[House Hearing, 110 Congress]
[From the U.S. Government Publishing Office]
PROBLEMS WITH 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
SECOND SESSION
__________
JUNE 4, 2008
__________
Serial No. 110-117
__________
Printed for the use of the Committee on the Judiciary
Available via the World Wide Web: http://judiciary.house.gov
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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. ``BOBBY'' 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
Sean McLaughlin, Minority Chief of Staff and General 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
----------
JUNE 4, 2008
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.. 4
The Honorable John Conyers, Jr., a Representative in Congress
from the State of Michigan, and Chairman, Committee on the
Judiciary...................................................... 6
The Honorable Lamar Smith, a Representative in Congress from the
State of Texas, and Ranking Member, Committee on the Judiciary. 8
WITNESSES
Ms. Julie Myers, Assistant Secretary, Immigration and Customs
Enforcement (ICE), U.S. Department of Homeland Security
Oral Testimony................................................. 12
Prepared Statement............................................. 15
Mr. Philip Farabaugh, Acting Director, Division of Immigration
Health Services, Immigration and Customs Enforcement (ICE),
U.S. Department of Homeland Security
Oral Testimony................................................. 25
Prepared Statement............................................. 27
Mr. Richard M. Stana, Director, Homeland Security and Justice
Issues, Government Accountability Office
Oral Testimony................................................. 32
Prepared Statement............................................. 34
Mr. Isaac Reyes, Washington Representative, U.S./Mexico Border
Counties Coalition
Oral Testimony................................................. 62
Prepared Statement............................................. 64
Mr. Edward Harrison, President, National Commission on
Correctional Health Care
Oral Testimony................................................. 66
Prepared Statement............................................. 69
The Reverend E. Roy Riley, Bishop of the New Jersey Synod,
Evangelical Lutheran Church in America
Oral Testimony................................................. 72
Prepared Statement............................................. 76
Ms. Gloria Armendariz, Wife of Isaias Vasquez, former detainee
Oral Testimony................................................. 83
Prepared Statement............................................. 84
Ms. Zena T. Asfaw, former detainee
Oral Testimony................................................. 85
Prepared Statement............................................. 87
Ms. Mary Meg McCarthy, Director, National Immigrant Justice
Center
Oral Testimony................................................. 88
Prepared Statement............................................. 90
Ms. Ann Schofield Baker, Partner, McKool Smith, and Attorney for
Amina Bookey Mudey, former detainee
Oral Testimony................................................. 97
Prepared Statement............................................. 99
Mr. Homer Venters, M.D., Attending Physician and Public Health
Fellow, Bellevue/NYU Program for Survivors of Torture
Oral Testimony................................................. 141
Prepared Statement............................................. 143
LETTERS, STATEMENTS, ETC., SUBMITTED FOR THE HEARING
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................................ 3
Revised and Extended Remarks of 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......................... 6
Prepared Statement of the Honorable John Conyers, Jr., a
Representative in Congress from the State of Michigan, and
Chairman, Committee on the Judiciary........................... 7
Prepared Statement of the Honorable Lamar Smith, a Representative
in Congress from the State of Texas, and Ranking Member,
Committee on the Judiciary..................................... 9
Prepared Statement of the Honorable Sheila Jackson Lee, a
Representative in Congress from the State of Texas, and Member,
Subcommittee on Immigration, Citizenship, Refugees, Border
Security, and International Law................................ 10
APPENDIX
Material Submitted for the Hearing Record........................ 161
PROBLEMS WITH IMMIGRATION DETAINEE MEDICAL CARE
----------
WEDNESDAY, JUNE 4, 2008
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 2:05 p.m., in
Room 2141, Rayburn House Office Building, the Honorable Zoe
Lofgren (Chairwoman of the Subcommittee) presiding.
Present: Representatives Lofgren, Conyers, Gutierrez,
Waters, Sanchez, Davis, Ellison, King, Goodlatte, and Lungren.
Also Present: Representative Smith.
Staff Present: David Shahoulian, Majority Counsel; Andres
Jimenez, Majority Professional Staff Member; George Fishman,
Minority Counsel.
Ms. Lofgren. This hearing of the Subcommittee on
Immigration, Citizenship, Refugees, Border Security, and
International Law will come to order.
Without objection, the Chair is authorized to call a recess
of the hearing at any time.
I would like to welcome the Subcommittee Members, our
witnesses, and members of the public to the Subcommittee's
hearing on problems with immigration detainee medical care.
This Committee held a hearing on this subject on October 4,
exactly 8 months ago. At that hearing we examined serious
concerns with the provision of medical care at immigration
detention facilities across the country. News reports of deaths
and the deficient care that may have led to those deaths
triggered that hearing. Unfortunately, here we are again.
As was the case 8 months ago, a string of recent news
reports has severely shaken our confidence in the health care
system used by ICE. The reports recount story after story of
detainees who received inadequate care or no care at all, and
they speak of suffering and death.
But this time those stories are not just reports; The
Washington Post and 60 Minutes support those stories with
internal Government documents and what appear to be many
interviews with Government whistleblowers who have uncovered
severe problems and desperately want to see them fixed. Some of
the witnesses today will deny that these problems exist, but I
believe these claims are belied by Government officials who
have reached out to the press and to us and by the documents
that support their claims.
The efforts of those whistleblowers tell me something, that
there are people within our Government who really care about
the medical and mental health care provided at ICE facilities.
But their stories and documents also say something else: That
their pleas and warnings have gone largely unheeded for far too
long.
Documents tell us that employees widely complained of
severe staffing shortages of medical personnel. ICE tells us
they are addressing these shortages now, but the documents
indicate they ignored these warnings for years, failing to
adequately address these shortages even as they ramped up
enforcement and brought detention beds on line.
Documents tell us that employees complained of certain
policies that appear to be in violation of ICE's detention
standards. For some time at the San Pedro facility, for
example, the clinical director prohibited medical staff from
doing any lab work for detainees no matter what their condition
until they had been detained for more than 30 days. As
indicated by an internal DHS document, this policy may have
played a role in the death of a detainee with HIV who was
denied medication during her first month in detention.
Documents show that ICE's policy may be designed to deny
care and save money rather than to provide care and save lives.
Last October, Francisco Castaneda testified before our
Committee concerning the medical care he received, or I should
say failed to receive, during his detention. He is now dead. A
quick review of his medical records shows that several on-site
physicians recommended biopsy to rule out cancer, but it also
shows that these requests were repeatedly denied over a 10-
month period by managed care coordinators here in D.C.
Some might say this is just one case and does not signify
anything. I disagree. When several doctors say that someone
needs a simple biopsy, but this is denied not once, not twice,
but repeatedly over 10 months by off-site bureaucrats,
something is fundamentally wrong. No matter how it happened,
there is no question that the system failed Mr. Castaneda over
and over again. He paid with his life, and now the Government
is on the verge of paying millions in a lawsuit pursued by his
family.
In any event, that necessary treatment is repeatedly
delayed or denied by ICE is supported by many other documents.
There are letters and affidavits from prison wardens expressing
profound exasperation with the denials of care.
And one document, which I can't even begin to reconcile
with humane treatments, lists the amount of money ICE saved by
denying requests for treatment. Such requests which were all
submitted by on-site medical personnel were for such things as
tuberculosis, pneumonia, bone fractures, head trauma, chest
pain and other serious complaints. How an off-site bureaucrat
can deny a request to treat tuberculosis or a bone fracture, I
just don't know, but the document makes it seem as if ICE is
proud of that fact.
Putting aside the inhumanity of denying necessary health
care, the $1.3 million savings that ICE brags about in this
document is going to pale in comparison to the money that DHS
will have to pay when courts begin to rule against it, as they
already have.
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. I hope that today's hearing will help us begin to
find solutions to what appears to be a very serious problem.
[The prepared statement of Ms. Lofgren follows:]
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
This committee already held a hearing on this subject on October 4,
2007--exactly 8 months ago. At that hearing, we examined serious
concerns with the provision of medical care at immigration detention
facilities across the country. News reports of deaths--and the
deficient care that may have led to those deaths--triggered that
hearing.
Unfortunately, here we are again. As was the case eight months ago,
a string of recent news reports has severely shaken our confidence in
the health care system used by ICE. The reports recount story after
story of detainees who received inadequate care, or no care at all. And
they speak of suffering and death.
But this time, those stories are not just reports. The Washington
Post and 60 Minutes support their stories with internal government
documents and what appear to be many interviews with government
whistleblowers who have uncovered severe problems and desperately want
to see them fixed.
Some of the witnesses today will deny that these problems exist.
But I believe these claims are belied by the numbers of government
officials who have reached out to the press--and to us--and by the
documents that support their claims.
The efforts of those whistleblowers tell me something--that there
are people within our government who really care about the medical and
mental health care provided at ICE facilities. But their stories and
documents also say something else--that their pleas and warnings have
gone largely unheeded for far too long.
Documents tell us that employees widely complained of severe
staffing shortages of medical personnel. ICE tells us that they are
addressing these shortages now. But the documents indicate they ignored
these warnings for years, failing to adequately address such shortages
even as they ramped up enforcement and brought detention beds on line.
Documents tell us that employees complained of certain policies
that appear to be in violation of ICE's Detention Standards. For some
time at the San Pedro facility, for example, the clinical director
prohibited medical staff from doing any lab work for detainees--no
matter what their condition--until they had been detained for more than
30 days. As indicated by an internal DIHS document, this policy may
have played a role in the death of a detainee with HIV who was denied
medication during her first month in detention.
Documents show that ICE's policies may be designed to deny care and
save money rather than to provide care and save lives. Last October,
Francisco Castaneda testified before our committee concerning the
medical care he received, or failed to receive, during his detention.
He is now dead. A quick review of his medical records shows that
several on-site physicians recommended biopsy to rule out cancer. But
it also shows that these requests were repeatedly denied, over a 10-
month period, by managed care coordinators here in DC.
Some might say that this is just one case and does not signify
anything. I disagree. When several doctors say that someone needs a
simple biopsy, but this is denied not once, not twice, but repeatedly
over 10 months by off-site bureaucrats, something is fundamentally
wrong. No matter how this happened, there is no question the system
failed Mr. Castaneda over and over again. He paid with his life, and
now the government is on the verge of paying millions in a lawsuit
pursued by his family.
In any event, that necessary treatment is repeatedly delayed or
denied by ICE is supported by many other documents. There are letters
and affidavits from prison wardens expressing profound exasperation
with delays and denials of necessary care. And one document, which I
can't even begin to reconcile with humane treatment, lists the amount
of money ICE saved by denying requests for treatment. Such requests,
which were all submitted by on-site medical personnel, were for such
things as tuberculosis, pneumonia, bone fractures, head trauma, chest
pain and other serious complaints. How an off-site bureaucrat can deny
a request to treat tuberculosis or a bone fracture, I don't know. But
the document makes it seem as if ICE is proud of the fact.
Putting aside the inhumanity of denying necessary health care, the
$1.3 million savings ICE brags about in this document will pale in
comparison to the money DHS will have to pay when courts begin to rule
against it--as they already have.
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. I hope that
today's hearing will help us begin to find solutions to what appears to
be a very serious problem.
Ms. Lofgren. I now recognize our Ranking Minority Member
Steve King for his opening statement.
Mr. King. Thank you, Madam Chair.
This Subcommittee just had a hearing on the topic of
immigration detainee medical care 8 months ago, and I am not
sure that the recent media blitz alleging poor medical care in
a few isolated instances warrants a second hearing.
The risk of being murdered in some U.S. cities is higher
than the risk of dying in an immigration detention facility.
That means people on the streets of America are not as safe as
some of the people that are incarcerated under ICE. For
example--and these numbers are significantly lower than other
data I have seen. For example, 2005 FBI statistics show in the
statistical metropolitan area encompassing the city of Houston,
712.6 residents per 100,000 were victims of violent crime, and
9.1 residents per 100,000 were murdered or victims of homicide.
That is Houston. In Houston alone there are 334 people murdered
on the streets.
In the statistical metropolitan area including Los Angeles,
575.5 per 100,000 were victims of violent crime; 8.8 out of
every 100,000 were victims of murder. In Los Angeles alone
there were 489 people murdered in 2005.
Some other examples would be the recent shootings in
Washington, D.C. For example, my legislative counsel's
neighborhood had four murders in a single 24-hour period right
in the same neighborhood.
And in the Chicago shootings that we know about, 32
shootings over a weekend, at one time the death count was 6,
and then it went to 12 or 13 in a single weekend. And we are
here having a hearing about people incarcerated by ICE and
getting medical care that is addressing their chronic illnesses
as well that they come with. But during that same period of
time, 2005, there were 6.8 deaths per 100,000 immigration
detainees, many of whom were unhealthy when they arrived, and
that is in ICE facilities. The number has dropped in subsequent
years, and the data is getting stronger.
I would submit that the constituents of the Members of this
Committee would be better served if our focus was on the high
risk of being murdered and violently victimized on the streets
of their own cities and own communities rather than focusing on
a media event that doesn't have the data to back up the
necessity for this hearing.
In any event, I am happy to use this opportunity to
congratulate Ms. Myers for taking a lead role in reinvigorating
ICE's worksite enforcement efforts, and that includes Iowa, and
I thank you. All of us concerned about the impact of illegal
immigration on American workers are grateful for your efforts.
The death rate in our immigration detention facilities are low
and dropping despite the fact that 25 percent of the detainee
population already had a chronic illness such as hypertension,
diabetes, tuberculosis, asthma, HIV/AIDS and seizure disorders
when they came into ICE custody because they come from places
where they don't get health care. That is why they are carrying
chronic illnesses with them. This is the best and sometimes the
first medical care that they have been exposed to in their
lifetime.
This is a fundamental difference between criminal
incarceration and immigration detention. Prison inmates who
have been sentenced to incarceration cannot choose when they
are released. They are detained in order to provide punishment
and rehabilitation to safeguard the community, and to deter
other criminals.
The medical care provided by the Bureau of Prisons ensures
that inmates are not prevented from serving their full
sentences, which average 9 years, because of illness. However,
illegal immigrants and illegal aliens are in detention an
average of only 37\1/2\ days, and they hold the keys to their
own cells because immigration detainees can simply agree to
their own deportations.
Why should the American taxpayer be liable for providing
Rolls Royce-quality medical care for aliens who are doing
everything in their power to stay detained and therefore avoid
deportation? ICE should not have to make up for a lifetime of
poor medical care during this brief period of detention. Once
they enter the ICE detention system, most immigration detainees
are getting by far the best medical care they have had in their
entire lives. It has cost the Federal taxpayers more than $360
million to provide such care since ICE was created 5 years ago,
$100 million in the last fiscal year alone.
But let's not forget that the full cost to American
taxpayers for the health care of illegal immigrants is far more
than the cost incurred by ICE detention. The majority of
illegal aliens do not have health insurance. As a result,
hospitals in the southwest border counties of Texas, New
Mexico, Arizona and California alone incur a cost of $190
million for uncompensated emergency medical treatment to
illegal aliens.
The California Hospital Association worries that care for
illegal aliens could tip some hospitals into bankruptcy; and,
in fact, some have closed. The medical crisis caused by
uninsured illegal immigrants clogging our emergency rooms and
seeking free medical care is also compromising our citizens'
accessibility to emergency health care. On top of all of these
costs, it appears that some want to give detained illegal
immigrants a blank check written on the account of the American
taxpayer.
Legislation introduced by Chair Lofgren seems to require
American taxpayers to pay medical bills for immigration
detainees even after they have been released or removed to
their home country. That is not the taxpayer's responsibility.
We need to make decisions in this Committee and in this
Congress based upon data, not anecdotes, and to allege the
inhumanity of denying necessary health care I don't think can
be substantiated, and I don't agree with that statement, and I
look forward to the hearing. I look forward to the testimony of
the witnesses. Thank you, Madam Chair.
[The revised and extended remarks of Mr. King follows:]
Revised and Extended Remarks of 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
Replace this text:
``For example, 2005 FBI statistics show that in the statistical
metropolitan area encompassing the city of Houston, 712.6 residents per
100,000 were victims of violent crime and 9.1 residents per 100,000
were murdered or victims of homicide. In the city of Houston alone,
there were 334 people murdered in 2005. In the statistical metropolitan
area including Los Angeles, 575.5 per 100,000 residents were victims of
violent crime--with 8.8 per 100,000 murders and homicides. In Los
Angeles alone, there were 489 people murdered in 2005.''
With the following paragraphs:
``For example, 13 homicides took place during one week of March
this year in our nation's capitol, Washington DC. Not to be left
behind, during a six-day period in April, Chicago suffered a shooting
spree that left 12 dead. The 2005 U.S. Census Bureau statistics show
that in Congressman Gutierrez's city of Chicago, there were 443 murders
in 2005, or 15.6 deaths per 100,000. In the Chairman of the House
Committee on the Judiciary John Conyers' city of Detroit, Michigan
2,361 residents per 100,000 were victims of violent crime and there
were 1,858 murders in 2005, or 41.4 deaths per 100,000. In
Congresswomen Zoe Lofgren, Maxine Waters and Linda Sanchez' state of
California, Los Angeles had 1,628 murders in 2005, or 12.6 deaths per
100,000 and 821 per 100,000 residents were victims of violent crime. In
Congresswoman Sheila Jackson Lee's city of Houston, Texas 1,173
residents per 100,000 were victims of violent crime and there were 860
murders, or 16.3 deaths per 100,000.
While 15 detainees died while under ICE custody in 2005, and while
the Members who represent the four cities I mentioned demanded we
retreat from Iraq due to American loss of life, and while 676 brave
American soldiers gave their lives in a just cause, 4,789 individuals
were murdered on the streets of just four cities without a word of
concern from the Members who represent many of the victims and their
families. These statistics support the fact that residents of Chicago,
Detroit, Los Angeles or Houston would be safer in an ICE detention
facility than walking on the streets of these cities. Constituents of
the Majority members of the House Judiciary Committee would be better
served if our focus was on the high risk that they will be murdered or
victimized by violent criminals in their own communities.''
Ms. Lofgren. I would just note that on the bill I have
introduced, it does not require provision of care after
release, but I would be happy to discuss that off agenda.
I would now recognize the Chairman of the full Committee
Mr. John Conyers.
Mr. Conyers. Thank you, Chairman Lofgren and Members. This
is, I think, important.
I want to agree to this extent with the opening statement
of my friend Steve King. Maybe we are able, Steve, to do both
things. We have to deal with the crime problem that you've
reported in your statistics, which are accurate, and perhaps
with this problem of how people who are brought into our
custody are treated afterward. I want my statement to be
included in the record.
I just wanted to welcome the head of ICE, whom I hadn't met
before, Ms. Myers. I wanted to welcome her, and I wanted to
talk with the Committee about this sudden breakout of mass
arrests, the largest in history, in Iowa last month, 300
undocumented people arrested, going all over, raids everywhere,
mass round-ups. Have we had a hearing on that yet?
Ms. Lofgren. No, Mr. Chairman, but if you are suggesting,
we can.
Mr. Conyers. I would like to talk with Steve King about it
first.
I yield to the gentleman.
Mr. King. I thank the Chairman. I think that would be a
constructive thing to do, and I would be very interested in
joining together for a request for a hearing.
Mr. Conyers. Thank you very much.
There is some kind of evenhandedness that ought to be
required. Employers bring in all these people. They know who is
illegal or undocumented or not. I think we have to start
rounding some of them up, too. But that's a subject for another
time.
I figure it is pretty reasonable that we look at this
subject matter again. As my friend pointed out, it was 8 months
ago we did this, but things keep happening, and let's stipulate
that a lot of people that have come here illegally need medical
assistance, but the question is what do we do about it?
And I will just close because I have been talking to some
of my friends here in the Congress and on the Committee about
universal health care, and a kind of similar issue that Steve
raised comes up. Well, if you have universal health care, why
include immigrants? Well, because they are going to spread
disease and make it tough on all of us who might someday have
universal health care.
So these are the interesting questions that surround this
hearing. You have brought together a great panel of witnesses,
and I thank you for allowing my opening comments.
[The prepared statement of Mr. Conyers follows:]
Prepared Statement of the Honorable John Conyers, Jr., a Representative
in Congress from the State of Michigan, and Chairman, Committee on the
Judiciary
A very disturbing pattern appears to be developing at the
Department of Homeland Security. First, there are revelations about
medical abuses, problematic raids, misplaced emergency priorities, and
inappropriate costumes. And, then--only after a formal Congressional
inquiry--the Department either denies there's a problem or announces
plans to correct it.
Today, we are going to continue our efforts to address one of these
recurrent problems, namely, the broken medical system in our Nation's
detention facilities. As many of you will recall, this Subcommittee
held a hearing on this issue last year where we heard the heartbreaking
testimony of a woman who stood helpless as her sister died behind bars
because ICE would not give her access to her medications.
But the reports of grossly inadequate detainee medical care
continue to surface. This callous disregard for detainee's medical
conditions must stop.
Accordingly, I want Assistant Secretary Julie Myers, and the other
witnesses to respond to three specific concerns.
First, I want to hear what concrete steps DHS has taken since our
hearing last October, and what concrete steps are will be undertaken
going forward. In the eight months since our last hearing, it appears
little has changed. That is why I am a proud cosponsor of Chairwoman
Lofgren's bill, the Detainee Basic Medical Care Act of 2008, which will
address this problem.
Second, I want hear what the DHS Inspector General has done and
will do to investigate the deaths in custody, not just on a case-by-
case basis, but across the board as well.
Third, I want to hear DHS's response to reports about a recent raid
at a meatpacking plant in Iowa.
In that raid, immigrants were penned up in a fairground and
subjected to a new version of assembly-line justice, in which criminal
charges and limited access to counsel replaced the normal
administrative immigration charges.
I want Ms. Myers and the other witnesses to tell us today what ICE
is doing to address health care and humanitarian concerns when these
mass raids are being undertaken. What kind of health care was provided
in Iowa? Was anyone sent back home without receiving any treatment? Is
this just an isolated incident or can we expect this to become the
Department's ``standard operating procedure.''
DHS should ensure that basic standards of life, safety, health
care, due process, and Constitutional rights are maintained, not just
in response to public scandal.
Ms. Lofgren. I now recognize the distinguished Ranking
Member of the full Committee, the gentlemen from Texas, Mr.
Smith.
Mr. Smith. Madam Chairman, recent news reports detail cases
of severe injury and even death in DHS detention facilities.
Each of the instances as reported is heartbreaking to family
members and of concern to all of us. However, we should not
rush to judgment based on one-sided media accounts about the
reported deficiencies in health care received by a few illegal
immigrant detainees. Congress has a responsibility to rely on
the facts in order to determine if there is a serious problem
with the medical treatment provided to these detainees.
Since 2004, 71 individuals out of over 1 million detained
have died while in DHS custody. Many of these individuals enter
detention facilities with prior medical conditions that can
cause injury or death.
About one-quarter of all immigration detainees are
diagnosed as having chronic illnesses when they enter the
detention facility. Many of these individuals are being
diagnosed for the first time, and many of them have infectious
diseases such as tuberculosis, which poses a serious health
threat to Americans. Immigrants, at over 12 percent of the
population now, account for more than half of all tuberculosis
cases in the U.S. That means that immigrants are over four
times more likely to carry that contagious disease than native-
born Americans.
Last year, ICE spent nearly $100 million on detention
immigration health care, double the funding level that existed
just 5 years ago. Medical facilities at all ICE-managed and -
contracted detention centers are required to meet or exceed
normal accreditation standards. Immigration detainees are
provided extensive free health care far beyond that available
to many of the American taxpayers who pay for the detainees'
health care.
In a recent series, The Washington Post alleged that there
is ``a hidden world of flawed medical judgments, faulty
administrative practices, neglectful guards, ill-trained
technicians, sloppy recordkeeping, lost medical files and
dangerous staff shortages.'' Yet according to ICE, the Post
reporters made no requests to tour a single ICE detention
facility.
A July 2007 Government Accountability Office report on
alien detention standards found no systemic problems in health
care delivery or any pattern of noncompliance with applicable
standards.
Substantiated allegations of improper medical care to
immigration detainees should be fully investigated. If it is
determined in a particular case that a detainee was denied
appropriate treatment, was not properly monitored or received
negligent care, then corrective measures must be taken.
Congress should be clear that it is not the responsibility
of ICE, or the American taxpayer, to pay for or ensure the
medical care of aliens after they are removed from our country.
Nor is it the responsibility of ICE, or the American taxpayer,
to keep aliens in detention solely for the purpose of providing
them care.
Today ICE and the Division of Immigration Health Services
have an opportunity to present their side of the story.
Holding hearings on this issue is important, but we must
have reasonable and realistic standards. Medical care is not
always perfect regardless of whether it is administered in a
detention center prison or even the emergency room of a
hospital.
I thank you, Madam Chair, and I yield back the balance of
my time.
Ms. Lofgren. Thank you, Mr. Smith.
[The prepared statement of Mr. Smith follows:]
Prepared Statement of the Honorable Lamar Smith, a Representative in
Congress from the State of Texas, and Ranking Member, Committee on the
Judiciary
Recent news reports detail cases of severe injury and even death in
DHS detention facilities. Each of the instances as reported is
heartbreaking to family members and of concern to all of us.
However, we should not rush to judgment based on one-sided media
accounts about the reported deficiencies in health care received by a
few illegal immigrant detainees.
Congress has a responsibility to rely on the facts in order to
determine if there is a serious problem with the medical treatment
provided to these detainees.
Since 2004, 71 individuals--out of one million detained--have died
while in DHS custody. Many of these individuals enter detention
facilities with prior medical conditions that can cause injury or
death.
About one-quarter of all immigration detainees are diagnosed as
having chronic illnesses when they enter the detention facility. Many
of these individuals are being diagnosed for the first time. And many
of them have infectious diseases, such as tuberculosis, which pose a
serious health threat to Americans.
Immigrants at over 12 percent of the population now account for
more than half of all tuberculosis cases in the U.S. That means that
immigrants are over six times more likely to carry that contagious
disease than native-born Americans.
Last year, ICE spent nearly $100 million on immigration detention
health care, double the funding level that existed five years ago.
Medical facilities at all ICE-managed and contracted detention centers
are required to meet or exceed normal accreditation standards.
Immigration detainees are provided extensive free health care far
beyond that available to many of the American taxpayers who pay for the
detainees' care.
In a recent series, the Washington Post alleged that there is ``a
hidden world of flawed medical judgments, faulty administrative
practices, neglectful guards, ill-trained technicians, sloppy record
keeping, lost medical files and dangerous staff shortages.'' Yet,
according to ICE, the Post reporters made no request to tour a single
ICE detention facility.
A July 2007 Government Accountability Office (GAO) report on alien
detention standards found no systemic problems in health care delivery
or any pattern of non-compliance with applicable standards.
Substantiated allegations of improper medical care to immigration
detainees should be fully investigated. If it is determined in a
particular case that a detainee was denied appropriate treatment, was
not properly monitored, or received negligent care, then corrective
measures must be taken.
Congress should be clear that it is not the responsibility of ICE--
or the American taxpayer--to pay for or ensure the medical care of
aliens after they are removed from our country. Nor is it the
responsibility of ICE--or the American taxpayer--to keep aliens in
detention for the purpose of providing them with care.
Today, ICE and the Division of Immigration Health Services have an
opportunity to present their side of the story.
Holding hearings on this issue is important. But we must have
reasonable and realistic standards. Medical care is not always perfect,
regardless of whether it is administered in a detention center, prison
or even the emergency room of a hospital.
Ms. Lofgren. In the interest of proceeding to our
witnesses, and mindful of the schedule, I ask other Members to
submit their statements for the record. Without objection, all
opening statements will be placed into the record.
[The prepared statement of Ms. Jackson Lee follows:]
Prepared Statement of the Honorable Sheila Jackson Lee, a
Representative in Congress from the State of Texas, and Member,
Subcommittee on Immigration, Citizenship, Refugees, Border Security,
and International Law
Madam Chair, thank you for your leadership in convening today's
very important hearing concerning the problems with immigration
detainee medical care. I would also like to thank the ranking member,
the Honorable Steve King. This hearing will explore recent reports
about inadequate medical care for immigrant detainees and deaths while
in custody.
