessing medical care.
Many detainees complained of difficulty obtaining
specialized care, including for chronic conditions. This raises
important questions about what care is appropriate and what can
reasonably be delayed.
The fundamental problem that we saw appears to persist
today, and the health care provided in these facilities that we
found then, and now, seems at best a short-term, stopgap ``jail
mentality''; that is, medical care seems based on the
assumption that the patients will be detained for only a few
days or weeks while, in fact, many of the individuals we
interviewed are detained for much longer. In fact, it would
seem that this is going to worsen, given that the trend seems
to be to detain more individuals rather than fewer.
In the individuals that we interviewed, for example, one
detainee who told us that he was shot in the groin while
attending a peaceful demonstration, while in detention his
groin pain worsened, he was told that he would have to wait
until he was out of detention to get that bullet removed. He
remained in detention for 2\1/2\ years.
Numerous individuals we talked to describe pain and
suffering from dental problems that went unaddressed for
months, if not years.
One recent case that I reviewed highlights a number of the
problems regarding poor health care--including both medical and
psychiatric--involves a woman I will refer to as LC who was
from an African country where she suffered repeated trauma, she
suffered female genital mutilation, she was raped, she
witnessed the murder of several family members. She fled to
this country seeking safety. She was imprisoned and recently
granted asylum, but she was imprisoned for approximately 6
months. Not surprisingly, when she arrived in this country she
was exhausted, and when she learned she was going to be
detained she panicked and she subsequently collapsed. At the
detention center, she was misdiagnosed as being psychotic. And
it should be clear that at that evaluation and as best I could
tell from the medical records, these evaluations were done
without the use of interpreters, although this woman spoke
barely any English.
She was put on a medication Risperdal, an antipsychotic.
She had profound significant side effects including lethargy,
confusion, and also lactation--production of breast milk. And
despite these symptoms, her medications were increased.
Finally, she refused to take them and her symptoms improved.
Later on when she had severe abdominal pain, she went weeks
without proper evaluation, and it was only when her lawyers
filed a habeas corpus case that she received medical care. And
even then, she wasn't informed of what care she received.
So clearly the problems with health care and immigration
which have received recent attention are not new. Many of the
problems described, including difficulties and delays, were
ones we identified 4 years ago. Congress must do its job of
overseeing immigration detention and providing this critical
oversight.
It is also essential that there be humane alternatives to
detention whenever possible. This, in addition to being morally
the right thing to do, is cost effective. Health problems for
immigrant detainees need to be adequately addressed from a
health perspective, including the pain and suffering and
potential morbidity of the individual, as well as from a
medical ethics perspective. It does not and should not matter
whether a condition is preexisting or began during immigration
detention. The individual is in Government custody, and with
that comes the responsibility to provide appropriate and needed
health services. Thank you.
Ms. Lofgren. Thank you very much, Dr. Keller.
[The prepared statement of Dr. Keller follows:]
Prepared Statement of Allen S. Keller
Ms. Lofgren. And, finally, Ms. Little.
TESTIMONY OF CHERYL LITTLE, EXECUTIVE DIRECTOR, FLORIDA
IMMIGRANT ADVOCACY CENTER
Ms. Little. Thank you so much. Good afternoon, and thank
you for the opportunity to testify about an extremely important
issue that, as we have just heard, profoundly affects the lives
of so many people.
As you mentioned, Congresswoman Lofgren, the Florida
Immigrant Advocacy Center provides free legal services to
immigrants of all nationalities, including many in Immigration
and Customs Enforcement detention, ICE detention in Florida and
elsewhere.
Lack of access to adequate medical care is one of their
chief complaints. Recent reports of more than 60 deaths in
immigration detention since 2004 have shed new light on a
system in crisis. FIAC is working to try to prevent further
deaths, although at times this seems a difficult battle.
Detainees report undue delays in obtaining proper medical care
or outright denial of such care. Even emergency treatment is
delayed or ignored.
Recently, FIAC took the case of Yong Sun Harvill, a 51-
year-old South Korean woman who has a history of cancerous
tumor, chronic lymphedema, hepatitis C, liver disease, and
mental health issues. Yong is currently detained at the Pinal
County Jail in Florence, Arizona. There is no on-site physician
there. In late September 2007, a board-certified hematologist,
oncologist and internist, Dr. Gotardo Rodrigues, reviewed
Yong's medical records and, in a letter that has been forwarded
to ICE, he concluded, and I am now quoting from the letter,
``The consequences of continued, incomplete, and superficial
care of Mrs. Harvill may include chronic infections,
disability, recurrence and progression of tumors, deteriorating
physical and mental health, and other complications that could
even lead to her death.''
