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DETENTION AND REMOVAL:

IMMIGRATION DETAINEE MEDICAL CARE

HEARING

BEFORE THE

SUBCOMMITTEE ON IMMIGRATION, 

CITIZENSHIP, REFUGEES, BORDER SECURITY, 

AND INTERNATIONAL LAW

OF THE

COMMITTEE ON THE JUDICIARY 

HOUSE OF REPRESENTATIVES

ONE HUNDRED TENTH CONGRESS

FIRST SESSION

OCTOBER 4, 2007

Serial No. 110–53

Printed for the use of the Committee on the Judiciary

(

Available via the World Wide Web: http://judiciary.house.gov 

(II)

COMMITTEE ON THE JUDICIARY 

JOHN CONYERS, JR., Michigan, Chairman 

HOWARD L. BERMAN, California 

RICK BOUCHER, Virginia 

JERROLD NADLER, New York 

ROBERT C. SCOTT, Virginia 

MELVIN L. WATT, North Carolina 

ZOE LOFGREN, California 

SHEILA JACKSON LEE, Texas 

MAXINE WATERS, California 

WILLIAM D. DELAHUNT, Massachusetts 

ROBERT WEXLER, Florida 

LINDA T. SA ́ NCHEZ, California 

STEVE COHEN, Tennessee 

HANK JOHNSON, Georgia 

BETTY SUTTON, Ohio 

LUIS V. GUTIERREZ, Illinois 

BRAD SHERMAN, California 

TAMMY BALDWIN, Wisconsin 

ANTHONY D. WEINER, New York 

ADAM B. SCHIFF, California 

ARTUR DAVIS, Alabama 

DEBBIE WASSERMAN SCHULTZ, Florida 

KEITH ELLISON, Minnesota 

LAMAR SMITH, Texas 

F. JAMES SENSENBRENNER, JR., 

Wisconsin 

HOWARD COBLE, North Carolina 

ELTON GALLEGLY, California 

BOB GOODLATTE, Virginia 

STEVE CHABOT, Ohio 

DANIEL E. LUNGREN, California 

CHRIS CANNON, Utah 

RIC KELLER, Florida 

DARRELL ISSA, California 

MIKE PENCE, Indiana 

J. RANDY FORBES, Virginia 

STEVE KING, Iowa 

TOM FEENEY, Florida 

TRENT FRANKS, Arizona 

LOUIE GOHMERT, Texas 

JIM JORDAN, Ohio

PERRY APELBAUM, Staff Director and Chief Counsel 

JOSEPH GIBSON, Minority Chief Counsel 

SUBCOMMITTEE ON IMMIGRATION, CITIZENSHIP, REFUGEES,

BORDER SECURITY, AND INTERNATIONAL LAW

ZOE LOFGREN, California, Chairwoman

LUIS V. GUTIERREZ, Illinois 

HOWARD L. BERMAN, California 

SHEILA JACKSON LEE, Texas 

MAXINE WATERS, California 

WILLIAM D. DELAHUNT, Massachusetts 

LINDA T. SA ́ NCHEZ, California 

ARTUR DAVIS, Alabama 

KEITH ELLISON, Minnesota 

ANTHONY D. WEINER, New York 

STEVE KING, Iowa 

ELTON GALLEGLY, California 

BOB GOODLATTE, Virginia 

DANIEL E. LUNGREN, California 

J. RANDY FORBES, Virginia 

LOUIE GOHMERT, Texas

UR MENDOZA JADDOU, Chief Counsel 

GEORGE FISHMAN, Minority Counsel 

(III)

C O N T E N T S 

OCTOBER 4, 2007

Page 

OPENING STATEMENTS 

The Honorable Zoe Lofgren, a Representative in Congress from the State 

of California, and Chairwoman, Subcommittee on Immigration, Citizenship, 

Refugees, Border Security, and International Law ........................................... 1

The Honorable Steve King, a Representative in Congress from the State 

of Iowa, and Ranking Member, Subcommittee on Immigration, Citizenship, 

Refugees, Border Security, and International Law ........................................... 2

The Honorable John Conyers, Jr., a Representative in Congress from the 

State of Michigan, and Chairman, Committee on the Judiciary ..................... 4

WITNESSES 

Mr. Gary E. Mead, Assistant Director for Detention and Removal, U.S. Immigration and Customs Enforcement, accompanied by Timothy Shack, M.D., 

Medical Director, Immigrant Health Services 

Oral Testimony ..................................................................................................... 5

Prepared Statement ............................................................................................. 7

Mr. Francisco Castaneda, former detainee 

Oral Testimony ..................................................................................................... 13

Prepared Statement ............................................................................................. 17

Ms. Edwidge Danticat, Author and Niece of Reverend Joseph Danticat, deceased detainee 

Oral Testimony ..................................................................................................... 44

Prepared Statement ............................................................................................. 45

Ms. June Everett, sister of Sandra Kenley, deceased detainee 

Oral Testimony ..................................................................................................... 47

Prepared Statement ............................................................................................. 49

Mr. Tom Jawetz, Immigration Detention Staff Attorney, ACLU National Prison Project 

Oral Testimony ..................................................................................................... 53

Prepared Statement ............................................................................................. 56

Mr. Allen S. Keller, M.D., Associate Professor of Medicine, New York University School of Medicine 

Oral Testimony ..................................................................................................... 61

Prepared Statement ............................................................................................. 63

Ms. Cheryl Little, Executive Director, Florida Immigrant Advocacy Center 

Oral Testimony ..................................................................................................... 68

Prepared Statement ............................................................................................. 71

APPENDIX 

Material Submitted for the Hearing Record .......................................................... 119

(1)

DETENTION AND REMOVAL:

IMMIGRATION DETAINEE MEDICAL CARE 

THURSDAY, OCTOBER 4, 2007

HOUSE OF REPRESENTATIVES, SUBCOMMITTEE ON IMMIGRATION, CITIZENSHIP, REFUGEES, BORDER SECURITY, AND INTERNATIONAL LAW

COMMITTEE ON THE JUDICIARY, Washington, DC.

The Subcommittee met, pursuant to notice, at 1 p.m., in Room 

2141, Rayburn House Office Building, the Honorable Zoe Lofgren 

(Chairwoman of the Subcommittee) presiding. 

Present: Representatives Lofgren, Berman, Sa ́nchez, Conyers, 

and King. 

Staff Present: Ur Mendoza Jaddou, Majority Chief Counsel; 

David Shahoulian, Majority Counsel; Andrea Loving, Minority 

Counsel; and Benjamin Staub, Professional Staff Member. 

Ms. LOFGREN. I would like to welcome the Subcommittee Members, our witnesses, members of the public to the Subcommittee’s 

hearing on immigration detainee medical care. 

According to the General Accountability Office, GAO, nearly 

300,000 men, women and children were detained by Immigration 

and Customs Enforcement, otherwise known as ICE, in 2006, tripling the amount of 2001 when less than 100,000 were detained. 

With a large increase of detainees in ICE custody, it is incumbent upon this Congress to ensure that ICE is properly executing 

its responsibility of providing safe and humane treatment of detainees in their custody. 