The hearing will also examine the quality of medical and mental
health care provided in detention facilities under ICE's jurisdiction.
The Subcommittee will study ICE's medical and mental health care
standards and procedures, and it will specifically look into the deaths
of the growing number of immigration detainees that have died during or
as a result of ICE custody, seeking to resolve the extent to which
policies, procedures, or practice caused these deaths. Finally, the
Subcommittee will seek recommendations to address any potential
problems.
The Bureau of Immigration and Customs Enforcement (ICE) within the
Department of Homeland Security (DHS) is responsible for the arrest,
detention, and removal of deportable non-citizens. In 2006, ICE
detained nearly 300,000 men, women, and children--most of whom had no
criminal history. This was three times the amount of immigration
detainees held by ICE in 2001, when less than 100,000 were detained.
ICE holds its immigration detainees in one of over 300 detention
facilities across the country. A small percentage of these detainees
are housed in 8 ICE-owned and operated service processing centers
(SPCs), including the Krome SPC in Miami, the Florence SPC in Arizona,
and the Port Isabel SPC in Texas. ICE also houses a small percentage of
its detainees in 6 contract detention facilities (CDFs), which are
operated by private contractors specifically for ICE. The majority of
detainees are held with general population inmates in about 300
federal, state, and local jails and other facilities, which operate
through intergovernmental service agreements (IGSAs) with ICE. In
addition to these adult detention facilities, ICE contracts for the
operation of 19 juvenile and 3 family detention facilities.
In carrying out its detention and removal responsibilities, ICE is
charged with ensuring that conditions are safe and humane in all
detention facilities used to hold immigration detainees. These
responsibilities include the provision of adequate medical and mental
health care to detainees.
On October 4, 2007, the Subcommittee held a hearing on medical care
in detention facilities after a New York Times article uncovered that
at least 62 people had died in ICE custody between 2004 and 2007. Since
that hearing, major media outlets have reported additional deaths and
have released documents indicating that some of these deaths were the
result of deficient medical care. A four-part series recently released
by the Washington Post raises similar concerns about the medical and
mental health care system at ICE detention facilities. This series,
founded on internal ICE documents and interviews with detention
facility employees, asserts severe staffing shortages of medical
personnel, long and routine delays in the provision of medical
treatment, frequent denials of necessary medication for chronic
illnesses, and a system geared to deny care rather than provide it.
In July 2007, the U.S. Government Accountability Office (GAO)
issued a report detailing additional problems with detention
conditions. The GAO report noted that when off-site medical care for
detainees appeared necessary, ICE determined whether to authorize such
care in conjunction with a DIHS Managed Care Coordinator (MCC).
According to the report, officials at some detention facilities
reported difficulty caring for detainees who required off-site medical
and mental health care because they were unable to get authorization to
provide that specialty care.
In addition, numerous media outlets--including the New York Times,
The Washington Post, and 60 Minutes--have reported stories suggesting a
lack of proper medical care for detainees. On June 13, 2007, the
Washington Post reported on a number of cases involving immigration
detainees who allegedly received inadequate medical care. That same
day, a class action lawsuit was filed on behalf of all immigration
detainees at the San Diego Correctional Facility (SDCF). The lawsuit,
Woods v. Myers, No. 07-cv-1078 (S.D. Cal.) charged ICE, DIHS, and the
Corrections Corporation of America, Inc. with failing to provide
adequate medical and mental health care to SDCF detainees. According to
the complaint, the 11 named plaintiffs suffered from mental illness,
chronic health conditions, and serious injuries that had not been
appropriately treated while in ICE custody.
Later in June 2007, the New York Times reported that at least 62
immigrants had died in ICE custody since 2004. In July, the editorial
board of the Miami Herald called upon Congress to investigate this
issue and require ICE to publicly report each death that occurs in
custody and to adopt legally binding healthcare standards.
Since the Subcommittee hearing in October, numerous reports from
major media outlets have raised additional concerns with the medical
and mental health care provided in immigration detention centers. On
May 5, 2008, the New York Times revealed a list of 66 individuals who
had died in ICE custody, reporting details on several of the deaths
that raised serious concerns about the quality of the medical care they
received.
This article was followed by an extensive, four-part series on
detainee medical care by the Washington Post in May. According to the
Washington Post, this series of articles was based on an extensive
investigation involving the review of thousand of internal ICE
documents and interviews with numerous ICE and DIHS personnel. The
articles--as well as the internal ICE documents produced along with the
articles--reveal serious staffing shortages of medical personnel,
regular delays in the provision of medical treatment, and frequent
denials of necessary treatment. In the first part in the series, System
of Neglect, the Washington Post summarized their investigation as
follows:
The most vulnerable detainees, the physically sick and the
mentally ill, are sometimes denied the proper treatment to
which they are entitled by law and regulation. They are locked
in a world of slow care, poor care and no care, with panic and
coverups among employees watching it happen, according to a
Post investigation.
The investigation found a hidden world of flawed medical
judgments, faulty administrative practices, neglectful guards,
ill-trained technicians, sloppy record-keeping, lost medical
files and dangerous staff shortages. It is also a world
increasingly run by high-priced private contractors. There is
evidence that infectious diseases, including tuberculosis and
chicken pox, are spreading inside the centers.
By statute and regulation, the U.S. Public Health Service (PHS) may
provide medical, surgical, psychiatric, and dental care to immigration
detainees around the country. However, PHS provides on-site health care
to only a small percentage of ICE detainees. PHS officers provide on-
site medical and mental health care at ICE-run service processing
centers (SPCs) and several of the contract detention facilities (CDFs)
and intergovernmental service agreement facilities (IGSAs). At all
other facilities, including virtually all state and county jails
operating under IGSAs with ICE, on-site medical care is provided either
by the county or a private company that owns or operates the facility,
or by private, for-profit companies that specialize in correctional
health care.
ICE holds its immigration detainees in one of over 300 detention
facilities across the country. A small percentage of these detainees
are housed in 8 ICE-owned and operated service processing centers
(SPCs), including the Krome SPC in Miami, the Florence SPC in Arizona,
and the Port Isabel SPC in Texas. ICE also houses a small percentage of
its detainees in 6 contract detention facilities (CDFs), which are
operated by private contractors specifically for ICE.
I look forward to hearing from today's witnesses. I truly hope that
we can understand the problems with immigration detainee medical care
and that we can also develop some solutions. I look forward to the
testimony of today's witnesses. Thank you, and I yield the balance of
my time.
Ms. Lofgren. We have two distinguished panels of witnesses
here today to help us consider the important issues before us.
Seated on our first panel is Ms. Julie Myers, Assistant
Secretary for U.S. Immigration and Customs Enforcement (ICE).
Previously she served as Assistant Secretary for Export
Enforcement at the Department of Commerce, Chief of Staff for
the Criminal Division at the Department of Justice, and Deputy
Assistant Secretary for Money Laundering and Financial Crimes
at the Treasury Department.
Before entering Government service Ms. Myers was an
associate at Mayer, Brown and Platt in Chicago, and she earned
a bachelor's degree at Baylor University and a law degree from
Cornell University.
Next we have Dr. Philip Farabaugh, the new Acting Director
of the Division of Immigration Health Services, or DIHS, which
we understand was recently moved from Health and Human Services
to the Department of Homeland Security. Prior to his position
as Acting Director, Dr. Farabaugh was the clinical director at
the Tacoma detention facility in Tacoma, Washington.
And the final witness on our first panel is Mr. Richard
Stana, Director of Homeland Security and Justice Issues for the
U.S. Government Accountability Office. During his 32-year
career with the GAO, he has directed reviews in a wide variety
of complex military and domestic issues. Most recently he has
managed GAO's work relating to immigration and border security
issues. He is a graduate of Cornell University and Harvard
University's JFK School of Government. He also earned a
master's degree from Kent State University.
Given the gravity of the issues we are discussing today and
the key roles you all play, we would appreciate you taking an
oath before you begin your testimony. Would each of you please
stand and raise your right hand.
[Witnesses sworn.]
Ms. Lofgren. The clerk will note that all three witnesses
have agreed to the oath.
Your written statement will be made a part of the record in
its entirety. We would ask now that you summarize your
testimony in about 5 minutes. The little machine on the desk
will flash a yellow light when you have 1 minute left, and when
the red light goes on, we would ask you to conclude the
testimony so we have time for our questions.
Ms. Myers, we will begin with you.
TESTIMONY OF JULIE MYERS, ASSISTANT SECRETARY, IMMIGRATION AND
CUSTOMS ENFORCEMENT (ICE), U.S. DEPARTMENT OF HOMELAND SECURITY
Ms. Myers. Thank you very much.
Good afternoon, Chairwoman Lofgren and distinguished
Members of the Subcommittee. I appreciate the opportunity to
appear before you today.
Chairwoman Lofgren, you're right, people in Government do
care. The men and women of ICE care. The men and women of the
DIHS care, and we work every day to ensure that those in our
custody are treated in accordance with the ICE detention
standards.
As you know, ICE was formed in 2003 with the broad mission
that includes immigration and customs enforcement and
management of the detention and removal processes for
apprehended aliens. Indeed, with such an important mission, we
had to look and see could we have additional oversight,
additional oversight not only for medical care, but really for
all of our detention, knowing that there are a large number of
aliens in our custody.
I think we have worked very hard over the past couple of
years to see where there are places where we can improve
detention oversight. To that end, I think the GAO has been very
helpful, the IG, as well as Congress and NGOs, in giving us
ideas and suggestions on how we can make sure that everyone in
our custody is treated in accordance with the ICE detention
standard.
We have done a number of things. Just giving a few
highlights of things that we have done for detention oversight
overall, including but not limited to medical care, in February
2007 we established the Detention Field Inspection Group, and
that is a group that is an independent arm that reports to the
Office of Professional Responsibility. They can go out and do
an independent inspection of a detention facility to see if
they are meeting up to the medical standard as well as all
other standards in the ICE detention standard. Before that
there was no such independent group.
In addition, we looked at our overall reviews of
facilities, and we recognized that previously under the old
INS, they used detention and removal officers who tried to do a
good job, but they were detention and removal officers who
actually did the annual compliance inspections. We changed
that. We contracted with outside groups to do annual reviews of
our facilities in order to make sure that we were getting the
best information, and if there were deficiencies, they could be
corrected. These deficiencies would include anything we needed
to work on with respect to medical oversight.
In addition, we have hired quality assurance specialists at
40 of our largest facilities. Their only job is to make sure
that ICE is complying with the ICE detention standards. And we
have also published our first Semiannual Report on Compliance
with the ICE National Detention Standards.
We created the first National Detainee Handbook, and we
have undertaken a comprehensive review of the current National
Detention Standards to see whether or not they could be
improved. We think they could be, so we are working to make
them more performance-based, working with the NGOs, the IGs,
DHS, CRCL and so on.
Turning specifically to detainee health care and oversight,
let me begin with some context. ICE spent almost $100 million
on detainee health care last fiscal year, double the funding of
just 5 years ago. And this doesn't even include the funding
providing for routine health care at IGSAs. During that same
period, the number of detention beds managed by ICE has grown
by approximately 30 percent, and since ICE was established,
nearly 1.5 million individuals have passed through our custody.
And although the ICE detainee population has increased by more
than 30 percent since 2004, the actual number of deaths in ICE
detention has declined from 29 in 2004 to 7 for the last
calendar year, and there have been no suicides in the last 15
months.
But there is still more work to do. ICE law enforcement
officers are not medical professionals, so we have historically
relied on the independent medical judgment of the experts, the
Public Health Service and DIHS.
By way of background, all detainees are required to receive
an initial health screening within the first 12 hours and a
physical examination within 14 days. And as Representative King
noted, last year nearly 34 percent of detainees were diagnosed
with a chronic condition.
Despite all of this, we recognize that there is need to
take additional steps. Among them was the need to strengthen
the suicide prevention process. The reality is since 2003,
suicides have accounted for 18 percent of the 74 deaths of
detainees in our custody. Even one preventable death is too
many, so in the last 2 years ICE instituted an extensive
suicide prevention program, and we have not had a single
suicide in the last 15 months.
We also are looking at the TAR process, and I believe there
is room for improvement on the appeals of TARs, and so we are
working with the Office of Health Affairs to see how we can
strengthen the TARs process and provide for more oversight by
independent individuals, as well as have the detainees have
more of a role in that.
We are also working with the DHS Office of Health Affairs
to improve operations at DIHS. Already we have reduced the
staffing issues from 30 percent vacancies down to 18. In
addition, we have asked the Office of Health Affairs to assess
all of DIHS's procedures to determine whether or not there are
additional things we can do to strengthen oversight for those
who are in our custody.
The final thing we have done is respond to suggestions that
we need to have more transparency in the reporting of deaths.
And so we have talked with the DOJ, and we are going to begin
reporting voluntarily pursuant to the Deaths in Custody
Reporting Act so that the Bureau of Justice Statistics will
have our information, and they can access it as appropriate.
In closing, I want to say we are committed to working with
you, outside groups and others to improve our processes and
ensure that those in our custody are well cared for. Thank you.
Ms. Lofgren. Thank you.
[The prepared statement of Ms. Myers follows:]
Prepared Statement of Julie L. Myers
Ms. Lofgren. Dr. Farabaugh, we would be pleased to hear
from you.
TESTIMONY OF PHILIP FARABAUGH, ACTING DIRECTOR, DIVISION OF
IMMIGRATION HEALTH SERVICES, IMMIGRATION AND CUSTOMS
ENFORCEMENT (ICE), U.S. DEPARTMENT OF HOMELAND SECURITY
Dr. Farabaugh. Good afternoon, Chairwoman Lofgren and
Members of the Subcommittee, and thank you for allowing me to
appear before you today.
The Division of Immigration Health Services provides or
arranges for health care and public health services in support
of immigration law enforcement. As a unit within U.S.
Immigration and Customs Enforcement, ICE, DIHS serves as the
provider of medical and mental health care for detainees housed
in DIHS-staffed detention facilities.
DIHS oversees the financial authorization and payment for
off-site specialty and emergency care for all detainees in ICE
custody, whether in DIHS or Intergovernmental Service Agreement
facilities.
DIHS comprises medical professionals and support personnel
detailed from the U.S. Public Health Service, General Schedule
employees and contracted medical staffing services. The PHS is
granted the authority to provide and arrange this care by
virtue of section 322 of the Public Health Service Act ``Care
and Treatment of Persons Under Quarantine and Certain Other
Persons.''
Each individual who comes through detention facilities
receives an initial medical screening within 12 hours of their
arrival into custody. Those remaining in ICE supervision at
least 14 days receive a comprehensive physical examination.
Many of these detainees initially learn of a medical ailment or
receive medical care and treatment for the first time through
this comprehensive screening. Each individual receives specific
treatment, as medically necessary according to their illness.
In fiscal year 2007, of the 184,448 screenings, approximately
34 percent, or 63,000 individuals, were identified as having
chronic conditions, most diagnosed with hypertension or
diabetes.
To address the needs of the growing number of detainees,
DIHS mental health staff have provided over 31,000 patient
encounters for psychological services since April 2007. These
services include psychological assessments and followups,
individual psychotherapy sessions, initial psychiatric
evaluations, psychiatric medication and medication management
followup, acute mental health hospitalizations, suicide risk
assessment and follow-up. This list is not all-inclusive, and
applies only to those detainees in facilities where DIHS mental
health officers and staff are assigned.
Individuals who have acute or chronic health care needs are
referred to a primary care provider for evaluation and medical
treatment. Those found to have an infectious disease are placed
in the appropriate health care setting and receive treatment
for their condition.
Patients are treated in accordance with nationally
recognized standards and guidelines. This care may be given off
site or on site, as appropriate for the individual patient's
clinical condition. Examples of such care include imaging
studies like X-rays, CT scans, and MRIs; surgery for broken
bones, heart conditions, gallstones, and appendicitis; and
specialty consultation with urology for a bladder disorder,
infectious disease for a patient with HIV, and gastroenterology
for evaluation of stomach ulcers. Pregnant detainees are
referred to community obstetricians to ensure the appropriate
prenatal care is delivered.
The DIHS medical staff and epidemiology branch monitor
tuberculosis cases to ensure continuity of care, whether the
detainee is to be released from custody into the United States
or returned to his or her country of origin. Between January 1,
2007, and May 31, 2008, ICE coordinated the repatriations to
home countries of 156 individuals with active or suspected
active tuberculosis. DIHS seeks to minimize stress to public
health domestically and globally and prevent transmission of
drug-resistant and multidrug-resistant tuberculosis.
Each DIHS-staffed clinic has a written plan for delivery of
24-hour emergency health care or immediate outside medical
attention. All facilities have arrangements with nearby medical
facilities or health care providers for health care not
provided within the facility. These arrangements require
appropriate custodial officers to transport and remain with the
detainee for the duration of any off-site treatment or hospital
admission. When an ICE detainee is hospitalized, the hospital
assumes medical decisionmaking authority, including the
patient's drug regimen, lab tests, et cetera.
Each DIHS clinic has a mechanism that allows detainees to
request health care services provided by a physician or other
qualified medical officer in a clinical setting. Detainees,
especially those who are illiterate or do not speak English,
can receive assistance in filling out the request slip to
access health care providers.
Each detainee who is identified with a chronic care issue
is treated and educated on self-care needs, and appropriate
treatment and follow-up is coordinated.
DIHS maintains accreditation from three nationally
recognized accrediting bodies to ensure the quality of health
care meets industry standards. This includes the American
Correctional Association, the National Commission on
Correctional Health Care, and the Joint Commission on
Accreditation of Health Care Organizations, as well as the ICE
National Detention Standards to evaluate the care provided to
our detainees.
All DIHS health care providers who care for detainees are
required to be licensed and credentialed under the same
guidelines as those serving the U.S. Bureau of Prisons and in
other Federal or community facilities, and we have an ongoing
credentials-monitoring program to identify and correct any
noted deficiencies.
Thank you once again for allowing me to provide testimony
before your Committee today, and I am happy to answer any
questions you may have.
Ms. Lofgren. Thank you.
[The prepared statement of Dr. Farabaugh follows:]
Prepared Statement of Philip Farabaugh
Ms. Lofgren. We will turn to you now, Mr. Stana.
TESTIMONY OF RICHARD M. STANA, DIRECTOR, HOMELAND SECURITY AND
JUSTICE ISSUES, GOVERNMENT ACCOUNTABILITY OFFICE
Mr. Stana. Thank you, Chairman Lofgren and Mr. King, for
the invitation to testify at today's hearing on ICE's adherence
to medical care standards in its detention facilities.
As you know, ICE maintains custody of a highly transient
and diverse population, with individuals from many countries
with varying medical conditions and security risks; and
includes males, females and families of every age group. The
care and treatment of aliens while in detention is a
significant challenge to ICE, as concerns continue to be raised
by Members of Congress and advocacy groups about the treatment
of the growing number of aliens while in ICE's custody.
In response to a request from the House Judiciary and
Homeland Security Committees, we reported last summer on ICE's
adherence to its National Detention Standards to help ensure
appropriate conditions of confinement.
Of the 38 standards, we selected 8 for examination based on
discussions with UNHCR, the ABA and the OIG. These dealt with
telephone access, medical care, hold room procedures, use of
force, food services, recreation, access to legal materials,
and detainee grievance procedures. Our report did not
specifically examine the quality of medical care issues, as
that was the subject of a separate request from this Committee.
I would like to discuss three main items that are germane
to today's hearing. First, at the time of our visits, we
observed instances of noncompliance with ICE's medical care
standards at 3 of the 23 facilities we visited, but these
instances did not show a pervasive or persistent pattern of
noncompliance across the facilities like those we identified
with the telephone system. Specifically, at the San Diego
facility in California, an adult detention facility, ICE
reviewers that we accompanied cited PHS staff for failing to
administer the mandatory 14-day physical exam to approximately
260 detainees. At the Casa de San Juan Family Shelter in
California, we found that the facility staff did not administer
medical screenings immediately upon admission. And at the
Cowlitz County Juvenile Detention Center in Washington State,
we found that no medical screening was performed at admission,
and first aid kits were not available as required.
Officials at some facilities told us that meeting the
specialized medical and mental health needs of detainees was
challenging. For example, officials at the York facility in
Pennsylvania cited difficulties in obtaining ICE approval for a
mammogram to evaluate a lump in a detainee's breast, and the
facility ultimately paid for the medical service itself.
On the other hand, we observed instances where detainees
were receiving specialized medical care, such as special
breathing equipment for a detainee at the Krome facility in
Florida where we were told that the detainee had sleep apnea.
And a detainee at the Hampton Roads facility in Virginia
received treatment from a kidney dialysis machine.
Second, ICE's own compliance inspections also showed
noncompliance with medical standards. The most recently
available annual inspection reports for 20 of the 23 detention
facilities that we visited showed that ICE reviewers had
identified a total of 59 deficiencies, 4 of which involved
medical care. The Wakulla County Sheriff's Office in Florida
had sick call request forms that were available only in
English, whereas the population was largely Spanish-speaking.
The Cowlitz County Juvenile Facility did not maintain alien
medical records on site. The San Diego facility, in addition to
the physical exam deficiency I just mentioned, failed to obtain
informed consent from the detainee when prescribing psychiatric
medication, and the Broward Transitional Center in Florida did
not have medical staff on site to screen detainees arriving at
5 p.m. and did not have a properly locked medical cabinet.
I should also note, though, that we observed three ICE
inspection teams reviewing facilities and found that one was
very good, but the two others were less thorough.
My last point relates to grievance procedures and the
grievances and complaints filed by detainees at the facilities
on a range of issues including the lack of timely response for
requests for medical treatment. We found that ICE grievance
standards were not followed at 4 of the 23 facilities we
visited, and noncompliance ranged from issues like not having
the grievance procedures in the handbook that is handed out to
the persons upon entry, not having a grievance log at all, and
not recording all grievances in the log. But the primary
mechanism for detainees to file external complaints is directly
with the IG, either in writing or by phone using the OIG
complaint hotline.
Our review of the approximately 750 detainee complaints in
the OIG database showed that about 11 percent involved issues
relating to medical care such as being denied access to
specialized treatment. But in testing the phone system, we
found that the OIG complaint hotline telephone number was
blocked or otherwise restricted at 12 of the 23 facilities that
we visited. So the number of reported allegations may not
reflect all detainee complaints.
Many complaints sent to the OIG were referred to ICE's DRO
for action, but we could not determine the number, nature or
disposition of these cases because DRO's complaint database was
not sufficiently reliable for audit purposes.
In closing, our work noted various deficiencies in
compliance with ICE detention standards, but there was not a
persistent or pervasive pattern regarding medical standards at
the locations we visited. Importantly, it should be noted that
our review did not examine quality of care issues or ICE
decisionmaking on specific detainee medical cases. Nonetheless,
our work showed the need for ICE to address a number of
internal control weaknesses to help ensure that it is in a much
better position to identify and address existing and potential
deficiencies.
This concludes my oral statement, and I would be happy to
answer any questions that the Subcommittee Members may have.
Ms. Lofgren. Thank you.
[The prepared statement of Mr. Stana follows:]
Prepared Statement of Richard M. Stana
Ms. Lofgren. All of the witnesses, this is the time when
Members of the Committee can pose questions. I will begin.
Ms. Myers, I would like to ask about the managed care
structure in the Department. It is my understanding that there
are three nurses here in Washington who are charged with
reviewing all medical treatment requests that are submitted by
the physicians who are actually examining patients who are
detainees at the various sites.
I am not aware of any other system that permits nurses to
overrule the judgment of the on-site physician who has actually
examined a patient. Do you know of any other system that uses
this?
Ms. Myers. Thank you for that question. That will allow me
to explain a little more about the TAR process and also about
the independence that physicians have on site.
As a point of clarification, the TAR process is not used
for routine medications or other decisionmaking that is made by
physicians or other officials on site. The TAR process is used
when there is something that is nonroutine or nonemergency. The
TAR process is used after an emergency just for reimbursement.
It is not an authorization for emergency care. So if there is a
particular thing that appears to be, where you need an outside
provider, the managed care coordinators are the ones that
review that to see whether it falls within the benefits
package.
I would say that ICE did not set up the managed care
system. That is under the Public Health Service and DIHS, which
has a managed care system not just for ICE, but also for the
Bureau of Prisons and the United States Marshals Service which
are also under that. They are the ones that placed that
organization.
Ms. Lofgren. If I may, there have been numerous complaints
that have been brought to the Committee's attention not only by
individuals, but through the press. For example, in The
Washington Post series, which I assume you have read, there are
several instances in which on-site medical personnel expressed
their frustration by the refusal to authorize necessary medical
care. And in the case of the York County prison, the county
actual sued ICE for not authorizing care.
In the July 2007 GAO report, the GAO wrote, ``Officials at
some facilities told us that the special medical and mental
health needs of detainees can be challenging. Some also cited
difficulties in obtaining approvals for outside medical and
mental health care as also presenting problems in caring for
detainees.''
Are you familiar with other facilities that have expressed
concern about denial of care to detainees?
Ms. Myers. The letter you referenced from the York County
facility actually involved a 2005 letter, and it is our
understanding Dr. Farabaugh and others just reached out to the
York County facility yesterday, and maybe as soon as I finish
my answer, I will have him go into more details with respect to
that.
On the TAR process, generally it is less than 10 percent
that are denied. I believe we need to look at the 10 percent
that may be denied. Some may be properly denied. We have
instances where we get a submission for an individual who is
not in ICE custody. It would not be a good use of taxpayer
money to pay for that, or something that is obviously elective.
Ms. Lofgren. Was Mr. Casteneda's biopsy denied under the
TARs system?
Ms. Myers. That case is in litigation.
Ms. Lofgren. But the Government has admitted liability.
Ms. Myers. The Government has admitted liability, but I
believe there is room for improvement in the TAR appeal
process, and that is why we have asked the Office of Health
Affairs, working in conjunction with the Division of
Immigration Health Service, to look at how does the TAR appeal
process work, and how do we make sure the alien has a role in
that process.
Ms. Lofgren. Let me ask you about forced sedation. In its
four-part series, The Washington Post cited what they said was
250 medically unnecessary instances since 2003 in which ICE
sedated a deportee against their will with what they called a
``preflight cocktail,'' Haldol. It is my understanding on
January 9 of this year, ICE headquarters issued a written
guideline stating that the field offices may no longer request
a medical escort from DIHS for involuntary sedation to
facilitate deportation unless the Federal Government has
obtained a Federal district court order authorizing sedation,
and that there was to be no exception to this policy.
The ICE memorandum, I understand, further recommends that
the court appoint counsel for aliens who are not represented or
who are unable to obtain counsel.
Since this policy has been issued, how many Federal court
orders have been issued authorizing sedation for deportation?
Ms. Myers. If I can clarify just a little bit the
information contained in your question, first of all, the
policy directive that I requested be issued in June of last
year said that we cannot do involuntary sedation absent a court
order except in emergencies. And then in January of this past
year, I said there is no emergencies, you know, court order, no
matter what.
It is my understanding, on information and belief, that
since June of last year, I believe there are four applications
that did go to court, and I believe they are all still pending.
But I would request the opportunity to put that in responses to
the record to make sure that I accurately describe the answers
to your question.
I will also add, I think this is just one of many areas in
which ICE is examining decades-long practices and putting in
enhanced oversight for things that have gone on for years, and
where DIHS is very helpful.
Ms. Lofgren. I am going to turn now to the Ranking Member
Mr. King for his questions.
Mr. King. Thank you, Madam Chairman.
It occurs to me as I listen to the testimony and some of
the comments made, including my own, that if someone is
incarcerated in an ICE facility, one can self-deport and simply
say, send me home; I am not satisfied with the food or the bunk
or the medical care. Ms. Myers, have you ever had that happen?
Ms. Myers. There are occasions in which an individual is
going through immigration proceedings, and they decide to
terminate the proceedings, and so that does happen, yes.
