hi we have an overflow room in room twenty three twenty two so whoever doesn't have a seat if you could please make it up there that we will be open until four and of space clears out between then and with the hearing goes along with the four you come back down here this hearing on the of the subcommittee on immigration citizenship refugees border security and international law will come to order without objection the chair is authorized to declare recess of the hearing at any time i would like to welcome the sub members are witnesses and members of the public to the subcommittees hearing on problems with immigration detainees medical care this committee held a hearing on this subject in october october fourth exactly eight months ago at that hearing we examined serious concerns with the provision of medical care and immigration detention facilities across the country news reports of deaths in the deficient care that may have led to those deaths trigger that hearing unfortunately here we are again as was the case eight months ago a string of recent news reports has of severely shaken our confidence in the health care system used by ice the reports recounts 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 sixty minute 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 bers 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 i 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 in force mint and brought detention beds online documents tell us that employs complained of certain policies that appear to be in violation of ice detention standards for some time at the san pedro facility for example the clinical director prohibited medical staff from doing in any lab work for detainees no matter what their condition until they had been to detain for more than thirty days as indicated by an internal d h as 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 isis policies may be designed to deny care and save money rather than to provide care and save lives last october francisco california 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 record shows that on several onside decisions recommended biopsy to rule out cancer but it also shows that these requests were repeatedly died over a ten month period by managed care coordinators here in d c 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 not not once not twice but repeated lee over ten months by offside bureaucrats something is fundamentally wrong no matter how this happened there's no question the system failed mr costin uta 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 and in the event that necessary treatment is repeatedly did not do delayed or denied by ice is supported by many other documents there are letters and affidavits from prison  expressing profound exasperate sion with delays and denials of care and one document which i can't even begin to reconcile with humane treatment lists the amount of money i save life denying requests for treatment such requests which were all submitted by onsite 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 one point three million savings that ice brags about in this document is going to pale in comparison to the money d h s will have to pay when courts begin to rule against it as they already have with a large increase of detainees and 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 i would no recognize our ranking minority member steve king for his opening statement yes thank you madam chair the subcommittee committee just had a hearing on the topic of immigration detainee medical care eight months ago i at the recent media blitz a la alleging poor medical care in a few isolated cases warrants a second hearing the risk of being murdered in some of us cities is higher than the risk of dying in an immigration detention facility i mean people on the streets of america are  as safe as some of the people that are incarcerated for under ice for example and these numbers are significantly lower than those that other this data that i have seen for example two thousand and five f b i stats show that in the statistical metropolitan area encompassing the city of houston seven hundred twelve point six residents per hundred thousand were victims of violent crime and nine point one residents per hundred thousand were murdered or victims of homicide that's houston there are three hundred thirty four people murdered on the streets in the statistical metropolitan area including los angeles five hundred seventy five point five were victims per hundred thousand were victims of violent crime eight point eight out of three hundred thousand were victims of murder in los angeles alone there were four hundred eighty nine people murdered in two thousand and five some other examples would be the recent shootings in washington d c and for example mileage councils neighborhood had four murders  a single twenty four hour period right in the same neighborhood and of the chicago shootings that we know about thirty two shootings over a weekend at one time the death count was six and then it went to twelve or thirteen in a single weekend and we're here having a hearing about people who are incarcerated by ice and getting a medical care that's addressing their chronic illnesses as well that they come with but during that same period of time two thousand and five there were six point eight deaths per one hundred immigration detainees many of whom were on healthy when they arrived and that's of course a nice facilities the numbers dropped in subsequent years 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 hide to higher risk of being ordered and violently victimized on the streets of their own cities in their own communities rather than focusing on a media event that doesn't have the data to back up an assess a day for this hearing in any event i'm happy to use this opportunity to congratulate ms miers for taking a lead role in reinvigorating ice's work site enforcement efforts and that includes i know and i thank you all of us concerned about the impact of really illegal immigration on american workers are grateful for your efforts the death rate in our immigration detention facilities is low and dropping despite the fact that twenty five percent of the detainee population already had a chronic illness such as hypertension diabetes tuberculosis as v aids and seizure disorders when they came into ice custody because they come from places where they don't get health care that's why they're carrying chronic illnesses with them this may this is the first and sometimes the best often and sometimes the first medical care that they've been exposed to in their lifetime this is a fundamental difference between criminal incarceration in 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 nine years because of illness however illegal immigrants and criminal aliens are in immigration detention an average of only thirty seven and a half 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 a daily ins who are doing everything in their power to stay to taint and therefore avoid deportation i 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 detainee are getting by far the best medical care they have had in their entire lives it has cost the federal taxpayers more than three hundred sixty million to provide such care since ice was created five years ago one hundred 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 costs incurred by ice detention the majority of the illegal aliens do not have health insurance as a result hospitals in the southwest border counties and counties of texas new mexico arizona and california alone incur a cost of one hundred ninety million per year for uncompensated emergency medical treatment to illegal aliens a california hospital association worries that care for illegal 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 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 charulata seems to require american taxpayers to pay medical bills for immigration detainees even after they've 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 do allegedly  in humanity of the nine necessary health care i don't think can be substantiated and i don't agree with that statement i look forward to the hearing i look forward to the the testimony of the witnesses thank you madam chair and i yield back the gentleman yield back i just would note that on the bill i've introduced that i'd be happy to brief you mr king it certainly does not require the provision of care after release but i will do that off agenda and i would now recognize the to agree to this extent with the opening statement of my friend steve king maybe we're able steve to do both things we've got to deal with the the crime problem that you reported in years to to six which are accurate and perhaps with this problem of how people that are brought into our custody custody are of ice whom i hadn't met before miss myers i wanted to welcome her and i wanted to talk with the committee about this sudden breakout of mass arrests arrests the largest in history in iowa last month three hundred and committed people arrested  that's a subject for another time i think it's pretty reasonable that we look at this subject matter again as as as my friend pointed out  it was eight months ago we did this but things keep happening and let's let's stipulate that a lot of people here to come here illegally need medical assistance  but the question is what do we do about it and this i'll just close with this thing because i've been talking to some of my friends  here in the congress and on the committee about universal health care and that kind of similar issue that steve raised comes up well if you have universal health care why include immigrants well because they're going to spread disease and make it tough on all of us that might someday have universal health care so these are the interesting questions that surround  and you brought together a great panel of witnesses i thank you for allowing my opening comment thank you mr chairman i now i recognize the distinguished ranking member the full committee the gentleman from texas thank you madam chair recent new reports detail cases of severe injury and even death and d h s 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 legal 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 two thousand and four seventy one individuals out of over one million detained have died  custody many of these individuals entered 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 twelve 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 i spent nearly one hundred million dollars on immigration detention health care double the funding level that existed just 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 health care in a recent series the washington post alleged that there is quote a hidden world of flawed medical judgments faulty administrative pop practices neglectful guards ill trained technicians sloppy recordkeeping lost medical files and dangerous staff shortages in quote yet according to ice the post reporters made no request to tour a single ice detention facility like two thousand and seven government accounting office report on a million 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 it detainees 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 their medical care after they are removed from our country though nor is it the responsibility of ice or the american taxpayer to keep aliens in detention solely 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 and 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 thank are back thank you this just myths in the interest of proceeding to our witnesses and mindful of the schedule i would ask that other members submit their statements for the record and with the out of jackson all opening statements will be placed into the record we have two distinguished panels of witnesses here today to help us consider the import issues before us seated on our first panel is ms julie myers assistant secretary for u s immigration and customs enforcement 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 miers was an associate at mayor brown and plot in chicago she earned a bachelor's degree at baylor university and a law degree from cornell university and next we have dr philip for a law the new acting director of the division of immigration health services or d i h s which we understand was recently moved from health and human services to the department of homeland security prior to his decisions acting director dr far above all with a clinical director at the tacoma detention facility in tacoma washington and the final witness on our first panel is mr richard m stana director of homeland security and justice issues for the u s government accountability office during his thirty two year career with o he has directed real reviews on a wide variety of complex military and domestic issues most recently he has managed jails work relating to immigration and border security issues he is a graduate of cornell university and harvard university k school of government he also earned a master's degree from kent state university given the gravity of the issues we're discussing today and the key roles you all play we would appreciate your taking an oath before you begin your testimony so would each of you please stand and raise your right hand do you swear or affirm under penalty of perjury that the testimony you are about to provide the committee will be the twelve the truth the whole truth and nothing but the truth to the best of your knowledge information and believe the clerk will note that all three witness since i have greed to that 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 five minutes the little machine on the desk will flash a yellow light when you have one minute left then when the red light goes on it means your five minutes are up but we would ask about point to really please try and conclude the testimony so we will