Recent reports suggest that ICE is not doing its job. In just the 

last few years, there have been several reports of individuals detained by ICE that suggest unsafe and inhumane treatment in ICE 

in contracted detention facilities. 

For example, the Boston Globe recently reported the case of a 

man who died in ICE custody due to epilepsy complications despite 

the fact that his sister twice attempted to provide necessary medication to detention officials, according to his family. His sister says 

she was turned away both times. 

Another reported case involves Victoria Arellano, who was taken 

off HIV drugs while in custody and subsequently died after serious 

complications and lack of appropriate medical care for several 

months. Reports indicate that fellow inmates tended to as much 

care as they could possibly provide on their own and repeatedly informed detention officials of Arellano’s illness. 

These and other cases have spawned questions from several 

Members of Congress, but so far few answers have been provided. 

2

There are two critical questions I hope we can address today. 

First, are the medical care standards employed by ICE satisfactory 

so as to create an environment that supports safe and humane 

treatment of individuals in ICE custody? Second, if those standards 

are adequate, are they being implemented in an appropriate manner? 

After a preliminary review of the standards and the various reports on the administration of medical care, it appears we could 

have problems on both levels. 

The DIHS Medical Dental Detainee Coverage Services Packet 

specifically states that medical care in ICE detention facilities is to 

be provided primarily for emergency care. Care for, and I quote, 

‘‘accidental or traumatic injuries incurred while in the custody and 

acute illnesses is not required but simply reviewed for appropriate 

care. Care for other illnesses, including pre-existing illnesses that 

are serious but not life threatening, is also not automatic but simply reviewable for appropriate care.’’

Furthermore, these reviews are conducted in Washington, D.C. 

by nurses, not physicians, who are away from the patients and simply reviewing paperwork submitted by other health care professionals recommending such care. 

With this policy, it is no wonder there are reports of unsafe and 

inhumane medical treatment in ICE custody. This policy fails to 

recognize a fundamental principle of medical care in detention. The 

patient is detained and there is no other option but care authorized 

by ICE. Yet the policy only ensures emergency care and considers 

other care even in serious cases on a case-by-case basis. 

I hope that today’s hearing will help us further understand and 

clarify the problems that exist in providing medical care to those 

in ICE custody so that we may begin to find solutions to what appears to be a very serious problem. 

I would now recognize our distinguished Ranking Member, Congressman Steve King, for his opening statement. 

Mr. KING. Thank you. First, I want to tell you and thank you on 

your willingness to work together and to ensure that U.S. Immigration and Customs Enforcement has the opportunity to give its side 

of the story at the same time as the statements made by the other 

witnesses are made here and an opportunity to respond and rebut 

if necessary. 

Earlier this week I was concerned that ICE wouldn’t get that opportunity, but they will have today, and I appreciate that. 

We all agree that when a person is in Government custody, he 

or she should receive adequate medical care. The issue before us 

today is whether or not ICE detainees are receiving that adequate 

medical care. Since American taxpayers pay over 72 million each 

year for ICE detainee health care, we should ensure that the care 

is cost effective and that it is competent. 

Much has been made in media reports about the number of detainee deaths while in ICE custody. And so I began to ask some 

questions about that, and I think it has been reported that 25 

deaths in ICE custody for the fiscal year 2004, 16 deaths in the fiscal year 2005, 17 deaths under ICE custody in 2006 and 11 in fiscal year 2007, although that may go up because I don’t think we 

actually have the final number on that. But when you look at the 

3

total number of ICE detainees in those years, it means the chance 

of death in 2004 while under ICE custody was one in 8,196. 

And in 2005 it was one in 12,912. In 2006 it was one in 13,288 

and so far in 2007 the chance of death while in ICE custody one 

in 23,146. 

Those numbers don’t mean very much, Madam Chair, until you 

compare them then to the death rate in our Federal Bureau of 

Prisons, which is one in 603 for 2006, one in 761 in 2007. The State 

prison death rate was one in 466 in 2005 and one in 464 in 2004, 

one in 459 in 2003. 

But finally the death rate in local prisons was as high as one in 

1,519 in 2005, one in 1,376 in 2004 and one in 1,425 in 2003. 

And so I will recognize that this is a total number of inmates 

that have passed through these institutions during these periods of 

time. And I will recognize that there is a faster turnover during 

ICE incarceration than certainly our Federal penitentiary and certainly for our local institutions, but, regardless, when you make adjustments for that, it appears that the fatalities under ICE are—

if they are atypical of that under other institutions, they appear 

that they are lower. And so those odds of death are safer in ICE 

institutions, by these statistics at least. 

And in December of 2006, DHS Inspector General issued a report 

in which he found instances of noncompliance with ICE detention 

medical standards at four of the five detention facilities that were 

studied. 

After that, ICE convened a working group to review the national 

standards and detention management control worksheets. The 

working group made several recommendations with ICE, and—that 

ICE is continuing to implement. Many of the ICE detention centers 

have more than adequate medical facilities. I have a couple of posters that will be on display down here that show the type of facilities at some of these centers. They seem to have updated equipment and respectable personnel. 

I would just like to mention one additional point. The death rates 

for ICE detainees do not even come close to the accidental and illness death rates of those serving in the active duty U.S. Military. 

For instance, in 2006, one in 2,004 military personnel died by accident or illness. And in 2005, that was one in 1,509. And in 2004, 

it was one in 1,614. 

So I think we need to take an objective look at this. Yes, we have 

a responsibility, as this Congress has accepted sometime well over 

100 years ago, to provide quality health care for the inmates in all 

of our institutions, including the ICE detention centers, and I just 

ask that we want to see ICE meet those standards, meet their own 

guidelines, have a system in place to have that check on services 

that are provided, and then put it in the perspective of the fact 

that people don’t live forever and they die in some places, and if 

there are reasons for that for a single individual, we ought to look 

into that, but I don’t see at this point that the statistics support 

the idea that there is an endemic flaw in the ICE health care. 

So I am interested in the testimony, and Madam Chair, I appreciate this hearing, and I would yield back the balance of my time. 

Ms. LOFGREN. I would now like to recognize the Chairman of the 

Committee, Mr. Conyers, for his opening statement. 

4

Mr. CONYERS. Thank you, Madam Chairwoman. 

This is an important hearing. I am still complaining about the 

fact that immigration ended up in the Department of Homeland Security, but I am trying to give it up with some grace. 

I am drawn to this hearing not only by the fact that immigration 

detention deaths are being examined out of the Immigration Customs Enforcement, but the fact that we have a Haitian presence 

here today. I am really pleased that we have got attorney Cheryl 

Little, who has been working in this area and is the head of the 

Florida Immigrant Advocacy Center for so many years. 

When I first began going to Haiti, I was in touch with the lawyers and other leaders that were working with her on the Haitian 

immigration crisis. Today, we have the pleasure of having her before us and also to have the distinguished writer, Ms. Edwidge 

Danticat, a Haitian of great distinction in terms of our literary contributions. I am very pleased that she is here as well. 

Now for me, this coincides perfectly because I am going to Haiti 

this weekend, and I will be joining Dr. Ron Daniels of New York 

and many others there. This plays into an issue, and hovering in 

this background is this double standard on immigration policy with 

reference to Haitians that come to this country. 