Mr. King. Does it ever happen with a complaint about the
facilities, the food or the health care, or anything that has
to do with the environment that they are in other than the fact
that they aren't free to travel?
Ms. Myers. I have no specific knowledge, but I will get
back to you in writing.
Mr. King. I would very much like a response to that. It
would be some interesting insight.
If it is so horrible, has anybody asked to leave because of
the conditions they are in rather than just to avoid the legal
process?
As I look at some memos that I have here, it shows that of
the 27,500 ICE detention beds, 65 percent are located in State
and local prisons or jail facilities; 19 percent commercial
contract facilities; 14 percent are ICE-owned and operated; 2
percent Federal Bureau of Prisons. Has anyone broken down the
data on the deaths during incarceration with regard to those
separate categories?
The reason I ask the question would be, let's just say if
it is a Federal prison or a State or a county, are they more
likely to die in any of those facilities, or is it scattered
across the board, or is there enough data for it to be
significant? I ask you first, Ms. Myers.
Ms. Myers. We would have to go back and make sure that we
go through the statistics to give an accurate reporting.
But we expect individuals, no matter where they are housed,
we expect individuals to live up to ICE standards. If they
don't, we will do just like we did last year: We will move
individuals out of those facilities, and in some instances even
shut facilities down if we can't ensure that individuals in our
custody are being treated in accordance with the ICE detention
standards.
Mr. King. I appreciate that.
Mr. Stana, could you discern any distinction between the
data on let me say unhappy health results with regard to
whether it would be a State or a local prison or a contract
facility or an ICE-owned service?
Mr. Stana. We didn't make that distinction. Every location
we went to, we asked if there had been a death in the facility.
And of the 23 we went to, I believe 2 had a death in the
facility. We didn't do a whole lot of probing, but in one case
the person died in their sleep apparently of natural causes.
And the other case, I believe, was a heart attack.
Ms. Myers. If I can add one point to that, we are starting
this reporting under the Death in Custody Reporting Act. I
believe the Bureau of Justice Statistics will be able to do the
same kind of metrics that they do with other facilities in
terms of looking at statistical deviances and so on. So that
will be one measure going forward that I think will be useful
on that front.
Mr. King. I will submit that if we are dealing with between
230,000 and 311,000 inmates a year, that there should be some
statistical data that would point to a facility or a type of
facility or something other than a random cross-section here.
And one of these things I have here is our 2004 and 2005
mortality rate in our U.S. jails and prisons at 550 deaths in
2004 per 100,000; 540 deaths per 100,000 in 2005; and we are
looking at ICE numbers of 10.8 or 6.8. Can you explain that,
Ms. Myers?
Ms. Myers. I am not a statistician, but we see that even
the flat numbers of deaths that we are having, and any death is
regrettable, the numbers of deaths we are having is going down,
even though the number of detainees are going up.
Some jails have very low lengths of stay, lower than in ICE
custody, which is about 37\1/2\ days. Certainly there is a
comparable thing there.
But many more detainees may not have health insurance than
individuals who come into other facilities. All of these
statistics are reasons why we have asked the Bureau of Justice
Statistics to look at this as we start reporting.
We do have instances, unfortunately, like last year where
someone was in our custody for about 72 minutes, and they had
swallowed some cocaine while in State custody. It exploded
within them, and they passed away.
Mr. King. In your opinion would it be rational or
irrational for this Congress to take action on a major policy
change within ICE health care without answering these questions
as to why there is a significantly lower death rate among ICE
inmates than there are among inmates across the broad spectrum
in other American prisons?
Ms. Myers. I certainly think it makes sense to evaluate all
of those things, and I think it also makes sense to consider
whether or not in the proposed bill it is actually requesting a
higher level of services than those provided to U.S. citizens
or aliens who are detained in U.S. Marshals Service custody who
have not yet primarily been convicted of a crime. I think it is
important to look at those things, look at the costs, and get a
sense of what kind of services are requested or expected.
Mr. King. It is irrational to look at the data before
making a decision.
Ms. Lofgren. As I turn to Mr. Gutierrez, I want to correct
for the record, under the Administration prior to the current
Administration, there actually was a requirement that there be
no sedation whatsoever on deportation, and that was changed.
I yield now to Mr. Gutierrez.
Ms. Myers. May I just respectfully ask to respond to that?
Ms. Lofgren. No, but you will have an opportunity to
respond.
Ms. Myers. I would like to respond to that statement prior
to the end of the hearing.
Mr. Gutierrez. Thank you very much.
I think once again what we see here is we have a hearing,
and then we blame the victim, those detained by ICE. We hear
again the demonization of immigrants. They are all sick; 34
percent. Now we have an argument between Ms. Myers and the
Ranking Member whether it is 34 or 25 percent.
They talk about chronic illnesses, hypertension. I am not
afraid of anybody with hypertension or diabetes. They then
repeat ad nauseam tuberculosis, something that is a contagious
disease, to make it appear after this testimony they are all
dangerously ill coming to this country.
I find it amazing that these very same people who are so
dangerously ill are the same people who are taking away the
jobs from Americans, showing up to work every day doing hard
work, intense labor at meat-packing plants, picking up the food
out in the fields under intense heat, and yet, well, a third of
them have a chronic illness. I wonder if that is the way it is
for the rest of the American population.
It makes it feel like you offer, Ms. Myers, Rolls Royce
health care. That is what we just hear from the Ranking Member,
Rolls Royce health care. I almost feel after listening to the
Minority that it is safer. I should maybe when I go to Chicago
not check into my house, check into an ICE facility. It is
probably safer there, according to the Minority, than it is on
the streets of Chicago.
Mr. King. Will the gentleman yield?
Mr. Gutierrez. I will not yield.
Mr. King. It probably is.
Mr. Gutierrez. I said I will not yield.
It appears it is safer for me. Again, the demonization, the
criminalization, we hear it all the time.
Let me ask Ms. Myers a question. How many people did you
detain on the streets in work sites in America last year that
you ultimately deported?
Ms. Myers. I will have to get back to you in writing.
Last year we arrested administratively in work site 4,667
or so. In addition, we had 863 criminal arrests.
We take our responsibility extremely seriously.
Mr. Gutierrez. I know you want to control the hearing, but
I have limited time, and I want to ask my questions.
How many people did you detain on the streets of America
and deport last year?
Ms. Myers. We deported almost 300,000.
Mr. Gutierrez. Three hundred thousand people, and you had
more money to do that last year than you have had in previous
years?
Ms. Myers. Congress gave us more money to do that.
Mr. Gutierrez. And you have more money for next year so you
can increase the level of deportations?
Ms. Myers. Our responsibility is to enforce the immigration
laws.
Mr. Gutierrez. Do you expect to have the capacity to deport
more people next year than you did last year?
Ms. Myers. Yes, I do expect that.
Mr. Gutierrez. What increase--do you think you will go from
300 to 330, so you have a 10 percent increase, a 20 percent
increase? What do you think it is going to be?
Ms. Myers. I will say that the number of aliens we charge
in jail--we expect to charge over 200,000 aliens in jails this
year.
Mr. Gutierrez. Okay, 200,000 this year. So next year you
expect to deport at least 300,000 people next year?
Ms. Myers. Well, not all of the aliens who are in jail, who
are charged, who are going through immigration procedures, will
get out of jail this year. But once they get out, assuming
their orders are removed and not allowed to adjust in any way,
yes----
Mr. Gutierrez. I know you want to emphasize on the
criminalization of the population that you deal with. I am just
asking you a general question, and I would really appreciate a
specific answer to the question.
How many--according to ICE, how many undocumented workers
or illegally present people are there in the United States of
America?
Ms. Myers. You know, I don't believe----
Mr. Gutierrez. You don't know.
Ms. Myers [continuing]. There is a number on that.
Mr. Gutierrez. You don't know. You have no idea. You have
no idea, and there is no documentation in ICE, under oath,
that--you have no idea, and you have never in ICE or at
Homeland Security come up with a number of undocumented workers
in the United States.
That's your testimony?
Ms. Myers. Well, certainly the Bureau of Immigration
Statistics looks at----
Mr. Gutierrez. And they say there are how many?
Ms. Myers. You know, that's not within my agency, so I am
going to have to reflect----
Mr. Gutierrez. Fine. I will not comment on what has been
statistically shown, since you don't know. You are the head
person at ICE and don't have a number.
You know, I would think that if I had a population of
people that I needed to police, I would at least have an
estimate of how many people it was I had to police and deal
with as part of my Federal responsibilities.
But it's your testimony here today that you cannot answer
that question because you don't have a number.
Ms. Myers. No, no, no.
Mr. Gutierrez. And because my time--let me finish. And
because my time is up, it begs the question once again. What
are we doing?
Ms. Lofgren. The gentleman's time has expired.
Mr. Gutierrez. Because you know as well as I know that
there have been estimates of between 12 and 20 million.
Ms. Lofgren. The gentleman's time has expired.
Mr. Gutierrez. And at a rate of 300,000 a year, which you
have been doing with lots of gusto, it would take us 25--with
not one more coming in, which begs the----
Ms. Lofgren. The time of the gentleman has expired.
Mr. Lungren. Privilege of the Chair, Madam Chairman.
Ms. Myers. May I please respond to that question?
Ms. Lofgren. The gentleman's time has expired.
I am going to take the privilege of the Chair to give you a
minute to comment on the Bush administration's policy of
requiring a court order in every case to sedate, to deport,
which I promise to give you an opportunity to comment on, as
well as a very brief response, before turning to Mr. Lungren.
Ms. Myers. I appreciate that very much.
First, I will say upon information and belief--and we
certainly would look forward to getting back to this in writing
to you, I am not aware that that was the policy in the previous
Administration and the former INS.
That was not my experience, which was why I believed that
it was important to issue the directive which I did last
summer.
If I could also respond to Congressman Gutierrez, what I
said related to the U.S. for an estimate of individuals
working, as opposed to an estimate of individuals who are
currently here. Certainly the Office of Immigration Assistance,
as well as the Pew Research Center--it does have--I can give
those statistics to you.
I am going to turn now to the Ranking Member, Mr. Smith. I
will give you the White House memo that outlines the Clinton
policy.
Ms. Myers. Well, it does follow the question that I had.
Ms. Lofgren. I turn now to the Ranking Member of the full
Committee, the honorable gentleman from Texas.
Mr. Smith. Thank you, Madam Chair. Before we get back to
the subject matter at hand, Secretary Myers, I don't want the
record to misrepresent your knowledge.
Of course, you have a range of millions of people you know
who are in the country illegally. Just because you can't give a
precise figure actually points to a lack of a failure or a
failure to enforce immigration laws; that's why we don't know
how many people are coming into the country illegally.
But if you were to be asked, you would probably agree that
there are 12 to 20 million people who are here in the country
illegally, would you not?
Ms. Myers. I would.
What I was responding to--his question was the individuals
who were working. I believe there were some independent studies
to talk about what percent of illegal aliens are working. They
are not ICE studies.
I can't vouch for the Pew Center's numbers, but certainly I
am aware of that.
Mr. Smith. There are no specific numbers. All we have is
sort of orders of magnitude. But, again, that points to the
failure or inability to enforce immigration laws.
Let me get back to the subject at hand. You made the point
earlier in your opening estimate that the number of deaths in
detention facilities had traumatically declined over the last
couple of years. What were those figures again?
Ms. Myers. In calendar year 2007, there were seven deaths
in our facilities. We had a detainee population of 323,000
individuals.
In calendar year 2006, there were 16 deaths in our
facility.
If you look back to calendar year 2004, there were 29
deaths.
Mr. Smith. The trend is dramatically down.
Ms. Myers. The trend is dramatically down and the record-
keeping is up.
Mr. Smith. Right.
Ms. Myers. When I look back at the----
Mr. Smith. Was that true or reported in any of the critical
articles, the substantial reduction in deaths?
Ms. Myers. You know, certainly we had challenges with
respect to The Washington Post, the implications that were
there. We disagree with a number of them. We have a long letter
into the office----
Mr. Smith. Would it have been a more balanced approach to
show the progress you have been making and compared how few
deaths there were compared to past years, would it not?
Ms. Myers. I think it would. That's why we have a formal
complaint in.
Mr. Smith. What else does your complaint encompass? Were
there other inaccuracies or omissions that should have been
included?
Ms. Myers. There are a number of those. If you read the
article, it implies suicides are up. Obviously, as my testimony
indicated, we haven't had a suicide in the last 15 months. We
are working very hard to do what we can to ensure that we have
quality medical care.
The series didn't focus on the fact that we actually took
over in a more direct fashion the administration of DIHS in
order to ensure greater oversight. The Washington Post series
failed to compare the treatment that DIHS provides with the
Marshal Service system. Instead, it claimed that DIHS provided
inadequate service and so on.
We certainly have a 5-page letter which I would be happy to
provide to the Committee, if you would like.
Mr. Smith. I would like to have a copy of that. I would
also like to make it part of the record. It seems to me at the
very least you are owed a correction or retraction on the basis
of that article.
Ms. Lofgren. Without objection, we will put into the record
the articles as well as the letter.
Mr. Smith. Thank you, Madam Chairman.
Mr. Stana, let me go back to your work at the GAO. You
said, I think, that you only found examples of noncompliance,
and I would say that some of them might be accurately described
as minor in 3 of the 23 facilities that you visited; is that
correct?
Mr. Stana. That is correct.
Mr. Smith. In only three did you find the noncompliance of
standards.
You also said they were not pervasive. Is that accurate as
well?
Mr. Stana. These were the medical care standards. There is
a distinction between quality of care. I wanted to point that
out. But this involves things like, was the proper equipment on
site, did they have access to a doctor, did they have medical
emergency procedures? Were inmates given the opportunity to go
to a sick call? Were there suicide watch procedures? Those
kinds of things.
Mr. Smith. In those 3 out of 23 facilities, 13 percent of
the facilities, would you describe the problems that you found
as comprising a hidden world of faulty administrative
practices, sloppy record-keeping and lost medical files; or is
that a slight exaggeration as to what you found in those 23
facilities?
Mr. Stana. I can tell you what we found at the 23
facilities.
We found some differences between the large ones and the
small ones as to how much equipment was on hand. We found that
they were clean, they were well attended to.
We did find there were some employee grievances--not
employee grievances. There were detainee grievances. If there
is an Achilles' heel to this whole process, it's the handling
of those grievances.
We are talking about what the scale of this problem is. One
way to find out is to use the grievance and the monitoring and
the compliance mechanisms as the canary in the coal mine,
because it is not reliable.
Mr. Smith. Right. Again, no systematic noncompliance in
those facilities?
Mr. Stana. We didn't find it, not at the facilities we were
at.
Mr. Smith. Great. Thank you very much.
I will yield back the balance of my time.
Ms. Lofgren. The gentleman yields back.
I would now recognize my colleague from California, the
gentlelady, Ms. Sanchez.
Ms. Sanchez. I thank the Chairwoman. Again, I just want to
start--before I start questioning, I just want to point out
something.
Much was made about the fact that detainees can voluntarily
choose to leave if the food or the medical care treatment is
that bad.
I might point out to my colleagues on the dais, if they
didn't already know this, that there are many countries with
whom we don't have repatriation agreements. It would be pretty
hard for somebody to allow--voluntarily allow themselves to be
deported to a country that we essentially can't send them back
to, and that there are many asylum seekers that end up in
detention facilities. They are not exactly anxious to go back
to war-torn places where they may be targeted for death or
other kinds of threats.
So I just wanted to make sure my colleagues on the dais
understand it's not necessarily as easy as saying, well, pack
me up and send me home because the medical care here is
substandard.
In terms of questions, Ms. Myers, both The Washington Post
and the Office of the Inspector General have cited the
debilitating shortages of medical staff at detention centers.
And at some facilities, vacancies in medical positions range
anywhere from 20 to 50 percent.
Is that degree of lack of staff in compliance with the
standards of the American Correctional Association or the
National Commission on Correctional Health Care?
Ms. Myers. Thank you for that question.
We certainly agree that there were some concerns with
respect to staffing, and we had some issues at ICE with respect
to moving along as quickly as we would like with ICE and
getting the staffing up. That's why in October of 2007 we
actually took DIHS over more formally for--and the
administrative side to really work on the staffing.
Last January----
Ms. Sanchez. But my question was----
Ms. Lofgren. I am going to interrupt. We have just been
notified that an alarm has gone off, that a tornado is heading
for the Capitol, and that we should stay away from windows and
stay inside.
Since there are three windows right in back of us, I think
that probably we should recess this hearing temporarily and
move into that hallway.
Thank you. We are in recess.
[Recess.]
Ms. Lofgren. That's the first time I have ever had to
recess a hearing for a tornado. As a Californian, that's kind
of a new thing for me.
We are trying to find Congresswoman Sanchez to let her know
we are back in session, and also the other Members who
recessed, to let them know that we are back.
So we will not use your time frivolously, I wonder, Mr.
Davis, if you would like to begin your questioning while we
notify other Members that we are back in session. Then we will
let Ms. Sanchez resume her questioning when she returns.
So I would turn now to Mr. Davis.
Mr. Davis. Thank you, Madam Chairwoman.
Ms. Myers, I am from Alabama so I am not scared of
tornados. You notice these California folks ran. The Iowan and
the Alabaman stuck around.
Let me, Ms. Myers, try to get us refocused a little bit. I
was reading your opening statement--didn't have a chance to
hear you--but I was reading your opening statement or the
transcript of it. And you talked for a moment about the quality
assurance professionals who inspect the largest ICE facilities,
and I want to ask you point-blank, how many of these quality
assurance professionals are doctors?
And, as they conduct their quality assurance review, are
they evaluating the facilities for their medical quality?
Ms. Myers. Thank you for that question. I am from Kansas,
and I am scared of tornados, being from Kansas.
But to be clear, the quality assurance professionals that
are in our 40 largest facilities, those are focused on overall
compliance with all our detention standards, so it's not solely
on medical care. So these are individuals to make sure, if
there is any issue with any particular detention center, they
are there.
We do have a detention field inspection group, which is
this independent arm operating under the Office of Professional
Responsibility. They have a medical professional within that
group, so they are able to go out and do target reviews.
But I think we can do more. That is the reason----
Mr. Davis. Well, you frankly said what I thought you would
say. My sense, from reading your testimony and from reading the
testimony of the other witnesses, is that it's a quality
assurance review that is far more generalized and the medical
review so that----
And, also, given your concession that we can do more, I
make a proposal to you: Why not have the American Medical
Association, a respected group of doctors, the equivalent of
the ABA for lawyers, why not ask the AMA to appoint a panel of
professionals to come in, review these facilities or to review
at least perhaps 20 of them?
Ms. Myers. Well, what--actually, what we have asked to do
which is similar to that, but not precisely that, is to ask the
Office of Health Affairs to look at--some experts that could do
an overall review of all of DIHS processes. So they are finding
experts, recognized medical experts, who can look and see, as
DHS has taken over greater administrative control of the DIHS,
what works, what doesn't work, where have things changed, where
can we really do best practices?
So this is our review that is starting now.
Mr. Davis. Well, slow down for 1 second.
Ms. Myers. Oh, sure.
Mr. Davis. That's a perfectly reasonable suggestion, but
what about my AMA suggestion? Good idea or bad idea?
Ms. Myers. Well, I think--I thought that some sort of--some
sort of review, once we took DIHS over, was appropriate. That's
why we conducted a baseline review of our own----
Mr. Davis. AMA, good idea or bad idea?
Ms. Myers. What?
Mr. Davis. AMA, good idea or bad idea?
Ms. Myers. Yeah. I think that--the OHA review that is going
on, I think really encompasses--and so I think that is
sufficient to do the kinds of things that both you and I want
to do.
Mr. Davis. Not to be contentious, but I do want to try to
get an answer because I mean it as a good-faith suggestion.
The AMA is an enormously respected entity that I assume is
the equivalent of the ABA. I certainly don't think they are
known as a partisan or democratic leaning entity in any sense
of the word.
What's wrong with having the AMA come in and do a review?
Listen to what I think the advantage would be: having
somebody other than the Federal Government take a look at the
Federal Government, having somebody outside the governmental
process come in. Because I think--and I think this is the
concern that others have driven home to you, I think, Ms.
Myers--that we can go back and forth on what's the quality of
care and all of that.
I am going to ask you some questions about that in a
moment, but if you are serious, and I take you at your word
that you are serious about improving the quality of care at
these facilities, it would seem that the best way to do that,
is, frankly, not to have an intragovernmental review or even to
have another Government agency conduct a review, but to frankly
have an assessment by medical professionals.
I am going to move on as my time is about up, but I would
seriously encourage you to give some thought to the idea of an
outside medical entity such as the AMA coming in and doing
analysis.
A final set of questions: Are you a lawyer, Ms. Myers?
Ms. Myers. Yes, I am. Not a practicing lawyer.
Mr. Davis. What do you believe is the standard of care for
the individuals who are held in these facilities?
Ms. Myers. I believe that DIHS has a responsibility to
provide medically necessary health care while at the same time
ensuring proper obligation of Federal funds, to ensure that we
don't overpay for anything.
Mr. Davis. Well, I would be curious in hearing--and perhaps
in writing would be a better place for discussion on this,
given the time limits, but I am seriously concerned about what
DIHS considers to be the standard of care toward these
individuals.
Is it analogous, for example, to the standard of care for
people who are in Federal prison?
Ms. Myers. Well, I think you raise an excellent point. I
believe it is analogous to the standard of care for U.S.
Marshal Service prisoners, individuals who are coming into
Marshal Service custody who have not yet been convicted of a
crime.
There may have been areas where it differs, but overall, it
appears that that standard of care is very consistent. But, as
I said, I am not a doctor.
Mr. Davis. Is that current policy? Is what you just said
current policy?
Ms. Myers. That is my understanding. But let me say that's
why we asked the Office of Health Affairs to actually consult
with outside professionals--not just to do an intragovernmental
review--but to consult with outside Government officials and
look at all the DIHS system processes and see where there's
room for improvement.
I can see myself where there's room, but the doctors may
have additional advice of counsel.
Mr. Davis. I see my time has expired.
Ms. Lofgren. The time of the gentleman has expired.
We will turn now to the gentleman from Virginia, Mr.
Goodlatte.
Mr. Goodlatte. Thank you, Madam Chairman.
Ms. Myers, I would like to ask about one of the provisions
in H.R. 5950 that has been introduced by the Chairman to
address some of the concerns. That bill appears to require the
Department of Homeland Security to provide continuity of care
for a reasonable period of time after removal.
Do you read that to mean that the Department would be
responsible for providing care to a detainee even after they
are removed from the United States?
Ms. Myers. Well, certainly. And I would caveat this with,
obviously our lawyers are going to take a thorough assessment
of the bill. The Administration will then take a position. But
I do believe the language is vague in that it is just, you
know, kind of what exactly is the continuity of care.
By the way, we do already provide continuity of care in
certain instances. But I think we need to look at the language
and understand what is expected.
Ms. Lofgren. Would the gentleman yield?
Mr. Goodlatte. I would be happy to yield.
Ms. Lofgren. I don't have a copy of the bill in front of
me, but the intent, and if we get to a markup, it for example,
the medical records should be provided to the person if they
are removed, and things of that sort; that there should be
planning, not just dumping somebody.
Mr. Goodlatte. But you wouldn't be contemplating providing
actual health care after they are no longer under the
jurisdiction?
Ms. Lofgren. No. In fact, we have strongly suggested that
for those individuals who are in custody with serious health
care problems, that they be provided alternatives to detention
standards, so they could bill their own insurance, instead of
the Federal Government.
For example, if you have a chronic condition, and you are
applying for a political asylum, why not put on an ankle
bracelet and get your own care instead of being in detention?
But I thank the gentleman for yielding so I could clarify
that.
Mr. Goodlatte. I thank the Chairwoman for that guidance. I
hope the language in the bill will be clarified to make it
clear we are not providing care to people after they have been
deported from the United States.
Ms. Myers, in your opinion, what is the maximum amount of
time that would comply with the, quote, ``reasonable period of
time'' requirement that's described in the bill during which
the Department of Homeland Security must ensure continuity of
care for detainees after release or removal?
Ms. Myers. You know, I couldn't really provide a precise
number at this time, but I think both points are very valid
that we would need to look at kind of what is expected.
Right now, in many instances we assist with follow-up
appointments. We provide detainees, for example, with several
days' worth of medication so that they could then go and find
an additional doctor back in their own country or back in the
United States.
With respect to asylum seekers, very few asylum seekers are
detained. Of course, we do have our parole policy which
provides that after they go through the considerable peer
process they are considered for parole.
Mr. Goodlatte. I also have concern about the phrase,
``serious medical or mental health conditions,'' which are not
defined anywhere in the bill, that would raise some questions
about how you would draw the line between serious medical or
mental health conditions and nonserious conditions.
Ms. Myers. I think that's exactly right. The bill also
talks about more comprehensive dental care and vision care than
is provided to prisoners in the United States Marshal Service
custody.
So I think there are a number of things that I think we
should consider. What does the Congress want to find? We, as
ICE, will implement, of course, whatever the Congress decides.
Mr. Goodlatte. Let me ask you if the Department has
considered the use of telemedicine to improve the quality of
care that detainees receive while saving the taxpayer dollars.
We have seen this utilized all across the country in prisons,
in jails, and other places where having doctors immediately
available, especially specialists, would be a considerable
expense.
Ms. Myers. I am going to have the doctor, if that's okay,
respond to that.
Dr. Farabaugh. We are actually actively pursuing a
telemedicine system for our agency. This would mainly be
utilized within DIHS facilities. Obviously we can't put
equipment in every--you know, all 350 IGSA facilities out there
that are used, but we can concentrate them with our own
facilities to enhance the care that's provided.
Mr. Goodlatte. Well, good. We hope you will do that,
because I have seen it used very effectively in rural areas.
Let me also say that I am stunned by the progress that you
have made in reducing fatalities, deaths in your facilities,
but even more so by the comparison of mortality rates in U.S.
jails and prisons and in your facilities. I see 10.8 per
100,000 a year in facilities and 550 in prisons. And in 2005,
6.8 compared to 540.
Is there some explanation for why your mortality rate is
dramatically lower than it is in prisons?
Ms. Myers. You know, I think certainly we are very pleased
that we have been able to reduce the number of deaths, although
absolutely any death is regrettable, I think. I am very proud
of the care that DIHS provides the professionals that are there
and the work that we do in order to make sure people get the
best medical care.
Of course, individuals in jails may be in for a much
shorter period of time than individuals in ICE custody.
Individuals in prison may be in there for a much longer period
of time than individuals in ICE custody.
So even--there are some variances, as well as the number of
individuals with insurance; it may be much lower for
individuals who come into our custody than for individuals who
come into other custodies.
There are a number of factors, but I am very proud of the
work that they do.
Ms. Lofgren. The gentleman's time has expired.
Mr. Smith had asked to make a unanimous consent request to
make a correction to his opening statement. I will recognize
Mr. King for that purpose.
Mr. King. Thank you, Madam Chairman.
I appreciate being recognized on behalf of Mr. Smith, who
wishes to correct a statistic he cited in his opening
statement.
The correct figure is that immigrants are over six times
more likely to have tuberculosis than native-born Americans,
not four times.
He appreciates your indulgence. I yield back.
Ms. Lofgren. Without objection.
I understand that Ms. Sanchez would like to yield her
remaining 3 minutes to Mr. Davis to continue his questions.
We are going to have votes pretty soon, so we will have to
say goodbye to this panel.
Mr. Davis. Thank you, Madam Chairwoman. I will try to not
take the 3 minutes.
Let me pick up, conveniently enough, on the last question
Mr. Goodlatte asked about the decreasing mortality rate, which
you contend is a very low mortality rate. You made this point,
but frankly, you made it at a rapid pace. I want to slow down
and make sure that everyone gets this.
I think it is enormously difficult to compare the ICE
population with the prison population. One reason I suspect
that people stay in American prisons a lot longer than people
stay in ICE facilities: What's the average length of stay for
someone at one of your detention facilities?