have time for our questions ms miers we will begin with you thank you so much and good afternoon cha day to ensure that those in our custody are treated in accordance with the ice attention standards as you know ice was formed in two thousand and three with a broad mission that includes immigration and customs enforcement and management of the detention and removal processes for apprehended aliens indeed it was 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 and i think we've worked very hard over the past couple of years to look and see where there are places where we can improve detention oversight to that end i think the g a o has been very helpful the i g as well as congress and n g o s and giving us ideas and suggestions on how we can make sure that everyone in our custody is treated in accordance with the ice attaches standards and we've done and number of things just giving a few highlights of things we've done for detention oversight overall including but not limited to medical care in february of two thousand and seven we established with the tension field inspection group and that's a group it's 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 whether or not they're leading up to the medical standards 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 recognize that previously under the old i the use 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 change 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 are deficiencies they could be corrected these deficiencies would include anything we needed to work on with respect to medical oversight and additional we we in addition we have higher quality assurance specialists at forty of our largest facilities their only job is to make sure that isis complying with ice attention standards we've also published our first semiannual report on compliance with ice national detention standards we created the first national detainee handbook and we've undertaken a comprehensive review of the current national detention standards to see whether or not they could be improved and we think they could be and so we are working to make them more performance based working with the n g o s the i g f v h s the r c l and so on turning now more specifically to detainee health care and oversight let me begin with some contacts i spent almost a hundred million dollars on detainee health care last fiscal year double the funding of just five years ago and this doesn't even include the funding provided for routine health care at i g s safe during that same period the number of detention beds managed by ice has grown by approximately thirty percent and since i was established nearly one point five million individuals have passed through our custody and tho taney population has increased by more than thirty percent since two thousand and four the actual numbers of deaths in ice attention has declined from twenty nine and a thousand and four to seven for the last calendar year there are also been no suicides in the last fifteen months but there's still much more work to do and ice law enforcement officers are not medical professionals so we have a story cle relied on the independent medical judgment of the experts the public health service and  background of course all detainees are required to receive an initial health screening within the first twelve hours and a physical examination within fourteen days and as representative king noted last year nearly thirty four 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 that since two thousand and three suicides of accounted for eighteen percent of the seventy four de detainees in our custody even one preventable death is too many in the last two years i since those who did an extensive suicide prevention program we've not had a single suicide in the last fifteen months we also are looking at the tar process  and i believe that there is room for improvement on the appeals of tars and so we're working there with the office of health affairs to see how we can strengthen the tar process and provide for more oversight by independent individuals as well as have the detainees have more of a role in that we're also working with the d h s office of health affairs to improve operations at the i h s already we've reduced the staffing issues from thirty percent vacancies down to eighteen in addition we've asked the office of health affairs to assess all of the i h s is 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 that we have done is response to suggestions that we need to do more have more transparency in the reporting of death and so we've talked with the department of justice 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 more information and they can assess it as appropriate in closing i want to say we're committed to working with you outside groups and others to improve our prophecies and ensure that those in our custody are well cared for thank you thank you dr we'd be pleased to hear from you the 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 immigration and customs enforcement or ice just serves as the provider of medical and mental health care for detainees housed in d i just after attention facilities overseas a financial authorization and payment for offsite specialty in emergency care for all detainees in ice custody weather and g i s or in a government intergovernmental service agreement i just a facilities the i just comprises of medical professionals and support personnel detailed from the us public health service general schedule employees contracted medical staffing services p h s is granted the authority to provide and arranges care by virtue of section three twenty two of the public health service act care and treatment of persons under quarantine and certain other person each individual who comes to detention facilities receives an initial medical screening within twelve hours of their arrival into custody those remaining in ice for supervision at least fourteen days receive a comprehensive physical examination many of these detainees initially learn of a medical ailments 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 two thousand and seven of the hundred eighty four thousand four hundred forty eight screenings approximately thirty four percent or sixty three thousand individuals were done to fight as having chronic conditions most diagnosed with hypertension or diabetes to address the growing number of detainees the need the growing number of detainees t h s mental health staff have provided over thirty one thousand patient encounters for psychological services since april two thousand and seven and the services include psychological assessments and follow up individual psychotherapy sessions psychiatric evaluations of medication management follow up assessment for acute mental hospital hospitalization mental health hospitalizations suicide risk assessment follow up this list is not all inclusive and applies only to those detainees in facilities where g i s mil help officers and staff are assigned individuals who have acute or chronic health care needs are referred to a primary care provider for evaluation a medical treatment the sound to have an infectious disease are placed in the appropriate health care setting and retrieve treatment 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 patients clinical condition examples of of such care including imaging studies like x rays c t scans and m r i s surgery for broken bones heart conditions gulf stones an test medical staff and epidemiology branch monitored tuberculosis cases to ensure continuity of care whether the detainees to be released from custody into the united states or return to his or her current country of origin between january one two thousand and seven and may thirty drug resistant tuberculosis each d i s step clinic has a written plan for delivery of twenty four hour emergency health care or immediate outs for immediate outside medical attention studies have arranged with arrangements with nearby medical facilities or health health care providers for health care not provided it within the facility and these arrangements require appropriate custody officers to transport and remain with the detainee for the duration of any off say treatment or hospital admission when a nice detainee is hospitalized the hospital assumes medical decision making authority including the patient's drug regimen lab tests x rays treatment etc each day as clinic has a mechanism that allows detainees to request healthcare 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 and filling out the request slip access to health care providers each detainee who is a dental fide with a chronic care issue is treated and educated on self care and appropriate treatment and follow up this coordinated t h s maintains accreditation on three nationally recognized accrediting bodies to ensure the quality of health care meets industry standards this includes the american correctional so ca ssion national commission on correctional health care and the joint serving in the u s bureau of prisons in another federal or community facilities and we have an ongoing credentialing credentials monitoring program to identify and correct any noted deficiencies thank you once again for allowing me to provide testimony for your committee today happy to answer any questions you may have thank you and we'll turn now to you mr stammer thank you chairwoman lofgren mr king for the invitation to testify at today's hearing on isis and here at here and 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 the care and treatment of aliens 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 isis custody in response to a request from the house judiciary and homeland security committee we reported last summer on isis adherence to its national detention standards to help ensure appropriate conditions of confinement of the thirty eight standards we selected for examination based on discussions with u n h c r specifically examine the quality of medical care issues as that was the subject of a separate request from this committee i'd like to discuss three main items that are germane to today's hearing first at the time of our visits we have observed instances of noncompliance with  medical care standards at three of the twenty three facilities we visited with 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 which is an adult detention facility reviewer's that we accompanied cited staff for failing to administer the mandatory fourteen day physical exam to approximately two hundred sixty detainees at the family shelter in california we found that the facility staff did not administer medical screenings immediately upon admission and at the collatz 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 cultivars 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 have served instances where detainees were receiving specialized medical care such a special breathing equipment for a detainee at the current facility in florida where we were told the detainee had sleep apnea and a detainee at the hampton roads disability in virginia receive treatment from a kidney dialysis machine second ices on compliance inspection also showed instances of noncompliance with medical standards the most recently available annual inspection reports for twenty of the twenty three detention facilities that we visited show that ice reviewer said identified a total of fifty nine deficiencies four of which involve medical care the water cooler county sheriff's office in florida had call request forms that were available only in english where the population was largely spanish speaking the collatz county juvenile facility did not maintain alien records on site the san diego facility in addition to the physical exam deficiency i just mentioned failed to obtain informed consent from the detainees went for scribing psychiatric medication and the broward transitional center in florida did not have medical st site to screen detainees arriving after five p m and did not have a properly locked medically medical cabinet i should also note at this time that we observed three ice inspection teams reviewing facilities and found that one was very good but the two others were certainly lost 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 to requests for medical treatment we found that ice grievance standards were not followed for the twenty three facilities we visited and noncompliance ranged from issues like not having the grievance procedures in the handbook that's handed out to the persons upon entry not having a grievance log at all and  according all grievances in the log but the primary mechanism for detainees to file external complaints is directly with the either in writing or by phone using the complaint hotline our review of approximately seven hundred fifty detainee complaints in the database show that about eleven percent involved issues related to medical care such as being denied access to specialized treatment but in testing the phone system we found that the complaint hotline telephone number was blocked or otherwise restricted at twelve of the twenty three facilities that we visited so the number of reported allegations may not reflect all detainee complaints many complaints were sent by the action but we could not determine the number nature or disposition of these cases because complaint database was not sufficiently reliable for audit purposes in closing our work noted various deficiencies in compliance with the tension standards but again there was not a 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 decision making on specific detainee medical cases nonetheless our work did show the need for ice to address a number of internal control we can do 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'll be happy to answer any questions at the subcommittee members  care structure in the department it's my understanding that there are three nurses here in washington