There are two policies: There is a standard and then there is the 

Haitian policy. And counsel for Ms. Lofgren advises me that we are 

putting together a very close examination of what these two different policies are and what they mean. 

This hearing is important to me for all of those reasons, and I 

will ask unanimous consent to put my written remarks into the 

record. 

And thank you. 

Ms. LOFGREN. Without objection, so ordered. 

If the Ranking Member of the full Committee comes, he would 

certainly also be permitted to submit his statement. 

We have been called away to votes on the floor of the House, and 

so we are going to go and comply with our obligation there. 

I would just like to note that under the rules of this Committee, 

testimony is due to the Committee 48 hours in advance. Sometimes 

people are a little bit late but I will note that what the Government 

handed me was still hot when I got it coming in here, and I recall 

when Jim Sensenbrenner chaired the Immigration, chaired the Judiciary Committee and the head of then INS came and did the 

same thing, he refused to let him testify. 

Now there has been a discussion. The minority is saying are we 

going to allow this. My inclination would be to allow it, but to note 

that this really falls way below what we expect of our witnesses 

and especially the Government with all of the resources. 

So we are going to sort this out. We will have our staffs discuss 

it and make sure we are all on the same wavelength. 

We are going to recess the hearing until a certain time so people 

can go get a cup of coffee or something, not just sit in the room, 

and we will try and be back here about 2:30, and so we will see 

you all then. 

And we are in recess until 2:30. 

[Whereupon, at 1:20 p.m., the Subcommittee was in recess, to reconvene at 2:30 p.m., this same day.] 

5

[2:40 p.m.] 

Ms. SA ́ NCHEZ. [Presiding.] In the interest of time, I want to 

apologize to our witnesses, we have no control over the vote schedule. But I appreciate your patience. And because of our busy schedules and the fact that more votes are likely to be called, I would 

ask that other Members submit their written statements for the 

record. 

Without objection, all opening statements will be placed into the 

record. 

Without objection, the Chair is authorized to declare a recess of 

the hearing at any point. 

We have two distinguished panels of witnesses here today to help 

us consider the important issues before us. I am pleased to welcome Gary Mead, the assistant director of management in the Office of Detention and Removal Operations at Immigrations and 

Customs Enforcement. Prior to joining ICE in 2006, Mr. Mead 

served with the U.S. Marshal Service. He worked as the associate 

director for administration, the associate director for operations 

support, and the assistant director for management and budget. He 

holds his bachelor’s degree from the State University of New York, 

a master’s from Bowling Green State University, and graduated 

from the management program of the National Defense University 

here in Washington. Welcome, Mr. Mead. 

Mr. Mead is joined by Dr. Timothy Shack, medical director at the 

Immigrant Health Services to assist in responding to any questions 

that we may have for Mr. Mead. 

Mr. Mead and Dr. Shack, again, thank you for joining us. We 

have just gotten a bell, but I am going to ask you to go ahead and 

begin your testimony because I think we should be able to accommodate your testimony before we head across for votes. 

At this time I would invite you to give us your oral testimony. 

TESTIMONY OF GARY E. MEAD, ASSISTANT DIRECTOR FOR DETENTION AND REMOVAL, U.S. IMMIGRATION AND CUSTOMS 

ENFORCEMENT, ACCOMPANIED BY TIMOTHY SHACK, M.D., 

MEDICAL DIRECTOR, IMMIGRANT HEALTH SERVICES 

Mr. MEAD. Thank you, Madam Chairman and distinguished 

Members of the Subcommittee, it is my privilege to appear before 

you to discuss the medical care of immigration detainees. 

DRO’s core mission is the apprehension, detention, and removal 

of deportable aliens. In carrying out our mission, one of our highest 

priorities is to provide the best possible health care to those in our 

custody. 

DRO partners with the U.S. Public Health Service’s Division of 

Immigration Health Services to provide detainee health care. DIHS 

includes more than 600 doctors, nurses, and other health care professionals. During fiscal year 2007, DRO spent almost $100 million 

on detainee health care to ensure the highest quality health care, 

DIHS medical facilities must be in compliance with the applicable 

health care standards from the American Correctional Association, 

the National Commission on Correctional Health Care, the Joint 

Commission, and the ICE National Detention Standards. 

During fiscal year 2007, approximately 300,000 individuals 

passed through ICE custody. Approximately 25 percent of these deVerDate 0ct 09 2002 12:47 Dec 17, 2007 Jkt 000000 PO 00000 Frm 00009 Fmt 6633 Sfmt 6601 H:\WORK\IMMIG\100407\38115.000 HJUD1 PsN: 38115
6

tainees had chronic health care problems including hypertension 

and diabetes. Many of these detainees first learned of these conditions as a result of the health screening and medical exams they 

received while being processed into custody. They received the appropriate medical treatment for their conditions that they would 

otherwise not likely have received. 

ICE health care policy requires that all detainees receive an initial health screening upon arrival at a detention facility to determine the appropriate medical, mental health, or dental treatment 

that is needed. Included in this process is either a chest x-ray or 

a skin test for TB. Immediate attention is provided to those detainees who present a danger or immediate risk to themselves or others, such as infectious diseases, uncontrolled mental health disorders, or conditions that would deteriorate if not immediately seen 

by medical personnel. 

Detainees also receive a physical examination within 14 days of 

arrival to identify medical conditions requiring monitoring or treatment. A detainee with a medical condition requiring followup treatment will be scheduled for as many appointments as needed, including to outside medical providers or facilities. 

ICE standards also require that all detainees have access to sick 

call. Procedures are in place to ensure that all sick call slips are 

received by the health care service provider in a timely manner. All 

facilities are required to have regularly scheduled times when medical personnel will be available to see detainees. In emergencies, 

medical staff or 911 are called immediately. 

During fiscal year 2007, as of June 30, DIHS completed more 

than 518,000 total medical visits, including 138,000 intake 

screenings, 12,000 dental visits, 16,000 mental health visits, 41,000 

short stay unit visits, 134,000 chronic disease visits, 64,000 physical exams, 71,000 sick call visits. By July 31 of last fiscal year, 

DIHS had filled more than 170,000 prescriptions and completed 

more than 427,000 pill line distributions. By the end of August 

2007, DIHS had completed more than 124,000 x-rays. 

The DIHS managed care program has a benefit package described in the health care services available to all ICE detainees. 

The services address imminent threats to life, limb, hearing, or 

sight, rather than elective or nonemergency conditions. Conditions 

that would cause suffering or deterioration of a detainee’s health 

are also covered. This program has a network of more than 500 

hospitals, 3,000 physicians, and 1,300 other health care facilities 

that provide a wide range of medical services. 

Detainees who require medical care beyond what can be provided 

at the detention facility access that care through treatment authorization requests. TARs are submitted to the DIHS managed care 

program. More than 40,000 TARs are submitted each year. The average turnaround time for a TAR is 1.4 days, with 90 percent being 

approved. Specialized procedures regularly approved through the 

TAR process include heart surgery, cancer treatment, dialysis, and 

a variety of general surgical procedures including gallbladder, appendicitis, and orthopedics. 

Before I conclude, I would like to make a few quick comments 

regarding detainee deaths. During the past 4 years, approximately 

1 million people have passed through our custody. Unfortunately, 

7

66 have died. We are always saddened by the death of a detainee. 

