News

Washington Post Detainee Health Care Series – Day 1

The Washington Post began a four part series on Sunday, May 11th, on detention health care.  The first article in the series and the companion CBS “60 Minutes” piece presented information on a number of detainee cases and incidents occurring before the transition of the DIHS from the Department of Health and Human Services (HHS) to ICE and before ICE assumed greater administrative control over DIHS.  Nonetheless, these pieces are very disturbing as they provide a very limited view of a complex and important topic. 

If you read the first article, you may also be interested in the following:

 

Myths vs. Facts regarding the May 11, 2008, article:

Myth: “During the intake screening, a part-time nurse began a computerized medical file on Osman, a routine procedure for any person entering the vast prison network the government has built for foreign detainees across the country. But the nurse pushed a button and mistakenly closed file #077-987-986 and marked it "completed" – even though it had no medical information in it.”

Fact: What was marked “Completed” was the physical exam appointment, which is why the individual did not receive a follow-up physical examination. The medical record had the intake screening in it and did not show any significant health problems. Mr. Osman’s medical record was active for the duration of detention.

Myth: “About 33,000 people are crammed into these overcrowded compounds on a given day, waiting to be deported or for a judge to let them stay here.”

Facts:  ICE detention facilities are not experiencing overcrowding conditions.  In fact, ICE takes appropriate and necessary action to ensure that facilities do not exceed their capacity.

Myth:  “The detainees have less access to lawyers than convicted murderers in maximum-security prisons, and some have fewer comforts than al-Qaeda terrorism suspects held at Guantanamo Bay, Cuba.”

Fact: Individuals who are detained while in administrative removal proceedings are entitled to an attorney at no expense to the government and we provide all detainees with a list of pro bono representatives.  All facilities are expected to abide by the ICE National Detention Standards.  Under these standards, attorneys are entitled to, and receive, more access than any other visitor to ICE facilities, and cannot be compared to how “convicted murderers” are treated. The facility shall permit legal visitation seven days a week, including holidays, for a minimum of eight hours per day on weekdays.  Given the comprehensive ICE National Detention Standards, developed in consultation with a number of immigrants’ advocacy groups and the American Bar Association, it is hard to imagine how the treatment of detainees can be in any way be compared to Guantanamo Bay.  It bears noting that neither reporter has requested to tour a single ICE detention facility.  Many reporters from a number of media have requested and been provided tours, resulting in more balanced stories.

Myth: “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.”

Fact: Sick call requests are prioritized 24/7 based on urgency of need for medical treatment.  They are triaged daily and scheduled accordingly. Those in need of immediate treatment are seen right away and lower priority cases are scheduled as appropriate.

Myth: “There is evidence that infectious diseases, including tuberculosis and chicken pox, are spreading inside the centers.”

Fact:  Varicella (chicken pox) is a highly contagious communicable disease and very little exposure time is required for transmission to an individual who is not immunized.  Most developing countries do not routinely vaccinate for chicken pox; in the United States, routine vaccination began in 1995.  Therefore it is expected that individuals in our care who are not born in the U.S. have not been vaccinated.  If one person enters a facility with active lesions (most likely infected in their country of nationality), and exposes other individuals who have never had Varicella and are not immune, transmission is likely to occur.  Facilities with DIHS staffing have strict protocols in place for management of Varicella, including restricted movement of exposed, non-immune persons, contact investigation for the entire incubation period for exposed persons who are not immune, and vaccination. The fact that DIHS initiated a vaccination protocol is indicative that we were proactive in intervening to halt further transmission; this was an appropriate and timely intervention. 

In addition, DIHS implements a state-of-the-art screening program for tuberculosis, using a digital chest radiograph to screen detainees.  This system produces a result within four hours and allows providers to place patients with a finding suspicious for active tuberculosis (TB) in an airborne infection isolation room before ever being placed in the general detention population. All TB patients are managed in accordance with Centers for Disease Control guidelines.  Additionally, DIHS initiated and provides national and international leadership for the Transnational Tuberculosis Continuity of Care Workgroup, which facilitates bi-national and international referrals for tuberculosis patients to enable them to continue their treatment without interruption in their countries of nationality following repatriation. This is a national initiative involving partnership with the Centers for Disease Control and Prevention, state and local health departments, nongovernmental partners, the U.S.-Mexico Border Health Commission, foreign governmental TB control programs, and foreign consulates, and is proving highly successful.  In a recent evaluation, between Jan. 1, 2004,  and July 31, 2006, DIHS helped 221 active TB patients complete their treatment regimen through these partnerships.