who are charged with reviewing all medical treatment requests that is submitted by the physicians who are actually examining  patients who are detainees at the various sites and i've just i'm not aware of any other system that permits nurses to overrule the judgment of the onsides physician who's actually examined a patient do you know of any other system that uses this well i thank you for that question and that will allow me to explain a little more about the tar process and also about the independence that physicians have kind of on side as a point of clarification the tar process is not used for routine medications or the decision making that's made by physicians or other officials providers on site the tar processes when there's something non routine or non emergency the tar process is as only used after an emergency just for reimbursement it's not an authorization for emergency care so if there's a particular thing that appears to be where do you need an outside provider the managed care coordinators are the ones that review that to see with that falls within the benefits package there and i would say that i said not obviously set up the managed care system that's under the public health service and the i just which is which has a managed care system not just for us but also 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 express their  frustration by their refusal to authorize nessun necessary medical care and in the case of the york county prison we know this actually boiled over and resulted in the county actually suing ice for not authoriz difficulties in obtaining approval for outside medical and mental health care as also presenting problems and caring for detainees are you familiar with other facilities who've expressed concern about denial of care to detainees are mature in life and i would like to point out that the letter you reference from the your county facility actually involved two thousand five letter and it's our understanding dr harbaugh and others just reached out to your county facility again yesterday maybe as soon as i finish my answer i'll have him go into more details with respect to that certainly as you know in the tar process generally it's less than ten percent arjan odd and so i do believe we need to look at the ten percent are  case obviously is in litigation so i really i really know that the government's already admitted liability in the middle i believe to let me say i believe there's room for improvement in in the tarp bill process and so that's why we have asked the office of health affairs working in conjunction with the division of immigration health service to look at how how does the tar appeal process work in that importantly how do you make sure that the only ask you on another carriage and let me finish the alien has a role in that process let me ask you about four sedation in its four part series the washington post cited what they say they said was two hundred fifty medically unnecessary instances since two thousand and three in which i sedated deportee against their will with what they call a preflight cocktail using haldol to understand tng on january ninth of this year ice headquarters issued a written guideline stating that the field offices may no longer request a medical escort memorandum i understand further recommends that the court appoint counsel for a lens who are not represented or who are unable to retain counsel since this policy has been issued how many federal court orders have been issued a year i believe there are four applications that did go to court and i believe that they are all still pending but i would request an opportunity to put that in responses to the record to make sure i accurately describe the answer all right i will and i will also add that i think this is just one of many areas and which i says examining decades long practices in putting in and hands over side for things that have gone on for years and years and years and we're just very helpful and my time has expired i'm going to turn now to the ranking about their health care or can self deport simply say send me home i'm not satisfied with the food or the bones or the medical care miss marr's have you ever had that happen you know there are occasions in which an individual's going through immigration proceedings and they decide to kind of terminate those procedures before they're over and do requests to go home so that does happen yes but 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're in other than the fact that they aren't free to travel you know i have no specific knowledge of that but i would certainly would prefer to get back to you in writing on that to make sure i'd very much like a response to that i just think that's a big help some interesting insight into this if it's orrible there as anybody ever asked to leave because of the conditions that they're in rather than just to avoid the legal process then it also as i look at some memos that i have here it shows that the twenty seven thousand five hundred ice detention beds sixty five percent are located in state and local prisons are jail facilities nineteen percent commercial contract facilities fourteen percent are isolated operated in two percent federal bureau of prisons has anyone broken down the data on these on these deaths during  our cars aeration with regard to those separate categories and the reason i ask question would be let's just say it's a federal prison or a state or a county or they're more likely to die in any of those facilities or is it scattered across the border or is there enough data for it to be significant i ask you f stana certainly and i think we would have to kind of go back and make sure we go through the specifics to give you an accurate reporting but i will say weeks that individuals no matter where they're held weeks like individuals to live up to high standards and if they don't will do just like we did last year we move individuals out of those facilities and in some instances even shut facilities down if we can ensure that people in our custody are being treated in accordance with ice attention and i understand that from your testimony and i appreciate that mr stanton was it could you do sir in any distinction distinction every location we went to we asked where there had been a death in the facility and of the twenty three we went to i believe it was two had a death in the facility we didn't do a whole lot of progress in one case the person died in their sleep apparently of natural causes  and the other case i believe was a heart attack and if i if i could just add one one point to that we are starting this reporting under the desk and custody reporting act i do believe then that the bureau of justice statistics will be able to do the same kind of metrics that they do with 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 that were born and one of these things that i've got in front of me is two thousand and four in two thousand and five mortality rate in our in our u s jails and prisons at five hundred fifty deaths in two thousand and four hundred thousand five hundred forty desperate hundred thousand and two thousand and five and we're looking at ice numbers of ten point eight or six point eight could you marr's well certainly i'm not a statistician but i certainly we see that even the flat number of deaths that we're having and one death of course any death is regrettable the number of deaths we're having are going down even though the number of detainees are going up and  certainly if you compare with jails you some jails have very low links to stay lower than the length of stay in ice custody which is about thirty seven and a half days and so certainly there's there's a comparable thing there but of course many many more detainees may not have health insurance than individuals who come into other facilities all these statistics are reasons why we've asked the bureau of justice statistics to really look at this as we start doing reporting i'll also say we do unfortunately have instances where last year someone came into our custody with our cost about seventy two minutes and  some cocaine and it exploded as well that when they were in state custody swallowed it exploded within them and they passed away so there are just a question as well what 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's a significantly lower death rate among ice inmates than there are among inmates across the most proud spectrum of those incarcerated i and other american prisons well  i certainly think it makes sense to kind of a value all value add all those things and i think it also makes sense as a congress is considering this to consider whether or not in the proposed bill it's actually requesting a higher level of services than those provided to us citizens or aliens who are detained  s marshal service custody has not yet primarily been convicted of a crime and so i think that it's important to look at those things look at the cost and get a sense at all what sort of a service for requested or expected it's a rational to look at the data before making a decision that the gentleman of time  will back to the chair i would just be as i turned to mr good tears i would just note i want to correct for the record that under the ministration prior to the current administration there actually was a requirement that there be no have an opportunity thank you very much i think i have regular order i think once again what we see here is we have a hearing and then we blame the victim those that were detained by ice we hear again the mina's ation immigrants once again here they're all sick thirty four percent now we have an argument between th myron ranking member whether it's twenty five or thirty four percent they talk about chronic illnesses hypertension i'm not afraid of anybody with hypertension diabetes i'm not afraid of anybody with diabetes then they go on to list other things that no one's great but then they nauseum tuberculosis something that's a contagious disease to make it appear after this testimony they're all dangerously ill coming to this country i find it amazing  these very same people that are so dangerously ill are the same people that are taking away the jobs from americans showing up to work every day doing hard work intense labor at meat packing plant picking up the fruit out in the fields in the intense heat and yet they're all close third of them have a chronic illness well i wonder if that's the same way it is for the rest of the american population and it makes it feel like you offer ms miers royall royce health care that's what we just hear from the ranking member royce health care wow amazing world royce health care i almost feel after listening to the minority that it's safer i should maybe when i go to chicago not check into my house but check into a nice facility it's probably safer there according to the minority than it is under streets of the city of chicago  you want to control the hearing but i have limited time and i would like to ask how many people that you detain on the streets of american deport last year the perry facility was a report last year we deported almost three hundred thousand and three hundred thousand people and you had more money to do that last year than you had in previous years congress gave us more money to do that because well if you have more money for next year to deport people so that you can increase the level of deportations our responsibility is to enforce the immigration under and have the capacity to deport more people next year than you did last year yes i do expect that what what like what increase do you think your go from three hundred to three hundred thirty you think it's a ten percent increase of twenty percent increase what do you think it's go aliens who are in jail who are charged we're going to immigration things obviously get out of jail this year but but once they get out assuming they're ordered removed and not allowed to adjust anyway yes i know you want to emphasize on the criminalization of the population that you deal with i'm just asking a general question and i would really appreciate to specific answer to the question how many according to ice how many undocumented workers are in legally present people are there in the united states of america you know i don't i don't believe don't know you have no idea on that you have no idea and there is no documentation and ice under oath that you have no idea and you have never or at home security come up with a number of undocumented workers in the united states that your testimony certainly the bureau of immigration sophistic who looks at and they say there are how many you know that's not within my agency so i'm going to have to have to reflect five or i will have been around on what is statistically been shown since you don't know you're the head person  ice and don't have a number you know i would think that if i had a population of people that i needed a police that 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 responsibility but it's your testimony here today that you cannot answer that question because you don't have a number no no i mean let me finish because my time is it begs the question once again comment on the clinton 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 i appreciate that ever imagine and first i will say upon information and belief and we certainly would look forward to get that getting back to the this in writing to you i am not aware that that that that was the policy in the previous administration and the former ins and so that that was not my experiences which was why i believe that it was important to issue the directive which i did last summer if i could also respond to congress with congressman gutierrez what i said related to us for an estimate of individuals working as opposed to an estimate of individuals who are currently here certainly the office of immigration as  knowledge of