DRO reports all death to the Office of Professional Responsibility, 

the DHS Office of the Inspector General, local medical authorities 

or coroners who frequently perform autopsies. DIHS also conducts 

an independent review of all custody deaths. 

I would like to thank you, Madam Chairman and Members of the 

Subcommittee, for the opportunity to appear before you today, and 

I look forward to answering any questions you may have. 

[The prepared statement of Mr. Mead follows:]

PREPARED STATEMENT OF GARY E. MEAD

Good afternoon, Chairwoman Lofgren and distinguished Members of the Subcommittee. My name is Gary Mead, and I am the Assistant Director of Detention 

and Removal Operations (DRO) at U.S. Immigration and Customs Enforcement 

(ICE). It is my privilege to appear before you to discuss the medical care and treatment of immigration detainees. 

DRO’s core mission is the apprehension, detention, and removal of inadmissible 

and deportable aliens. In carrying out our mission, one of our highest priorities is 

to provide the required health care to those in our custody. We take this responsibility very seriously and have created an outstanding detainee health care program, 

of which we are very proud. 

DRO partners with the U.S. Public Health Service’s (PHS) Division of Immigration Health Services (DIHS) to provide or arrange health care for ICE DRO detainees. DIHS staff consists of more than 600 doctors, nurses, and other health care professionals. During Fiscal Year 2007, DRO spent almost $100 million on detainee 

health care. 

To ensure the highest quality of health care delivery services, DIHS medical facilities must be in compliance with applicable health care standards from the American 

Correctional Association (ACA), the National Commission on Correctional Health 

Care (NCCHC), the Joint Commission, and the ICE National Detention Standards. 

During Fiscal Year 2007, approximately 300,000 individuals passed through ICE 

custody. 

At a minimum, two examinations must be performed on every detainee. It should 

be noted that approximately 25% of these detainees have chronic health care problems, including hypertension and diabetes. Many of these detainees first learn of 

these conditions as a result of the health screening and medical examinations they 

receive while being processed into custody. They then receive the appropriate treatment for their condition that they would have otherwise not likely have received. 

ICE health care policy requires that all detainees receive an initial health screening immediately upon arrival at a facility to determine the appropriate medical, 

mental health, and/or dental treatment that is needed. Included in this process is 

either a chest x-ray or skin test for tuberculosis. Immediate attention is provided 

to detainees who present a danger or an imminent risk to themselves or others, 

such as infectious diseases, uncontrolled mental health disorders, or conditions that 

would deteriorate if not addressed immediately by medical personnel. 

In addition to the initial health care screening, ICE policy also requires that detainees receive a health appraisal and physical examination within 14 days of arrival to identify medical conditions that require monitoring or treatment. A detainee 

with a medical condition requiring follow up treatment will be scheduled for as 

many appointments as needed. Scheduled visits include appointments made in advance for ambulatory care or specialty care clinics. Unscheduled visits are performed as needed to attend to emergent or urgent conditions. 

During screenings, evaluations, and visits, a medical professional assesses the detainee’s health and treatment requirements and arranges any medications, consultations, or other services needed. If language difficulties prevent the health provider 

or officer from directly communicating with a detainee for purposes of completing 

a medical screening or health evaluation, the officer is required to obtain translation 

assistance. ICE most commonly provides translation services through our contracts 

with AT&T and Languages Services Associate, Inc. 

In addition to the initial screening and medical evaluation, the ICE standard on 

Medical Care requires that all detainees, regardless of classification, have access to 

sick call. Detainees have the opportunity to request health care services provided 

by a physician or other qualified medical officer in a clinical setting. Procedures are 

in place to ensure that all request slips are received by the health service provider 

in a timely manner. 

8

The sick call process allows detainees to access non-emergent medical services, 

and all facilities are required to have regularly scheduled times when medical personnel will be available to see detainees who have requested services. For emergent 

or urgent medical services, detainees may notify a correctional officer or other facility personnel at any time that a problem occurs, and medical staff or 911 will be 

called immediately. 

In Fiscal Year 2006, DIHS staff had more than 491,000 detainee visits. These visits included 16,000 dental, 17,000 mental health, 28,000 short stay unit visits, 

150,000 chronic disease visits, 54,000 physical exams, 61,000 sick call visits, and 

327,000 pill line distributions. DIHS also completed more than 103,000 chest x-rays 

during intake screening. 

As of June 30, 2007, DIHS showed an increase in total caseload with more than 

518,000 total visits, broken down as 138,000 intake screenings, 12,000 dental, 

16,000 mental health, 41,000 short stay unit visits, 134,000 chronic disease visits, 

64,000 physical exams, 71,000 sick call visits, and 427,000 pill line distributions. 

Medical care provided at each detention facility also includes access to necessary 

prescription medications. Prescriptions written for detainees by the health service 

provider are filled either by an on-site pharmacy or by a local community pharmacy. 

If a prescription medication is not readily available and a detainee has a supply of 

the medication needed or can obtain a supply of the medication from a family member, that medication may be used as long as the facility’s medical staff can verify 

the validity of the medication to ensure it is appropriate for the detainee to take 

and to prevent contraband from entering a facility. By July 31, DIHS had filled 

more than 170,000 prescriptions, already exceeding the more than 136,000 prescriptions filled in Fiscal Year 2006. By the end of August 2007, DIHS had completed 

more than 124,000 chest x-rays. 

The ICE Medical Program has an established covered benefits package that delineates the health care services, medical products and treatment options available to 

any and all detainees in ICE custody. The ICE covered services package emphasizes 

that benefits are provided for conditions that pose an imminent threat to life, limb, 

hearing or sight, rather than to elective or non-emergent conditions. Medical conditions which the local treating physician believes would cause suffering or deterioration of a detainee’s health are also assessed and evaluated through the DIHS Managed Care Program. The DIHS Managed Care Program has a network of more than 

500 hospitals, 3000 physicians, and 1300 other health care facilities that provide a 

wide range of medical care and services. 

Detainees who require medical care beyond what can be provided at their detention facility, access that care through Treatment Authorization Requests (TARs), 

which are submitted to the DIHS Managed Care Program. More than 40,000 TARs 

are submitted each year. The average turnaround time for a TAR is 1.4 days with 

90 percent of requests being approved. Specialized procedures regularly approved 

through the TAR process include heart surgery, cancer treatment, dialysis, and a 

variety of general surgical procedures including gall bladder, appendicitis, and orthopedics. In fiscal year 2006, there were 465 hospital admissions. 

Before I conclude, I would like to make a few comments regarding ICE detainee 

deaths. During the past four years approximately 1 million persons have passed 

through our custody. Unfortunately, 64 have died. We are always saddened by the 

death of a detainee in our custody. 

DRO reports all detainee deaths to the ICE Office of Professional Responsibility 

(OPR) and the DHS Office of the Inspector General (OIG) so that they have an opportunity to determine if an investigation into the circumstances of the detainee’s 

passing is warranted. Deaths are also routinely referred to the local medical examiner or coroner’s office who will conduct an autopsy if required. DIHS also conducts 

an independent review of all in-custody deaths. 