Ms. Myers. The average length of stay in ICE facilities is
actually between 33 and 37 days. Jails, in some American jails,
the average length of stay is also in the 30 days--in that time
period. But absolutely, in prisons it can be much longer.
Mr. Davis. So that's one reason. Obviously, very few people
get sentences of 30 days in the American prison system, so
that's one comparison.
You mentioned another having to deal with the level of the
uninsured. I would suspect there are also some age differences.
What's the average age of people in the ICE facilities?
Ms. Myers. You know, I am going to have to get back to you
on that in writing, so I can be positive.
I have seen, in jails, the average age--I think--in the
Bureau of Prisons, I believe, the average age is 38, so, you
know, kind of midlife.
But let me say, I agree with you that having a more robust
analysis of the statistics would be useful. That's why we have
asked the Bureau of Justice Statistics to take our statistics
and look at them with all the other statistics under the Deaths
in Custody Reporting Act. They can do the analysis, they have
the statisticians. They can draw the comparisons that maybe we
can't as effectively draw.
Ms. Lofgren. Would the gentleman yield for a question?
Mr. Davis. Yes.
Ms. Lofgren. One of the differences between people in your
ordinary, for example, State prison and ICE detentions, number
one, the ICE detention people aren't criminals. But, number
two, the ICE detention people are oftentimes moved around
whereas the prison population tends to be sedentary.
How do you--we have had a lot of complaints that medical
files and medication don't get moved with detainees. How do you
make sure that happens so that the medical care isn't deficient
or, at the next facility, the person has to start over from
scratch?
Ms. Myers. Well, there are a couple of things that we do
more generally, and a couple of initiatives, to make sure that
we are comprehensively addressing this problem.
I think more generally if we have specific instances that
are brought to our attention, we address them, we look at them.
Obviously, the detainee standard addresses this as well as some
of the standards that apply to DIHS.
But we are looking at our performance-based standards that
are out for review by the Inspector General where we receive
comments from the NGOs and other groups to make sure that the
transfer standards make it clear about the transfer of the
record----
Ms. Lofgren. But there is a standard right now. Do you
require that the files be sent with the inmate?
Ms. Myers. A file--or in cases where we don't have access
to a complete file, a summary of that information. Absolutely.
Ms. Lofgren. And that their medication be transferred with
them?
Ms. Myers. That their medication be----
Ms. Lofgren. That's what you require?
Ms. Myers. That's what we require.
I believe there is some room for improvement on some of
these, certainly in the IT area, the--you know, the DIHS IT
system has a lot of room for improvement.
Ms. Lofgren. Okay. Our time has expired, and we are out of
Members who want to ask questions. So we will thank this
witness for your presentation today.
The record will be open for 5 legislative days. There may
be additional questions that we will forward to you in writing,
and we would ask that those questions be promptly answered, if
that happens.
We will now ask the next panel to come forward. I would
like to introduce all of them.
First, I am pleased to welcome Dr. Homer Venters, Attending
Physician at the Bellevue/NYU Program For Survivors of Torture,
as well as a Public Health Fellow at New York University.
As part of Doctors of the World, Dr. Venters sees detained
asylum seekers who are victims of torture, and his research
involves health care for detained immigrants. Dr. Venters first
became involved with immigration health care as a health
volunteer while in the Peace Corps in Togo. His most recent
publications deal with public acceptance of torture in the
United States and health care for detained immigrants.
Next, I would like to introduce Ann Schofield Baker, a
principal in the New York office of the law firm of McKool
Smith, where she is the head of the firm's national trademark
litigation practice. Along with her diverse practice, Ms.
Schofield Baker maintains an active pro bono practice, through
which she represented Amina Mudey, an asylee from Somalia who
was detained at the Elizabeth Detention Center in New Jersey.
She is admitted to the New York, Washington D.C., and
Massachusetts bars, and to the Federal District Courts in the
Southern and Eastern Districts of New York.
Our next witness is Mary Meg McCarthy, Executive Director
of the National Immigrant Justice Center, which she has led
since 1998. NIJC serves approximately 8,000 asylum seekers,
trafficking victims, unaccompanied immigrant children, detained
adults, and other low-income immigrants each year, drawing on a
network of 1,000 pro bono attorneys. Prior to joining NIJC, Ms.
McCarthy practiced civil litigation at the law firm of Horvath
& Lieber and served as a pro bono attorney for NIJC's asylum
project.
Our next witness is Zena Asfaw, a former immigration
detainee. Zena was born in Addis Ababa, Ethiopia, where she
worked for Ethiopian Airlines. Having endured persecution at
the hands of the Ethiopian Government, she fled Ethiopia and
made her way to the United States, where she applied for
asylum.
Upon arriving in the U.S., Zena was detained and held for 5
months in an ICE detention center. She was finally released
when an immigration judge granted her application for asylum.
She currently lives in Los Angeles and is employed by the
Sheraton Delfina in Santa Monica.
Next, I would like to introduce Gloria Armendariz. Gloria
is a U.S. citizen and is here to testify concerning her common-
law husband, Isaias Vasquez, a veteran of the Armed Forces, who
was detained for about 18 months in several detention
facilities. After his release, Isaias was granted U.S.
citizenship based on his military service.
Our next witness is the Reverend Roy Riley, Bishop of the
New Jersey Synod of the Evangelical Lutheran Church in America,
the largest Lutheran denomination in the United States. Bishop
Riley serves on the board of directors of Lutheran Immigration
and Refugee Services, which serves and advocates on behalf of
refugees, asylum seekers, unaccompanied children, immigrants in
detention, families fractured by migration, and other
vulnerable populations.
Next is Mr. Edward Harrison, President of the National
Commission on Correctional Health Care, a not-for-profit
organization that provides standards and independent
accreditation of correctional health services. Mr. Harrison
advocates for a better understanding of the importance of
appropriate medical and mental health care in corrections
facilities, and the relationship between correctional health
care and the public's health.
He has been employed by NCCHC since 1986 and has been its
president since 1993. He earned his Master's degree from
Northwestern University's J.L. Kellogg Graduate School of
Management and his undergraduate degree from the University of
Illinois.
Our final witness is Mr. Isaac Reyes, partner with the
government relations firm of Austin, Copelin & Reyes, which
represents the U.S./Mexico Border Counties Coalition. Mr. Reyes
spent 7 years working on Capitol Hill, most recently as policy
adviser at the Senate Democratic Policy Committee, a leadership
office of the former Democratic Leader of the Senate, Tom
Daschle. Mr. Reyes received a Bachelor of Arts, with a major in
political science, from California Polytechnic University at
San Luis Obispo.
Each of your written statements will be made part of the
record in its entirety. We are going to ask you to give about 5
minutes of oral testimony. But we are going to ask you to do
this when we come back from voting.
All of those bells and whistles mean that on the floor of
the House right now there is a vote going on. We have about 10
minutes left to get over there, and then I think there are four
additional 5-minute votes. So what that means is at about 4:30,
if we are lucky, we will be back here to hear your testimony.
So, relax, I think there's a coffee shop down the stairs if
you want. We will be back, we hope, about 4:30. We are in
recess until that time.
[Recess.]
Ms. Lofgren. We have finished our voting for the next 2 or
3 hours. I would like to wait for the Ranking Member to arrive
before we begin the testimony.
However, perhaps we could go through the formality of
swearing each of you in. If so, would you stand and raise your
right hands. I will read the oath, and you can say, yes, if you
agree at the end.
[Witnesses sworn.]
Ms. Lofgren. We notice that all of the witnesses have
indicated in the affirmative.
Because several witnesses have transportation issues, I am
going to ask that we get started, since the Ranking Member is
on his way in. If we can start at the end with Mr. Reyes and
then move right along, Mr. Harrison and the like.
So we are going to start with Mr. Reyes.
TESTIMONY OF ISAAC REYES, WASHINGTON REPRESENTATIVE, U.S./
MEXICO BORDER COUNTIES COALITION
Mr. Reyes. Thank you, Chairwoman Lofgren, Ranking Member
King and Members of the Subcommittee, for inviting me for to
testify about the U.S./Mexico Border Counties Coalition
findings on the costs of providing medical care to undocumented
immigrants.
The Border Counties Coalition is a nonpartisan policy and
technical forum comprised of the elected officials from the 24
governments located on the Southwest border. Our efforts at the
Federal level are focused on increasing the reimbursement
levels for the costs associated with undocumented immigration
resulting from the failure of the Federal Government to secure
our borders.
Because of their proximity to the border, our member
counties bear a disproportionate share of these costs. My
testimony this afternoon is about the cost to border counties
for providing health care to undocumented immigrants.
It is awkward to be discussing fiscal costs related to
undocumented immigration when many of the witnesses this
afternoon are addressing the loss of life and the horrific
treatment of people in custody.
The focus of this hearing, the treatment of immigrants in
detention, most of whom were, up to the time of their jailing,
working and contributing members of their communities, whose
only crime was to be living and working in the U.S. without
permission, is an issue that needs more congressional
oversight, and I urge continued examination of this problem.
Let me say clearly that our organization does not oppose
the delivery of health care to undocumented immigrants. What we
are saying is that the Federal Government should be responsible
for these costs, not counties.
The Federal Government controls our Nation's borders and
has the sole responsibility for developing and enforcing the
immigration policy. The Federal Government's success or failure
in protecting the Nation's borders directly affects State and
local governments, particularly Southwest border counties.
Border counties receive pennies on the dollar when it comes
to reimbursements from the Federal Government, whether we are
talking about the State Criminal Alien Assistance Program, the
Southwest Border Prosecution Initiative or Section 1011 Funds
for Emergency Health Care reimbursement.
These three pots of money, developed as reimbursement
programs, did not come close to making border counties whole.
From 1999 to 2006, the 24 counties along the border spent a
cumulative $1.23 billion to process criminals, undocumented
immigrants, through the law enforcement and criminal justice
systems. During that same time border counties only received
$54 million in reimbursements from the Federal Government.
Again, the costs were $1.23 billion, and only $54 million in
reimbursements from the Federal Government.
In fiscal year 2006 alone the cost was 192 million. Of that
192, border counties received only $1.47 million. These are
staggering costs, considering the rural nature and poverty
level of most of these border counties.
Our 2002 study, entitled ``Medical Emergency: Who Pays the
Price for Uncompensated Emergency Medical Care Along the
Southwest Border?'' provides an estimate of the costs for
providing emergency hospital and transportation services to
undocumented immigrants. Our study determined that undocumented
immigrants cost border hospitals $189.6 million in
uncompensated emergency medical costs during 2000. To put this
figure in context, total reported uncompensated costs at border
hospitals were 831 million, meaning that costs attributable to
undocumented immigrants comprised almost 25 percent of the
uncompensated emergency room care.
In addition, we estimate that emergency medical service
providers had 13 million in uncompensated costs, bringing the
total to more than 200 million in uncompensated emergency
medical costs during 2000. Our study found that the former INS
brought injured and ill-undocumented entrants to hospital and
emergency rooms or called ambulances without arresting them, so
that the Federal Government would not bear the cost of
treatment.
Although the Federal Government reimbursed the States and
counties for part of the costs they incurred for providing
federally mandated and mercy health care services to
undocumented immigrants, Southwest border counties are
absorbing a significant and disproportionate amount of the
costs.
The position of the Border counties Coalition is that the
Federal Government should support the medical treatment of
undocumented immigrants and pay for 100 percent of these costs.
The Federal Government is responsible for the costs associated
with undocumented immigration, not counties.
The costs to process undocumented immigrants come at the
expense of basic, vital services to county residents. The unmet
needs include libraries, jails, courtrooms, parks and basic
infrastructure to colonias' new developments, flood prevention,
social service programs for abused children and women, child
care and after-school programs, but the overwhelming needs
expressed by our elected officials are related to health care.
They need more ambulances, clinics, more indigent health
care funding and more funding for comprehensive health care
programs. These are basic services that lift the quality of
life and communities. And the residents of border counties
should not be asked to go without them because of the failure
of the Federal Government to fully reimburse them.
Thank you for the opportunity to present the findings of
our report, and I will be happy to answer any questions.
Ms. Lofgren. Thank you very much.
[The prepared statement of Mr. Reyes follows:]
Prepared Statement of Isaac A. Reyes
Chairwoman Lofgren, Ranking Member King, members of the
subcommittee, thank you for inviting me to testify about the U.S./
Mexico Border Counties Coalition findings on the costs of providing
medical care to undocumented immigrants. I am the Washington
representative of the Border Counties Coalition, a nonpartisan, policy
and technical forum compromised of the elected officials from the
twenty-four county governments located on the U.S./Mexico border. Our
efforts at the federal level are focused on increasing the
reimbursement levels for the costs associated with undocumented
immigration resulting from the failure of the federal government to
secure our borders. Because of their proximity to the border, our
member counties bear a disproportionate share of these costs.
My testimony this afternoon is about the costs to border counties
for providing health care to undocumented immigrants. It is awkward to
be discussing fiscal costs related to undocumented immigration when
most of the witnesses this afternoon are addressing the loss of life
and horrific treatment of people in custody. The focus of this
hearing--the treatment of immigrants in detention--most of whom were,
up to the time of their jailing, working and contributing members of
their communities whose only ``crime'' was to be living and working in
the U.S. without permission--is an issue that needs more Congressional
oversight and I urge continued examination of this problem.
The federal government controls our nation's borders, and has sole
responsibility for developing and enforcing immigration policy. The
federal government's success or failure at protecting the nation's
borders directly affects state and local governments, particularly
southwest border counties. Border counties receive pennies on the
dollar when it comes to reimbursements from the federal government,
whether we are talking about the State Criminal Alien Assistance
Program, the Southwest Border Prosecution Initiative, or Section 1011
funds for Emergency Health Care Reimbursement. These three pots of
money, developed as reimbursement programs, do not come close to making
border counties whole.
From 1999 through 2006, the 24 counties along the border spent a
cumulative $1.23 billion on services to process criminal undocumented
immigrants through the law enforcement and criminal justice system.
During that same time, border counties received only $54.8 million in
reimbursements from the federal government. In fiscal year 2006 alone,
the cost was $192 million. Of that $192 million, border counties
received one percent of the SCAAP appropriation--only $4.7 million came
back to them. These are staggering costs considering the rural nature
and poverty level of most of these border counties.
Many members of this subcommittee are well aware of the problems
associated with SCAAP and are trying to improve that program. The
recent passage of H.R. 1512, sponsored by Representative Sanchez and
approved by this subcommittee, will bring more SCAAP funds to our
counties and we thank you for your efforts and recognition of the
problem.
Our 2002 study, entitled ``Medical Emergency: Who Pays the Price
for Uncompensated Emergency Medical Care Along the Southwest Border?''
provides an estimate for the cost of providing emergency hospital and
transportation services to undocumented immigrants. Our study
determined undocumented immigrants cost border hospitals $189.6 million
in uncompensated emergency medical costs during 2000. To put this
figure in context, total reported uncompensated costs at border
hospitals were $831 million, meaning that costs attributable to
undocumented immigrants comprised almost 25 percent of the
uncompensated emergency room care. In addition, we estimate that
emergency medical service providers had $13 million in uncompensated
costs, bringing the total to more than $200 million in uncompensated
emergency medical costs during 2000. The $200 million broke down in the
following manner: $79 million in California, $74 million in Texas, $31
million in Arizona, and $6 million in New Mexico. Our study also found
that the former Immigration and Naturalization Service brought injured
and ill undocumented entrants to hospital emergency rooms or called
ambulances without arresting them so that the federal government would
not bear the cost of treatment.
Yet, this $200 million figure does not represent the total costs
borne by southwest border counties and local medical providers. Costs
incurred for preventive, acute, extended or rehabilitative healthcare,
and non-emergency medical transportation are not included in our
estimate since these services fall outside the federal definition of an
``emergency'' and were therefore beyond the scope of our analysis.
Furthermore, services delivered by a physician in a hospital's
emergency department that are not paid by or through the hospital are
billed separately and cannot be captured by examining uncompensated
hospital costs. As such, costs incurred by physicians attending an
undocumented immigrant in a medical emergency also are not included in
our cost estimate.
The problem of uncompensated emergency services has far reaching
implications beyond loss of hospital revenues. Health care costs and
insurance premiums are rising, due in part to burgeoning levels of
uncompensated care. Rising health insurance premiums are threatening
business' ability, particularly small business, to offer employees
affordable health care benefits. High liability costs and low levels of
compensation are threatening the viability of emergency rooms and
emergency transportation providers along the border. Some counties with
high rates of uncompensated care can no longer afford to provide
``charity'' care for local needy residents. In some instances, high
levels of unpaid medical bills related to undocumented immigrants have
forced local healthcare providers to reduce staffing, increase rates,
and cut back services.
The border counties health and health care systems face a much
different set of issues than the rest of the nation. In 2007, the
Border Counties Coalition released a report entitled, ``At The Cross
Roads: U.S./Mexico Border Counties in Transition.'' This report
provided an in-depth analysis of the 24 border counties and compared
them to the 50 states in our country. In terms of health care, the
report found that if the border counties were considered a 51st state,
it would rank last in the presence of health care professionals. Border
counties would rank as the 50th state out of 51 in insurance coverage
for adults and children. The prevalence of tuberculosis per 100,000
persons among residents of all border counties (10.4) is twice that of
the United States (5.1) as a whole. Border county populations suffer
higher rates of diseases, such as asthma, adult diabetes, and
hepatitis, which are compounded by the low socioeconomic status
characteristic of the population and a large migrating population
between the United States and Mexico that relies heavily on public and
charity health programs. As a significant segment of the population
moves back and forth across the border, they become transfer agents of
contagions and potential illnesses. It is clear that border counties
could use the money spent on health care for undocumented immigrants
for health care needs for their own residents.
There has been a lot of heated debate about whether or not
undocumented immigrants should receive free emergency medical care. Let
me point out that Congress mandated this policy. In 1996, Congress
passed two major laws that affect the delivery and financing of
emergency services to undocumented immigrants. The first is the
Emergency Medical Treatment and Active Labor Act (EMTALA), which
requires hospitals and emergency personnel to screen, treat and
stabilize anyone who seeks emergency medical care regardless of income
or immigration status. The second law, the Personal Responsibility and
Work Opportunity Reconciliation Act of 1996 (PRWORA), among other
things, limits Medicaid benefits for undocumented immigrants to
emergency health services and non-Medicaid funded public health
assistance (e.g., immunizations, communicable disease treatment). In
addition, PRWORA requires states that want to provide non-emergency
medical assistance to ``non-qualified'' immigrants to pass affirmative
legislation before providing such services, even if the state already
had such a law in place prior to the federal Act's passage.
Although the federal government reimburses states and counties for
part of the costs they incur providing federally-mandated emergency
health services to undocumented immigrants, southwest border counties
are absorbing a significant and disproportionate amount of costs. The
position of the Border Counties Coalition is that the federal
government should support the medical treatment of undocumented
immigrants and pay for 100 percent of the costs. The federal government
is responsible for the costs associated with undocumented immigration,
not counties. Few state resources are made available to help counties
with this burden, so costs fall heavily on local taxpayers in these 24
counties along the border.
The costs to process undocumented immigrants come at the expense of
basic, vital services to county residents. The unmet needs include
libraries, jails, courtrooms, parks, and basic infrastructure to
colonias, new developments, flood prevention, social service programs
for abused children and women, childcare, and after school programs.
But the overwhelming needs expressed by our elected officials are
related to health care--ambulances, clinics, more indigent healthcare
funding, and more funding for comprehensive healthcare programs. These
are basic services that lift the quality of life in communities and the
residents of border counties should not be asked to go without because
of the failure of the federal government to fully reimburse them.
Thank you for the opportunity to present the findings of our report
and for giving you a glimpse into the situation facing border counties.
I will be happy to answer any questions.
Ms. Lofgren. Mr. Harrison.
TESTIMONY OF EDWARD HARRISON, PRESIDENT, NATIONAL COMMISSION ON
CORRECTIONAL HEALTH CARE
Mr. Harrison. Thank you. I am pleased to be with you today
to describe our organization's standards setting and
accreditation processes.
The National Commission on Correctional Health Care is a
not-for-profit organization that grew out of a project begun at
the American Medical Association in the early 1970's. Our board
of directors is made up of representatives of 38 major
supporting organizations, including the AMA, the American
College of Physicians, the American Nurses Association, the
National Association of counties, the American Dental
Association, the American Bar Association, the American Public
Health Association and the National Sheriffs' Association.
There was some comment earlier about getting the AMA or the ABA
involved, and they are involved through our organization.
We are solely and completely dedicated to improving health
services in our Nation's jails, prisons and juvenile
confinement facilities. Our pioneering work began even before
the Supreme Court's position in Estelle v. Gamble that inmates
have a constitutional right to health care. So we have watched
this field evolve and improve over time and have helped the
correctional systems and correctional health care professionals
adapt to new challenges that were unheard of 30 years ago.
Our standards are based on three basic principles: that
inmates should have access to necessary medical and mental
health care, that assessment and treatment should be done by
competent health care professionals, and that health care
ordered by clinicians should be delivered without undue delay
or interference. These principles may seem obvious and simple,
but adhering to the standards is often complicated by the
institutional nature of corrections.
Our standards are available to anyone. They have been used
by State medical societies who have been contracted to review
local correctional health care services. They have been used by
the Department of Justice in its investigation into civil
rights violations in correctional facilities, and by numerous
consultants and other third parties hired by correctional
systems to help evaluate and improve the quality of their care.
Even correctional systems accredited by other
organizations, when confronted with growing problems, have
asked us to conduct a review of their own facility and to make
recommendations for improvement based on the NCAC standards.
Our organization advocates continuous quality improvements,
CQI, as a great way for correctional systems to improve their
operations. CQI, which is one of our standards, dictates that
service staff actively seek out areas in need of improvement.
The model embraces the discovery of problems as an opportunity
to improve. From the thousands of correctional system reviews
we have done over the past 30 years, I can say that what
distinguishes the best systems from the mediocre is this
culture of quality.
We never come across a perfect system. Indeed, the whole
notion of CQI is that there is always room for improvement.
In the case of ICE facilities, ICE has taken the step of
not only seeking accreditation from our organization, but from
The Joint Commission on Accreditation of Health Care
Organizations and others, and it is unusual in our field to see
an organization take that step to seek multiple accreditations.
Several years ago I had the chance to go into an ICE
facility, and I saw tremendous cooperation between the custody
staff and the health staff. And that interplay between custody
and health is a key component in a good correctional health
care system.
Patient safety in this country, not just in corrections, is
a huge problem. The Institute for Health Care Improvement
estimates that each year as many as 15 million patient injuries
occur in health care settings and between 100,000 to 200,000
deaths fromunintended injury. This is more deaths than would
occur if a 747 jumbo jet crashed each and every day. So within
the profession of health care we are well aware that unintended
problems arise when treating patients. Within the world of
corrections, as I mentioned earlier, treatment can be more
complicated and, therefore, more susceptible to problems in the
community.
I have read a number of press reports about the medical
problems in some ICE detention facilities. It is always deeply
troubling to hear about neglect and suboptimal care. Reports of
these kinds require careful investigation and the warranted
changes to improve the system. Some of the reported problems
had to do with custody staff action or inaction, which is not
my organization's area of expertise. If there were critical
performances involved, we were very, very concerned.
While we recognize that not every problem can be
anticipated, we strongly believe that a correctional facility
should be proactive in implementing patient safety systems to
prevent near-miss and adverse critical events.
There should be an error reporting system for health staff
to report, to voluntarily report in a nonpunitive environment,
errors that affect patient safety; and all deaths should be
reviewed promptly, both administratively and critically. In the
cases of suicide, a psychological autopsy should also be
conducted. Importantly, treating staff should be informed of
any review findings and necessary corrective actions needed to
be implemented.
Ms. Lofgren. Mr. Harrison, could you sum up at this point?
Your 5 minutes are up and we have many witnesses.
Mr. Harrison. Thank you very much. I appreciate the
opportunity to be here. I understand that some of the steps
that ICE has taken, and I think that making improvements in
systems is always possible. We will be glad to help the
Committee and ICE.
Ms. Lofgren. We do very much appreciate that offer of help.
Mr. Harrison. Thank you.
[The prepared statement of Mr. Harrison follows:]
Prepared Statement of Edward Harrison
Ms. Lofgren. I now turn to Bishop Riley.
TESTIMONY OF THE REVEREND E. ROY RILEY, BISHOP OF THE NEW
JERSEY SYNOD, EVANGELICAL LUTHERAN CHURCH IN AMERICA
Reverend Riley. I am E. Roy Riley, Bishop of the New Jersey
Synod of the Evangelical Lutheran Church of America, the
largest Lutheran denomination the United States, about 5
million members, many good members in Iowa.
I thank Chairman Lofgren and Ranking Member King for the
invitation to be here today.
Deeply woven into the Christian faith is love and concern
for all of our brothers and sisters in the human family. The
Bible is clear: Welcome one another just as Christ welcomed
you. The bishops of the ELCA hold a special concern for the
treatment of individuals held in the U.S. immigration detention
system.
In just the past month, seven of my fellow bishops have
visited three detention facilities in the States of Virginia,
Michigan and Washington. I personally visited the detention
system facilities in Elizabeth, New Jersey, and in New York.
Since the detention facility opened in Elizabeth, New
Jersey, Lutheran Church members have been providing ministry to
immigration detainees through weekly visits and have been
providing ministry and pastoral care through a glass partition
and over a two-way telephone as best they could.
In the course of these visits, our visitors have become
aware of the very serious lack of appropriate medical care for
detainees. These reports are documented in my written testimony
and supported in various media reports. In fact, this very week
a woman who came to this country seeking asylum from Nigeria
and who was released from the Elizabeth Detention Center with
full asylum 9 months after detention reported to me her story
of inadequate medical treatment.
The reports of inadequate medical care for detainees and
confiscation of needed medicines and medical equipment at
arrest have foreshadowed the worst news of all that since 2003
at least 80 persons have apparently died either in detention or
as a result of the lack of appropriate medical care while they
were in detention.
Members of the synod I serve are troubled that it has
required evidence of people dying to move Congress to take
action. Of even greater concern to us is that a Nation that has
so prided itself on the compassion expressed by that statue in
New York Harbor could, by its own Government, treat immigrants
and asylum seekers, our fellow human beings, in such a punitive
way.
Three years ago, in 2005, the New Jersey Synod Assembly
passed a resolution decrying the treatment of immigrants.
Tomorrow, on June 5, our synod will convene again in annual
assembly and we will consider adopting a resolution expressing
our grave concern about the growing number of ICE raids
targeting immigrants and, especially, the devastating effect
these raids have on families, children and communities.
I fully expect the synod assembly to adopt that resolution,
which will continue to provide guidance for thousands of our
members and help them as they work with their own legislative
representatives.
Most of what is driving this discussion today is rooted in
our own fears, primarily the fear for our own security and our
own economic stability. When we are so driven by fear, it
becomes something that is no longer helpful and, in fact,
causes us to act in ways that are not true to our best selves.
On May 12, in the little town of Postville, IA, Government
agents stormed into a workplace and arrested hundreds of
people, handcuffing them and herding them to the Cattle
Congress yards in Waterloo. In the process, hundreds of
children were left not knowing where their parents were. The
children were traumatized, both the immigrant children and
children whose families had lived in Iowa forever. At the end
of the day, teachers and administrators and citizens looked at
each other and said, What happened here? What country is this?
It's time for us to act with common sense and good judgment
and compassion, not just for the sake of immigrant men, women
and children, but for our sake as human beings and citizens of
a country that is supposed to be a model for human rights.
In light of these serious, systemic problems, I urge the
Subcommittee to consider the following.
One, improve medical treatment and immigration detention.
H.R. 5950 is a good step;
Two, improve conditions of detention; and
Three, cap expansion of detention and provide alternatives
to detention. There are alternatives.