Myth: “These way stations between life in and outside the United States are mostly out of sight: in deserts and industrial warehouse districts, in sequestered valleys next to other prisons or near noisy airports. Some compounds never allow detainees outdoor recreation; others let them out onto tiny dirt patches once or twice a week.”
Fact: With the exception of the Varick Street Facility in Manhattan, which opened in January 2008, all ICE Service Processing Centers and Contract Detention Facilities have outside recreation areas. Further, it is factually inaccurate to say that detainees are only allowed outdoor recreation once or twice per week.  Detainees are provided outside recreation five times per week, weather permitting.
Myth: “When doctors and nurses at the immigration compounds believe that detainees need more than the most basic treatment, they have to fax a request to the Washington office, where four nurses, working 9 to 4, East Coast time, five days a week, make the decisions.” 

Fact: If a detainee requires off-site care, the facility where they are housed submits a request by means of email or fax. Submissions are adjudicated by the next business day, but no more than 72 hours after receipt. If the request is urgent or emergent, the medical care is provided and the managed care requests are adjudicated after the fact.

Myth: “To this end, the agency recently increased its inspections of facilities and is in the process of creating an inspection group at headquarters to review serious incidents, including deaths or allegations that standards are not being met.” 
Fact: ICE implemented the Detention Facilities Inspection Group (DFIG) within the ICE Office of Professional Responsibility in February 2007. The DFIG provides objective oversight and independent validation of the detention facility inspection program. It also conducts immediate focused reviews of serious incidents involving detainees. In October 2007, ICE contracted with the Nakimoto Group to obtain their services to have full time professionals inspect each ICE facility annually, providing ICE field managers with the support of expert inspectors.  Also in October 2007, ICE contracted with Creative Corrections, Inc. to provide full time, on site, quality control experts at 40 of our most active facilities.
Myth: “A new director for health services arrived six months ago, following a stretch when the agency was run first by Sampson and then by a second interim director. The new boss is LaMont W. Flanagan, who brought with him the credential of having been fired in 2003 by the state of Maryland for bad management and spending practices supervising detention and pretrial services. An audit found that Flanagan had signed off on payments of $145,000 for employee entertainment and other ill-advised expenditures. His reputation was such that the District of Columbia would not hire him for a juvenile-justice position.”

Fact:  Mr. Flanagan served as Commissioner of the Maryland Pretrial Detention and Services system for 12 years. In May, 2003, he resigned, five months after the election of the new governor. On May 14, 2003, the newly appointed Secretary of the Department of Public Safety announced the resignation of Commissioner Flanagan in writing stating, "He served the Department with distinction during his tenure, and we wish him every success in the future." During Commissioner Flanagan's tenure, he was lauded by the media, his superiors, the legislature and his peers for his programmatic initiatives and superior management in corrections. Editorials and articles from the Baltimore Sun have lauded the performance and leadership of Flanagan. (May 29, 1992 – June1, 1992 – May 24, 1999 – April 8, 2000).  In addition, two months after the resignation of Commissioner Flanagan, the Maryland State Senate passed a resolution congratulating and recognizing Mr. Flanagan for “Outstanding and Dedicated Service to the State of Maryland as Commissioner of Pre-trial and Detention Services”

In February, 2005, two years after Commissioner Flanagan's resignation, the Maryland Department of Legislative Services conducted a routine audit of his former agency, the Division of Pretrial Detention. The audit noted that the agency's annual budget requests submitted to the Maryland General Assembly did not adequately disclose general fund entertainment-related expenditures which totaled approximately $145,000 during fiscal years 2002 to 2004. The entertainment-related expenditures emanated from an “Inmate Welfare Fund" mandated by a Federal Consent Decree governing the agency. The Inmate Welfare Fund emanated from the profits from commissary and telephone receipts. The Inmate Fund was utilized exclusively for the benefit of inmates, providing social, cultural and educational initiatives for inmate programs and activities. This program assisted in reducing violence by seventy-one percent and providing inmates extracurricular activities.  All expenditures were reviewed and approved by finance and budget authorities in the Office of the Secretary of Public Safety and the State Comptroller.