While a single death of an ICE detainee is serious matter, the ICE Detainee 

Health Program has an overall death rate that is well below those in comparable 

detention or correctional settings. ICE detainee death rate per 100,000 detainees, 

based on the number of detainees booked into custody per Fiscal Year, was ten 

deaths in Fiscal Year 2004; seven deaths in Fiscal Year 2005; and seven deaths in 

Fiscal Year 2006. The comparatively low death rate among ICE detainees is remarkable, given that many of the ICE detainees have a history of poor or no health 

care before coming into ICE’s custody. 

In conclusion, our comprehensive detainee health program is based on state of the 

art medical care, sound management, continuous review and process improvement. 

DIHS staff consists of highly motivated correctional health care professionals who 

are dedicated to providing high quality services. The scope of ICE’s medical services 

and operational processes is continually monitored by both internal and external 

healthcare experts with the ultimate goal of providing the best possible health care 

9

to those in our custody. As I mentioned at the start of my statement, the well being 

of our detainees is among our highest priorities and we take this responsibility very 

seriously. 

I would like to thank you, Ms. Chairwoman and Members of the Subcommittee, 

for the opportunity to appear before you today, and I look forward to answering any 

questions you may have.

Ms. SA ́ NCHEZ. Thank you for your testimony, Mr. Mead. Unfortunately, the bells beckon and we have votes on the floor. I think this 

is a natural point in time to take a break to head over for votes. 

When we come back, we will begin with questioning, and we appreciate that both of you will be available for that. Again, I beg your 

indulgence and I recognize your patience, and we will be back from 

voting as quickly as possible. 

We stand in recess. 

[Recess.] 

Ms. LOFGREN. [Presiding.] The Subcommittee will come back into 

order. 

At this point I understand that the testimony has been concluded, and we will go into questions for our witnesses; and I would 

turn first to the Ranking Member, Mr. King, for his 5 minutes of 

questions. 

Mr. KING. Thank you, Madam Chair. 

And, Mr. Mead, thanks for your testimony. 

As I look through some of the material that you provided preliminarily to your testimony being submitted, I notice here that of 

the—in this material, it says 27,500. I think you testified 30,000 

would be the number of beds that are available in a given year. So 

that would be the snapshot of the number of inmates that you 

could max out at. 

I am presuming that. I will let you define that more precisely in 

a moment. 

But as I also look at this information, it says 65 percent are located in State and local prison jail facilities, 19 percent are in commercial contract facilities and 14 percent are in ICE-owned service 

processing centers; that leaves another 2 percent there for the Federal Bureau of Prisons. 

My question is, of these fatalities that are the subject of this 

hearing, how many of those fatalities took place in the State and 

local prisons that are—represent the 65 percent of the overall inmates; how many took place in ICE commercial—in the commercial 

facilities; how many took place in ICE facilities? Can you break 

that down? 

Also, I would presume that the medical care in those State and 

local-run facilities—at 65 percent, I would presume that medical 

care would be identical to that of the other inmates that are incarcerated in the same facilities. 

Could you shed some light on those components as part of the 

question that I have asked you? 

Mr. MEAD. Yes. 

Off the top of my head, I can’t break down those 66 between 

State and local contract or Government-owned and operated, but 

the 66 were the total deaths from everyone in our custody. 

The State and local facilities in most cases come under the same 

accreditation requirements as the Federal facilities do, and they 

10

answer to State authorities, county authorities; and many, as I 

said, have exactly the same accreditation as ours. 

In addition, when it comes to housing our detainees, they must 

be in compliance with our ICE detention standards; and those detention standards are applied to our own facilities, our contract facilities, and the State and local facilities. 

So you are correct that the care received across the board is relatively consistent. 

Mr. KING. Do those health care practitioners, though, in our 

State and those that—of that 65 percent, say, primarily in our 

State institutions and the local, are they the same health care providers in most instances as they are for the other inmates in the 

same institution? 

Mr. MEAD. Yes. Whatever health care program county inmates, 

for example, are afforded and whoever is providing that health 

care—our detainees are ICE detainees—get the same medical program. 

Mr. KING. Then if there is an issue here of, I will say, an unusual 

number of deaths, which I don’t know that the statistics support—

if there is an issue here, wouldn’t it be an issue then that cast that 

same question for the balance of the inmates within those facilities 

that two-thirds of the ICE inmates are incarcerated in? 

Mr. MEAD. Yes. If there were an aberration there, it would be applied across the same or the entire population at that county facility, because our detainees do not get special health care while in 

there. 

However, if there is health care required beyond what the county 

jail can provide, we do manage that centrally through DIHS, and 

we can remove them from that facility and provide health care 

elsewhere. And it is not a reflection on the county; it is just a reflection on what their——

Mr. KING. I will submit at least one question to be answered 

after this hearing, at least one, and that one will be the question 

that asks you to break down those deaths into those categories 

which are ICE facilities and those which are ICE-approved facilities. 

Within those actually four different categories, I ask you, do 

those deaths include suicides or homicides? 

Mr. MEAD. They include suicides; and during the past 4 years, 

we have not had a homicide. 

Mr. KING. Can you tell me how many are suicides out of the 66? 

Mr. MEAD. I would say it is approximately 13 over the past 4 

years. I can confirm that after the fact, but I would say it is about 

13. 

Mr. KING. Thirteen of 66. And then the numbers that show the 

deaths for 2007 shows 11 with the data that I have. Is that a current number and does that complete the fiscal year? 

Mr. MEAD. As far as I know, that completes the fiscal year. 

Mr. KING. So that would indicate the numbers that trend—I 

shouldn’t say ‘‘trend’’ because we only have a 4-year snapshot for 

me, 16, 17 and then one number larger than that down to 11. If 

one could draw a trend, that would indicate that it is going at least 

in a positive direction. 

Mr. MEAD. Yes, sir. 

11

Mr. KING. I would make that point. 

And then, as you transition, you have also written information 

here that shows a number, about 254,000 total, that were processed by ICE, and your testimony says 300,000. 

What is the right number? 

Mr. MEAD. Hopefully, the 254 would have either been the last 

fiscal year or a year-to-date number. Our 2007 number in terms of 

passing through our custody is approximately 300,000. 

Mr. KING. And these inmates are being processed through—it 

takes time to process them. If you could process them more quickly, 

would that have an effect on the number of inmate deaths that you 

have? 

Mr. MEAD. Conceivably, the average length of stay in our custody 

would be a factor, certainly on illnesses that are, what, related to 

longer term care. 

Mr. KING. Mr. Mead, I would just ask you to reflect upon—you 

heard my opening statement with regard to the number of deaths 

in our U.S. military, nonrelated to hostilities, and those numbers 

being higher than the numbers of the inmates in ICE care; and the 

balance of the statistics that were part of that opening statement 

that I made, how do you explain that—that, apparently, if your interest is to improve the statistical odds of your survival, joining the 

military in a time not of war seems to be statistically, or being a 

part of a—let me just say that compared to being an ICE inmate—

I would like to hear you respond to that. 

Mr. MEAD. I am not in a position to comment on the military 

issue, but the ICE health care program is an extremely robust program. 

We do a lot of screening. As I mentioned in my opening statement, last year DIHS completed over 500,000 medical visits for the 

detainees in our custody. Many of our detainees receive almost 

daily attention. 