This letter followed a similar letter written by Dr.
Rodrigues on July 10, 2007 that was submitted to ICE.
Yong has kept a journal since her transfer to a jail from
South Florida to Arizona. On August 29, 2007 she wrote, ``I'm
afraid, because I have seen in the news how many people have
died because they don't get medical care. I don't want to be
the next one. They deny special tests that I need. I wish my
judge can see how frightened I am. In the meantime, I can only
pray to God to help me.''
Another of FIAC's clients had been diagnosed with cancer
before he was detained at the Krome Detention Center in July
2006. Although a physician recommended that he urgently be
referred for prostate surgery in October 2006, it was not until
late December of that year, and after FIAC was preparing to
sue, that he had surgery.
Sometimes it practically takes an act of Congress for a
detainee to receive medical attention. On March 8, 2002, one of
FIAC's clients who was detained at the Turner Guilford Knight
Correctional Center in Miami was spitting up blood in the
presence of an officer. Despite attempts by both the officer
and FIAC staff to get the detainee appropriate medical care,
this was not done until Congressman John Conyers visited the
jail and insisted she be seen by a doctor. That same day, she
was taken to the hospital, 1 month and 2 days after she began
spitting blood.
Women often do not receive regular gynecological and
obstetric care. One woman who was detained at the Broward
Transitional Center in Pompano Beach first brought her symptoms
to the attention of the medical staff on December 18, 2003.
Although she had the classic symptoms of an ectopic pregnancy,
a painful and potentially fatal condition, her concerns were
ignored. On several occasions she was simply given Tylenol and
told her pain was normal. When she began to bleed profusely,
the medical staff still did not take her complaint seriously.
On January 4, 2004, when she was finally seen by a doctor, she
was immediately taken to the hospital for surgery.
Even children have been deprived of adequate medical care
in ICE custody. On April 10, 2003, FIAC staff observed Lormise
Guilaume carrying her 2-year-old son, Jordan, who was visibly
ill. FIAC requested immediate assistance, and officers called
911. Jordan was rushed to the emergency room of a local
hospital. His health had been deteriorating for some time and
medical attention, repeatedly requested, was inexcusably
delayed. A week before Jordan was rushed to the hospital,
Lormise told FIAC, and I am quoting, ``My son has been sick for
weeks. The problem was that I don't speak English and the
doctor didn't speak Creole. I never imagined the United States
would treat us like this.''
Edwidge Danticat testified earlier about the death of her
uncle, Reverend Danticat, while in ICE custody. Danticat's
lawyers and family have serious questions about the adequacy of
medical care provided him while in ICE custody, including at
Jackson Memorial Hospital. FIAC also believes the investigation
requested by Congressman Kendrick Meek and conducted by the
Office of Inspector General into Reverend Danticat's death was
a whitewash, and we wrote a detailed letter of complaint
requesting the OIG to reopen their investigation. They declined
to do so.
It can be extremely difficult for detainees to access their
own medical records, and can even take months for FIAC or other
lawyers to access records on their clients' behalf. The process
for requesting records is different at each facility where
immigrants are detained, but is consistently riddled with
bureaucratic red tape. With transfers of detainees from one
facility to another becoming more and more routine, it can take
months to gather a detainee's medical records. When there is a
death, such as in Reverend Danticat's case, it is even more
difficult to obtain medical records. FIAC had to sue in Federal
court to get his records. The medical records we did obtain
contained 31 redacted pages on the basis of privacy, despite
the fact that the family had requested them.
There is a serious lack of oversight regarding the adequacy
of medical care provided ICE detainees. ICE standards adopted
in 2000 to ensure the safe and secure treatment of detainees in
immigration custody are not binding, and routinely ignored.
These standards must have teeth. And outside independent
scrutiny of detainees' medical care is necessary to ensure that
DHS carries out its moral and legal responsibility to provide
for the health and safety of detainees entrusted to its care.
Given the dramatic increase in the use of ICE detention, the
need for proper scrutiny of medical care afforded detainees is
more critical than ever. Thank you.
Ms. Lofgren. Thank you, Ms. Little.
[The prepared statement of Ms. Little follows:]
Prepared Statement of Cheryl Little
ATTACHMENT
Ms. Lofgren. Thank you to all of the witnesses for your
compelling testimony. I will just ask a handful of questions,
if I could.