course you have a range of millions of people who you know are in the country illegally just because you can't give a precise figure actually points to a lack of this or our failure to enforce immigration laws that's one of the reasons we don't know how many people are coming into the country illegally but if you were to be asked you probably agree that there are twelve to twenty million people in the country who are here illegally would you not i would and i know what i was what i was responding to his question was the individuals who are working i believe there are some independent studies that talk about what percent of illegal aliens  working there not my studies i can't vouch for the for the pew center's numbers but certainly there's no way to number 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 early in your opening statement that the number of deaths in detention facilities had dramatically declined of the last couple of years what were those figures again in calendar year two thousand and seven there were seven deaths in our facilities we had we had a detainee population of three hundred twenty three thousand individuals in calendar year zero six there were sixteen deaths in our facility if you look back the calendar year two thousand and four there were twenty nine deaths are the trend is challenges with respect to the washington post implications that were there we disagree with a number of we have a long letter in so on would have been a more balanced approach to show the progress you've been making and how few deaths there had been compared to past years would it not i think i think it would and that's what we have a testimony indicated we haven't had a suicide in the last fifteen months and we're working very hard to do what we can to ensure you know quality medical care the series didn't focus on the fact that we actually took over in a more direct fashion the administration  and so on we certainly have a five page letter which i'd be happy to provide to the committee if you'd like to i'd like to have a copy of that and i'd also like to make it part of the record seems to me at the very least you're owed a correction or a retraction on the basis of that article without objection we will put into the record the articles as well as the letter thank you madam chair mr stener let me go back to your work at the g a o and you said i think that you only found examples of noncompliance and i'd say that some of them might be accurately described as minor in three of the twenty three facilities that you visited is that correct that's correct so only thirteen percent of you find the noncompliance with standards and you also said they were they found as comprising a hidden world of faulty administrative practices sloppy recordkeeping and lost medical files or is that a slight exaggeration is that what you found in those twenty three facilities i can tell you what we found at the twenty three facilities  back i would now recognise my colleague from california the gentle lady i think the chairman and i just want to start question i just want to point out something much was made about the fact that detainees can voluntarily choose to leave or the medical term care treatment is that bad i might point out to my colleagues on the day if they didn't already know this that there are many countries with whom we don't have  repatriation agreements said be pretty hard for somebody to voluntarily allow themselves to be deported to a country that essentially can't send them back to and that there are many asylum seekers in detention guillotines and they're not exactly anxious to go back to war torn places where they may be targeted for death or other kind of threat so i just want to make sure my colleagues on the day us understand that it's not necessarily as easy as saying well pack me up and send me home because the medical care here is is substandard in terms of questions ms miers 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 from anywhere from twenty to fifty 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 i thank you for that question and i think we certainly agree that there are that there were some concerns with respect to staffing and we were we had some issues that i with respect to moving along as quickly as we'd like with the i just and getting the staffing up and so that's one october of two thousand and seven we actually took the i h s over more formally for minister administrate aside to really work on the staffing and what would satisfy my where i'm going to interrupt because we have just been notified that alarm has gone off that a tornado is heading for the capital and that we should stay away from windows and stay inside since there are three windows right in back of us i think that will probably we should recess this hearing temporarily and move into that hallway thank you well that's the first time i've ever had to recess a hearing for a tornado as a californian that's kind of a new thing for me we're trying to find congresswoman sanchez and let her know we're back in session and also the other members who recessed to let them know that we are back but 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 and then we'll let ms sanchez resume her questioning when she returns so us refocused a little bit i was reading your opening statement in evidence to hear you but i was reading your opening statement or the transcript of it and you talk for my what 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 well thank you for that question and i'm from kansas and i am scared of tornados of being from kansas but to be clear the quality assurance  professionals that are in our forty largest facilities those are focused with overall compliance with all our detention standards so it's not not solely on medical care so these are individuals to make sure if there's any issue with any particular detention center they're there we do have a detention field inspection group which is this independent are operating under the office of professional responsibility they have a medical professional within that group so they're able to go out and you targeted you but i think we can do more and that's well and you frankly said what i thought you would say my sense from reading your testimony and from reading the testimony of the witnesses is that it's a quality assurance review there's far more generalized in the medical review so that and also given your concession that we can do more and like a proposal to you why not have the american medical association respect that group of doctors one of the a b a for lawyers why not ask the a m a to appoint a panel of professionals to come in these facilities or at least to perhaps twenty of them what actually what we've asked to do which is similar to that but not not precisely that is we've asked the office of health affairs to look at some experts they could do an overall review of the i h s processes so they are finding experts recognize medical experts who can look and see as the h s has taken over greater administrative control of the i just you know what works what doesn't work you know as things change where can we really do best practices so this isn't a review that is starting now but i go down for one second that's a perfectly reasonable suggestion but what about my a m a suggestion good idea or bad idea well i think i thought that some sort of some sort of review once we took the i h s over was appropriate and so that's why we actually conducted a baseline review of our own am a good idea bad idea with a m a good idea but you know i think that the oh it's a review that is going on i think really normously respected entity that i assume is the equivalent of the a b a i certainly don't think they're known as a terribly partisan a democratic leaning entity in a sense of the war what's wrong with having the a m a come in and do a what i think the advantage would be having somebody else in 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 but others have driven home to  think miss myers you know that you know we can go back and forth on what's the quality of care and all of that emotions and questions about then a moment but if you're 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 intergovernmental review or even to have another government agency conduct a review but to frankly have an assessment from medical professionals and i'm going to move on is my time to put out but i would seriously encourage you to give some thought to the day of an outside medical entity such as the a m a coming in and doing analysis final set of questions or you ensuring proper obligation of federal funds and sure that we don't overpay for anything well i would be curious and hearing and perhaps in writing would be a better place than oral discussion on this given the time limits but i'm very concerned very seriously concerned about what the considers to be the standard of care for these individuals is analogous for example to the standard of care for people who are in federal prison i think you raise an excellent point i believe it is analogous to the standard of care for s marshal service prisoners individuals who are coming in to marshal service custody who have not yet been convicted of a crime there may be areas where it differs but overall it appears that that that standard of care is very consistent but as i said i'm not a doctor and so that's your own policy is what you just said that that is my understanding but let me say that's why we asked the office of health affairs actually consult with outside professionals not just an intergovernmental review but to consult with outside professionals and look at all of the require the department homeland security 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 the removed from the united states well certainly and i would i would carry out this with you know the 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 vegan that it could suggest you know kind of what exactly is continuity care and by the way we do already provide certain continuity of care in certain instances but i think we need to look at the language and understand what is expected what the gentleman yield i'll be happy i don't have a copy of the bill in front of me  but the intent and if we get to a markup will make this clear is the 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 but you would be contemplating providing actual health care after that no longer under the duress now and in fact we have strongly suggested that for those individuals who are in custody with serious health care problems that they'd be provided alternative to detention standards so they could build their own insurance instead of the federal government for example if you have a chronic condition and you are applying for political asylum why not put on an ankle bracelet and and get your own care instead of being in detention but i think the gentleman for yielding so i could clarify that i thank the chairman for that guidance and i hope the language in the bill will be clarified to make it clear that we're not providing care to people after they have been deported from the united states ms miers in your opinion what is the maximum amount of time that would comply with a quote reasonable period of time requirement that describ bill during which the department homeland security must ensure continuity of care for detainees after release or you know i couldn't really provide it for size number at this time but i think i think both points are very valid that we need to look at kind of what is  now in many instances we assist with follow up appointments we provide for example detainees with several days worth of medication so that they can then go and find an additional doctor either back in our home country or back in the united states and with respect to asylum seekers very few as are are detained of course we do have our parole policy which provides that after they go through the credible fear process they're considered for parole i also have a 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 non serious condition i think i think that the i think that's exactly right the bill also talks about more comprehensive dental care and vision care then provided to prisoners in united states marshal service custody so i think there are a number of things that we should look at and consider what you know what does the congress want to fund and then we as ice will implement whatever of course the congress decides let me ask you  if the department has considered the use of tell of medicine to improve the quality of care that detainees receive while saving the taxpayer dollars we have seen this utilize all across the country in prisons and jails and other places where having doctors immediately available especially specialists would be a considerable expense i'm going to have a doctor if that's ok response to that we are facilities out there that are that are used but we can concentrate them within our own facilities to enhance the care that's provided well good we hope you'll do that because i've seen it used fact of lee in earlier years let me also say that i'm stunned by the the  lower than it is in prisons you know i think certainly we're very pleased that we've been able to reduce the number of deaths with oh absolutely any any death is regrettable you know i think i'm very proud of the care that the i h s provides the professionals that are there and the work that we take in order to make sure people get the best medical care of course individuals in jails may be in for a much shorter period time individuals and ice custody individuals some prisons may be in there for a much longer period of time individual and eyes custody so that you know there are some variances as well as the number of individuals who have insurance maybe maybe low much lower for individuals to come into our custody than individuals who come and other other custody number factors