So it is an aggressive program, and we do everything possible to 

maintain the best quality of life for the detainees in our custody. 

Mr. KING. Thank you. 

Madam Chair, I yield back. 

Ms. LOFGREN. I will be very brief because I know we have another panel that has been waiting all afternoon. I just want to 

make one comment, and I will have one question. 

Before I was in Congress, I served on the Board of Supervisors 

in Santa Clara County, the fourth largest county in California, and 

one of my jobs was to oversee the county jail, then one of the largest jails in America. And a major focus was the medical care that 

needed to be provided because once you have somebody in custody, 

it is all on you. They can’t go to another doctor. 

You take up whether they are charged with murder or jaywalking, you have the same obligation for their care. And I would 

just note that when I was in charge of that, we didn’t have to call 

Washington, D.C., to get permission for treatment of an inmate in 

the county jail as the—as is the case for ICE detainees. 

So to say the two populations are being treated the same, simply 

is incorrect and I think very misleading. I would also like to note 

some skepticism that I have about your testimony. 

12

On page 6 you note that the DRO reports all detainee deaths to 

the ICE Office of Professional Responsibility and the DHS Office of 

the Inspector General. However, we have a letter from the Inspector General of DHS to Senator Dayton, just last year, 1 year ago, 

where he pointed out—and I won’t mention the woman’s name because I don’t know whether there is a privacy issue—but Ms. X had 

died, but we were unaware of her death until the complaint was 

received from the complainant some number of months later. So I 

guess it makes me skeptical about the testimony that you have 

given to us. 

And finally, I have this question: For the deaths that are reported, does it include individuals who are released and then expire for the lack of treatment they received in custody or only those 

who die while they are actually in your facilities? 

Mr. MEAD. Well, not necessarily in our facilities. They could still 

be in our custody and at a hospital, but those who die later are not 

included. 

Ms. LOFGREN. And the stories that we have, it is not years later; 

it seems to be a direct cause of the neglect received in the facility. 

At this point—my time has not expired, but it is already 3:30, 

and there are no other Members to ask, I would thank you for 

being here for your testimony. Note that the record is open for 5 

days and additional questions may be forthcoming, and if they are, 

we would ask that you answer them promptly. 

Thank you very much. I thank all of you for your willingness to 

be here today and for your patience for all of the votes that we had 

on the floor. 

We will now call the next panel. 

Seated first on the panel, we would like to extend a warm welcome to Francisco Castaneda, a former ICE detainee. Mr. 

Castaneda immigrated to the United States from El Salvador with 

his family in 1982 at the age of 10 to escape that nation’s civil war. 

His family moved to Los Angeles where he went the school and 

began working at the age of 17. 

Mr. Castaneda has a 14-year-old daughter, who is with us here 

today, and has celebrated his 12th anniversary with his girlfriend, 

Cynthia. 

He entered ICE’s custody in March of 2006 and will tell us about 

it. 

Next, we are joined by Edwidge Danticat, the renowned American author and niece of the Reverend Joseph Danticat, a deceased 

detainee. She was born in Haiti and moved to the United States 

to join her family at the age of 12. 

She has written several critically acclaimed books including 

Breath, Eyes, Memory, an Oprah Book Club section; Krik!Krak!, a 

National Book Award finalist; and the Farming of Bones, an American Book Award winner. She earned her bachelor’s degree from 

Barnard College and her MFA from Brown University. 

I would like to extend a welcome to June Everett, the sister of 

Sandra Kenley, a deceased ICE detainee. Ms. Everett and her sister grew up in Barbados. Ms. Kenley raised Ms. Everett and her 

two other siblings while their mother worked to provide for their 

family. 

13

Ms. Everett, a U.S. Citizen, currently resides outside of Washington in New Carrollton, Maryland, and has become an advocate 

for ICE detainee family members since her sister’s death. 

Next, I am pleased to introduce Tom Jawetz, an immigration detention staff attorney with the American Civil Liberties Union. 

Prior to his work as an immigration detention staff attorney, Mr. 

Jawetz worked on the ACLU’s National Prison fellowship and the 

Immigrant and Refugee Rights Project at the Washington Lawyers 

Committee for Civil Rights and Urban Affairs. He clerks for U.S. 

District Court Judge Kimba Wood of New York and served as an 

AmeriCorps member in South Carolina. 

Mr. Jawetz graduated with honors from both Dartmouth College 

and the Yale University School of Law. 

I am also pleased to welcome Dr. Allen Keller, an Associate Professor of Medicine at the New York University School of Medicine 

and Director of the Bellevue/NYU Program for Survivors of Torture. 

Dr. Keller also directs NYU’s School of Medicine Center for 

Health and Human Rights, chairs the policy committee of the National Consortium of Torture Treatment Programs and served on 

the American College of Physicians Ethics and Human Rights 

Committee. He additionally worked as a source advocacy fellow 

with Human Rights First and led a study on asylum seekers at the 

request of the U.S. Commission on International Religious Freedom. 

He completed his medical education and residency at NYU and 

served as the hospital’s Chief Resident in the early 1990’s. 

And finally we would like to welcome Cheryl Little, 

the Cofounder and Executive Director of Florida Immigrant Advocacy Center, or FIAC. FIAC, based in Miami, provides free legal 

assistance to immigrants of all nationalities. 

Ms. Little began her career in immigration law with the Haitian 

Refugee Center after graduating with her bachelor’s degree from 

Florida International University and her law degree with honors 

from the University of Miami’s School of Law. 

Well, thank you all for your willingness to tell us your stories 

and to give us your information and share your expertise. Each of 

your written statements will be made part of the record in its entirety. 

We would ask that you summarize your testimony in about 5 

minutes, and there is a machine that is not—it is hidden but when 

4 minutes have gone by, a yellow light will go on. That means you 

have got 1 minute more. When the red light goes on, it means your 

time is up; and we would ask, if at all possible, you summarize so 

we can hear the other witnesses. And then we will have questions. 

So we will start, if we could, with Mr. Castaneda for your 5 minutes of testimony. 

TESTIMONY OF FRANCISCO CASTANEDA, FORMER DETAINEE 

Mr. CASTANEDA. Good afternoon. Thank you to the Chairwoman 

Lofgren for inviting me to——

Ms. LOFGREN. Could we move the mike? 

14

Mr. CASTANEDA. Thank you to the Chairwoman Lofgren for inviting me and to the Immigration Subcommittee for holding this hearing. 

My name is Francisco Castaneda. I was held in immigration detention over 2 months and was just released this past February, 

due to my medical condition, after many letters from the ACLU 

were sent on my behalf. 

First, I would like to tell you a little bit about myself. 

I am 35 years old. I came to the United States from El Salvador 

with my mother and siblings when I was 13 years old to escape 

from the civil war. My family moved to Los Angeles where I went 

to school and began working at the age of 17. My mother died of 

cancer when I was pretty young before she was able to get us legal 

immigrant status. 

After my mom died, I looked to my community for support and 

found myself wrapped up in drugs instead, which today I deeply regret. I worked doing construction up until I went to prison on a 

drug charge, where I spent just 4 months before I was transferred 

into ICE detention. 