Commissioner Flanagan had no direct check-writing authority and each expenditure was a requisition request with a three-level management review/approval process above the Commissioner.

In 2004, the Executive Director of the Department of Human Services for the District of Columbia asked Mr. Flanagan to apply for the position of Juvenile Services Administrator. Flanagan interviewed for the position and was designated by the press as a major candidate. Advocates within the Juvenile Justice community impressed upon the Mayor that a corrections administrator was not their preference for administering the juvenile services program.  The Mayor appointed a juvenile justice advocate as the juvenile services administrator. Subsequently, Mr. Flanagan was appointed by Mayor Anthony Williams to the position of Deputy Director for administration in the Department of Human Services, where he served with distinction for two years.

Mr. Flanagan is not the director of DIHS.  He is the Detention Health Care Unit Chief, within the Detention and Removal Office, where he serves as the liaison with DIHS.  Mr. Flanagan does not make clinical decisions; however he has been instrumental in overseeing several aspects of the transition and increasing the staffing at all DIHS facilities. 

Myth: “An entry-level emergency medical technician, with barely any training, had done Guevara's intake screening and physical assessment at the Otero County immigration compound in New Mexico. Under DIHS rules, those tasks are supposed to be done by a nurse.”

Fact: The ICE National Detention Standards require that intake screening and physical assessments be conducted by trained personnel, including Emergency Medical Technicians (EMT).

Myth: “His wife, pregnant at the time with their second child, recalled that she rushed to the hospital, but ICE guards would not let her inside until the Mexican Consulate interceded. Guevara's mother waited five hours before they let her in. By then he was brain dead.”

Fact: Otero County officers were providing security coverage during Mr. Guevara’s hospitalization. ICE contacted Mr. Guevara’s family so they could report to the hospital immediately to see their family member and to speak with the doctor regarding his condition.  ICE was never made aware that there was a delay in their ability to see Mr. Guevara and we have no record of the Mexican Consulate interceding.

Myth: “The government's internal medical records say Dantica died of pancreatitis. A one-page death certificate in his file has "VOID" stamped across it. Two outside doctors who reviewed his medical records for The Post said he probably died of heart problems.”

Fact:  There is no space on the actual death certificate in which to enter the cause of death. This likely explains why Mr. Dantica’s death certificate does not indicate the cause of death.  The VOID mentioned in the article on the death certificate is a security feature to prevent forgery.

Myth:  “But internal documents and interviews reveal unsafe conditions that forced the agency to relocate all 404 detainees that month.  An audit found 53 incidents of medication errors.  A riot in August pushed federal officials to decrease the dangerously high numbers of detainees, many of them difficult mental health cases, and caused many health workers to quit.  Finally, the facility lost its accreditation.”

Fact:  San Pedro was temporarily closed because of the need to perform significant work on the fire suppression system and to replace the boiler. A decision was made that it would be a life safety issue to house the detainees there while the fire suppression system was offline while undergoing repairs. That would have placed the detainees in a potentially dangerous situation. We opted to relocate them.

In addition, and for clarification, San Pedro lost its ACA accreditation for not having been in compliance with one mandatory standard. That standard had to do with the manner in which caustic and toxic substances (like cleaning supplies, oil, gas, bleach, etc) are stored and inventoried.  The facility immediately addressed the deficiency and were then in compliance with the standard again. Nonetheless, because the standard is mandatory, not having been in compliance with it was the cause for the loss of accreditation. According to ACA policy, ICE must wait two years before being eligible for accreditation regardless of the fact that the standard was immediately corrected.

 

# ICE #
U.S. Immigration and Customs Enforcement (ICE) was established in March 2003 as the largest investigative arm of the Department of Homeland Security. ICE is comprised of five integrated divisions that form a 21st century law enforcement agency with broad responsibilities for a number of key homeland security priorities.