What I have said today will make no difference at all for
50-year Boubacar Bah, 35-year-old Francisco Castaneda, 45-year-
old Sandra Kenley or 50-year-old Abdolai Sall. They and others
like them have died in ICE-sponsored detention or as a result
of the lack of appropriate medical care while in detention.
What I have said will make no difference for them.
I have spoken today for the men and women and children who
are still living, but being held in prison-like conditions as
asylum seekers or immigrants without clear documentation. On
behalf of the church I serve, I am lifting them up as brothers
and sisters who need our help, the help of this Government.
But I am lifting up before you also the citizens of this
country, myself included. We all need help in finding a just
and sensible solution to the issue of immigration.
I thank you for your kind attention.
Ms. Lofgren. Thank you, Bishop.
[The prepared statement of Reverend Riley follows:]
Prepared Statement of Reverend E. Roy Riley
Ms. Lofgren. We would now be honored to hear from you, Ms.
Armendariz.
TESTIMONY OF GLORIA ARMENDARIZ,
WIFE OF ISAIAS VASQUEZ, FORMER DETAINEE
Ms. Armendariz. I'd like to thank the Committee for
inviting me. It's an honor for me on behalf of Isaias Vasquez.
My name is Gloria Armendariz, and I am a United States
citizen. I reside in San Antonio, TX, with Isaias Vasquez, who
immigrated to the United States from Mexico when he was 2-years
old, served in the United States Army during the Vietnam War,
and recently became a naturalized U.S. citizen. I have lived
with Isaias for over--for more or less 30 years.
After many years of suffering from mental illness, he was
diagnosed in 1990 with schizophrenia, was hospitalized over 18
years at the Audie Murphy Memorial Veterans Hospital. He was
also hospitalized and received treatment for schizophrenia at
the North Texas State Hospital following an arrest for
possession of marijuana.
Isaias' conviction for drug possession led to the detention
and removal proceedings in November of 2004 by the Department
of Homeland Security. Until August 2005, he was detained in San
Antonio at the GEO facility.
I visited Isaias every week while he was detained in San
Antonio, and a number of times I was concerned he was not
receiving adequate medical attention. Isaias complained that he
was having side effects from the medication he received and was
fainting. He said that the detention staff did not believe him.
He was mentally ill or fainted. On two occasions, I learned
that he fell and hit his head. When I complained to the
detention staff, I was told that Isaias was fine and did not
need additional medical attention.
In August of 2005, Isaias won his immigration case. When
the immigration judge granted his application under the
Convention Against Torture, the judge found that Isaias would
likely suffer torture in Mexico due to the mental illness.
DHS did not appeal from the judge's decision, but Isaias
was not released and was, instead, transferred to the South
Texas Detention Complex at Pearsall, TX. There his condition
became much worse. I was unable to see Isaias as often because
of the distance from San Antonio to Pearsall. It was a hardship
for me. But Isaias complained that he was not receiving his
medications and that he was not fed properly and that he was
being punished and put in segregation.
When I saw him, he was frail and undernourished. He seemed
unstable and disoriented. A few times I tried to see Isaias,
but I was told that he did not want to see me.
In January 2006, I learned that the DHS believed Isaias did
not have schizophrenia, and it was trying to get the
immigration judge to rescind the order allowing Isaias to stay
in the United States. Later I found out that in November 2005
the medical staff at the detention center diagnosed Isaias with
unspecified personality disorder and that thereafter they
decided to take Isaias off his medication for schizophrenia and
depression. Isaias became very sick and was put on suicide
watch.
He smeared feces and spit in his cell. He became very
disoriented and refused his other medications for diabetes and
high blood pressure. He was punished by the detention staff.
They put him in solitary confinement and gassed him. This was
like 6, 7 months in there.
I tried the best I could to get help for Isaias. Our
immigration lawyer made requests to DHS to release Isaias. I
called Advocacy, Inc., an organization which helps individuals
with disabilities. I spoke to the detention center warden. I
contacted my congressman's office a lot of times. I filed
complaints with the FBI, six, seven times. Suddenly, in May
2006, DHS, our lawyer, was told that Isaias was being released.
I drove to Pearsall, TX, to get him. I was stunned at his
condition. And, when I got there, Isaias was very thin. His
feet were swollen. He was covered with sores and was ranting. I
was afraid of him because he was so sick, disoriented, and they
also told me that he had TB.
I asked the Dr. Johnson to transfer Isaias to the VA
hospital to transport him, because I was afraid, and he refused
and said Isaias was not sick. I don't have it here, but there
was like a SWAT team all around me--the warden, a lady taking a
videotape of us. And I was pleading to them, Don't, I am afraid
to take him, but I still had to leave with him.
So I drove him straight to the VA in San Antonio, I learned
when I got there that Dr. Johnson had already called the VA and
told them that there was nothing wrong with Isaias. So at first
the VA would not admit him though for many years he had been
treated for schizophrenia at that hospital.
I refused to take him. When Isaias became violent, the VA
staff had to subdue him. And several people on the staff, they
had to subdue him and finally they admitted him to the
psychiatric ward.
Isaias remained there for about 2 months and was put on the
medications which had been discontinued at Pearsall.
On January 30, 2007, at a hearing with the immigration, DHS
agreed to dismiss the removal case so Isaias could apply for
naturalization. On September 27, 2007, Isaias was granted
naturalization based on his military service.
Now he has good and bad days, but he still suffers from the
treatment memories of Pearsall.
[The prepared statement of Ms. Armendariz follows:]
Prepared Statement of Gloria A. Armendariz
My name is Gloria Armendariz. I am a United States citizen and I
reside in San Antonio, Texas with Isaias Vasquez, who immigrated to the
United States from Mexico when he was 2 years old, served in the U.S.
Army during the Vietnam War, and recently became a naturalized U.S.
citizen. I have lived with Isaias for over 30 years. After many years
of suffering from mental illness, he was diagnosed in 1990 with
schizophrenia. Isaias was hospitalized over 18 times at the Audie L.
Murphy Memorial Veteran's Hospital (VA) in San Antonio, Texas. He was
also hospitalized and received treatment for schizophrenia at the North
Texas State Hospital following an arrest for possession of marijuana.
Isaias's conviction for drug possession led to his detention and
removal proceedings in November, 2004 by the Department of Homeland
Security (DHS). Until August, 2005, he was detained in San Antonio at
the GEO facility. I visited Isaias every week while he was detained in
San Antonio, and a number of times I was concerned that he was not
receiving adequate medical attention. Isaias complained that he was
having side effects from the medication he received and was fainting.
He said that the detention staff did not believe he was mentally ill or
had fainted. On two occasions I learned he fell and hit his head. When
I complained to the detention staff I was told that Isaias was fine and
did not need additional medical attention.
In August, 2005, Isaias won his immigration case when the
Immigration Judge granted his application under the Convention Against
Torture. The judge found that Isaias would likely suffer torture in
Mexico due to his mental illness. DHS did not appeal the judge's
decision, but, Isaias was not released and was instead transferred to
the South Texas Detention Complex at Pearsall, Texas. There his
condition became much worse. I was unable to see Isaias as often
because of the distance from San Antonio to Pearsall, but Isaias
complained that he was not receiving his medication, that he was not
fed properly and that he was being punished and put in segregation.
When I saw him he was frail and undernourished. He seemed unstable and
disoriented. A few times I tried to see Isaias, but I was told that he
did not want to see me.
In January, 2006 I learned that DHS believed Isaias did not have
schizophrenia and it was trying to get the Immigration Judge to rescind
the order allowing Isaias to stay in the United States. Later I found
out that in November, 2005 the medical staff at the detention center
diagnosed Isaias with ``unspecified personality disorder'', and that
thereafter, they decided to take Isaias off his medication for
schizophrenia and depression. Isaias became very sick and was put on
suicide watch. He smeared feces and spit in his cell. He became very
disorientated and refused his other medication for diabetes and high
blood pressure. He was punished by the detention staff--they put him in
solitary confinement and gassed him.
I tried the best I could to get help for Isaias. Our immigration
lawyer made requests to DHS to release Isaias. I called Advocacy Inc.,
an organization which helps individuals with disabilities. I spoke to
the detention center warden, contacted my congressman's office, and
filed complaints with the FBI
Suddenly, in May, 2006 DHS our lawyer was told that Isaias was
being released. I drove to Pearsall, Texas to get him and I was stunned
at his condition when I got there. Isaias was very thin, his feet were
swollen, he was covered with sores and he was ranting. I was afraid of
him because he was so sick, and I asked the doctor, Dr. Johnson, to
transfer Isaias to the VA hospital. He refused and said that Isaias was
not sick. So, I drove him straight to the VA hospital in San Antonio. I
learned when we got there that Dr. Johnson had called to the VA and
told the staff that there was nothing wrong with Isaias. So, at first
the VA would not admit him, even though for many years he had been
treated for schizophrenia at that hospital. I refused to take him home,
and when Isaias became violent, the VA staff had to subdue him and he
was finally admitted to the psychiatric ward. Isaias remained at the VA
hospital for several weeks and was put back on the medications which
had been discontinued at Pearsall.
On January 30, 2007 at a hearing with the Immigration Judge, DHS
agreed to dismiss the removal case so Isaias could apply for
naturalization. On September 27, 2007 Isaias was granted naturalization
based on his military service. Now, he has his good and bad days, but
he still suffers from the memories of his treatment at Pearsall.
Ms. Lofgren. Thank you very much for sharing your story.
Ms. Asfaw?
TESTIMONY OF ZENA T. ASFAW, FORMER DETAINEE
Ms. Asfaw. Good afternoon. My name is Zena Asfaw. I am a
political refugee from Ethiopia.
I arrived in the United States November 15, 2006, fleeing
persecution from my home country. Upon arrival, I asked for
political asylum in the United States. I was taken into custody
by immigration officials and remained in custody for about 5
months until the immigration judge granted my political asylum
application on April 10, 2007.
Because of the trouble and difficulty I endured in my
country, I will never regret making the decision to leave. I am
alive, safe, and I am grateful to the United States for giving
me refugee.
I was transferred to the immigration detention center in
San Pedro, California, after complaining about being unable to
sleep because I was nervous about being deported. I was seen by
a psychologist. He prescribed medication that was supposed to
relax me and allow me to sleep the night.
One day, I had a near-death experience due to the
negligence of the attending nurse. On this day, between 7 and 8
p.m., the attending nurse gave me seven pills to take at the
same time. In the evening, I was only supposed to take two
pills.
Also, the pills she was giving me were different in color
and shape than my regular pills. I asked her if she was sure
those were my pills. She became angry and told me loudly to
swallow them. Then she instructed the security guard to check
my mouth to make sure that I did not hide the pills in my
mouth. The guard used a flashlight to examine my mouth. I
believe I was forced to take the medication that I am not sure
were not mine.
Immediately my body started shaking. I feel so cold. I
thought I was freezing to death, but at the same time I was
sweating. I went to my bed to lay down. Within a minute, I had
a seizure and my body began to shake so violently that I fell
off the bed on the floor.
I was taken to the immigration center medical unit where
the same nurse who had given me the wrong pills examined me.
She took my blood pressure, gave me another four pills, and
ordered the guard to take me back to my bed. I spent the entire
night shaking and sweating.
In the morning, a different nurse came to give me my pills.
She noticed that I was shaking and sweating, and she asked me
what was wrong. I told her what happened the night before. The
ICE officer immediately took me to the hospital. At the
hospital, I had my stomach pumped. I was taken back to the
detention center.
The next day, I was still feeling sick. I was vomiting
continuously. I lost control of myself and fainted. I start
bleeding from my mouth and my private parts. A fire department
ambulance came and took me to the hospital. I was still
vomiting.
At the hospital, numerous tests were done on me. The
examining doctor came and informed me that the test results
showed damage on my liver, and he said he needed to do more
tests. He said ICE would be informed about the results.
It took about a month for me to feel better. I needed help
from other detainees to dress, bathe and walk. During this
month, I was only given medication to manage my pain. I
couldn't even go to the bathroom by myself.
I had my attorney call ICE and request my medical record.
He was refused and told that I personally had to request these
documents. I have requested all of my medical record on
numerous occasions. To date, I have not received any of my
records to this day.
I am not sure to what extent my health has been damaged. I
was never officially told that I was given the wrong
medication. It was only in passing that one of the male nurses
told me that he was sorry that I had been given the wrong
medication.
I have repeatedly request that I be informed about my test
result, especially regarding my liver. I have just recently
obtained health insurance and have taken tests.
Ms. Lofgren. It's all right. Take your time. Take a breath.
Ms. Asfaw. I hope that those tests will finally allow me to
find out what, if any, permanent damage was done to my health
while I was in detention by ICE.
I hope that my testimony helps this Committee to evaluate
the state of medical care within the ICE detention centers.
Thank you.
[The prepared statement of Ms. Asfaw follows:]
Prepared Statement of Zena T. Asfaw
Hello, my name is Zena Asfaw. I am a political refugee from
Ethiopia. I arrived in the United States on November 15, 2006, fleeing
persecution from my home country. Upon arrival, I asked for political
asylum in the United States. I was taken into custody by Immigration
officials, and remained in custody for about five (5) months until an
Immigration Judge granted my political asylum application on April 10,
2007.
I had never considered coming to the United States until I was
jailed, beaten, and sexually assaulted after being arrested by the
Ethiopian government. In late June of 2005, after the May elections in
my country, the government arrested me for what they believed was my
participation in the opposition party. There were many demonstrations
regarding the legitimacy of the elections. Many believed that the
government had committed fraud to win the election and to retain power.
The government began to crack down on opposition party members as well
as anyone they believed might be involved with the opposition. I was
arrested after a police officer grabbed my cell phone and found some
messages that had been sent to me by someone who did not support the
government.
I was held for 12 days and released after I was forced to sign a
document stating that I would not involve myself in any political
movements. After I was released, I went to the hospital because I was
having physical/female problems because of the sexual assault. I was
given some medication for my symptoms.
I tried to put what happened to me at the jail out of my mind. I
tried to move on with my life, continuing to work. In late October of
2005, there was a riot that happened after a demonstration. People were
demonstrating once again against the government because of the
fraudulent elections. The government began to arrest and detain
opposition party members and anyone they suspected of being such. Soon
after this, I received a letter from the police asking me to report for
questioning regarding the riots. I decided to flee my country in order
to save my life. I fled first to Kenya on October 27, 2005 and arrived
in Los Angeles on November 15, 2006. It took me 13 months, traveling
through 17 countries to arrive here.
Because of the troubles and difficulties I endured in my country, I
will never regret making the decision to leave. I am alive and safe and
I am grateful to the United States for giving me refuge.
Upon arrival in the United States, I was photographed,
fingerprinted, X-rayed and then transferred to the Immigration
detention center located in San Pedro, CA. Upon arrival at the
detention center I went to the medical unit and reported having female
problems. I was given some antibiotics, which did not help.
After complaining about not being able to sleep because I was
nervous about being deported, I was seen by a psychologist. The
psychologist concluded that these problems were because of what I had
experienced in Ethiopia, together with the stress of being under
deportation proceedings. He prescribed medication that was supposed to
relax me and allow me to sleep at night.
After taking this medication for about four or five days I found it
difficult to wake up and get involved in the daily activities of simply
dressing and feeding myself. I told the attending nurse of the problems
I was having because of the medication and informed her that I would no
longer take them. I requested to see the psychologist. Within a couple
of days I saw the psychologist and told him how the medication was
affecting me. He changed the prescription. The new medications were
working for me. I remained on them for over a month.
One day I had a near death experience due to the negligence of the
attending nurse. As is the procedure, it is the attending nurse that
gives all the detainees their medication. On this day, between 7 and 8
pm, the attending nurse gave me seven pills to take at the same time.
In the evening, I was only supposed to take two pills. Also the pills
she was giving me were different in color and shape than my regular
pills. I asked her if she was sure that those were my pills and told
her that I was supposed to only take two at night. She became angry and
told me loudly to swallow them. Then she instructed the security guard
to check my mouth to make sure I did not hide the pills in my mouth.
The guard used a flashlight to examine my mouth. I believe I was forced
to take medications that I am sure were not mine.
Immediately my body started shaking. I felt so cold that I thought
I was freezing to death, but at the same time I was sweating. I went to
my bed and lay down. Within minutes I had a seizure and my body began
to shake so violently that I fell off the bed onto the floor.
The other detainees became alarmed and thought that I was dying.
They yelled and made all kinds of noise to get the attention of the
security guards. The guards, sensing the severity of the situation,
cleared the room. I was taken to the detention center medical unit
where I was seen by the same nurse who had given me the wrong pills.
She took my blood pressure, gave me another four pills and ordered the
guards to take me back to my bed. I spent the entire night shaking and
sweating.
In the morning a different nurse came to give me my pills. She
noticed that I was shaking and sweating and asked me what was wrong. I
told her what had happened the night before. She looked at my chart and
immediately locked up all the medication she was going to dispense and
called ICE officers. The officers immediately took me to the hospital.
At the hospital, I had my stomach pumped so that I would throw up the
medication that was inside me. The doctor asked me why I was taking so
many medications. I told him that I was only taking medication for
depression and for sleeping. I remember that he said there was some
kind of allergy medication that had been given to me. I was then taken
back to the detention center.
The next day I was still feeling sick. I was vomiting continuously.
I lost control of myself and fainted. Again, the other detainees
started making noise and yelling as they had done before. Emergency was
called and two nurses came. I was taken to the medical unit at the
facility by wheelchair and examined. They gave me an I.V. and I started
bleeding from my mouth and my private parts. The nurses noticed the
severity of my situation and ordered a lock up of the detention
facility. A fire department ambulance came and took me to the hospital
again. I was still vomiting.
At the hospital numerous tests were done on me. The examining
doctor came and informed me that the test results showed damage to my
liver and said he needed to do more tests and that ICE would be
informed about the results.
It took about a month for me to feel better. I needed help from
other detainees to dress, bathe and walk. During this month I was only
given medication to manage my pain. I couldn't even go to the bathroom
by myself. The other detainees needed to help me with just about
everything. Sometimes the guards would also help me. Also during this
time the detainees and myself were told to sign some document which
absolved the facility from liability for dispensing medications related
to depression and difficulty sleeping. I refused to sign.
I had my attorney call ICE and request my medical records. He was
refused and told that I personally had to request these documents. I
requested all my medical records on numerous occasions. To date, I have
not received any of my records.
To this day, I am not sure to what extent my health has been
damaged. I was never officially told that I was given the wrong
medication. It was only in passing that one of the male nurses told me
that he was sorry that I had been given the wrong medication. I have
repeatedly requested that I be informed about my test results,
especially regarding my liver. I have just recently obtained health
insurance and have taken some tests. I hope that these tests will
finally allow me to find out what if any permanent damage was done to
my health while I was detained by ICE.
I hope that my testimony helps this committee to evaluate the state
of medical care within the ICE detention centers around the country.
Ms. Lofgren. Thank you so much. I know that your testimony
was difficult to give.
Ms. McCarthy?
TESTIMONY OF MARY MEG McCARTHY, DIRECTOR,
NATIONAL IMMIGRANT JUSTICE CENTER
Ms. McCarthy. Thank you, Madam Chairwoman and Members of
the Subcommittee. I am grateful for this opportunity to testify
in support of the Detainee Basic Medical Care Act of 2008. I
have submitted my written testimony for the record, and I would
like to offer the following prepared remarks and then take your
questions.
I think the testimony of my colleagues here has been very
moving and powerful and illustrates so many of the issues that
we see at the National Immigrant Justice Center.
I am the director of the National Immigrant Justice Center,
a program of Heartland Alliance For Human Needs and Human
Rights, based in Chicago, Illinois. The National Immigrant
Justice Center coordinates the largest network of pro bono
attorneys in the country, providing legal representation to
approximately 8,000 individuals each year, including low-income
immigrants, refugees, victims of human trafficking,
unaccompanied children and asylum seekers. Our diverse client
base and firsthand observation of different detention
facilities gives us a unique perspective on detainee health
care.
Across the country, U.S. Immigration and Customs
Enforcement contracts with more than 300 local county jails to
detain noncitizens held in administrative custody. Many of
these facilities are located in remote, rural areas, far from
lawyers and other service providers.
In Illinois and Wisconsin, the National Immigrant Justice
Center regularly visits county jails under contract with ICE to
offer legal rights orientations, conduct individual intake, and
accept individual cases for representation.
In the thousands of detention cases that the National
Immigrant Justice Center has handled during the past 10 years,
we have witnessed a constant stream of complaints about the
denial of adequate medical care. These complaints range from
treating common colds to managing serious, permanent illnesses,
such as issues relating to reproductive health care, to
diagnosing and treating the physical and mental trauma
resulting from torture.
I think it is also very important that we look at the
numbers of days that individuals are staying in detention. We
have heard this afternoon that the average length of stay is
approximately 37 days. However, as my colleagues have testified
today, that is not always the case.
In those cases where individuals are detained for longer
periods of time, it is critical that those individuals have
access to adequate medical care. In fact, the General
Accounting Office statistics indicate that approximately 5,660
detainees of the 283,000 who were deported in fiscal year 2006
that were detained for more than 210 days, or roughly 7 months.
And as my colleagues testified today, many of those
individuals are not here illegally. They have legal claims.
Many were granted relief. They were granted immigration status
in the United States.
I briefly want to talk about one particular case from the
Midwest. My written comments explore a wide range of areas
regarding health care, but the one particular case I will
describe involved an Algerian asylum seeker, Ms. Hassiba
Belbachir who came to the United States seeking asylum. She was
taken into custody in McHenry County Jail in Illinois.
She suffered from severe depression, she told a nurse of
her desire to take her own life, and repeated this cry for help
to a social worker shortly thereafter. Instead of scheduling an
emergency appointment with a psychiatrist, the nurse put Ms.
Belbachir on a list to see the psychiatrist at his routine
weekly jail visit 4 days later. Ms. Belbachir committed suicide
before that appointment. The jail-issued socks wrapped around
her neck asphyxiated her.
Ms. Belbachir's story shows what is wrong with our detainee
health-care system. She was an asylum seeker with a serious
mental health problem. Because she had no effective advocate
and because, like the other 30,000 noncitizens detained by ICE
on a daily basis, her case was all but invisible to the public
and any number of civic organizations or even State agencies
that might have come to her aid. In addition, the county jail
did not comply with ICE detention standards. Staff did not
conduct a comprehensive initial medical screening upon Ms.
Belbachir's arrival. Her subsequent care was inappropriate.
ICE authorities knew that this facility had a history of
failing to provide adequate screening to immigrants and failed
to adequately train staff. And while ICE has detention
standards, it has steadfastly refused to codify them. Thus, the
standards are legally unenforceable, leaving immigrant
detainees and their advocates little recourse.
How do we prevent future deaths and ensure that immigrant
detainees receive proper medical care? The Detainee Basic
Medical Care Act is a necessary first step. Among its
requirements, each immigrant in ICE custody must receive a
comprehensive medical and mental health screening upon arrival
at a facility and a comprehensive examination. Appropriate
personnel must have access to medical records to ensure proper
treatment.
Ms. Lofgren. Could you summarize at this point?
Ms. McCarthy. Yes, I'll be happy to wrap up.
In conclusion, adequate health care is a critical component
of humane detention conditions. When lives hang in the balance,
maintaining humane detention conditions will depend upon
oversight, transparency and accountability, from Washington,
DC, to local ICE contract facilities. Lifting the veil of
secrecy shrouding the immigration detention system and starting
an honest discussion about its humanity and fairness would be a
great start.
Thank you for this opportunity.
[The prepared statement of Ms. McCarthy follows:]
Prepared Statement of Mary Meg McCarthy
I. INTRODUCTION
Thank you, Madame Chairwoman and members of the Subcommittee. My
name is Mary Meg McCarthy. I have served as Executive Director of the
National Immigrant Justice Center, a program of Heartland Alliance for
Human Needs & Human Rights, for 10 years. Prior to joining the
organization, I represented asylum seekers as a pro bono attorney. I am
grateful for the opportunity to testify in support of the Detainee
Basic Medical Care Act of 2008.
Madame Chairwoman and members of the Subcommittee, medical care for
people who are detained in this country is in critical condition. It is
but one symptom of a dysfunctional immigration system.
This afternoon, I would like to provide a brief overview of the
broken health care system for immigrant detainees, detail examples of
the battles fought by the National Immigrant Justice Center to obtain
health care and urgent treatment for immigrants in detention, and make
recommendations for reform. The Detainee Basic Medical Care Act will
greatly improve the quality and delivery of care to detained asylum
seekers and other men and women in administrative detention. In
addition to this critical function, it will remove the veil of secrecy
that shrouds the deeply flawed immigration detention system.
The National Immigrant Justice Center, or NIJC, is a legal aid
organization based in Chicago. In addition to direct service, NIJC
litigates in the federal courts and advocates for systemic reform with
policy makers. NIJC and its pro bono partners provide legal
representation to approximately 8,000 individuals annually, including
low-income immigrants, refugees, victims of human trafficking,
unaccompanied minors, and asylum seekers. During the past 25 years,
NIJC has developed the largest network of pro bono attorneys in the
United States, totaling more than 1,000 attorneys from leading law
firms.
Throughout most of the nation, the U.S. Immigration and Customs
Enforcement, or ICE, contracts with local county jails to detain non-
citizens held in administrative custody. Many of these facilities are
located in remote rural areas, far from immigration lawyers and social
service providers. Strict secrecy regarding the disclosure of
information regarding administrative detainees keeps them further
isolated.
NIJC regularly visits the Illinois and Wisconsin county jails under
contract with ICE to offer legal rights orientations, conduct
individual intake, and accept cases for representation of non-citizens
held in ICE custody. Immigration detention is administrative, not
criminal, in nature. Unlike individuals held in criminal detention,
immigrants in administrative custody have no right to court-appointed
counsel. Despite the best efforts of NIJC and other legal aid
organizations, only about ten percent of detainees obtain sufficient
legal counsel.\1\ Thus, legal rights presentations are often the only
opportunity for detained immigrants and asylum seekers to gain an
understanding of their legal rights and the available avenues for
complaint and redress.
---------------------------------------------------------------------------
\1\ According to the Washington Post's recent series on health care
in immigration detention, only one in ten detained immigrants have
legal representation. Dana Priest and Amy Goldstein, ``As Tighter
Immigration Policies Strain Federal Agencies, The Detainees in Their
Care Often Pay a Heavy Cost,'' Washington Post, May 11, 2008. In fiscal
year 2006, only 48% of all non-citizens were represented by counsel in
immigration court proceedings. United States Department of Justice,
Executive Office for Immigration Review, FY 2006 Statistical Year Book,
G1 (2007).
---------------------------------------------------------------------------
The government has broad authority to decide who is detained and
for what duration, with little oversight and virtually no checks-and-
balances. As a result, the system is arbitrary and lacks transparency.
NIJC's direct representation of detained clients and its regular
presence in the jails gives it a unique, insider's perspective on ICE's
persistent failure to provide basic health care, respond to urgent
needs, conduct vigorous oversight, and take corrective action. Despite
this insight, much of the data obtained by NIJC related to detention
conditions is garnered through requests under the Freedom of
Information Act and federal litigation.
The medical staff and guards at ICE contract facilities have proven
to be more open to communication with advocates and service providers
than the federal agencies. In 2003-04, NIJC conducted a program under
which it educated jail staff on the medical and mental health needs of
the immigrant detainee population, and trained them to better
understand the unique and often tragic experiences of asylum seekers,
torture survivors, and victims of domestic violence in immigration
detention. This project, which was implemented in Illinois, Michigan,
and Wisconsin, was well received by medical staff and guards at the
jails, who welcomed information on areas of medicine in which they were
unfamiliar, such as tropical medicine and infectious diseases. The
project also addressed practical issues, such as conducting medical
exams through interpreters. Throughout this project, NIJC staff tried
to work with the Division of Immigration Health Services (DIHS) to
share our findings and seek its involvement, but to no avail. DIHS all
but ignored our attempts to collaborate and improve conditions for
these men and women.