When I entered ICE custody at the San Diego Correctional Facility in March 2006, I immediately told them I had a very painful 

lesion on my penis. After a day or two, Dr. Walker examined me 

and recognized that the lesion was a problem. He said he would request that I see a specialist right away. But instead of sending me 

directly to a specialist, I was forced to wait and wait and wait. 

All the while, my pain got worse. I started to bleed even more 

and it smelled really bad. I also had discharge coming out of it. Dr. 

Walker submitted a request to the Division of Immigration and 

Health Service. After more than a month, it was finally granted. 

When I saw an oncologist, he told me it might be cancer; I needed a biopsy. He offered to admit me to a hospital. He admitted me 

for the biopsy, but ICE refused to permit a biopsy and told the 

oncologist that they wanted to try a more cost-effective treatment. 

I was then referred to a urologist, but I only got to see the urologist 21⁄2 months later, after I filed a request and a grievance with 

ICE. The urologist said I needed an incision to remove the lesion 

and stop the pain and bleeding, and also said I needed biopsy to 

figure out if I had cancer. ICE and the Division of Immigration 

Health Services never did either of those things. They said that it 

was ‘‘elective surgery.’’

My pain was getting worse day by day. When you are in detention, you can’t help yourself. I tried to get medical help every day. 

Sometimes I would show the guards my underwear, the blood on 

it, to get them to take me to medical; but they would say they 

couldn’t help me for nothing. 

Several more requests for biopsy were denied. They told me in 

writing that I couldn’t get the surgery after—they told me I could 

get the surgery after I left the facility and was deported. 

In late November 2006, I was transferred from San Diego to San 

Pedro Service Processing Center. When I got there, I immediately 

filed sick call slips about my problem. After a few days I saw a doctor. I told him about my pain and showed them the blood in my 

boxer shorts and asked them to examine my penis. They didn’t 

15

even look at it. One of them said I couldn’t be helped because I 

needed elective surgery. 

In the middle of December, I noticed a lump in my groin. It hurt 

a lot. It was a little bit smaller than a fist, so I filed a sick call 

slip about it. I never got any treatment for it. I later found out it 

was a tumor; the cancer had already spread. 

In beginning of January, they put me in handcuffs and leg shackles and drove me to the emergency room. When I got there, the officer tried to find someone to see me. But he was told I would have 

to wait in line like everybody else. After about an hour over the following time, all chained up, they took me back to San Pedro, and 

I never got to see no one. 

Back when I was in San Diego, another detainee give me the 

phone number from the ACLU and said, They might be able to 

help you. I called them and spoke with them and told them about 

my story and about how much pain I was in. When I got to San 

Pedro, he sent letters and called the people at the facility to try to 

help me get medical care. 

Finally, around the end of January, Immigration agreed to let me 

get a biopsy. They made an appointment with the doctor. But just 

before the surgery, they released me from custody. A doctor actually walked me out of San Pedro and told me I was released because of my serious medical condition. The first thing I did was call 

a doctor to see whether I could still get my biopsy; the secretary 

told me I had canceled it. 

I then went back to emergency room at Harbor-UCLA on my own 

and I waited to see the doctor and finally got my biopsy. A few 

days later, the doctor told me I had cancer, I would have to have 

a surgery right away to remove my penis. They said if I didn’t have 

the surgery, I would be dead in less than 1 year. 

On February 14th, Valentine’s Day, after I was released from 

custody, I had the surgery to remove my penis. Since then I have 

been through five aggressive week-long rounds of chemotherapy. 

The doctor said my cancer spreads very fast—it had already spread 

to my lymph nodes. 

I am sure you can imagine how this feels. I am a 35-year old 

man with my life on the line. I have a young daughter, Vanessa, 

who is only 14. She is here with me today because she wanted to 

support me and because I want her to see her father do something 

for the really good so that she would have that memory of me. The 

thought that her pain and mine could have been avoided almost 

makes this too much to bear. 

I have to be here today because I am not the only one who didn’t 

get the medical care I needed. It was routine for the detainees to 

have to wait weeks or months to get basic care. Who knows how 

many tragedies can be avoided if ICE only remembers that regardless of why a person is in detention and regardless of where they 

will end up, they are still humans and they deserve basic care, humane medical care. 

In many ways, it is too late for me; short of a miracle, the most 

I can hope for are for some good days with Vanessa and some justice. My doctors are working on my good days; and thankfully, my 

attorneys at Public Justice here in Washington, Mr. Conal Doyle in 

California, and the ACLU are working on the justice not just for 

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me but for many others who are suffering and who will never get 

the help unless ICE is forced to make major changes in the medical 

care provided to immigrant detainees. 

I am here to ask each of you, the Members of the Congress, to 

bring an end to the unnecessary suffering that I and too many others have been forced to endure in ICE detention. 

Thank you for your time. 

Ms. LOFGREN. Thank you. Thank you, Mr. Castaneda for your 

willingness to be here and to explain your tragic experience. 

[The prepared statement of Mr. Castaneda follows:]

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PREPARED STATEMENT OF FRANCISCO CASTANEDA


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Ms. LOFGREN. Ms. Danticat. 

TESTIMONY OF EDWIDGE DANTICAT, AUTHOR AND NIECE OF 

REVEREND JOSEPH DANTICAT, DECEASED DETAINEE 

Ms. DANTICAT. Madam Chair, Members of the Subcommittee. I 

thank you very much for the opportunity to appear before you. 

I come today not in my own name, but in the name and in the 

stead of a loved one who died while in the custody of the Department of Homeland Security and ICE officials in the Krome Detention Center in Miami. His name was Joseph Danticat and he was 

81 years old. 

He had been living in the same neighborhood in Haiti for more 

than 50 years, but on October 24th, 2004, United Nations troops 

and Haitian police forces launched a military operation there. Their 

goal was to oust armed neighborhood gangs. However, during the 

clash that followed, they used his roof to fire and kill more than 

a dozen of his neighbors. 

After these forces left the neighborhood, because of the shots had 

been fired from his roof, the gangs threatened his life, and so he 

fled and eventually traveled to the United States where he had 

been a very frequent visitor for more than 30 years. 

He had a passport and a valid visa when he arrived at Miami 

International Airport. However, because he requested asylum, he 

was arrested and taken to the Krome Detention Center where the 

medications he was taking for high blood pressure and an inflamed 

prostate were taken away from him. 

A few days later, on the morning of his credible fear hearing, he 

became ill and began to vomit. Vomit was shooting out of his 

mouth, his nose as well as the tracheotomy hole he had in his neck 

that he had for cancer surgery. Still, when a medic arrived at the 

scene, the medic accused him of faking his illness. I am not just 

saying this; it was in an OIG report that we got through FOIA. 

Later that morning, his condition was worse and with shackles 

on his feet, he was transported to Miami’s Jackson Memorial Hospital. He arrived in the emergency room there at 1 p.m. And was 

transferred to the prison Ward D where he was first seen by a physician 24 hours after he arrived. Later that evening, he was sweating profusely and complained of weakness, and soon after, he was 

found dead by an immigration guard. 

There are certainly many heartbreaking elements to my uncle’s 

death. However, there are certainly very crucial moments where 

the medical system in detention failed him. 

