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Report Finds Substandard Medical Care in ICE Facilities

by Derek Gilna

In a July 2016 report, Human Rights Watch (HRW) found that 16 of the 18 immigrant detainees who died in Immigration and Customs Enforcement (ICE) custody from 2012 to 2015 received substandard medical care, and that in 7 of those cases, inadequate care likely contributed to their deaths. According to HRW, two independent medical experts reached that conclusion after reviewing treatment notes, death reviews and other details of the medical care that was provided – or sometimes not provided.

“The records also show evidence of the misuse of isolation for people with mental disabilities, inadequate mental health evaluation and treatment, and broader medical care failure,” the report stated. Clara Long, a researcher at Human Rights Watch, added, “these death reviews show that system-wide problems remain, including a failure to prevent or fix substandard medical care that literally kills.”

Responding to similar complaints regarding ICE medical care in 2009, the Obama administration had promised improvements by providing more centralized oversight and better medical treatment. However, the HRW study indicates there have not been significant improvements since that time.

Even more troublesome was what the 18 deaths examined in the report say about medical care in ICE’s detention system. According to HRW, “the [death] reviews raise serious concerns about ICE’s ability to detect, respond appropriately to, and successfully correct serious lapses in medical care that arise in any of these facilities.”

A prior study jointly published by the ACLU, Detention Watch Network and National Immigrant Justice Center in February 2016, which examined the deaths of eight immigrant detainees from 2010 to 2012, reached similar conclusions. That study found ICE had violated its own medical treatment standards, and the agency’s “inspection and oversight mechanisms ... failed to identify or address problems that contributed to the deaths.” [See: PLN, April 2016, p.52].

HRW’s review of deaths in ICE custody was carried out by Dr. Marc Stern, who previously worked for the Washington Department of Corrections and now serves as an assistant affiliate professor at the University of Washington’s School of Public Health, and by Dr. Allen Keller, an associate professor at the New York University School of Medicine. According to HRW, their reviews were “based on medical and other records; interviews with medical, custodial, and ICE staff; and in most cases a security and health report by Creative Corrections, a national management and consulting firm contracted by ICE [that contained] a timeline of relevant medical and detention events.”

One of the detainees who died in custody was Raul Ernesto Morales-Ramos, a 44-year-old man who suffered from gastrointestinal issues while at the Theo Lacy Facility in Orange County, California. According to the HRW report, despite an order that he receive a follow-up with a specialist, that examination did not occur for over a year. Morales-Ramos was transferred to another ICE facility more than one year after he was first diagnosed, but the records of his gastrointestinal problems did not accompany him. After complaining of symptoms for another nine months, including body aches, weight loss, joint pain and diarrhea, he filed a grievance.

In early 2015, a registered nurse who examined Morales-Ramos reported that he had a distended abdomen. Finally seen by a physician, the doctor commented that he had “the largest [abdominal] mass” she had ever seen, which was notably visible through his abdominal wall. He finally had a colonoscopy, underwent surgery to remove a “huge rectal mass,” and died when surgeons could not stop him from bleeding out. Medical tests indicated that he had likely suffered from cancer for at least three years, which had gone untreated.

In another incident where a detainee died, staff at the Eloy Detention Center, operated by CCA (now known as CoreCivic), thought they were not allowed to call 911 for a medical emergency without first receiving prior authorization. Delays in calling 911 were also cited in two suicides that subsequently occurred at the Eloy facility.

“It’s quite alarming to me that based on these death reviews, how often it appears that debriefings are not done by medical and security staff at the facility following deaths to determine whether mistakes were made,” Dr. Keller noted in the HRW report.

Nor has medical care in ICE detention facilities noticeably improved since the report was released.

Seven ICE detainees have died thus far during fiscal year 2017. Most recently, Jean Jimenez-Joseph, 27, committed suicide by hanging himself in his cell at the CCA-operated Stewart Detention Center in Georgia on May 15, 2017.

Project South advocacy director Azadeh Shahshahani called his death a “horrific tragedy that could have been prevented.” 



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