Mr. Castaneda, an incredible story, and I do appreciate
that you are here to change things for others and I honor you
for that. As I was listening to your story of a situation that
got worse and worse and worse, I was trying to put--how many
months were you in custody? When you arrived, you had a problem
and it got worse and worse. Over what period of time were you
in custody?
Mr. Castaneda. Over 10 months.
Ms. Lofgren. It was 10 months. In 10 months' time, it
wasn't until you were so sick that they essentially threw you
out.
Mr. Castaneda. Until they saw I was bleeding and
discharging and couldn't stop bleeding, and that is when they
released me.
Ms. Lofgren. Let me ask you, Ms. Danticat, a question.
There are a lot of myths about immigration, but as you told
your story of your uncle, he had a valid visitor's visa to come
into the United States, and he had been here before. I mean,
why would an 81-year-old Baptist minister who had a valid visa
even be stopped? And how was he treated when he was stopped
when he came into the United States just before the detention?
Do we know about that?
Ms. Danticat. Well, I think the people who detained him
would have to answer the why. But as to how he was treated,
when he made known his request for asylum he was taken into
custody, he was interviewed, and then he was brought to the
Krome Detention Center.
Ms. Lofgren. Ms. Everett, when your sister was at the
airport, she already had the fibroid problem and she had
scheduled surgery, in fact. Did she tell the ICE agents that
she had surgery scheduled, do you know?
Ms. Everett. Yes. And we also gave them copies of the
appointment card for the people that she was seeing that were
preparing her for that, in addition to the appointment card for
her surgery.
Ms. Lofgren. And they simply just ignored it?
Ms. Everett. Just ignored it completely.
Ms. Lofgren. Well, this is a little sideline. California
State Prison System Health Care is now being run by Bob Sillen,
the guy who used to be in charge for Santa Clara County Jails
when I was on the board of supervisors. And this sounds like
the sort of situation where either we get our act together, or
some Federal judge is going to take somebody like Bob Sillen
and say, You are in charge now. And I think those are the two
choices. Certainly, we want to get to the bottom of whether
there are things that have not been reported. But, obviously,
Mr. Castaneda has suffered a tremendous amount and he would not
show up in a statistic.
And so I think the suggestions made, Mr. Jawetz, are
excellent ones.
Certainly, Ms. Little, the need to make mandatory changes,
not just advisory, are obviously important.
And, Dr. Keller, your testimony particularly, I have always
thought it was a mistake--and I didn't vote for it when we
changed the rules--that the default is that someone seeking
freedom in the U.S. is incarcerated.
You know, our policy is that we are the beacon of hope and
freedom in the world, and that those people who are fleeing
from oppression, from communism can come to this free place and
breathe free air. And now our policy is: and then go to jail.
So certainly there need to be rules in place so that you have
people who show up, who aren't gaming the system. That has
happened in some cases. But it is not necessary to incarcerate
people in every case. And certainly people who have been
traumatized and abused are not going to do well in a custodial
setting many, many times.
So I would just like to say that this is, I think, one of
the most important hearings that I have had an opportunity to
participate in, in the 13 years that I have been in Congress,
and I hope that it will be the first step in making necessary
changes.
And I appreciate all of you, especially those who have lost
a loved one, for sharing a very painful part of your life in an
effort to set things right. And I can't promise success, but I
can promise efforts that are equal to the sacrifice you have
made to be here and to share your thoughts.
So, with that, thank you, on behalf of the Subcommittee,
and this hearing is adjourned.
[Whereupon, at 4:23 p.m., the Subcommittee was adjourned.]
A P P E N D I X
----------
Material Submitted for the Hearing Record
Prepared Statement of the Honorable Zoe Lofgren, a Representative in
Congress from the State of California, and Chairwoman, Subcommittee on
Immigration, Citizenship, Refugees, Border Security, and International
Law
I would like to welcome the Immigration Subcommittee Members, our
witnesses, and members of the public to the Subcommittee's hearing on
immigration detainee medical care.
According to the General Accounting Office (GAO), nearly 300,000
men, women, and children were detained by Immigration and Customs
Enforcement (ICE) in 2006, triple the amount in 2001 when less than
100,000 were detained.
With the large increase of detainees in ICE custody, it is
incumbent upon this Congress to ensure that ICE is properly executing
its responsibility of providing safe and humane treatment of detainees
in their custody.
Recent reports suggest that ICE is not doing its job.
