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Report: Border Patrol Misappropriated Funds and Failed to Provide Proper Medical Care to Accurately Report Migrant Deaths

According to a July 2020 report by the U.S. Government Accountability Office (GAO), officials with federal Customs and Border Protection (CBP) — part of the massive Department of Homeland Security (DHS) — misappropriated funds, failed to provide proper medical care, and failed to accurately report migrant deaths and injuries.

The review was requested by more than 20 U.S. Senators and one Representative after three migrant children died in CBP custody between December 2018 and May 2019. At the time, the administration of former President Donald J. Trump (R) had been forced by public outrage to end a “zero-tolerance” policy that dictated incarceration and prosecution of every adult who crossed the border illegally — even those with minor children, who were summarily taken from their parents.

Though the policy ended in June 2018, there remained 465 children who had not been reunited with their parents in April 2020. Meanwhile economic crises in Central America fueled a surge in migrants at the southern U.S. border, with CPB encountering 171,700 in March 2020. The majority — 99,300 — were single adults, most of whom were sent back to Mexico. But 18,800 were unaccompanied children, whom President Joseph R. Biden, Jr. (D) has refused to turn away. Some of the 53,500 families who arrived also ended up in the U.S. because of capacity limitations in Mexican detention facilities.

After a dip in fiscal year 2020 to just over 405,000, border encounters in the current year had already topped 550,000 in March 2021 — six months away from the end of the fiscal year on October 1 — putting them on pace to match or exceed the nearly 860,000 undocumented individuals CBP officers apprehended in fiscal year 2019.

That number overwhelmed the detention capacity of DHS and CBP facilities, creating overcrowded, unsafe conditions with inadequate medical care, and it raised the threat of spreading infectious diseases.

To address the situation, Congress passed the Emergency Supplemental Appropriations for Humanitarian Assistance and Security at the Southern Border Act in July 2019. It provided an additional $4.59 billion to DHS, with $1.1 billion of that directed to CBP. It also required that CBP use certain amounts for specific purposes (referred to as “line items”), including $111.9 million to be spent on “consumables and medical care.”

“Consumables” included “clothing, diapers, formula, blankets, shower facilities, and meals” for those detained. “Medical care” included “goods and services used to provide assistance related to the diagnosis and treatment of disease or injury and maintaining health.” Permitted expenditures included “defibrillators, masks, ointments, gloves” and other items related to “the treatment of disease or injury.”

By May 2020, CBP had spent a total of $86.9 million of these funds and committed another $15.2 million toward future purchases, leaving $8.9 million still available. But GAO’s Report documented violations of the law when CBP used the funds to purchase items for its canine program (muzzles, leashes, vet services, dog food, kennels, etc.); facility upgrades (heating, ventilation, air conditioning, sewer, janitorial); a video recording system for its computer network; transportation items (motorcycles, ATVs, dirt bikes, boats, passenger vans, small utility vehicles, trailers); influenza vaccinations for CBP personnel (but not for detainees); and law enforcement equipment (restraints, tactical gear, etc).

While the Report does not specify the total amount of misappropriated funds, it revealed that the CBP had so far agreed that $3.9 million previously charged would be paid from other funding. CBP emphasized that all of the purchases were legal but had been “inaccurately categorized.”

The Report also documented deficiencies in CBP’s medical care. In January 2019, CBP issued a directive that all detainees were to receive a medical screening using a standardized medical questionnaire, and persons under 18 would also receive an evaluation of their health. Adults would receive the evaluation if their answers on the questionnaire indicated a need. The screening and evaluations were to occur as soon as possible after initial contact.

But the Report documented that detainees at several facilities were confined with others for a day or more before receiving the medical screening, posing the risk of previously infected persons spreading diseases among the population already confined.

Furthermore, at 31 CBP facilities without contracted medical personnel, no medical screenings were conducted at all. CPB apprehended 373 minor children the first week of February 2020, for example, but 143 of them received neither a medical screening nor health evaluation at the facility where they were processed.

The Centers for Disease Control and Prevention (CDC), along with the American Academy of Pediatrics (AAP) made several recommendations to CBP to improve medical care at its facilities. CBP officially adopted some of these recommendations but failed to communicate them to field operatives. For example, CBP adopted the CDC recommendation that contracted medical providers conduct daily walk-throughs of facilities to identify potentially ill persons and provide ongoing monitoring of respiratory illnesses. But at five of the seven CBP facilities visited by the GAO team in Texas, none of the medical personnel were aware of the duty to conduct daily walk-throughs, and so none implemented it.

Perhaps most shockingly, CBP refused to implement the CDC recommendation that detainees be offered an influenza vaccine. CBP predicated its refusal on the logistics of providing cold storage for the vaccines and the expense of additional medical personnel to administer them, as well as the cost of additional record keeping.

But the Report documented that CBP failed to engage in any cost-benefit analysis of this decision. Would the additional costs of vaccination be offset by potential savings from not having to treat massive influenza outbreaks at its facilities? What about other costs — such as death from influenza or the fact that many detainees are released into the interior of the United States without having been vaccinated against influenza? These questions weren’t even asked.

Finally, the Report documented CBP’s failure to timely and accurately report deaths, suicide attempts, and serious injuries of individuals in their custody. CBP provided documentation showing it reported 20 in-custody deaths to Congress from fiscal year 2014 through fiscal year 2019. But the GAO team identified 31 in-custody deaths for that same time period. And in each of those years, CBP failed to report those deaths within the allotted time period (with the exception of 2014, all in-custody deaths were to be reported to Congress within 24 hours).

CBP admitted that its numbers of reported suicide attempts and serious injuries were not reliable. But the agency claimed that was because there wasn’t any uniform, standard definition of what qualified as a “serious injury” or “suicide attempt.” For example, some facilities counted a verbal threat of suicide as an attempt, whereas other facilities required an overt act. While serious injuries included those that created a substantial risk to human life, some officers counted those injuries sustained before apprehension, while others counted only those injuries occurring in custody.

GAO made 10 recommendations to correct the errors and deficiencies it found, all of which were agreed to by the DHS and CBP. These included that the CBP develop and implement guidance for ensuring that funds appropriated for specific purposes were spent only for those purposes; develop and implement oversight mechanisms to ensure medical directives were communicated and practiced at CBP facilities; document how CBP weighs the costs and benefits of whether to offer influenza vaccinations; and provide additional guidance to ensure deaths, serious injuries, and suicide attempts were uniformly defined and accurately reported.

See: GAO Report No. GAO-20-536 


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