but i'm very proud of the work they do gentleman's time has expired mr smith had asked to make a unanimous consent request to make a correction to his opening statement all recognize mr king for that purpose thank you madam chair appreciate being recognized on behalf of mr smith who wishes to correct a statistic he cited in his opening statement the correct davis to continue his questions and then we will we're going to have votes pretty soon so we'll have to say goodbye to this panel thank you madam chairwoman i'll try to take three minutes ms miers let me pick up conveniently enough in the last question to mr king ask compare the ice population with the prison population one reason i suspect that people stay in american prisons a lot longer than people today and i suppose that is what the average length of stay so so that's one reason to save very few people get sentences of thirty days american prison system so that's one comparison you mentioned another having to deal with the level of uninsured i would suspect there are also some age differences what's the average age of people in the ice facilities you know i would have to get back to you don that in writing so i tend so i can be positive i've seen that in some jails the average age i think of the bureau of prisons i believe the average age is about thirty eight so you know  kind of mid life but let me say i agree with you that having a more robust analysis of the statistics would be useful and that's why we've asked bureau of justice to take our statistics and look at them with all the other statistics under the desk in custody reporting act and then they medical files and medication doesn'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  well there are a couple of things that we do more generally and a couple of initiatives we have to make sure that we're comprehensibly 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 transfer standard addresses as  well as some of the standards that apply to d i s but we're looking in our performance based dander dd's and that are out kind of for review right now by the inspector general where we receive comments from the n g o s and other groups to make sure that the transfer standard you know makes it clear about the transfer the right but  this panel for your presentation today we the record will be open for five legislative days there may be additional questions that we will forward to you in writing and we would ask those questions be probably answered if if that happens we'll now ask the next panel to come forward and i would like to introduce all of them first i'm pleased to welcome dr homer venters who is the attending physician at the bellevue n y u program for survivors of torture as well as a public health at new york university as part of doctors of the world d venture's sees detained asylum seekers who are victims of torture and his research involves health care for detained immigrants dr venture's 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 and show field baker a principal in the new york office of the law firm of mccool smith where she is head of the firm's national trademark litigation practice along with her diverse practice news show field baker maintains an active pro bono practice through which she represented i mean a muddy and a silo from somalia who is detained at the elizabeth detention center in new jersey she's 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 are next witnesses mary mag mccarthy executive director of the national immigrant justice center which is led since one thousand nine hundred eighty eight and i jaycee serves approximately eight thousand asylum seekers trafficking victims unaccompanied immigrant children detained adults and other low income in immigrants each year drawing an on a network of one thousand pro bono attorneys prior to joining and i j c ms mccarthy practiced civil litigation of the law firm of both and labor and served as a pro bono attorney for an eye jaycee's asylum project and made her way to the united states where she applied for asylum upon arriving in the u s dina was detained and held for five months in a nice 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'd like to introduce gloria are men there is gloria's a u s citizen here to testify concerning her common law husband isaias vasquez a veteran of the armed forces who was detained for about eighteen months and several detention facilities after his release isaiah's was granted u s citizenship based on his military service our next witness is reverend royle riley bishop of the new jersey sign and 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 an advocate 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 a better understanding of the importance of appropriate medical and mental health care in corrections and the relationship between correctional health care in the public's health has been employed by n c c eight seasons one hundred eighty six has been its president since one nine hundred ninety three year and his masters degree from northwestern university's kellogg graduate school of management and his undergraduate degree from the university of illinois our final witness is mr isaac gray is a partner with the government relations firm of austin cope with andreas which represents the us mexico border counties coalition he spent seven years working on capitol hill most recently as policy advisor at the senate democratic policy committee a leadership office of the former democratic leader of the senate tom daschle mr ayers received a bachelor's of with a major in political science from cal poly in san luis obispo each of your written statements will be made a part of the record in its entirety we're going to ask you to give about five minutes of oral testimony but we're going to ask you to do that after 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 ten minutes left to get over there and then i think there are three or four additional five minute votes so what that means is let's say we've got ten minutes and about four thirty if we're lucky we will be back here to hear your testimony so relax i think there's a coffee shop down stairs in the basement if you want and we will be back we hope about four thirty thank you and we're in recess till that time really we have finished our voting for the next two or three 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 and if so would you stand and raise your right hands and i will read the  you can say yes if you agree at the end do you swear or affirm under penalty of perjury that the testimony you are about to provide the committee will be the truth the whole truth and nothing but the truth to the best of your knowledge information and belief and we notice that all of the witnesses have indicated the affirmative because of several witnesses have  oh good the ranking member is here have transportation issues i'm going to ask that we get started soon the ranking member is on his way in and if we can start at the end with mr ray is and then move right along mr harris and then the like i know but they have they have trains they have to and planes they have to reach so we're going to start with m technical form comprised of the elected officials from the twenty four 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 disproportionate share of these costs my testimony this afternoon is about the cost the border counties for providing health care to on documented immigrants it is awkward to be discussing fiscal cost gratian when many of the witnesses this afternoon are addressing the loss of life and the perfect 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 can urge continued examination of this problem and you see clearly that organization does not oppose the delivery of health care to indoc immigrants but we are saying is that the federal government should be responsible for these cost not counties the federal government controls our nation's borders and has a sole responsibility for developing and forcing immigration policy the federal government success or failure in protecting the nation's borders directly affect state and local governments particularly southwest border counties or counties receive pennies on the dollar when it comes to reimbursements from the federal government whether we're talking about state criminal alien assistance program the southwest border prosecution initiative or section ten eleven funds for emergency health care reimbursement these three pots of money to develop this reimbursement programs do not come close to making border counties whole from one thousand nine hundred ninety two thousand and six the twenty four counties along the border spend a cumulative one point two three billion dollars on services to process criminal undocumented immigrants through the law enforcement and criminal justice system during that same time border counties received only fifty four million dollars in reimbursements from the federal government again the cost for one point two three billion and only fifty four million dollars in reimbursements from the federal government in fiscal year two thousand and six alone the cost was one hundred ninety two million of that one ninety two border counties received only four point seven million these are staggering cost considering the rule nature and poverty level of most of these border counties or two thousand and two study entitled medical emergency who pays the price for uncompensated emergency medical care along the southwest border provides an estimate for the cost providing emergency hospital and transportation services to undemanding immigrants  study determined that undocumented immigrants cost hospitals one hundred eighty nine point six million dollars in income state and emergency medical costs during two thousand and to put this figure into context total reported uncompensated costs at border hospitals were eight hundred thirty one million meaning that cost attributable and documented immigrants comprise almost twenty five percent of the uncompensated emergency room care in addition we estimate that emergency medical service providers had thirteen million or uncompensated costs bringing the total to more than two hundred million in uncompensated emergency medical costs during two thousand our study found that the former ins brought injured in ill undocumented intra and trance to hospital emergency rooms or called ambulances without arresting them so that the federal government would not bear the cost of treatment although the federal government reimburse the states and counties for part of the costs incurred for providing federally mandated mercy health care services to under community immigrants southwest border counties are absorbing a significant and disproportionate amount of the cost the position of the border counties coalition is that the federal government should support the medical treatment of undocumented immigrants and pay for one hundred percent of these costs the federal government is responsible for the costs associated with undocumented immigration not counties the cost the process undocumented immigrants at the expense of basic vital services to county residents the unmet needs include libraries jails courtrooms parks and basic infrastructure to colonia as new developments flood prevention social service programs for abused children and women childcare and afterschool programs but the overwhelming need 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  communities and the residents of moore county should not be asked to go without them because it a failure of the federal government to fully reimburse them thank you for the opportunity present the findings of our report and i will be happy to answer any questions thank you very much mr harrison thank you i'm pleased to be with you today to describe our organization's standards setting an 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 one nine hundred seventy s our board of directors is made up of representatives of thirty eight major supporting organizations including the a m a 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 mayor the a b a involved and they are involved through  organization we are slowly and completely dedicated to improving health services in our nation's jails prisons and juvenile confinement facilities are pioneering work began even before the supreme court's decision in a stove a gamble  that inmates have a constitutional right to health care so we'll watch this field evolve and improve over time and of health correctional systems and correctional health care proposals dept to new challenges that were unheard  of thirty years ago our standards are based on three basic principles that inmate 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 by these principles may seem obvious and simple but it hearing to the standards is often complicated by the institutional nature of corrections our standards are available to anyone they have been used by as state medical societies and and have been contracted to review who have been contracted to review local correctional health care services they've been used by the department of justice in its investigations 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 their own review of their facilities and to make recommendations for improvement based on the n c c age the standards our order our organization advocates continuous quality improvement c q i as a great way for correctional systems to improve their operations c q i which is when our standards dictates that facilities 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 thirty 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 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 organizations and others and it is unusual in our field to see an organization take that step to seek multiple accreditation so several years ago i had a chance to go into a nice facility and i saw tremendous cooperation between the