In just the last few months, there have been several reports of
individuals detained by ICE that suggest unsafe and inhumane treatment
in ICE or contracted detention facilities. For example, the Boston
Globe recently reported the case of a man who died in ICE custody due
to epilepsy complications, despite the fact that his sister twice
attempted to provide necessary medication to detention officials,
according to his family. His sister says she was turned away both
times. Another reported case involves Victoria Arellano who was taken
off HIV drugs while in custody and subsequently died after serious
complications and lack of appropriate medical care for several months.
Reports indicate that fellow inmates tended to as much care as they
could possibly provide on their own and repeatedly informed detention
officials of Arellano's illness.
These and other cases have spawned questions from several Members
of Congress, but so far, few answers have been provided.
There are two critical questions I hope we can address today.
First, are the medical care standards employed by ICE satisfactory so
as to create an environment that supports safe and humaen treatment of
individuals in ICE custody? Second, if those standards are adequate,
are they being implemented in an appropriate manner?
After a preliminary review of the standards and the various reports
on the administration of medical care, it appears we have problems on
both levels.
The DIHS Medical Dental Detainee Covered Services Package
specifically states that medical care in ICE detention facilities is to
be provided primarily for emergency care. Care for ``[ac]cidental or
traumatic injuries incurred while in the custody . . . and acute
illnesses'' is not required, but simply ``reviewed for appropriate
care.'' Care for other illnesses, including pre-existing illnesses that
are serious but not life-threatening, is also not automatic, but simply
reviewable for appropriate care. Furthermore, these reviews are
conducted in Washington, D.C. by nurses, not physicians, who are away
from the patient and simply reviewing paperwork submitted by other
health care professionals recommending such care.
With this policy, it is no wonder there are reports of unsafe and
inhumane medical treatment in ICE custody. This policy fails to
recognize a fundamental principle of medical care in detention--the
patient is detained and there is no other option but care authorized by
ICE. Yet, the policy only insures emergency care and considers other
care, even in serious cases, on a case-by-case basis.
I hope that today's hearing will help us further understand and
clarify the problems that exist in providing medical care to those in
ICE custody so that we may begin to find solutions to what appears to
be a very serious problem.
Prepared Statement of the Honorable John Conyers, Jr., a Representative
in Congress from the State of Michigan, and Chairman, Committee on the
Judiciary
I have read reports collected regarding medial care provided to
individuals in ICE custody and, frankly, I am very concerned.
There is the case of Reverand Joseph Nosius Dantica, a courageous
man who was a minister for decades in Port-a-Prince, Haiti. After
watching his neighbors get killed and gang members threatening his
life, Rev. Dantica, at the age of 81 and after 50 years of service to
his community, fled Haiti to seek safe haven in the United States where
he was a frequent visitor for 30 years. When he arrived in the United
States, he had a valid passport and visa, but decided that this time he
would need to seek asylum. He was immediately arrested and detained and
his heart medication was confiscated. He tried and tried to let as many
people know about his need for medication to no avail. The problems
that followed are more than gruesome. 15 minutes went by before medical
care was provided when Rev. Dantica appeared to be having a seizure and
vomited. A nurse accused him of faking his illness and there was
inadequate care at a hospital hours later. With this lack of medical
attention, it wasn't long before Rev. Dantica passed away.
Then there's the case of Mr. Abdoullai Sall, who, I am told, also
died in detention after being denied necessary medication despite
several requests by him and his attorney. Mr. Sall eventually collapsed
and died in detention without ever receiving his medication. I am told
that efforts to investigate the case by the ACLU have been stymied by
DHS.
There's the case of Victoria Arellano, a transgender, HIV-positive
individual who was held in ICE custody for two months without
medication she was taking prior to detention. Weeks before her death,
medical staff told her that her T cells were down and simply prescribed
an antibiotic, a drug that doctors say is not the choice for HIV
patients. I am told that over the next few days, Arellano began
vomiting blood and suffering from diarrhea and fellow detainees took
care of her. They lodged numerous complaints about the lack of medical
care, and ultimately began chanting ``hospital'' until she was finally
taken to the hospital, where she died on July 20, 2007. Again I am told
that DHS has stymied efforts to get answers on this case, including the
transfer of two detainees who spoke to the press about also being
denied access to their own HIV medications.
Sadly, the list of horror stories goes on. I want answers to these
horrendous cases. How is this possible in American detention centers
and what can we do to prevent this?
Responses to Post-Hearing Questions from U.S. Immigration and Customs
Enforcement