II. OVERVIEW OF THE BROKEN HEALTH CARE SYSTEM FOR ICE DETAINEES
The use of administrative detention for non-citizens has
skyrocketed during the past 12 years. In 1996, the U.S. government had
a daily immigration detention capacity of 8,279 beds. By 2006, that
number had increased to 27,500, with funds appropriated for future
expansion.\2\ In fiscal year 2007, more than 322,000 non-citizens were
held in immigration detention facilities,\3\ with a daily average of
approximately 33,000 detainees. According to ICE officials,
approximately 350 facilities that hold immigrant detainees operate
under Intergovernmental Service Agreements (IGSAs). An additional eight
service processing centers (SPCs) are owned and operated by ICE, and
seven contract detention facilities (CDFs) are operated by private
contractors such as Corrections Corporation of America or the GEO
Group.\4\ Most of the IGSA facilities are county jails that were not
designed to hold a civil detainee population for what can be months or
years.
---------------------------------------------------------------------------
\2\ Jorge Bustamante, Report of the United Nations Special
Rapporteur on the Human Rights of Migrants, Mission to the United
States of America, A/HRC/7/12/Add.2, 5 March 2008, at 11.
\3\ Testimony of Gary Mead, before the House Subcommittee on
Immigration, Hearing on ``Problems with ICE Interrogation, Detention,
and Removal Procedures,'' February 13, 2008.
\4\ For a list of CDFs and SPCs, see ``Semiannual Report on
Compliance with ICE National Detention Standards January-June 2007,''
U.S. Immigration and Customs Enforcement Office of Detention & Removal
(released May 2008).
---------------------------------------------------------------------------
The May 2008 reports by ``60 Minutes,'' The New York Times, and The
Washington Post revealed the shockingly sub-standard conditions under
which many asylum seekers and other non-citizens are held in federal
custody. Eighty-three immigrants have died in custody in the past five
years.\5\ Countless others have suffered immeasurably while they or
their loved one begged ICE to provide care. The press has done an
admirable job of educating the public and policy makers on the sorry
state of this system. Sadly, these reports were not news to many
advocates. In NIJC's extensive experience, immigration detainees
frequently have to fight to obtain basic medical care and treatment for
life-threatening conditions. Many never receive care, especially those
with limited English language fluency and no legal representation.
---------------------------------------------------------------------------
\5\ Dana Priest and Amy Goldstein, ``System of Neglect,''
Washington Post, May 11, 2008.
---------------------------------------------------------------------------
ICE detention facilities are governed by the ICE Detention
Standards, which were negotiated between the Immigration and
Naturalization Service (INS) and the American Bar Association, to apply
to facilities that hold non-citizens in ICE custody for 72 hours or
more. ICE adopted these standards when it succeeded the INS, but it has
steadfastly refused to codify the standards in statute or regulation,
leaving the standards legally unenforceable. This is a fundamental
point. Immigrant detainees and their advocates have little recourse
when the government refuses to enforce its own rules.
While ICE touts its expenditure of funds on immigrant health
care,\6\ as described below, only a few DIHS nurses decide whether or
not to authorize the thousands of requests for treatment that are
submitted by on-site medical care staff in these jails.
---------------------------------------------------------------------------
\6\ ICE has stated that it spent nearly $100 million in fiscal year
2007 on medical care for detainees. ICE Statement for the Washington
Post, May 7, 2008, available at www.ice.gov/pi/
detainee_health_wash_post_statement.htm.
---------------------------------------------------------------------------
III. DOMESTIC AND INTERNATIONAL HUMAN RIGHTS LAW
REQUIRES ADEQUATE HEALTH CARE
The United States is a nation that values liberty and respects the
rule of law. We do not deprive individuals of liberty without due
process of law, regardless of their nationality or alienage. Our due
process protections include the right to humane treatment while in
custody. Of course, people in immigration detention are in
administrative, not criminal custody. Many have no criminal record
whatsoever, having arrived on our shores seeking asylum or protection
from torture. Others have committed only minor civil infractions and
have no serious or violent history. As a result, our immigration
detention facilities are filled to a significant degree with immigrants
who pose no threat to our communities and who should be released on
parole, into secure alternative programs, or under orders of
supervision.
A host of constitutional principles and international laws govern
the treatment of individuals in custody. All individuals in this
country--regardless of their legal status--are protected by the Eighth
Amendment (made applicable to the states by the Fourteenth Amendment),
which prohibits cruel and unusual punishment. International human
rights law also requires that all individuals in custody be treated
humanely, regardless of citizenship status. For example, Article 10 of
the International Covenant on Civil and Political Rights (ICCPR) states
that ``all persons deprived of their liberty shall be treated with
humanity and with respect for the inherent dignity of the human
person.'' \7\ Torture and cruel, inhuman, and degrading treatment are
outlawed by the Universal Declaration of Human Rights (UDHR) \8\ and
the Convention Against Torture (CAT).\9\ The ICCPR and CAT were both
ratified by the United States; the UDHR is accepted as universal law.
In addition, United Nations guidelines call for non-discrimination
while in custody, prompt medical care and attention, access to hygiene
and sanitary conditions, and health care that meets national and
community standards.\10\
---------------------------------------------------------------------------
\7\ International Covenant on Civil and Political Rights art. 10,
December 19, 1966, 99 U.N.T.S. 171.
\8\ Universal Declaration of Human Rights art. 5, December 10,
1948, U.N.G.A. res. 217 A(III).
\9\ Convention against Torture, and Other Cruel, Inhuman or
Degrading Treatment or Punishment arts. 2 and 16, December 10, 1984,
1465 U.N.T.S. 85.
\10\ See, e.g., United Nations Standard Minimum Rules for the
Treatment of Prisoners, May 13, 1977, Economic and Social Council res.
2076 (LXII); Body of Principles for the Protection of All Persons under
Any Form of Detention or Imprisonment G.A. res. 43/173, annex, 43 U.N.
GAOR Supp. (No. 49) at 298, U.N. Doc. A/43/49 (1988).
---------------------------------------------------------------------------
The United Nations High Commissioner's Guidelines on Applicable
Criteria and Standards Relating to the Detention of Asylum Seekers call
the detention of asylum seekers ``inherently undesirable.'' \11\ The
Guidelines recognize that there may be circumstances in which detention
of asylum seekers becomes necessary.\12\ However, in those situations
the Guidelines are unambiguous: ``Conditions of detention for asylum
seekers should be humane with respect shown for the inherent dignity of
the person.'' The Guidelines state that ``the permissible exceptions to
the rule that detention should normally be avoided must be prescribed
by law.'' \13\
---------------------------------------------------------------------------
\11\ ``UNHCR Revised Guidelines on Applicable Criteria and
Standards Relating to the Detention of Asylum Seekers,'' United Nations
High Commissioner for Refugees (February 1999), Geneva, available at
http://www.unhcr.org.au/pdfs/detentionguidelines.pdf. Although UNHCR's
guidelines are not binding, they represent how UNHCR, the agency
charged with supervising the application of the Refugee Convention,
believes asylum seekers should be treated.
\12\ Id.
\13\ Id.
---------------------------------------------------------------------------
Due process also affords detained non-citizens the right to
counsel, which has proven to be a near prerequisite to obtaining basic
health care in immigration detention. However, rights are meaningless
if they cannot be effectuated by the individuals they are meant to
protect. Because non-citizens in custody are not provided counsel
(although they are entitled to it), the right to adequate health care
is a battle that many are left to fight on their own from remote and
isolated detention facilities, a battle not often won.
IV. DIHS POLICIES VIOLATE APPLICABLE LAWS AND ICE'S OWN DETENTION
STANDARDS
The ICE Detention Standard on Medical Care, while far from perfect,
requires that, ``All detainees shall have access to medical services
that promote detainee health and general well-being.'' \14\ But because
the standard is not enforceable, it remains, in effect,
``aspirational.'' Unfortunately, the policy that seems to exercise
greater influence over provision of medical care to ICE detainees is
implemented by the Division of Immigration Health Services (DIHS) in
Washington, D.C.
---------------------------------------------------------------------------
\14\ See ICE Detention Standard on Medical Care, section I,
available at http://www.ice.gov/doclib/partners/dro/opsmanual/
medical.pdf.
---------------------------------------------------------------------------
As a matter of policy, DIHS errs on the side of refusing treatment
to people who need care. The results are dangerous for detainees and
frustrating to many jailers. In fact, the Deputy Warden of York County
Prison in York, Pennsylvania, where federal immigration officials have
held detainees for years, famously wrote to the local ICE office that
DIHS had ``set up an elaborate system that is primarily interested in
delaying and/or denying medical care to detainees.'' \15\
---------------------------------------------------------------------------
\15\ Letter from Roger Thomas, Deputy Warden, York County Prison,
to Joe Sallemi, D.A.D.D., ICE, regarding DIHS, dated November 28, 2005,
at p. 3.
---------------------------------------------------------------------------
In fact, the DIHS mission statement is contradictory to provisions
of the ICE Detention Standard on Medical Care, which provides for at
least basic medical care for the duration of detention. DIHS provides
health services only for emergency care, defined as a ``condition that
is threatening to life, limb, hearing or sight.'' In short, the DIHS
mission, as revealed in a document obtained by The Washington Post, is
to keep the detainee ``medically ready'' for deportation.\16\ This view
was reiterated by Mr. Gary Mead, Acting Director of ICE Detention and
Removal Operations, who questioned whether care was necessary as long
as the detainee was ``medically capable'' of being removed.\17\
---------------------------------------------------------------------------
\16\ Dana Priest and Amy Goldstein, ``System of Neglect,''
Washington Post, May 11, 2008.
\17\ Transcript of The Diane Rehm Show, ``Medical Care of Detained
Immigrants,'' WAMU Radio 88.5 FM, (a National Public Radio affiliate in
Washington, D.C), May 13, 2008, available at www.wamu.org.
---------------------------------------------------------------------------
Another significant barrier to obtaining health care is the fact
that requests for treatment that are made by medical personnel on-site
in the jails must be submitted to off-site DIHS Managed Care
Coordinators (MCCs). These are three nurses, not doctors, who are based
in Washington, D.C. These three MCC nurses currently receive and review
the medical requests submitted by on-site staff in the jails,
effectively serving all 33,000 individuals currently in ICE custody
across the nation.\18\ According to The Washington Post, in one recent
month, the MCCs received 3,000 requests for care.\19\ Working five days
per week, at this rate, each of the three MCC nurses would have to
review and respond to approximately 50 requests per day.
---------------------------------------------------------------------------
\18\ We understand that previously a fourth nurse reviewed requests
from hospitalized detainees across the nation, but that such requests
are now spread among the three remaining staff. See, e.g., http://
www.icehealth.org/ManagedCare/ManagedCare.shtm.
\19\ Dana Priest and Amy Goldstein, ``In Custody, In Pain,''
Washington Post, May 12, 2008.
---------------------------------------------------------------------------
In a press conference on May 21, 2008, Chairwoman Lofgren described
changes to DIHS policy that raise additional concerns about the quality
of medical care provided under this system. Apparently, until 2007 an
MCC nurse had the authority to approve requested medical care, but not
to deny it. Cases that an MCC recommended for denial had to be reviewed
by the Medical Director. As Chairwoman Lofgren described, a policy
change now allows denial of requested treatment to be issued by the
MCCs without review by the Medical Director. As a result, off-site
nurses may deny care that was requested by on-site jail medical
personnel--potentially endangering lives, and doing so with little to
no oversight by doctors.
Chairwoman Lofgren described another change to DIHS policy that we
find alarming. DIHS previously allowed on-site physicians or medical
personnel in the ICE facilities to effectively appeal a denial of
treatment by asking that the request be reviewed by three DIHS
physicians, not including the Medical Director who may have previously
authorized denial of treatment. While not fully independent, this
process at least allowed for review by additional physicians.
Chairwoman Lofgren's comments in the May 21 press conference suggest
that this process has been replaced with a grievance process that no
longer permits independent or even quasi-independent review.
Vigorous oversight by Congress and independent investigators must
be conducted to measure the impact of these policy shifts with regard
to the fairness of detainee access to treatment and the well-being of
detainees. The Detainee Basic Medical Care Act corrects some of these
problems by mandating that treatment decisions are based solely on
professional clinical judgments and by mandating the continuity of
care. These ensure that immigrant detainees are able to consistently
obtain prescribed medicine that they were administered prior to
entering ICE custody. Finally, the bill's establishment of an
administrative appeals process for denials of medical or mental health
care will help to correct the dangerous DIHS policy that is in place
today.
V. NIJC'S CLIENTS HAVE BEEN ROUTINELY DENIED ADEQUATE HEALTH CARE
We all know that policies have consequences for real people.
Policies that are carried out with a callous disregard for humane
treatment, medical ethics, and international human rights standards
lead to the horrific stories you have heard today and read in recent
national press coverage.
I would like to describe briefly several specific cases that
reflect the persistent problems I have seen over a dozen years.\20\ The
stories of these men and women illustrate the urgent need for systemic
reform of the immigration detention health system to improve screening,
comprehensive medical and mental health evaluations, access to medical
records, and response to urgent treatment requests. Many of these
problems can be addressed through enactment of the Detainee Basic
Medical Care Act.
---------------------------------------------------------------------------
\20\ To protect client confidentiality, most of these cases are
described without using the client's name. NIJC will provide this
information to the Committee upon request and with client permission.
---------------------------------------------------------------------------
A. Inadequate Screening
Inadequate screening can fail to catch obvious medical conditions,
including advanced stages of pregnancy, kidney stones, suicidal
tendencies, and infectious disease. Early in my tenure at the National
Immigrant Justice Center, a woman held in a county jail under contract
to the INS, ICE's predecessor agency, gave birth in a jail bathroom.
The INS and jail staff did not know she was pregnant. Granted, this
case occurred several years ago, but little has changed. The same
detention standards that were adopted by the INS in 2000 are still in
place and frequently violated.
NIJC represented an Afghan asylum seeker who was detained for more
than eight months in a county jail in Wisconsin. He developed kidney
stones and saw the jail nursing staff repeatedly. On rare occasions, he
was provided with Tylenol or ibuprofen. It took the intervention of an
attorney at NIJC to obtain medical tests to diagnose his serious
condition. Then, this asylum seeker was transferred to another facility
unexpectedly, before the test results were available.
NIJC also represented a West African asylum seeker who suffered
immeasurable harm after being kidnapped by soldiers and held for six
months as a sex slave and laborer. She finally escaped her captors and
reached the United States, where she was detained in a Detroit area
jail. Even though she was an asylum seeker, she was held with the
criminal population. She was unable to obtain adequate medical
screening or access to health care, despite the fact that she suffered
from pelvic pain and bleeding as a result of the torture she endured in
captivity. After extensive negotiations with NIJC, the government
agreed to release her. NIJC arranged for her to obtain the medical and
mental health counseling she desperately needed. She eventually won
asylum.
In yet another case, a female client of NIJC exhibited signs of
malaria that were not recognized by jail medical staff. The woman, an
asylum seeker from Rwanda, recognized the symptoms and asked for
medical care. She was provided with aspirin by the jail's medical
staff. NIJC attorneys intervened and educated the jail physician, who
had no experience or knowledge of tropical diseases. Malaria is easily
treated, but can be fatal if misidentified or treated incorrectly. NIJC
eventually convinced the government to release our client.
The Detainee Basic Medical Care Act requires that each immigrant in
ICE custody receive a comprehensive medical and mental health screening
upon arrival at a facility, and a comprehensive examination within 14
days of arrival. It also requires that appropriate personnel have
access to medical records, an important step to ensuring proper
diagnosis, prescriptions, and treatment.
B. Inadequate Treatment and Deaths in Detention
In 2005, an Algerian asylum seeker, Hassiba Belbachir was detained
at McHenry County Jail in Woodstock, Illinois.\21\ According to the
complaint filed in a civil rights and wrongful death suit brought by
her estate, on March 13, 2005, Ms. Belbachir, who suffered from severe
depression and panic attacks, told a nurse of her desire to take her
own life. The next day, she saw a social worker and again expressed her
suicidal feelings. The social worker recommended she see a
psychiatrist. But rather than scheduling an emergency appointment, the
nurse placed her on a list to see the psychiatrist at his routine
weekly jail visit a full four days later. Ms. Belbachir committed
suicide before she had an opportunity to see the psychiatrist. To make
the situation even more tragic, on the day of her death, jail staff saw
her lifeless body motionless on the floor of her cell in the medical
pod, but did not intervene for 40 minutes, when they finally called for
emergency service. By the time jail staff entered her cell, it was far
too late. Her face was purple. The jail-issued knee socks knotted
together and wrapped around her neck had asphyxiated her.\22\
---------------------------------------------------------------------------
\21\ The case of Hassiba Belbachir is discussed publicly because it
is the subject of federal litigation. In addition, the attorneys for
the Belbachir estate authorized the use of her name in this testimony
\22\ Amended Complaint of the Estate of Hassiba Belbachir v. County
of McHenry et al, Case 1:06-cv-01392, Filed Nov. 9, 2007 (N.D.Ill.)
---------------------------------------------------------------------------
Significantly, ICE authorities knew from annual inspections, before
Ms. Belbachir's death, that McHenry County Jail had a history of
failing to provide adequate mental health and suicide screenings to ICE
detainees, maintained no adequate written suicide prevention policy,
and failed to adequately train staff to prevent suicides. Even so,
according to the Belbachir complaint, ICE authorities did not enforce
the Detention Standards until after Ms. Belbachir's death.\23\ Further,
no one charged with overseeing her custody and care was disciplined in
any matter related to this gross failure of medical and mental health
care and supervision.\24\
---------------------------------------------------------------------------
\23\ Id.
\24\ Id.
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Such tragic and preventable cases call into question ICE's ability
to monitor its facilities and conduct adequate, much less vigorous,
oversight of its own operations. The Detainee Basic Medical Care Act
requires ICE to report any death in detention to the Offices of the
Inspector General of the Department of Homeland Security and Department
of Justice within 48 hours. It also mandates reporting to Congressional
oversight committees. These are critical measures long overdue. Only
with greater transparency will we achieve accountability.
C. Failure to Transfer Medical Records When Detainees are Moved is a
Persistent and Dangerous Problem
Over the lifespan of NIJC's project to educate health care
practitioners in Midwestern facilities holding ICE detainees, NIJC
spoke to dozens of jail staff and asked about their experience treating
detainees. A common complaint from these nurses and other personnel
included widespread failure to receive medical records when detainees
were transferred from one ICE facility to another. In fact, in no case
did a jail guard or medical professional tell NIJC that medical records
were transferred to a new facility with an incoming detainee, despite
the requirement in the ICE Detention Standards that records be
transferred with each detainee.\25\
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\25\ See ICE Detention Standard on Medical Care, section III.N.,
``Transfer and Release of Detainees,'' which states, ``When a detainee
is transferred to another detention facility, the detainee's medical
records, or copies, will be transferred with the detainee.'' This
standard was issued by the INS on September 20, 2000 and adopted by ICE
along with the other Detention Standards when it succeeded the INS.
---------------------------------------------------------------------------
VI. IN ITS HASTE TO DEPORT NON-CITIZENS, ICE CUTS CORNERS AND MAKES
RASH DECISIONS THAT HAVE THE POTENTIAL TO EXPOSE THE PUBLIC TO HEALTH
RISKS
Last year, NIJC helped an African immigrant with infectious
tuberculosis and AIDS seek much-needed medical treatment. This man was
previously detained, but ICE released him on an order of supervision
when it discovered he was HIV-positive. He was later diagnosed with
AIDS. NIJC filed a motion for a stay of removal and expended
extraordinary efforts to notify senior ICE officials that deportation
would be inhumane in this case and could create a public health risk.
The man was nonetheless put on a plane to Africa, an action that may
have exposed other passengers to his infectious tuberculosis. NIJC
strongly urges Congress to enact, and ICE to adopt, the provisions in
the Detainee Basic Medical Care Act regarding continuity of care and
development of discharge plans. As this case makes clear, such steps
are not only critical for detainee health but also influence public
safety.
VII. FOR DETAINEES WITHOUT ATTORNEYS, SEEKING MEDICAL ATTENTION
CAN BE A FRUITLESS QUEST
ICE, DIHS, and congressional oversight committees must recognize
that due to a chronic lack of legal counsel, most detained immigrants
never know of their right to health care, much less how to exercise
that right. When they do request treatment or complain about a lack of
adequate care, detainees face insurmountable procedural obstacles and
an accountability vacuum. A lack of transparency regarding who is
detained, where, and for what purposes keeps claims related to health
care and detention conditions beyond the reach of legal service
providers and out of public view. Most of the stories you heard today
have pierced the veil only because a lawyer, a social service provider,
a volunteer with a religious organization, or a family member fought to
hold the government accountable for the treatment of a particular
individual in its custody. Like the cases revealed by Freedom of
Information Act requests and the recent reports from The New York Times
and the Washington Post cited above, they are powerful anecdotes that
suggest broader violations.
NIJC legal staff members routinely advocate for clients who need
medical care and who cannot obtain it in ICE detention. Complaints
about access to medical care are a constant theme in our conversations
with detained immigrants. These grievances range from the denial of
over-the-counter pain medication to a refusal to provide life-
sustaining medication for chronic illnesses. In addition to general
medical conditions, NIJC has fought on behalf of asylum seekers who
have been denied treatment for injuries sustained from the torture and
the persecution from which they have sought refuge in the United
States. Without an attorney or an advocate, these individuals would
never have received appropriate care. How many other detained
individuals are being denied critical medical care? How can we balance
the use of detention with the humane treatment of detainees?
Considering alternatives to detention would be a good start. It is
inhumane to detain asylum seekers and other immigrants who have
experienced trauma or other severe medical conditions. Alternatives to
detention through non-governmental and private entities are proven to
be secure and effective. Under these programs, an immigrant in removal
proceedings is released to participate in an ``enhanced supervision''
program that requires regular check-ins with a caseworker, or in some
cases, the use of an electronic ankle bracelet. Alternatives are less
expensive than ICE detention, which averages approximately $95 dollars
per day. Alternatives also provide a wider array of medical and mental
health care options. The Detainee Basic Medical Care Act recognizes
this humane and common sense approach by prioritizing the parole or
bond of immigration detainees who have serious medical or mental health
conditions.
VIII. CONCLUSION
ICE and DIHS must provide screenings to all detainees in a timely
manner and make decisions about treatment based on medical conditions,
and not on the individual's immigration status. Providing adequate
medical care is part of a broad range of detention conditions that the
government must monitor and for which it must be accountable.
Accordingly, decisions about health care must be made by on-site
attending medical professionals, and not by a team of bureaucrats in
Washington, D.C. An appeals process must be established for the review
of request denials from detainees by on-site medical professionals in
detention facilities. The medical and mental health requirements,
appeal process for denial of care, and increased oversight in the
Detainee Basic Medical Care Act will facilitate care for all detained
immigrants. In many cases, alternatives to detention may be both the
most humanitarian and fiscally responsible actions.
Like any other area of government responsibility, where lives hang
in the balance, maintaining humane detention conditions will depend
upon oversight, transparency and accountability.
Thank you for the opportunity to testify today. I request that my
full statement be made part of the record and would be pleased to
answer your questions.
Ms. Lofgren. Thank you very much for your testimony.
Ms. Baker, we would be pleased to hear from you.
TESTIMONY OF ANN SCHOFIELD BAKER, PARTNER, McKOOL SMITH, AND
ATTORNEY FOR AMINA BOOKEY MUDEY, FORMER DETAINEE
Ms. Baker. Thank you. I am Ann Schofield Baker. I am a
principal at the law firm of McKool Smith in charge of their
trademark litigation practice. Thank you to Congresswoman
Lofgren and this Subcommittee for inviting me to testify today.
As an intellectual property trial lawyer, I will admit I
knew very little about asylum law or about the inner workings
of detention centers until I agreed to represent pro bono Amina
Mudey, a 29-year-old torture survivor from Somalia who sought
asylum in the United States. Amina suffered unspeakable
torture, abuse and loss in Somalia, as evidenced by her scars
and four murdered family members.
In April of 2007, Amina fled to America and sought asylum.
She was incarcerated in the Elizabeth Detention Center in New
Jersey, which is run by CCA.
When I took Amina's case, I had no idea that I was destined
to spend over 600 hours in the first 3 months focusing not on
her asylum case but on battling DIHS, ICE and CCA to ensure
that Amina didn't die in their care.
Amina has authorized me to testify before you today.
During Amina's 5-month ordeal in ICE custody, she
experienced repeated incidents of medical mistreatment,
incompetence and neglect that threatened her life, her health
and her asylum case. In fact, there were two separate incidents
in which her life was threatened because of poor medical
treatment.
When Amina first arrived at the CCA, she had a panic attack
and fainted. She didn't speak English at the time, and DIHS
medical staff examined her without an interpreter. They wrote
in her medical records that, ``Patient complains that she has
epilepsy and has seizures once or twice a week for 5 years.''
When I had the aid of an interpreter, I asked her, ``What's
this all about?'' And she said, ``I don't have epilepsy. I was
trying to tell them I've had headaches once or twice a week for
last 5 years.''
Then detention center doctors misdiagnosed her as being
psychotic. They placed her on a powerful antipsychotic drug
called Risperdal that had cataclysmic side effects on her, and
they are telltale side effects of Risperdal. She started to
lactate. She started to drool and convulse like she had
Parkinson's disease. She fell off her chair. She stopped
getting a period. She started to drool. You can't miss these
side effects. She became dizzy and confused.
Amina had no idea what was happening to her since no one
ever gave her treatment with an interpreter. She showed the
nurse that milk was coming out of her breasts, and she gave her
a pregnancy test and gave her a cup to go get a urine sample.
And since she couldn't speak English, she started giving them a
milk sample from her breasts.
Two weeks after this incident--it actually took 2 weeks for
a doctor to evaluate her after she began to exhibit signs of
lactation. What was his reaction? To increase her dosage of the
Risperdal. She was still on Risperdal when I took her case 2
months later.
And I brought in two outside doctors to examine her on her
underlying asylum case. Dr. Katherine Falk wrote in her sworn
affidavit in the case, ``The diagnosis given to her by the
doctor seeing her at the detention center is post-traumatic
stress disorder, psychosis and depression. There is no evidence
of psychosis, and there is absolutely nothing in the notes to
indicate that she had any symptoms that would lead a medical
doctor to be able to diagnose psychosis. She is not psychotic
and should not be taking Risperdal.''
Dr. Laurie Goldstein wrote in her affidavit, ``At the time
of my exam of Ms. Mudey, I was alarmed at the side effects that
I witnessed due to the medications she was being prescribed at
the Elizabeth Detention Center. And I advised her to refuse the
Risperdal.''
Both doctors submitted handwritten notes to the detention
center doctors explaining their credentials, explaining that
they had given a full examination, that the Risperdal was
wrong, ``Please contact me if you want to discuss the issue.''
The doctor became angry at Amina and said, ``You need to
keep taking this drug.'' Thankfully she refused, because the
side effects she was exhibiting--if you go on Risperdal's Web
site, they are all right there--the side effects were
potentially permanent and life-threatening.
Well, about 6 weeks later, as I was trying to prepare Amina
to testify during my lawyerly duties, she developed symptoms of
a serious abdominal illness that required immediate medical
attention, but DIHS medical professionals ignored her pleas for
help for weeks. A guard threatened to throw her in the SHU,
CCA's solitary confinement chamber, if she continued to request
medical attention and exhibit signs of sickness.
She called me in tears, doubled over in pain, and asked me
to intervene. I called the CCA and spoke to a medical
professional and alerted them that she had someone inside the
facility that needed to go to a hospital immediately or else I
was going to call 911. And the person on the other end of the
phone eventually said, ``Okay, fine, we will go and look in on
her and see what is wrong with her.''
Amina called me back 2 days later to say that nobody had
had come to see her. And I didn't call 911 because the person
on the other end of the phone told me, if you call 911, we
won't let them into the facility.
Well, after I found out that no one had come to see her, I
prepared a Federal lawsuit to force them to take her to a
hospital because I was afraid she would be dead by the end of
the weekend. And the only reason they took her to a hospital is
that they found out that I was going to file this complaint.