cost of the 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 fifteen million patient injuries occur in health care settings and between one hundred thousand to two hundred thousand deaths from unintended injury this is more deaths than would occur of a seven forty seven jumbo jet crashed each and every day so then the profession of healthcare we are well aware that unintended problems arise when treating patients and within the world of corrections as i mentioned earlier treatment can be more complicated and therefore more susceptible to problems and in the community i read a number of the press reports about the medical problems and some of these detention facilities it always is deeply troubling to hear about  these kind require careful investigation and when warranted changes to improve the system and some of the reported problems had to do with custody staff action or inaction which is not my organizations area of expertise or clinical performance is involved we are very very concerned while we recognise 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 clinical probably both administratively and critically in the cases of suicide psychological autopsy should also be conducted importantly treating cells should be informed of any review findings and necessary corrective action base of the new jersey senate of the even jalapa lutheran church in america the largest lutheran denomination the united states not five million congregants many good members in iowa i think 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 c a 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 had visited three detention facilities in the states of virginia michigan and washington i personally visited the detention system facility in elizabeth new jersey and in new york since addition to densham to so they opened in elizabeth new jersey lutheran church members ha 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 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 nine months after detention reported to me her story of inadequate medical treatment the reports of  adequate medical care for detainees and confiscation of needed medicines and medical equipment at a rest have foreshadowed the worst news of all that since two thousand and three at least eighty persons have apparently died either in detention or as a direct result of the lack of appropriate medical care while they were and detention members of the senate i serve are troubled that it is 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 the new york harbor could by its own government treat immigrants and asylum seekers our fellow human beings in such punitive way three years ago in two thousand and five the new jersey senate assembly passed a resolution decrying the treatment of emigrants tomorrow on june five our senate will convene again an annual assembly and 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 childrens and communities i fully expect the senate 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 fear primarily the fear for our own security and our own economic stability when we're 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 twelfth in the little town of postville iowa 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 emigrant children and children whose families had lived in iowa for ever at the end of the day teachers and administrator 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 emigrant men women and children but for our own sake as human beings and citizens of the country that is supposed to be the model for human rights in light of these serious systemic problems i urged the subcommittee to consider the following one improve medical treatment in immigration detention h r fifty nine fifty is a good step to improve conditions of detention three cap expansion of detention and provide alternatives to detention there are in ice sponsored detention or as a result of 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 condition as asylum seekers or immigrants without clear documentation in behalf of the church i serve i'm lifting them up as brothers and sisters who need our help the help of this government but i'm 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 thank you bishop we would now be honor united states from mexico when he was two years old served in the united states army during the vietnam war and recently became a naturalized u s citizen i've lived with isaiah's for over for my last thirty years after many for schizophrenia at the north state texas hospital following an arrest for possession of money when a scumbag him for drug possession led to the detention and removal proceedings in november two thousand and four by the department of homeland security until august two thousand and five he was detained in san antonio at the g e o passivity i visited isaiah's every week while he was detained in san antonio and a number of times i was concerned he was not received inadequate medical attention i just complained that he was having side effects when 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 i was a us was fine and did not need additional medical attention in august two thousand and five i say as one his immigration case when the immigration judge granted his application under the convention against torture the judge found that isaiah's was would likely suffer torture in mexico due to the mental illness d h s did not appeal from the judge's decision but i sales was not released and was instead transferred to the south texas detention complex at pier texas there his condition became much wars i was unable to see i z s as often because of the distance from san antonio to pierce it was a hardship for me but there was complain that he was not receiving his medications and that he was not that properly and that he was being punished and putting segregation when i saw him he was frail and undernourished he seem unstable and disoriented and it was and it was trying to get the immigration judge to rescind the order allowing isaiah's to stay in the united states later i found out that in november two thousand and five the medical staff at the detention center diagnosed on specify person to disorder and thereafter they decided to take i say us off his medication for schizophrenia and depression isaiah's became very sick and was put on suicide watch he smeared faeces 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 step they put him in solitary confinement and him this was like six six seven months in there i tried the best i could to get help for i say as our immigration lawyer made request to the h s to release isaiah's i called the advocacy incorporated corporation an organization with which helps individuals with disabilities i spoke to the detention center warden i contacted my congressman office a lot of times i filed a complaint with the f b i six seven times suddenly in may two thousand and six d h s ard lawyer was told that i sales was being released i drove to piers saw texas to get him i was stunned at his condition and i when i got there i say i 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 this oriented and they also told me that he had tb i asked the dr johnson to transfer i said to the v a hospital to transport him because i was afraid and he refused and said i sail house not sick i don't have it here but there were like a swat team all around me the warden a lady taking a videotape of of us and i was pleading to them don't  i'm afraid to take him but i still had to leave with him so i drove him straight to the v a in san antonio i learned when i got there that dr johnson had already called the v a and told them that subdue him and several people and staff they had to subdue him and finally admitted him to the psychiatric ward i say has remained there for about two months and was put on the on september twenty seventh two thousand and seven i say us with a grant to naturalization based on his military service now he has good and bad days but he still suffers from the treatment memor difficult to get ms mccarthy you go thank you madam chairwoman and members of the subcommittee and i'm grateful for this opportunity to testify in support of the detainee basic medical care act of two thousand and eight 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 heart and alliance for human needs and human rights based in chicago illinois the national guard justice center coordinates the largest network of problem attorneys in the country providing legal representation to approximately eight thousand individuals each year including low income immigrants refugee refugees victims of human trafficking unaccompanied children in the silence seekers are diverse client based in first hand observation of different detention facilities gives us a unique perspective on detainee health care across the country immigration and customs enforcement contracts with more than three hundred local county jails to detain non citizens while the ministry of custody many of these facilities are located in remote rural areas far from lawyers and other service providers in illinois and wisconsin the national guard justice center regularly visits county jails to offer legal rights orientations conduct individual intake and accept individual cases for representation in the thousands of detention cases that the national mint justice center has handled during the past ten years we have witnessed a constant stream of complaints about the denial of adequate medical care these complaints range from treating common cold to managing serious permanent illnesses such as including issues relating to reproductive health care to diagnosing and treating the physical or mental trauma resulting from torture i think it's also very important that we look at the numbers of days that individuals are staying in detention we've all heard this afternoon often referred the average length of stay is approximately thirty seven days however as my colleagues have testified today that's not always the case in those cases where individuals are detained longer periods of time it is critical that those individuals have access to adequate medical care in fact the general accounting office to fix indicate that there's approximately five thousand six hundred sixty detainees of the two hundred eighty three thousand  al year two thousand and six who are detained that were detained for more than two hundred ten days or roughly seven months and as my colleagues today testified those individuals aren't here illegally they have legal claims they were granted relief they were granted immigration status in the united states briefly want to talk about one particular case in the midwest and my comments my written comments explore ride range of areas regarding health care but the one particular case that within the jury an asylum seeker who came to the united states seeking asylum she was taken into custody in the mchenry county jail in a new illinois she suffered from very from severe depression 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 psychiatr the nurse put miss bell bashir on the list to see the psychiatrist and his routine weekly jail visit four days later miss babbitt you're committed suicide before that appointment the jail issued sacks wrapped around her neck is fixated her misspell bashir story shows what's wrong with our detainee healthcare system she was an asylum seeker with a serious mental health problem because she had no effective advocate and because like the other thirty thousand non citizens detained 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 the county jail did not comply with ice standards staff did not conduct a comprehensive initial medical screening upon miss arrival her subsequent care was inappropriate ice authorities knew that this facility had a history of failing to provide adequate screenings to immigrants and failed to adequately trained staff and while ice has standards it has steadfastly refused to codify thus the standards remain legally enforceable 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 makes government are the most important rise at this point and 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 d c to local contract facilities lifting the veil of secrecy shouting the immigration detention system and starting an honest discussion about its humanity and fairness would be a great start thank you very much after that investment i miss baker would be pleased to hear from you thank you i'm ann scofield baker on the principle at the law firm of mccool 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 i made a movie a twenty nine year old torture survivor from somalia who sought asylum in the united states i mean a suffered unspeakable torture abuse and loss in somalia as evidenced by her scars and four murdered family members in april of two thousand and seven ameena flew her fled to america and sought asylum she was incarcerated in the elizabeth detention center in new jersey which is run by c c a when i took i mean this case i had no idea that i was destined to spend over six hundred hours in the first three months focusing not on her asylum case but on battling d i h s ice and c c a to ensure that i mean it didn't die in their care i mean it has authorized me to testify before you today during a minus five 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  threatened because of poor medical treatment when i mena first arrived at the c c a she had a panic attack and fainted i mean it didn't speak english at the time and d i s 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 five years when i got it 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 him i have headaches once or twice a week for the last five years then detention center doctors misdiagnosed her as being psychotic they placed her on a powerful anti psychotic drug called respond all that had  effects on her and their telltale side effects the risk brittle 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 i mean i 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 breast 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 after two weeks after this incident it actually took two weeks for a doctor to evaluate her after she started to exhibit signs of lactation what was his reaction to increase her dosage of the risk brittle she was still on risk but all when i took her case two months later and i brought in to outside doctors to examine her on her underlying silent case dr catherine fall 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 was no evidence of psychosis and there was 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 risks with all dr laurie goldste both doctors submitted handwritten notes to the detention center doctors explaining their credentials explaining that they to get given a full examination that the risk but always wrong please contact me if you want to discuss the issue the doctor became angry ameena and said you need to keep taking this drug thankfully she refused because the side effects she was exhibiting to go on reciprocals red side they're all right there the side effects were potentially permanent and life threatening well about six weeks later as i was trying to prepare a minute to testify doing my loyally duties she developed symptoms of a serious abdominal illness that required immediate medical attention but d i m a chest medical professionals ignored her pleas for help for weeks a guard threatened to throw or in the shoe c c a 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 c 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 nine one one and the person on the other end of the phone eventually said ok fine we'll go and look we'll look in on her and see what's wrong with her i mean to call me back two days later to say that nobody had come to see her and i didn't call nine one one because the person on the other end of the phone told me if you call nine one one 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 believe i was afraid she'd be dead by the end of the weekend and the only reason they took her to a hospital is that they found out 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 have 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 us in search of safety i mean another asylum seekers simply don't have the option to just go home i look forward to taking your questions thank you very much finally dr venters that afternoon my name is dr omer venters i'm an attending physician at the bellevue n y u program for survivors of torture as well as a public health fellow with the c d c in new york university i would like to thank the chairwoman and the other members of the committee for the invitation to speak here today i gather with my colleague dr alan keller i conducted an analysis of the ice health care system for the last months contrary to public statements by ice it is our conclusion that this health system and the care it allows for detainees movie 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'll briefly review the flaws in the statistics provided by ice refer to several specific failures in the ice health plan and conclude with are 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 two thousand and six and two thousand and seven that's why present these years when appropriate adjustment is applied to ice his own mortality figures one sees that links adjusted mortality has increased to twenty nine percent from two thousand and six to two thousand and seven other misleading statistics published by ice include hollow comparisons between deaths among detainees and among prison populations in the general us population without any adjustment for age disease prevalence or again length of detention ice mortality figures reveal two important pieces of information first the link to just mortality for detainees increased from two thousand and six to two thousand and seven 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 that 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 assess and improve its own health care system this committee has heard tragic and compelling testimony concerning the deaths of vice detainees i would like to m 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 i felt the plan was recently changed to eliminate chronic care visits every three 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 and other harmful practices requiring the inclusion of non medical criteria in referring detainees for outside care including whether or not failure to treat will impact deportation this inappropriately limits care pretty chaney's creates ethical jeopardy for ice providers and i will mention is different than the standard for the marshal service a third problem pertains to health screening the ice health plan again was very recently changed to allow basic health screening test 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 non symptomatic 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 has recently scrapped the tar appeals process but it's also give an offsite nurses the ability to reject tars by detention center physicians so now physicians in detention centers may have their treatment authorisation requests rejected by offsite nurses and they've 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 dyce health plan must be altered so that health screening tests and care for chronic disease are routinely and effect reflect accepted medical standards non medical criteria must be eliminated from this health plan as part of the referral process and detention center provider should not have tires rejected by offsite nurses without physician review and without possible appeal other changes to the larger ice health system should be include mandatory reporting of vital health statistics statistics including morbidity not just mortality to a body outside homeland security and routine consideration of parole for seriously ill detainees finally 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 think you know i have to take any questions  thank you dr venters and thank you all of the witnesses this is a time when we have an opportunity to ask a few questions and i have several first  your testimony so it's hard to listen to what happened  he had been treated at the v a for years that because he was a veteran and they diagnosed him with schizophrenia fifteen years ok so that that's a federal facility that's federal medical records was  those records become of it were never made available to ice i guess that didn't mean anything to them at that time i told them and my his attorney told them ok so in his face he felt that they had beaten him and it was because they gave them strong thor's and i think it had side effects and that's when i got advocacy involved right this as far  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 and what were those ok that's all right we'll i'll follow up in writing with you on that if i will be easier let me ask you miss baker your testimony is very compelling at first six hundred hours is a lot of billable hours i think it's pretty admirable that you have  has donated that kind of time on a pro bono basis you i think were here this morning to hear the testimony of ms miers how does her testimony compare with what you saw as an attorney with the client last year even as opposed to the rolls royce of medical treatment correct there are very clear systemic problems as evidence by my my client's case and by a number of other people people's cases who testified here today number one there are no interpreters in the five months that ameena was in ice detention she didn't once have a medical examination or treatment with an interpreter offered to provide i were all ready to provide you soon as i came into the case i realize 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 never i still to this day as i said have not seen her medical records i think that the the medical care that she was provided i mean even if you can look the other way at a misdiagnosis in the first place to say that they thought maybe she was psychotic it really wasn't when you when you have the side effects that she was exhibiting the it's just inexplicable that none of the medical professionals got a gynecologist to i brought in instantly figured out that she was on an anti psychotic drugs and the psychiatry just actually figured out that it was reciprocal because at the time we didn't even have her medical records when dr kathy vulcan examined her so that the side effects were just catastrophic and they completely either missed them or worse knew about them and increase the dosage anyway what were you provided them with a second opinion without side physicians to have second opinions and his in his respond they actually wrote full letters to them  i didn't get to this in my testimony but later on i started writing letters to sing i mean i'm moody i don't speak english and i demand my medical records my lawyers writing this on my behalf the lawyer the inside doctor gave all the letters back including the letters were at least one letter written by the doctor told me to tell your lawyers stop writing me letters miss mccarthy before my time runs out your agency he is in a lot of facilities doing  pro bono assistance you heard the testimony this morning from miss myers is that sort of rosy picture that was given to us comport with what you were seeing in the facilities and unfortunately no and i think what's really alarming is that as much as we'd like to try to represent all the individuals who are detained which as we all know is increasing dramatically daily there are enough attorneys and problem attorneys and legal service providers the three stories that we've heard today are stories of people who have legal representation and advocate just imagine what it's like for those individuals who don't have evidence and unfortunately miss palliser was one of those situations where she had no one from the outside advocating for her there's no court appointed counsel available for immigrants and these individuals are detained and deprived of their liberty and their only option for help as set up right now is immigration customs enforcement thank you very much my time is expired so i'll turn the ranking man in sticking for his question thank you madam chair and listening to testimony i want to say that i surely don't i don't doubt the testimony that's before us here and i don't doubt that there are tragic human circumstances that take place  that there are three hundred million people in america and six billion people on the planet and there are going to be many many of these stories and it's a small sampling that you've delivered here today one of our jobs is to evaluate the policy that existed against the policy this 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 turn first to ms baker and ask you what in ms law bill that is really part of the subject here today even though it's not formally the bill that's before us and hearing what in that bill would have a levy at this circumstance as you testified with regard to today regarding as i understand it and i have to admit that i only read it once about two weeks ago so i'm not fully prepared to discuss the terms of it today but that it creates a standard for for the care that's provided 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 and so what in the summer is an 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 not have intervened before these circumstances took place that's that's that's a point that i think we need to keep in mind here and i appreciate the 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 and 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 you draw a distinction between human dignity and human rights and in any way that you like to i think that human dignity is is is a human right it's one of the rights of dignity let me give an example of a lack of dignity one of the things that often happens is that when our detention facilities like the one elizabeth builds up then folks are farmed out to the county jail if you're farmed out to the county jail such as monmouth county no matter what you there for if you are asylum seeker or whatever then you wind up being strip searched for drugs with the rest of the criminal population measured when that also be true for someone who was and let's just say someone who was lawfully unlawfully present the united states has that's a next piece of this question i make it four parts i think there's a distinction between human dignity which should be abided to all people but then between that and human rights and get to between human rights and the distinction between those lawfully present and those unlawfully present the united states as well as a distinction between the rights of u s citizens as that's those for definitions do they have a distinction in your mind and do you draw those distinctions as far as supporting are the laws of this nation with regard to immigration as 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 in 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 our own failed laws frankly share your point with us in this situation and so i ask 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 minorites that you and i believe in if i use is an extension of this government that is me because this government is by the people that i expect ice to to do this and to i don't believe isis conforming to its own policies i think that's why we're 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 but you do believe it's possible to enforce the law and still provide for him again human rights i would current law i would hope that it is i would steve king and i have agreed to send a letter to the lady that was the head of mrs m miers with the testimony of one two three four five and ask her to respond to it affected her testimony or or what comments he's going to have about this at all but anyway that's