To this day, they have refused to tell me what hospital
they took her to, and I don't have her medical records, and I
haven't seen medical records from her since June. I wonder why
they don't want to give them to me. Can you figure it out?
This is how ICE treated a torture survivor who fled to the
U.S. in search of safety. Amina and other asylum seekers simply
don't have the option to just go home.
I look forward to taking your questions.
[The prepared statement of Ms. Baker follows:]
Prepared Statement of Ann Schofield Baker
Ms. Lofgren. Thank you very much.
Finally, Dr. Venters?
TESTIMONY OF HOMER VENTERS, M.D., ATTENDING PHYSICIAN AND
PUBLIC HEALTH FELLOW, BELLEVUE/NYU PROGRAM FOR SURVIVORS OF
TORTURE
Dr. Venters. Thank you, and good afternoon. My name is
Homer Venters, and I am an attending physician at the Bellevue/
NYU Program for Survivors of Torture, as well as a public
health fellow with the CDC and New York University. I would
like to thank the Chairwoman and other Members of the Committee
to speak here today.
Together with my colleague, Dr. Allen Keller, I have
conducted an analysis of the ICE health-care system for the
last 8 months. Contrary to public statements by ICE, it is our
conclusion that this health system and the care it allows for
detainees may be getting worse, not better.
The central thesis of my remarks is that, behind confusing
and unreliable statistics concerning detainee deaths, the ICE
health-care system contains key elements that may jeopardize
detainee health. I will briefly review the flaws of the
statistics provided by ICE, refer to several specific failures
in the ICE health plan, and conclude with our specific
recommendations for improving the system.
ICE reports falling detainee mortality rates, but their
figures are based on unreliable calculations. The most
important failure is the lack of adjustment for average length
of detention. Adjusting for risk exposure, such as length of
detention, is a fundamental practice of both medicine and
epidemiology, and failure to do so reflects flawed methodology.
Figures for average length of detention are available for
2006 and 2007. That is why I present these years. When
appropriate adjustment is applied to ICE's own mortality
figures, one sees that length-adjusted mortality has increased
29 percent from 2006 to 2007.
Other misleading statistics published by ICE include hollow
comparisons between deaths among detainees and among prison
populations and the general U.S. population without any
adjustment for age, disease prevalence or, again, length of
detention.
ICE mortality figures reveal two important pieces of
information. First, the length-adjusted mortality for detainees
increased from 2006 to 2007. The cause of this increase is
unclear, and mortality likely under-represents problems with
detainee health care. Morbidity is a better marker. But it is
certainly not the case the mortality has dramatically fallen
during this time.
Secondly, reliance by ICE on unsound statistical methods
that consistently present a more positive picture of detainee
health should generate concerns about the ability of ICE to
adequately access and improve its own health-care system.
This Committee has heard tragic and compelling testimony
concerning the deaths of ICE detainees. I would like to mention
four specific aspects of the ICE health plan that establish an
unacceptable level of care for detainees and must be addressed
if similar tragedies are to be averted.
First, the ICE health plan was recently changed to
eliminate chronic care visits every 3 months. This change will
mean that less care and less consistent care is provided to the
one-third of detainees who suffer from chronic medical
problems. And this is in stark contrast to the proven medical
standard of establishing system-wide protocols for chronic
disease management.
Another harmful practice is requiring the inclusion of
nonmedical criteria in referring detainees for outside care,
including whether or not failure to treat will impact
deportation. This inappropriately limits cares for detainees,
creates ethical jeopardy for ICE providers, and I will mention
is different than the standard for the Marshals Service.
A third problem pertains to health screening. The ICE
health plan, again, was very recently changed to allow basic
health screening tests, such as mammograms and pap smears, and
I quote, ``on a case-by-case basis subject to clinical
findings.'' Screening tests are, by definition, applied to an
entire nonsymptomatic portion of a population. To wait until
clinical suspicion or symptoms appear completely undermines the
screening aspect of the test. It deprives detainees of the
accepted medical standard of early detection and treatment, and
it lets diseases such as cervical, breast and prostate cancer
develop to the point of symptoms.
A final critical point regarding the ICE health plan
involves the treatment authorization request, or TAR. ICE has
recently scrapped the TAR appeals process but has also given
off-site nurses the ability to reject TARs by detention center
physicians. So now physicians in detention centers may have
their treatment authorization requests rejected by off-site
nurses, and they have lost the ability to effectively appeal
such decisions.
We recommend the following specific changes to the ICE
health plan as well as the larger infrastructure of ICE.
The ICE health plan must be altered so that health
screening tests and care for chronic disease are routinely
available and reflect accepted medical standards. Nonmedical
criteria must be eliminated from this health plan as part of
thereferral process. And detention center providers should not
have TARs rejected by off-site nurses without physician review
and without possible appeal.
Other changes to the larger ICE health system should
include mandatory reporting of vital health statistics,
including morbidity, not just mortality, to a body outside
Homeland Security and routine consideration of parole for
seriously ill detainees.
Finally, the health-care system for ICE detainees must be
guaranteed and defined as a matter of law. Many of the deaths
reported among ICE detainees involve poor adherence to existing
ICE guidelines.
Unfortunately, the present response of ICE to the
overwhelming evidence of inhumane health care for detainees
shows that officials are more concerned with public relations
than confronting a grim medical reality suffered daily by
immigrants in detention.
I thank you, and I'd be happy to take any questions.
[The prepared statement of Dr. Venters follows:]
Prepared Statement of Homer D. Venters, M.D.
Good Afternoon. My name is Dr. Homer Venters. I am an attending
physician at the Bellevue/NYU Program for Survivors of Torture as well
as a Public Health Fellow with New York University. I am testifying
today on behalf of the Bellevue/NYU Program for Survivors of Torture
and the NYU School of Medicine Center for Health and Human Rights. I
would like to thank Congresswoman Lofgren and members of the
Subcommittee for inviting me to testify on immigrant detainee
healthcare. My area of research as a Public Health Fellow is the
medical care provided to Immigration and Customs Enforcement (ICE)
detainees. Together with my colleague, Dr. Allen Keller (Director of
the Torture Survivors Program and the Center for Health and Human
Rights) I have conducted analysis of the ICE healthcare system,
including the mortality statistics recently released by ICE and the
specific provisions of the ICE health plan. My comments today focus on
these two areas and I will provide recommendations for improvements of
the ICE healthcare system. The central thesis of my remarks is that
behind confusing and unreliable statistics concerning detainee deaths,
the ICE healthcare system contains key elements that may jeopardize
detainee health. Contrary to public statements by ICE, it is our
conclusion that this health system, and the care it allows for
detainees, is getting worse not better.
I. Misleading Mortality Statistics
I would like to begin with the recent discussion of detainee
mortality reported by ICE. I am referring to the ICE fact sheet on
detainee deaths dated May 2008 \1\ as well as the Op-Ed by Assistant
Secretary Myers in the Washington Post.\2\ In these documents, ICE
relies on inappropriate use of basic epidemiologic terms and inaccurate
comparisons between populations known to be radically different. The
lack of standardized mortality or morbidity reported in these documents
provokes grave concern for the welfare of ICE detainees and the ability
of ICE to monitor the quality of its own health care system.
ICE reports falling detainee 'mortality' rates but their figures
are based on unreliable calculations. In Fiscal Year 2006 ICE detained
approximately 250,000 people while in 2007, that number rose to
310,000. Because the total number of detainee deaths dropped from 17 to
11 during those periods, ICE claims that the mortality rate fell from
6.7 to 3.5 per 100,000 detentions, a 49% decrease.\3\ However this
conclusion neglects a very basic and essential issue, the length of
detention. From 2006 to 2007, the average length of ICE detention
decreased from 90 days to 37. Adjusting for risk of exposure (such as
length of detention) is a fundamental practice of both medicine and
epidemiology and failure to do so reflects flawed methodology. For
instance, no physician would make conclusions about a patient's risk
from smoking without including how long that patient had been a smoker.
Taking ICE's same fiscal year numbers, but correctly adjusting for
average length of detention, it is clear that the length-adjusted
mortality actually increased between 2006 and 2007 from 27 to 34 per
100,000 detention-years, a 29% increase (see Table 1 for side by side
comparison).\4\ Consequently, the statistics presented by ICE tend to
present an unduly rosy picture of detainee mortality.
A second glaring weakness in the ICE statistics is found in their
comparison between deaths of ICE detainees and those in a general
prison population. Again, the lack of standardization for length of
detention makes this a flawed comparison, since prisoners are typically
held for a longer period of time in a given year than are ICE
detainees. For example, imagine that ICE detained 300,000 people per
year for one day each and U.S. prisons detained 300,000 people each for
a full year. It would be incorrect to conclude that because fewer
people died in ICE custody than in prison custody, the healthcare
provided to ICE detainees was somehow superior. The fact that the
average ICE detainee spends so much less time in custody than the
average prisoner in a given year must be factored in to provide any
meaningful results.
Aside from lacking standardization over a given year, any
comparison of ICE detainees to prisoner populations is dubious because
prisoners are incarcerated for much longer periods of time in total
than ICE detainees. Prison research has shown that mortality rates
increase with time of incarceration, so even if ICE had standardized
for time detained in a given year, prisoners who have accumulated years
of prior detention are known to have higher rates of mortality.\5\
Also, when ICE favorably compares mortality of detainees to those of
prisoners and the general population, there is no adjustment for age or
disease prevalence. For example, U.S. prisoners have high rates of
infectious disease, and the general U.S. population may be older,
suffering from higher rates of heart disease and cancer than the ICE
population. Without correct adjustment for these types of possible
differences, the figures provided by ICE are unreliable.
To be clear, mortality is an imprecise method for appraising
healthcare in a transitional population. Because death is rare and
detention is short, mortality likely under-represents problems with
health care delivery among ICE detainees. Morbidity, which refers to
sickness or having a disease, is a better measure of the efficacy of
ICE healthcare since by ICE estimates, at least 34% of detainees suffer
from chronic diseases.\6\ Consequently, complications from poorly
controlled chronic disease, such as diabetes, HIV, asthma or
hypertension are more sensitive health care measures. Unfortunately,
ICE makes reports no specific information about morbidity of detainees.
However, even morbidity may under-represent adverse effects of this
system. As with mortality, shorter detentions will tend to produce
fewer adverse events. In thinking of ICE detention as a risk factor, as
ICE detention time shortens, the likelihood is that adverse events
caused by this risk will occur afterwards. This may have been the case
with Juan Guillermo Guerrero, 37, who was denied his seizure medicines
while detained by ICE and died of complications from seizures shortly
after being deported to Mexico.\7\
This discussion of ICE detainee mortality reveals two important
pieces of information. First, the length-adjusted mortality for
detainees has increased from 2006 to 2007. The causes or significance
of this increase are unclear but it certainly is not the case that
detainee mortality is dramatically falling, as ICE has asserted.
Second, the reliance by ICE on unsound statistical methods that
consistently present a more positive picture of detainee health should
generate concerns about the ability of ICE to adequately assess and
improve its own healthcare system. Our review of the ICE health plan,
including recent changes, suggests that ICE detainees are receiving
medical care that is increasingly limited and inconsistent with current
standards of medical practice.
II. An Acute Care Health System for a Population in Need of Much More
The healthcare provided for ICE detainees is directed by a set of
rules under the Detention Management Control Program of the Department
of Homeland Security (DHS). This program creates procedures for ICE
detention operations but does not carry the force of law. Particular
medical policies and reimbursement guidelines are determined by the
Division of Immigration Health Services (DIHS), recently incorporated
into DHS from the Health Resources and Services Administration of the
U.S. Department of Health and Human Services. DIHS guidelines then
become part of the overall set of ICE rules for detention
operations.\8\ Despite acknowledging the substantial burden of chronic
disease among detainees, the ICE health plan maintains a steadfast
focus on an acute care model. The 1/3 of detainees with medical
problems that require ongoing, skilled care for problems such as
diabetes, hypertension, asthma and HIV find themselves in a medical
setting geared towards addressing ankle sprains, cuts and bruises and
calling 911 in case of emergency. Unfortunately, the ICE health plan is
clearly not crafted to care for a population with significant chronic
medical or mental health needs. The introduction of the ICE plan
explains ``The DIHS Medical Dental Detainee Covered Services Package
primarily provides health care services for emergency care. Emergency
care is defined as 'a condition that is threatening to life, limb,
hearing or sight.'' \9\
This institutional aversion to caring for detainees with chronic
disease is evidenced in recent detainee deaths. One year ago, a 23 year
old transgender woman, Victoria Arellano was detained by ICE.\1\0 Ms.
Arellano had AIDS and was taking a life saving medicine to prevent
opportunistic infections that could quickly cause pneumonia and death
were she to stop. These medicines are essential for people with AIDS
and even a brief interruption risks sickness and death for a patient.
Despite reporting her medical history and her medication when detained
(and throughout her detention), Ms. Arellano was refused her medicine.
Over the following weeks, Ms. Arellano developed a cough and fever,
which should have prompted hospitalization and evaluation. Instead, Ms.
Arellano was given an inappropriate antibiotic by the detention center
medical staff, was still refused her needed medication, and returned to
her cell. By the time Ms. Arellano's cellmates staged a protest to draw
attention to her deteriorating condition, she had become very ill and
died soon thereafter, comatose and shackled to her bed. Faced with a
common chronic disease, ICE medical staff withheld the correct
medicines, gave inappropriate medicines and failed to seek more
competent care for Ms. Arellano. The care that Ms. Arellano required
would be routine in almost any medical clinic or hospital in the United
States.
Among the most prevalent chronic diseases from which detainees
suffer may be depression and anxiety. The prevalence of these
conditions is difficult to gauge in part because detainee may fear
being placed in segregation should they report mental health symptoms.
This fear was documented in study conducted jointly by the Bellevue/NYU
Program for Survivors of Torture and Physicians for Human Rights in
2003 among asylum seekers (admittedly, a small subset of all
detainees). This report found that ``the mental health of asylum
seekers interviewed for this study was extremely poor and worsened the
longer that individuals were in detention.'' In this study, symptoms of
depression were present in 86% of the 70 detained asylum seekers, and
anxiety was present in 77% and PTSD in 50%.\11\ The study also
documented significant difficulties for immigrant detainees accessing
health services for painful and sometimes dangerous health problems.
Unfortunately, recent reports by the Washington Post and New York Times
demonstrate that the problems with detainee healthcare documented in
2003 are not new and have not been corrected. In fact the concerns are
even greater today, given that current immigration policies continue to
dramatically expand immigration detention.
The fear of arbitrary and inhumane segregation is not hypothetical
and has real bearing on the health of ICE detainees. In 2007, a 52 year
old man from Guinea, Boubacar Bah, fell while in ICE custody and
sustained a head injury.\12\ Mr. Bah was transferred to the medical
unit of the detention center but when he became agitated, confused and
vomited, Mr. Bah was written up for disobeying orders and transferred
to segregation (a euphemistic term for solitary confinement) with
approval of medical staff. The behavior that served as an excuse for
disciplinary transfer to solitary confinement was in reality a sentinel
sign of intracranial bleeding. The most shocking aspect of this case is
that Mr. Bah was actually in the medical unit, under the care of ICE
medical staff when the ill-conceived idea to place him in solitary
confinement was approved. Mr. Bah's condition deteriorated steadily
under the watch of ICE personnel until 14 hours after his fall, foaming
at the mouth and unresponsive, he was transferred to a hospital. Mr.
Bah was quickly diagnosed with a fractured skull, multiple spots of
bleeding in his brain and ICE notified his family five days later of
his condition. Mr. Bah died several months later without ever regaining
consciousness and ICE medical staff originally reported his cause of
death as 'aneurysm' without any mention of his fractured skull. While
most detainees who are inappropriately placed in solitary confinement
do not die, this case illustrates how very basic medical judgment can
be abandoned in the detention setting. A man who had just fallen and
lost consciousness, already inside the medical unit, was somehow judged
to be 'disobeying orders' instead of manifesting a clearly recognizable
sign of head trauma. Solitary confinement is obviously inappropriate
for someone who is ill, but this case and others call into question the
very practice of placing detainees in such a setting.
III. Specific Weakness in the ICE Health Plan Imperil Detainees
In addition to the broad institutional problems facing detainees
who require medical care, there are very specific aspects of the ICE
health plan that warrant concern. DIHS has altered the Covered Services
Package several times in the past few years, limiting the scope of
medical care for detainees. Publicly reported deaths of detainees have
included cases in which persons with chronic diseases were refused
access to care outside their respective detention centers.\13\ The
refusal for this care comes in the form of a Treatment Authorization
Request (TAR) submitted by local medical staff at a detention center
and denied by DIHS. Before 2005, the Covered Services Package entitled
detained with chronic medical problems to 'chronic care' visits every
three months. In 2005, the Covered Services Package was changed in the
following manner: ``we have clarified to providers that DIHS does not
mandate the frequency a detainee is seen or what testing needs to be
done by the onsite physician. The responsibility will lie with the
provider.'' \14\ In stark contrast to these recent changes by ICE,
there is clear and convincing evidence that establishing system-wide
protocols for chronic disease diagnosis and treatment (including pre-
approved visits, tests and treatments) results in decreased mortality
and morbidity.\15\,\16\,\17\ Because this change eliminated any notion
of standard of care (such as a set protocol for treating specific
diseases), and further increased the burden of securing prior approval
for outside care, the net effect may have been to limit care for
detainees with chronic medical problems. One tragic example is
Francisco Castaneda, a 34 year old man from El Salvador, who was
detained for 11 months by ICE with bleeding penile lesions. Despite
numerous physicians documenting concern that his lesions were
cancerous, DIHS refused the TAR for biopsy labeling the test
'elective'. After being released from detention, Mr. Castaneda was
finally able to receive appropriate evaluation and treatment. But by
then it was too late and Mr. Castaneda died shortly after beginning
treatment for metastatic penile cancer.\18\
Another potential threat to detainee medical care is the
requirement of the Covered Services Package that mandates that
detention center medical providers include non-medical criteria in any
potential referral for outside care. The Covered Services Package
allows non-emergent care with the following explanation: ``Other
medical conditions which the physician believes, if left untreated
during the period of ICE/BP custody, would cause deterioration of the
detainee's health or uncontrolled suffering affecting his/her
deportation status will be assessed and evaluated for care.'' \19\ With
these conditions, ICE simultaneously demands that a care provider
estimate the length of detention for a detainee and assess whether or
not deterioration of the condition might impact deportation. Both of
these non-medical criteria potentially limit the care provided to
detainees and likely create ethical (and potentially legal) jeopardy
for ICE providers. In contrast, the U.S. Marshals Service relies on
medical necessity alone in establishing criteria for outside
referral.\20\
A third problem with the care allowed under the Covered Services
Package pertains to health screening. Originally (prior to the 2005
changes), the plan approved basic health screening tests such as
mammograms and pap smears only after one year in detention. This
guideline was substandard because many detainees likely had little or
no prior health screening and would have benefited from indicated
health screening tests (as is the standard at Rikers Island Jail in New
York City, where average length of stay is shorter than average ICE
detention).\21\ But even this substandard coverage was further reduced
in 2005 when the Covered Services Package substituted diagnostic
criteria for what they continued to call screening tests. The new
guidelines stated: ``screening for disease processes (e.g., breast,
cervical, prostatic, colorectal cancer) are considered on a case by
case basis, subject to clinical findings . . . In other words, clinical
findings must support the need for the requested screening. This change
will remove the impression that these tests are automatically approved
for a detainee who is in custody for over 12 months.'' \22\ Screening
tests are by definition, applied to the entire non-symptomatic portion
of a population. For example, in discussing Pap smears, the U.S.
Preventative Services Task Force recommends screening for cervical
cancer in women who have been sexually active and have a cervix.\23\
There is no reference to symptoms or clinical suspicion in this, or any
other screening recommendation and to wait until clinical suspicion or
symptoms appear completely undermines the 'screening' aspect of the
test. This difference is enormously important because while ICE
continues to call these tests 'screening', they are in fact forcing
tens of thousands of people to forgo some of the most beneficial and
cost-effective measures of modern medicine. By waiting until detainees
show symptoms or arouse clinical suspicion of a disease, ICE deprives
detainees of the accepted medical practice of early detection and
treatment in favor of letting diseases such as cervical, breast and
prostate cancer develop to the point of symptoms.
A final but critical problem with the ICE health plan involves
changes in how each Treatment Authorization Request (TAR) is processed.
Prior to changes in 2005, detention center medical staff could submit a
TAR and if it was rejected by DIHS, they could appeal this refusal.
These appeals were reviewed by a team of 3 DIHS physicians. This formal
appeal process was scrapped in 2005 in favor of a 'grievance' process
that eliminated the physician review component. In addition, in 2007
ICE changed the guidelines for refusing TAR's so that DIHS nurses could
reject a TAR without any input from the DIHS medical director. Such
oversight by the medical director was required for rejection of TAR's
prior to this change. The net effect of these two changes is that
physicians in detention centers may have their TAR's rejected by off-
site nurses and they have lost the ability to appeal such decisions to
a group of physicians.
IV. Recommendations
We recommend several specific changes to the DIHS Medical Dental
Detainee Covered Services Package as well as to the larger health
infrastructure if ICE. Without these changes, we are concerned that all
detainees held by ICE face an unacceptably low standard of medical care
that will adversely affect their health.
1. The DIHS Medical Dental Detainee Covered Services Package must
be altered in the following ways:
A.
Care for chronic disease must be routinely available and
reflect community standards for the care of HIV, diabetes, hypertension
and other common chronic diseases. Part of these improvements must
include pre-approval for standard, foreseeable care.
B.
Health screening tests must be made available based on
prevailing medical standards and any mention of 'clinical suspicion' or
'symptoms' must be eliminated from criteria for these tests.
C.
Non-medical criteria must be eliminated from the process of
detention center medical staff seeking a TAR for detainees.
Specifically, the mandate that ICE providers balance a deteriorating
condition and uncontrolled suffering against the ability to deport the
detainee or estimate a detainee's length of detention must be
eliminated from the health plan.
D.
TARs generated by physicians should not be rejected by nurses
without review by a physician. Any TAR rejected by DIHS should be open
to a genuine appeal, including review by physicians
2. ICE should be mandated to report vital health statistics
(including deaths, disease complications, accidents and forcible
medical actions against detainees) to a body outside DHS with expertise
in public health and epidemiology. One possible solution would be to
return DIHS to the Health Resources and Services Administration of the
Department of Health and Human Services and include an ICE medical
monitoring division.
3. Detainees with serious medical ailments requiring high levels
of care should be routinely considered for parole. The correctional
setting is an inefficient and inhumane venue for persons with medical
problems requiring high levels of ongoing medical care.
4. Healthcare for ICE detainees must be guaranteed and defined as
a matter of law. Many of the deaths reported among ICE detainees
involve poor adherence to existing ICE guidelines. Greater
accountability is needed to ensure compliance in healthcare standards
across the wide spectrum of detention centers.
These improvements will require substantial effort, including
financial investment. Currently, ICE argues that the number of medical
visits, procedures and overall medical budget ($100 million)
demonstrate a high degree of care for detainees. But these details tell
us nothing about key factors in care delivery, including delays in
treatment and the nature of visits. Several detainee deaths involved
delays in care and the explosive increase in immigration detainees has
outpaced increases in medical spending. Moreover, $100 million may be a
low health care budget for a system that detains 300,000 people per
year. By comparison, Rikers Island Jail in New York City detains
roughly half the people annually and on any given day that ICE detains,
but has spent over $100 million annually on healthcare for over a
decade for a population that is generally detained for less time than
ICE detainees. Without transparency from ICE on basic health outcomes
or costs, ICE's raw expenditures tell us little about the efficacy of
this system of care.
We believe that the most basic principles of decency and sound
medical practice demand that an adequate standard of health care for
detainees be legally mandated aggressively enforced and that basic
health outcomes among detainees be reported for evaluation outside ICE.
Unfortunately, the present response of ICE to the overwhelming evidence
of inhumane healthcare for detainees shows that officials are more
concerned with public relations than confronting the grim medical
reality suffered daily by immigrants in detention.
REFERENCES
1. Immigration and Customs Enforcement, Office of Public Affairs.
Fact sheet: Mortality rates at ICE detention facilities. Office of
Public Affairs, U.S. Department of Homeland Security; 2008.
2. Myers JL. Caring for immigration detainees. Washington Post. 5/20/
08 2008;A13.
3. mmigration and Customs Enforcement, Office of Public Affairs. Fact
sheet: Mortality rates at ICE detention facilities. Office of Public
Affairs, U.S. Department of Homeland Security; 2008.
4. If one were to use the calendar year deaths for 2006 and 2007 (16
and 7), then the length-adjusted mortality does fall slightly from 25
to 22 per 100,000 detention-years. However, this calculation is
unreliable since it mixes fiscal and calendar year numbers at a time of
rapid changes in numbers and length of detentions. Length of detention
numbers were unavailable for years other than 2006 and 2007.
5. Mumola CJ. Department of Justice, Bureau of Justice Statistics.
Medical causes of death in state prisons, 2001-2004. 2007; ncj216340.
6. Myers JL. Caring for immigration detainees. Washington Post. 5/20/
08 2008;A13.
7. Bernstein N. Few details on immigrants who died in custody. New
York Times. May 5, 2008 2008;A.
8. Jawetz, T. (American Civil Liberties Union) 2007, Medical Care and
Deaths in ICE Custody, House Subcommittee on Immigration, Citizenship,
Refugees, Border Security, and International Law.
9. Government Accountability Office 2007, Alien Detention Standards,
Governemtn Accountability Office, Washington D.C.
10. Human Rights Watch 2007, Chronic Indifference: HIV/AIDS Services
for Immigrants Detained by the United States.
11. Physicians for Human Rights/Bellevue/NYU Program for Survivors of
Torture 2003, From Persecution to Prison: The health consequences of
Detention for Asylum seekers.
12. Bernstein N. Few details on immigrants who died in custody. New
York Times. May 5, 2008 2008;A.
13. Lutheran Immigration and Refugee Service and Detention Watch
Network 2007, Overview of U.S. Detention; Briefing materials for the
United Nations Special Rapporteur on the Human Rights of Migrants,
Detention and Deportation Working group.
14. Division of Immigration Health Services (DIHS) 2005a, DIHS Medical
Dental Detainee Covered Services Package, Division of Immigration
Health Services (DIHS).
15. Solberg, L.I., Asche, S.E., Pawlson, L.G., Scholle, S.H. & Shih,
S.C. 2008, ``Practice systems are associated with high-quality care for
diabetes'', The American Journal of Managed Care, vol. 14, no. 2, pp.
85-92.
16. Tsai, A.C., Morton, S.C., Mangione, C.M. & Keeler, E.B. 2005, ``A
meta-analysis of interventions to improve care for chronic illnesses'',
The American Journal of Managed Care, vol. 11, no. 8, pp. 478-488.
17. ``Supplement 1. American Diabetes Association: clinical practice
recommendations 2000'', 2000, Diabetes care, vol. 23 Suppl 1, pp. S1-
116.
18. Priest, D. and Goldstein, A. System of neglect. Washington Post.
May 11, 2008 2008;A1.
19. Division of Immigration Health Services (DIHS) 2005a, DIHS Medical
Dental Detainee Covered Services Package, Division of Immigration
Health Services (DIHS).
20. U.S. Marshalls Service 2008, Prisoner Health Care Standards.
Available:
http://www.usmarshals.gov/prisoner/standards.htm.
21. Fein, E. September 19, 1997, Deal to Brink Rikers Inmates Managed
Care, New York Times,A.
22. Division of Immigration Health Services (DIHS) 2005b, Summary of
Changes to the DIHS Detainee Covered Services Package, Division of
Immigration Health Services (DIHS).
23. U.S. Preventive Services Task Force. Screening for cervical
cancer. 2003
Ms. Lofgren. Thank you, Dr. Venters and all of the
witnesses.
This is a time when we have an opportunity to ask a few
questions. I have several.