i think this has to be continued  you know it doesn't sound like this is in america that 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 would say it's awful it's too bad they do things like that over there but this is happening right under our nose and i'm beyond shocked now having been physician physicians are on staff at the nice facilities yes i've interacted with some of the medical staff when i do my evaluations and so generally their internist i think elizabeth detention center right now has a cardiologist who is trained as an internist and that has specialist care and cardiology but generally internist or family practitioners if they're physicians however great many of the smaller facilities  have a physician's assistant or a nurse i think the goal is to have a physician there during business hours and then for a lot of these facilities and they have somebody else to cover the meeting weekends well i guess the first thing th committee might want to do is find out what kind of medical practitioners are not or health providers at each facility that will help  i can not 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 the person's name was never identified as far as i can tell so i am not sure who provided the or who prescribe the risk for it all to my client there may have been a psychiatrist but i can't say for  what else are we to make attorney baker of the fact that 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  is the audacity of the person on the other end of the phone when i called and said i'm about to call nine one one because you have someone who is doubled over in pain who has not been seen by a doctor for two weeks and she's i had a doctor's affidavit or  doctor on the phone who prepared an affidavit who identified that there were this was a life threatening potentially anyway a life threatening situation as much as she could tell over the phone and then two days went by before anybody went to see here and only when they went they went to see her only after my colleague adam perl and i got back on 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 well what this intervention here miss mccurry thing to any banker how do we deal with this lack of legal representation problem this this isn't going to be cured by pro bono there not enough lawyers and law firms in america that can produce the baker do i think there's a number of things but i think the first thing is i said in my comments i think we really need to look at this detention system is it really necessary that we have all these individuals locked up at taxpayer expense this is administ e 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 have access to medical care or asylum seekers merely seeking protection and you have some studies or proposals are essays that suggest that the answer is no that we shouldn't be locking up so many very institute has conducted a study in which they fall of individuals who were released from detention to determine what the outcome of their immigration proceedings and i think it was a very successful result because they were paired up with attorneys outside of the detention system they had access to health care they had access to social services and access to religious communities that supported them so i think it's a very viable viable option well maybe can you and i can  necessary or is this overkill i mean this sounds like we're in a country other than america about what's going on here 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 one of the deportation officers gave me to fill out included the person 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 ten years and i'm told i had no abra member i'm the newbie on the panel this is my first asylum case so i a if i get something wrong i'm sure my colleague will will correct me but it's my understanding that the the form that i was given by the ice official was created for a completely different purpose other than parole  so she had someone who was willing to to house her in the interim but i couldn't get her out because that person didn't make enough money i'm i just that i know ms miers spoke today about the asylum parole process but i think there are some serious flaws in that process and that needs to be reviewed and looked at and especially any type of appeal of a decision by the administration not to grant parole there needs to be additional review of that and it does not exist as for their personal testimony in this case look you were here the witnesses were here and then the members of the panel were here we heard the representatives of the federal government i've been in congress now for sixteen years i've had many witnesses few of them as belligerent as questioning 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 latino male between eighteen and forty five regardless of any other information she said yes and she said she did it probably the bet 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 and they call the justice department justice department bytes and the court to the port those parolees after they've asked for asylum so i think we have a great problem here the the eloquence of the witnesses who have suffered so much here today  hands of of ice and our and our justice system are but the tip of the iceberg we receive cases almost every week like this 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 a m a and having an outside agency come in and intervene and use standards outside it was very difficult to have 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 you were going to ask mr chairman i think mr king should write that letter we wrote a letter asking about ice sitting out across the country outside of health care  child care centers childcare center that's 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 is there sitting outside i mean one of the purposes should be to make a safer to make us more secure i don't know that sitting having ice agents outside of daycare cent makes more i'll tell you it doesn't make more secure it doesn't make the moms and dads that have to take their children to those health care to those daycare centers to more secure what they do mr chairman and members are women if 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 of the  knitters and owners of the facility not paying them wages serious child labor infractions and wow one hand of the federal government the department of labor is investigating very serious allegations against the owners and the managers of a meat packing guess what happens ice comes in arrests everybody deport over one hundred forty five people and all 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 rate i mean ninety eight percent of the prosecutions that i've conducted were going to individuals not against the owners of the factories last years but against the individual people the individual people who i think and let me just end with this i like to to just join bishop riley in the sense that all of us think that all human beings should be treated differently because they're american citizens or because of their legal status in this country i have heard many of my colleagues speak eloquently about their great date and their great faith in the christian faith and i don't i'm not a theologian but you know i went to catholic school 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 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'm going to 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 compelling very informative testimony and i also just want to add very favorable support for the level of passion that the advocates possess we need you to help our country run run better and i thank you for you for what you've done and what you've said today you know are huge practice criminal law for sixteen years i never was immigration lawyers so i don't really know the process i know that when i appear with a client i had to the prosecutor would argue that they were a flight risk or that they were daja public safety and i would usually argue they work and the judge would make a decision what are the criteria you use when with a person who is  detention is is when the question of their release is before the court of mean what what was it like just i think it's good for the record for people watching to know that what clinton analysis  the the magistrate is going to apply in deciding to let a person be on parole or lead or have a person stay in custody but i think it's really important the fundamental difference between criminal detention and the tension system of immigrants is that in the ministry of process so unlike the criminal system in the ministry of detention system of immigrants there's no judge who reviews that individual's detention it is in the ministry of decision initially reviewed by immigration and customs enforcement and some occasions an immigration judge may have an option to review that and set bond but even if an immigration just sets bind the government has the action to stay that bond if they choose to do so so for example i had a client who the immigration judge to grant him five thousand dollars bond the government stated that he would be maintained for three years until he finally went all the way up to the judicial proceeding so these are these are folks i think it's important to be clear on the record we're talking about people who are not even alleged to have harmony want to be a danger to the public or anything like that we're talking about people who like process for for example who have been a victim of torture and political repression herself she's detained for five months wasn't doing either the question of the fact that she had hurt anybody or was no threat or it would even it would even be cheaper for the government to let her just be in the community that the does that come up when the decisions about detention are evaluated remain detained till after the individual passes what's called a credible fear interview the government agency ice can review whether this ascot should have been continued to be detained and what they look at is exactly what you mentioned whether she's a flight risk or a danger to the community ok and they've added another element to whether or not it's in the public interest that she be released into the community so what we end up doing as advocates a lawyers representing asylum seekers identifying sponsors and individuals who they could possibly release to and advocate for their release but even in those situations we have found even more so these days that they're not being releases so it's all discretionary there's the question of expand medical all need ever arise in the detention release calculus i mean there's somebody has a serious medical problem and it's brought to the attention of the decision maker because that mitigate in favor of them being released in the community where they can get their medical needs met yes how often does that come up and is it sounds like that one i'm sorry sounds like based on the testimony we've heard that it's not being very well heated by the decision maker and i wrong i think your point is well taken yes i think that's one of the issues and i think this island arris is case is a very strong example of that why her husband would continue to be detained given his medical condition to illustrate the fact that that that factor is not taken seriously into consideration and if we had judicial law judges doing the evaluating would we probably get better outcomes i think you're absolutely right and as ms baker mentioned she was ready to file a hey b s petition in her case which is an option but there are many hurdles to that so if we can build into the law some type of did issue a review of the continued detention of the individual i think would be very valuable you know the american process is americans we value liberty we consider liberty an important value doesn't matter whether would have even less discretion in a criminal defendant who at least there's some problem cause for anyway that's just my editorial let me ask this well what are the applications for overcrowding i mean what about when we get into jails  county jails other kind of facilities when people can't be in 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 enters into contracts with county jail surround the country they have over three hundred other mixed in there are occasions when they are mixed in although the standards provide that they should not be mixed in but what happens we've seen is because of the increase we have a lot of overcrowding you hear about where was he going to go they could find them so i think they could have saved them money and and he and wait for the process and that shouldn't have happened thank i could be one length you it would save the government money and maybe be a little more respectful that vietnam era vet i thank you ms mccarthy dr venters for your excellent suggestions miss baker it was fascinating to hear your story and i hope that in addition to doing ip litigation you'll have time to do put your new knowledge of the violin cases to work again we have the record will be open for five legislative days we may have additional questions for you so we will forward them to 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 miers we may need additional hearings we don't know but this is a very serious to me to hear these stories the g a o was not able actually to go in and do the the study because of the litigation involved but certainly we've received substantial information that there is a substantial problem everybody in america is entitled to due process of law that and i have very serious concerns about whether that is in fact occurring in this area of the law and certainly we wherever we stand on the issue of immigration we all need to know that the 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 either so there are some obligations we 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