First, Ms. Armendariz, your testimony is so hard to listen
to due what occurred. He had been treated at the VA for years,
because he was a veteran, and they had diagnosed him with
schizophrenia.
Ms. Armendariz. Fifteen years.
Ms. Lofgren. Okay. So that is a Federal facility with
Federal medical records. Were those records ever made available
to ICE?
Ms. Armendariz. I guess it didn't mean anything to them at
that time. I told them--or his attorney told them.
Ms. Lofgren. Okay. So that answers one question, that the
medical records we were told this morning that always follow,
there is a problem there, it appears.
Ms. Armendariz. The first facility, because he was in San
Antonio, the first facility, he fell down. And his face, I
thought they had beaten him, and it was because they gave him
strong Thorazine. It had side effects. And that is when I got
advocacy involved.
Ms. Lofgren. Right.
Ms. Asfaw, you have been granted political asylum here in
the United States. You received very abusive treatment in your
home country. When you were put into custody after you made
your indication to apply for asylum known, was there any effort
to provide information or care to you to deal with the things
that had been done to you that you had escaped?
Ms. Asfaw. Yes.
Ms. Lofgren. And what were those things?
Ms. Asfaw. Back in my country?
Ms. Lofgren. No, here in the ICE facility, did anybody in
the ICE facility try to help you cope with the things that had
been done to you in Ethiopia?
Ms. Asfaw. Yes.
Ms. Lofgren. And what were those things?
Ms. Asfaw. I don't understand.
Ms. Lofgren. Okay. That is all right. I will follow up in
writing with you on that. That will be easier.
Let me ask you, Ms. Baker, your testimony is very
compelling. First, 600 hours is a lot of billable hours. I
think it is pretty admirable that you have donated and your
firm has donated that kind of time on a pro bono basis.
You, I think, were here this morning to hear the testimony
of Ms. Myers. How does her testimony compare to what you saw as
an attorney with a client last year?
Ms. Baker. You mean as opposed to the Rolls Royce of
medical treatment?
Ms. Lofgren. Correct.
Ms. Baker. There are very clear systemic problems, as
evidenced by my client's case and by a number of other people's
cases who have testified here today.
Number one, there are no interpreters. In the 5 months that
Amina was in ICE detention, she didn't once have a medical
examination or treatment with an interpreter.
Ms. Lofgren. Did you offer to provide that for her?
Ms. Baker. I offered to provide--as soon as I came into the
case, I realized that there were glaring miscommunications, and
I offered to provide them with an interpreter for months in
writing, and no one ever called. They refused to do it.
I still to this day, as I have said, have not seen her
medical records. I think the medical care that she was
provided, I mean, even if you can look the other way at a
misdiagnosis in the first place and say they thought maybe she
was psychotic but really wasn't, when you have the side effects
that she was exhibiting, it's just inexplicable that none of
the medical professionals got it.
A gynecologist who I brought in instantly figured out that
she was on an antipsychotic drug. And the psychiatrist figured
out it was Risperdal, because at the time we didn't have her
medical records, when Dr. Kathy Falk examined her. So the side
effects were just catastrophic, and they completely either
missed them or, worse, knew about them and increased the dosage
anyway.
Ms. Lofgren. Well, you provided them with a second opinion
with outside physicians, right?
Ms. Baker. Two second opinions. They actually wrote full
letters to them. I didn't get to this in my testimony, but
later on--and I started writing letters, too, saying, ``I'm
Amina Mudey. I don't speak English. And I demand my medical
records. My lawyer is writing this on my behalf.'' The inside
doctor eventually gave all of the letters back, including at
least one letter written by the doctor, told Amina, ``Tell your
lawyer to stop writing me letters.''
Ms. Lofgren. Ms. McCarthy, before my time runs out, your
agency is in a lot of facilities doing pro bono assistance. You
heard the testimony this morning from Ms. Myers. Does that,
sort of, rosy picture that was given to us comport with what
you are seeing in the facilities?
Ms. McCarthy. Unfortunately, no. I think what is really
alarming is the lack of attorneys available to represent
detainees, the number of which is increasing dramatically.
The three stories that we have heard today are stories of
people who had legal representation and advocates. Just imagine
what it is like for those individuals who do not have legal
advocates. Unfortunately, Ms. Belbachir was one of those
individuals. She was a suicidal asylum seeker who had no one
from outside the ICE facility to advocate for her.
There is no court-appointed counsel available for
immigrants who are detained or placed in legal proceedings.
Individuals are detained and deprived of their liberty and
their only option for medical help, as the system is set up
right now, is through Immigration and Customs Enforcement.
Ms. Lofgren. Thank you very much.
My time has expired, so I'll turn to the Ranking Member,
Mr. King, for his questions.
Mr. King. Thank you, Madam Chair.
In listening to the testimony, I want to say that I surely
don't doubt the testimony that's before us here, and I don't
doubt that there are tragic human circumstances that take
place. There are 300 million people in America and 6 billion
people on the planet, and there are going to be many, many of
these stories. And it is a small sampling that you have
delivered here today.
One of our jobs is to evaluate the policy that exists
against the policy that's proposed and see where the data
that's delivered to us matches up to that and also see where
the anecdotes that are delivered to us matches up to that.
And with that in mind, I'd turn first to Ms. Baker and ask
you: What in Ms. Lofgren's bill, that is really part of the
subject here today, even though it's not formally the bill
that's before us in the hearing, what in that bill would have
alleviated the circumstances that you testified with regard to
today regarding your client, Ms. Mudey?
Ms. Baker. The bill, as I understand it--and I have to
admit that I only read it once about 2 weeks ago, so I'm not
fully prepared to discuss the terms of it today--but that it
creates a standard for the care that's provided. It's
effectively like a bill of rights, as I understand it, that
these kinds of situations just simply can't be swept under the
carpet, that there needs to be some kind of standard set for
the care provided to these people.
Mr. King. And so, to summarize that answer, and I
understand it this way too, that it provides a cause of action
and perhaps a means of appeal. But it probably would have not
have intervened before these circumstances took place. That's a
point that I think we need to keep in mind here. And I
appreciate the balance of your answer.
And I'd turn to Bishop Riley. I'm, of course, very
interested in your testimony and very respectful of you as a
man of the cloth and the tone that you bring here as well.
And I have a question that drifts in my mind with regard
to, let's just say, human dignity. Human dignity is, in my
judgment, a basic human right that should be provided to every
human being regardless of their citizenship or whether they are
lawfully present or whether they are not.
Do you draw a distinction between human dignity and human
rights in any way that you'd like to describe to this panel?
Reverend Riley. I think that human dignity is a human
right. It's one of the rights.
Dignity--let me give you an example of a lack of dignity.
One of the things that often happens is that when our detention
facilities like the one in Elizabeth fills up, then folks are
farmed out to the county jail. If you are farmed out to the
county jail, such as Monmouth County, no matter what you're
there for, if you're an asylum seeker or whatever, then you
wind up being stripped searched for drugs with the rest of the
criminal population.
Mr. King. Reverend Bishop, wouldn't that also be true for
someone who was, let's just say, someone who was lawfully or
unlawfully present in the United States? Because that is the
next piece of this question.
Let me make it--there's four parts. I think there is a
distinction between human dignity, which should be provided to
all people, but then between that and human rights and between
human rights and the distinction between those lawfully present
and those unlawfully present in the United States, as well as
the distinction between the rights of U.S. citizens.
Those four definitions, do they have a distinction in your
mind? And do you draw those distinctions, as far as supporting
the laws of this Nation with regard to immigration?
Reverend Riley. As you pointed out when you started this
question, I come at this from a little bit different
perspective, in that I look at all of the people as part of the
family of God and the children of God. And so everyone in that
vision is equal.
I believe that the country has to have and maintain its
laws, no question about that. And I think those laws need to be
applied equally across the board.
But I think it's also true that at the heart of our law is
respect for human beings, wherever they come from, whoever they
are. And I think that's at the crux of this matter, is that our
own failed laws, frankly----
Mr. King. Well, and I appreciate your point.
Reverend Riley [continuing]. Put us in this situation.
Mr. King. And so I'm asking you, do you believe that it's
possible for ICE to enforce current immigration law and still
provide for human dignity and still provide for the human
rights that you and I believe in?
Reverend Riley. If ICE is an extension of this Government
that is me, because this Government is by the people, then I
expect ICE to do this.
I don't believe ICE is conforming to its own policies. I
think that's why we are here today, is that law is going to
have to be enacted to get ICE to respond to its own written
policies in terms of its standards of care.
Mr. King. But you do believe it is possible to enforce the
law and still provide for human dignity and human rights under
the current law?
Reverend Riley. I would hope that it is.
Mr. King. I would, too, Reverend. Thank you for your
testimony.
And thank you all for your testimony.
I yield back the balance of my time.
Ms. Lofgren. The gentleman's time has expired.
I turn now to the Chairman of the Judiciary Committee,
Chairman Conyers.
Mr. Conyers. Thank you very much.
I commend the witnesses.
Steve King and I have agreed to send a letter to the lady
that was the head----
Ms. Lofgren. Ms. Myers.
Mr. Conyers. Yes, Ms. Myers, with the testimony of Ms.
Armendariz and ask her to respond to it so we can find out
where she comes down on it.
This is one of the times I would've liked to have had this
panel go first and see how that might have affected her
testimony or what comments she would've had about this at all.
But anyway, I think this has to be continued.
You know, this doesn't sound like this is in America this
kind of thing is happening, to me. I mean, if you told me--I
could name a number of countries that if you said this, I'd say
it's awful and it's too bad they do things like that over
there. But this is happening right under our nose.
And I am beyond shock now, having been in this body enough
years. But this is stunning testimony that needs to be followed
up on.
Now, could I ask anybody that knows what type of physician
or physicians are on staff at the ICE facilities?
Yes, sir?
Dr. Venters. I have interacted with some of the medical
staff when I do my evaluations. And so, generally, they're
internists. I think Elizabeth Detention Center right now has a
cardiologist who was trained as an internist and then has
specialist care in cardiology. But, generally, internists or
family practitioners, if they are physicians. However, a great
many of the smaller facilities may have a physician's assistant
or a nurse.
I think the goal is to have a physician there during
business hours, for a lot of these facilities, and then they
have someone else to cover the evening and weekends.
Mr. Conyers. Well, I guess the first thing the Committee
might want to do is find out what kind of medical practitioners
or health providers are at each facility. That would help us
get off the ground.
And dare I ask, are there any psychiatrists or
psychologists at any of these facilities that we know of?
Ms. Baker. I cannot state with certainty that my client was
seen by a psychiatrist. However, in reviewing her medical
records, it said something like ``seen by psych.'' But the
person's name was never identified, as far as I can tell, so
I'm not sure who prescribed the Risperdal to my client. There
may have been a psychiatrist, but I can't say for sure.
Mr. Conyers. Well, what else are we to make, Attorney
Baker, of the way you were treated? I mean, for goodness sake,
how many people, if they had counsel, would have people of your
professional caliber making regular, logical interventions with
questions and so forth? And they were shrugging you off like,
please get out of my way.
Ms. Baker. They were sick of me, I will tell you that much.
They definitely were sick of me.
But the thing that bothers me most in all of this--well,
there are many, but one of the things that bothers me the most
is the audacity of the person on the other end of the phone
when I called and said, ``I'm about to call 911 because you
have someone who is doubled over in pain, who has not been seen
by a doctor for 2 weeks,'' and I had a doctor on the phone who
prepared an affidavit who identified that this was a life-
threatening, potentially anyway, a life-threatening situation,
as much as she could tell over the phone. And then 2 days went
by before anybody went to see her. And they went to see her
only after my colleague, Adam Pearl, and I got back to the
phone and started saying, ``Hey, you told me someone was going
to go and see what was wrong with my client,'' and nobody ever
did.
Mr. Conyers. Well, one last intervention here. Ms.
McCarthy, Attorney Baker, how do we deal with this lack of
legal representation problem? This isn't going to be cured by
pro bono. There are not enough lawyers and law firms in America
that they can produce the Bakers around here to provide--we are
in a hell of a situation.
What do you tell the Congress to do?
Ms. McCarthy. Well, I think there are a number of issues,
but I think the most significant issue, as I said in my
comments, is the overuse of the immigration detention system.
Is it necessary to have all of these individuals locked up at
taxpayer expense? This is administrative detention; this is not
criminal detention.
I question whether it's necessary that we lock up men and
women who are, many times, hardworking members of our
community, need access to medical careoutside of the
immigration detention system, or are asylum seekers merely
seeking protection.
Mr. Conyers. Do you have some studies or proposals or
essays that suggest that the answer is, no, that we shouldn't
be locking up so many?
Ms. McCarthy. The Vera Institute of Justice has conducted a
study in which it followed individuals who were released from
detention to determine what the outcome of their immigration
proceedings was. The study demonstrated successful results,
because upon release from detention the immigrants were paired
up with attorneys, they had access to health care, they had
access to social services, and they had access to religious
communities that supported them. So I think it's a very, very
viable model.
Mr. Conyers. Well, maybe King and I can work on analyzing
this. The window of opportunity is closing here in the 110th
Congress, but maybe we can work on getting some more
information about what's going on and whether it is necessary
or is this overkill.
I mean, this sounds like we're in a country other than
America about what's going on here.
Ms. Baker. I would definitely support the notion of having
more of these asylum seekers paroled, certainly.
My client actually investigated trying to get parole, but
this is an interesting fact, is that the document that her
deportation officer or one of the deportation officers gave me
to fill out included a very onerous financial statement and
obligation on the part of the parolee that said they would----
Mr. Conyers. That it would cost them?
Ms. Baker. Yes. It was something to the effect that if you
were going to sponsor someone for parole, you had to sign a
document that said, I'm going to support this person for 10
years.
And I'm told--remember, I'm the newbie on the panel. This
is my first asylum case. And if I get something wrong, I'm sure
my colleague will correct me.
But it's my understanding that the form I was given by the
ICE official was created for a completely different purpose
other than parole of an asylee.
So she had someone who was willing to house her in the
interim, but I couldn't get her out because that person didn't
make enough money.
Ms. McCarthy. I might just add to this discussion because I
know Ms. Myers spoke today about the asylum parole process, but
I think there are some serious flaws in that parole process. It
needs to be reviewed and monitored. When ICE issues a decision
to deny parole, that decision should automatically and
immediately be reviewed by a Federal court judge. That review
does not exist today.
Mr. Conyers. Thank you very much.
Ms. Lofgren. Thank you, Mr. Chairman.
I'll turn now to my colleague, Mr. Gutierrez.
Mr. Gutierrez. Well, thank you very much, Madam Chairwoman,
for putting together this hearing. I think the testimony has
been very eloquent and very clear.
I'd like to say hello to Ms. McCarthy from Chicago, say a
special hello to her, and like to thank the witnesses who have
come forward, Ms. Armendariz, for their personal testimony in
this case.
Look, you were here, the witnesses were here, and I think
the members of the panel were here. We heard the
representatives of the Federal Government. I've been in
Congress now for 16 years. I've had many witnesses, few of them
as belligerent, as questioning of our authority as we've had
here this morning.
I would share with my colleagues on this panel that that
has been my experience with ICE. In the Chicago area, when the
head of ICE was asked, ``Did you actually pick up every Latino
male between 18 and 35 regardless of any other information?'',
she said yes, and she said she did it proudly, that that was
her mission, enforcement. I mean, this is the police in the
strictest sense of the word, and I won't go any further in
terms of defining them.
ICE works with our Justice Department. You think that they
only hold the parolees? Then they call the Justice Department,
and the Justice Department fights in the court to deport those
parolees after they've asked for asylum.
So I think we have a great problem here. The eloquence of
the witnesses who have suffered so much here today at the hands
of ICE and our justice system are but the tip of the iceberg.
We receive cases like this almost every week that come into our
office, people pleading.
It is very difficult to believe that we can trust an
agency--and I think there was a question asked earlier about
the AMA and having an outside agency come in and intervene and
use standards outside. It is very difficult to watch the
Federal Government watch the Federal Government when the
Federal Government's mandate almost is to deport as many people
as quickly as possible regardless of the consequences.
How do we take the testimony seriously about health care
when--we are going to ask, Mr. Chairman--I think you and Mr.
King should write that letter. We wrote a letter asking about
ICE sitting across the country, outside of child care centers.
That is where they put ICE agents. And we got a letter back
from them basically telling us, ``Send us some more
information.'' If there had been a little more time, I would
have asked her: Did you actually ask the ICE agent if they are
sitting outside?
I mean, one of the purposes should be to make us safer, to
make us more secure. I don't know that having ICE agents
sitting outside of daycare centers makes us--I'll tell you who
it doesn't make more secure. It doesn't make the moms and the
dads that have to take their children to those daycare centers
feel more secure. What they do, Mr. Chairman and Madam
Chairwoman, is they take those children to work with them.
I mean, we had this wonderful raid, and we should really,
really have a hearing on this raid in Iowa because there were
serious allegations of sexual abuse on the part of the managers
and owners of the facility, not paying them wages, serious
child labor infractions. And while one hand of the Federal
Government, the Department of Labor, is investigating very
serious allegations against the owners and the managers of a
meat plant, guess what happens? ICE comes in, arrests
everybody, deports over 145 people, and all of the witnesses
are gone.
I mean, you can exploit this labor as readily as possible
as long as you have an ICE institution that will come in and
cause a raid. I mean, 98 percent of the prosecutions that ICE
conducted were against individuals, not against the owners of
the factories, last year, but against the individual people.
And let me just end with this. I would like to just join
Bishop Riley in this sense. Not all of us think all human
beings should be treated differently because they are American
citizens or because of their legal status in this country. I
have heard many of my colleagues speak eloquently about their
great faith and their great faith in the Christian faith. And
I'm not a theologian, but, you know, I went to Catholic school
for a few years. I remember two fundamental lessons: to love
God above everything else and to love my neighbor as I love
myself.
Now, when I go to church on Sunday, the undocumented sit in
the pews. They receive the body and the blood of Christ with me
as we go up, and we don't ask them. And if I really love my
neighbor as I love myself, if I am an American citizen and I
have guarantees of this country as an American citizen, and I
love my neighbor as I love myself, then I want them to have
better and greater guarantees than the ones that I have.
And I think that that is really the mission of this panel
and the Congress of the United States, to make sure we treat
everyone as well as we expect to be treated, that is here in
this country.
And I thank the gentlelady, Chairwoman for the extension of
the time.
Ms. Lofgren. Thank you.
I yield now to Mr. Ellison.
Mr. Ellison. Let me join with my colleagues in thanking all
of the very compelling, very informative testimony.
And I also just want to add a very favorable support for
the level of passion that the advocates possess. We need you to
help our country run better, and I thank you for what you've
done and what you've said today.
You know, I practiced criminal law for 16 years. I never
was an immigration lawyer, so I don't really know the process.
I know that when I appear with a client, the prosecutor would
argue that they were a flight risk or that they were a danger
to public safety, and I would usually argue that they weren't,
and the judge would make a decision.
What are the criteria you use when a person who is in
detention, when the question of their release is before the
court? What's it like?
Just I think it is good for the record and for people
watching to know what kind of analysis the magistrate is going
to apply in deciding to let a person be on parole or have a
person stay in custody.
Ms. McCarthy. This a very important point. The fundamental
difference between criminal detention and the detention system
of immigrants, is that immigration detention is an
administrative process. So, unlike the criminal system, in the
administrative detention system of immigrants there is no judge
who reviews the individual's detention. Detention typically is
an administrative decision initially reviewed by Immigration
and Customs Enforcement.
In some cases, an immigration judge may have an option to
review that and set bond. But even if an immigration judge sets
bond, the Government has the option to stay that bond if it
chooses to do so.
For example, I had a client for whom the immigration judge
granted a $5,000 bond. The Government stayed that decision and
the client remained detained for 3 years while seeking judicial
review of the administrative decision.
Mr. Ellison. So these are folks--I think it's important to
be clear on the record, we are talking about people who are not
even alleged to have harmed anyone or be a danger to the
public. We are talking about people who are like Ms. Asfaw, for
example, who had been a victim of political and physical
torture herself, she is detained for, what, 5 months, was it?
Did the fact that she hadn't hurt anybody or wasn't a
threat or it would even be cheaper for the Government to just
let her be in the community, does that come up when the
decisions about detention are evaluated?
Did that come up in your case, Ms. Asfaw?
Could somebody help her?
Ms. McCarthy. Yes, I can answer the question. I am not sure
with respect to her case, but for asylum seekers in general the
Government does have the option to review whether or not that
individual should remain detained. So after the individual
passes what's called a ``credible fear'' interview, the
Government agency, ICE, could review whether or not Ms. Asfaw
should have remained detained. And what ICE should consider is
exactly what you mentioned: whether she's a flight risk or a
danger to the community. But ICE has added another element to
this review: whether or not it is in the public interest that
the asylum seeker be released into the community. ICE added
this irrelevant factor that makes it difficult for an asylum
seeker to be released.
As lawyers representing asylum seekers, we identify
sponsors and individuals who the asylum seeker could possibly
be released to, and then advocate for their release. But even
in those situations, where the detainee meets the criteria, ICE
denies release of the asylum seeker and there is no judicial
review of the decision. ICE has complete discretion over the
asylum seeker's release.
Mr. Ellison. Does the question of extant medical need ever
arise in the detention-release calculus? I mean, if somebody
has a serious medical problem and it'd brought to the attention
of the decision-maker, does that mitigate in favor of them
being released into the community where they can get their
medical needs met?
Ms. McCarthy. It does, yes.
Mr. Ellison. How often does that come up? It sounds like,
based on the testimony we've heard, that it's not being very
well heeded by the decision-maker. Am I wrong?
Ms. McCarthy. I think your point is well-taken. Yes, I
think that's one of the issues. And I think Ms. Armendariz's
case is a very strong example of that. Her husband continued to
be detained des[ote his medical conditions. This case
illustrates that that medical humanitarian factors are not
taken seriously into consideration by ICE.
Mr. Ellison. If we had judicial judges doing the
evaluating, would we probably get better outcomes?
Ms. McCarthy. I think you're absolutely right. And, as Ms.
Baker mentioned, she was ready to file a habeas petition in her
client's case, which is an option, but there are many hurdles
to habeas relief. So if we can build into the law some type of
judicial review of the continued detention of the individual, I
think that would be very valuable.
Mr. Ellison. As Americans, we value liberty. We consider
liberty an important value. It doesn't matter whether you are
documented or undocumented. Whether you have a right to remain
in the country is what is to be determined, right, later?
Ms. McCarthy. Absolutely.
Mr. Ellison. So it seems to me a somewhat strange anomaly
in the law that when it comes to people who are trying to enter
the country, that we would have even less discretion than a
criminal defendant, who at least there is some probable cause
for.
Anyway, that's just my editorial.
Let me ask you this. What are the implications for
overcrowding? What about when we get into jails, county jails,
other kinds of facilities when people can't be at a detention
facility, which I would imagine is somewhat suited to meet the
need that it's designed for, what about the overflow when--I
mean, do we have people who are immigrants waiting to be
determined about their status----
Ms. Lofgren. I will give Mr. Ellison an additional minute
so that question can be answered.
Mr. Ellison. Thank you, Madam Chair--in the county jails?
Ms. McCarthy. Well, Immigration and Customs Enforcement
enters into contracts with county jails throughout the country.
They have over 300.
Mr. Ellison. Are they are mixed in?
Ms. McCarthy. There are occasions when the immigration
detainees are mixed in with the criminal detainees, although
the detention standards provide that they should not be mixed
in. But what happens in reality is that due to the increase of
the number of detainees, there is a great deal of overcrowding.
You hear about people sleeping on the floor, people not having
access to proper hygienic materials, as well as adequate food
and proper treatment.
Mr. Ellison. Thank you for your testimony.
Thank you, Madam Chair. I yield back.
Ms. Lofgren. Thank you.
And thanks to all of the witnesses.
Mr. Harrison had to leave early to catch his flight, but we
will certainly appreciate his offer of continuing help, Mr.
Reyes as well, Bishop.
Ms. Armendariz, yes, certainly you can speak.
Ms. Armendariz. May I just make a point? Isaias had just
served a year and a half in prison. I didn't see the point of
keeping him in ICE. They could have saved money by him waiting
for his hearing--he was on Social Security. Where was he going
to go? They could find him. So I think it could have saved them
money and wait for the process, and that shouldn't have
happened. That could be one----
Ms. Lofgren. Thank you. It would save the Government money
and maybe be a little more respectful of that Vietnam-era vet.
I thank you, Ms. McCarthy, Dr. Venters, for your excellent
suggestions.
Ms. Baker, it was fascinating to hear your story, and I
hope that, in addition to doing IP litigation, you will have
time to put your new knowledge of asylum cases to work again.
The record will remain open for 5 legislative days. We may
have additional questions for you. If so, we will forward them
to you and ask, if at all possible, that you respond promptly
if that occurs.
With that, we will follow up with this hearing, as Mr.
Conyers and Mr. King have agreed to solicit comments from Ms.
Myers. We may need additional hearings, we don't know. But this
is very serious to me, to hear these stories.
The GAO was not able, actually, to go in and do the study
because of the litigation involved. But, certainly, we have
received substantial information that there is a substantial
problem. Everybody in America is entitled to due process of
law, and I have very serious concerns about whether that is, in
fact, occurring in this area of the law.
And, certainly, wherever we stand on the issue of
immigration, we all need to know that there are civilized
requirements for the Government when individuals are held in
custody. Those people who are in custody don't have the option
of going across town to their doctor any more than, you know,
we have to feed them because they don't have the option of
going across town to Burger King, too. So there are some
obligations we undertake when we incarcerate. And, certainly,
we need to take a look at what are the alternatives to that
system.
So we do thank you for your patience with our voting
schedule, for your important testimony.
And this hearing is now adjourned.
[Whereupon, at 6:15 p.m., the Subcommittee was adjourned.]
A P P E N D I X
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Material Submitted for the Hearing Record
Prepared Statement of Karen Long, RN, APN,C, CWOCN, Member of First
Friends, Elizabeth Detention Center Visitor Project, Board Member of
the Interfaith Refugee Action Team-Elizabeth
I have been a visitor at the Elizabeth Detention Center for the
past four years with an organization called First Friends. During this
time I have met many detainees from all over the world in the same dire
situation.
During these visits there were often health complaints which were
usually minor such as a headache, generalized fatigue or stomach upset.
I would often find myself telling the detainees that I was visiting
that they should go to the medical clinic to get treatment. I said this
even though I was sure I knew the answer. I would get a smirk of some
sort and would be told something to the effect ``Oh what's the use,
they don't do anything for you anyway.'' Many would mention getting the
``red pill'' and being sent back to their dorm. Since these complaints
never seemed emergent I just went on with my visit and wished them
well.
The young woman I had visited most recently is from Liberia. She is
25 years old. She has documented evidence of Female Genital Mutilation
(FGM), which unfortunately no longer holds weight with asylum cases.
This young woman kept complaining of abdominal pain. She told me that
when she went to the clinic at the EDC all they would do is give her
some pills and send her back. While in her dorm, when she complained of
continued pain, despite ``treatment'', she would be given an
appointment for later that week.
As a nurse I began to be concerned that she could have a bleeding
ulcer or some other abdominal pathology because she also was quite
fatigued and was not getting any sleep. At one point when her case was
being considered for parole I called down to the parole officer with my
concern that she needed additional health care and if paroled I or a
friend of hers would get her the care she needed.
She did eventually receive parole and at a nearby hospital was
diagnosed with pelvic Inflammatory Disease (PID), a condition that if
left untreated could cause fertility problems in the future. She
continues to have gynecologic problems related to the FGM and will most
likely need continued management.
Because of the personal nature of this story I choose not to tell
her name. If the committee seeks further information from this young
woman please let me know. I keep in touch with her and a family friend
who continues to fight for her by spending thousands of dollars in
legal fees attain asylum for her.
Submissions from Immigration and Customs Enforcement (ICE), U.S.
Department of Homeland Security