First of all, the fact that his medication, which he had been taking for many years in a careful balance that took into consideration 

his high blood pressure and his status as a cancer survivor, that 

was taken away and that was one. 

Secondly, the fact that he was not taken seriously when he became ill at a public hearing; and having been accused of faking his 

illness was certainly another. 

Furthermore, the fact that he was not seen by a physician when 

he was brought to an emergency room was surely detrimental. And 

finally, the fact that he was not permitted by criminal officials and 

Homeland Security officials to see his loved ones during his final 

hours must have left him feeling less than human at best. 

45

After my uncle died—and by the way, his death was not reported 

until it was in the press contrary to these things—the Department 

of Homeland Security simply gave my family a corpse, a cadaver, 

and a cause of death, which they said was acute and chronic pancreatitis, which my uncle had never shown any symptoms of before 

he became ill at Krome and for which he was never screened, tested, diagnosed or treated while he was either at Krome or Jackson 

Memorial. 

We were given no further explanations or clarification concerning 

his last days, and in order to receive his medical records, we had 

to file those FOIA requests that I mentioned. 

Recently, in an article entitled New Scrutiny As Immigrants Die 

in Custody, Nina Bernstein, a New York Times reporter, quoted 

Jamie Zuieback, a spokesman for the Department of Homeland Security as saying, quote, that ‘‘Anybody who violates our immigration laws is going to get the same treatment by ICE regardless of 

their medical condition.’’

It is worth noting that my uncle and many others who have died 

and are dying in the custody of the Department of Homeland Security and ICE officials did not violate any immigration laws. All my 

uncle did was request asylum, which I believe is an internationally 

acknowledged human right. 

Furthermore, if it is the intention of the Department of Homeland Security and ICE official to criminalize the right of a person 

to seek asylum and then see that lack of medical attention given 

to that person as part of the punishment, then more and more people will continue to die. 

Today, our loved ones are being referred to in this hearing as 

‘‘detainees.’’ But when they enter the system they are in sick, we 

quickly learn that they are prisoners; as family members, we quickly learn that. But even prisoners deserve to be treated fairly, decently and humanely. 

Death in custody will continue to increase if we neglect to care 

for people who have already suffered great traumas before getting 

here and are dying, hurt and uncared for, in immigration jails. 

Many people like my uncle, who in spite of the designation that 

he was given as Alien No. 2704199, was a father, a grandfather, 

a brother, an uncle, a friend who is missed and treasured every day 

by those of us who loved him. 

Thank you. 

Ms. LOFGREN. Thank you very much, Ms. Danticat. 

[The prepared statement of Ms. Danticat follows:]

PREPARED STATEMENT OF EDWIDGE DANTICAT

Madame Chairwoman and Members of the Committee and Subcommittee: 

I thank you very for the opportunity to submit for the record this testimony concerning immigration detainees and medical care. 

I write today not in my own name, but in the name—and stead—of a loved one 

who died while in the custody of Department of Homeland Security and Immigration and Customs Enforcement officials, and the Krome Detention Center in Miami. 

His name was Joseph Nosius Dantica and he was 81 years old. He was the patriarch, the head, of our family. He was a father of two and grandfather of fifteen, 

an uncle to nearly two dozen of us, a brother, a friend, and even, after having survived throat cancer, which took away his voice, a minister to a small flock in Portau-Prince, Haiti. He had been living in the same impoverished neighborhood in 

Haiti for more than fifty years when on October 24, 2004, United Nations troops 

and Haitian police forces launched a military operation there. Their goal was to oust 

46

armed neighborhood gangs. However, during the clash that followed, they used the 

roof of his church to fire at and kill more than a dozen of his neighbors. After these 

forces left the neighborhood, because the shots had been fired from his roof, gang 

members came to my uncle’s home and threatened to kill him. He was able to flee 

and eventually travel to the United States, where he has been a frequent visitor 

for more than 30 years. He had with him a passport and a valid multiple-entry visa, 

which would have expired in 2008. However because he requested what he termed 

‘‘temporary’’ asylum, he was immediately arrested and taken to the Krome Detention Center in Miami, where the medications he was taking for his high blood pressure and inflamed prostate were taken away from him. He made this known as 

much as he could, to his son, to his lawyer, and to me on the phone, and to the 

medical staff at Krome where he was held in the short stay medical unit. However 

his pleas were ignored by those who had taken his medication away. 

On the morning of his credible fear hearing, my uncle became ill as a result of 

this. To those who saw him, including his lawyer, he appeared to be having a seizure and he began to vomit. Vomit shot out of his mouth, his nose, as well as the 

tracheotomy hole he had in his neck as a result of the throat cancer operation. The 

vomit was spread all over his face, from his forehead to his chin, down to the front 

of his dark blue Krome issued overall. 

According to a report prepared by the Office of the Inspector General of the Department of Homeland Security, fifteen minutes passed before help arrived. When 

a medic and nurse arrived at the scene, the medic accused my uncle of faking his 

illness. To prove his point, the medic grabbed my uncle’s head and moved it up and 

down. It was rigid rather than limp, he said. Besides, my uncle would open his eyes 

now and then and seemed to be looking at him. 

‘‘You can’t fake vomit,’’ my uncle’s lawyer, John Pratt shot back. ‘‘This man is very 

sick and his medication shouldn’t have been taken away from him.’’

The medications were indeed taken away, replied the medic, in accordance with 

the facility’s regulations, and substituted with others. 

Later that morning, my uncle’s condition worsened and with manacles on his ankles, he was transported to Miami’s Jackson Memorial Hospital. My uncle’s medical 

records from Krome and from Jackson Memorial Hospital indicate that he arrived 

in the emergency room at Jackson Memorial Hospital around 1:00 PM with an intravenous drip in progress from Krome. He was evaluated by a nurse practitioner 

at 1:10 PM. 

At 4:00 PM, during a more thorough evaluation by the nurse practitioner, he complained of acute abdominal pain, nausea and loss of appetite. At 5 PM, he was 

transferred to the hospital’s prison area, Ward D. The records indicate that he was 

seen for the first time by a physician at 1:00 PM the next day, exactly twenty-four 

hours after he’d been brought to the emergency room. At 7:00 PM, after more than 

twenty hours of no food and sugarless IV fluids, my uncle was sweating profusely 

and complained of weakness. He was found to be hypoglycemic, with a lower than 

normal sugar level of 42 mg/dl. At 7:55 PM, his heart rate rose to 110 beats per 

minute. An electrocardiogram (EKG) was performed at 8:16 PM. The next note on 

the chart shows that he was found pulse-less and unresponsive by an immigration 

guard at 8:30 PM. He was pronounced dead at 8:46 PM. 

There are certainly many heartbreaking elements to my uncle’s death. However, 

there are certainly moments where the medical system in detention failed him. First 

of all, the fact that his medication, which he had been taking for many years in a 

careful balance that took into consideration his high blood pressure and his status 

as a cancer survivor, had been taken away was one. Secondly the fact that he had 

not been taken seriously when he fell ill during the credible fear hearing, had been 

accused of faking his illness, was another. The lack of instant and serious response 

to his becoming ill at the credible fear hearing implied that his symptoms might 

also not have been taken seriously elsewhere away from the view of others. Furthermore, the fact that he was not seen by a physician soon after he was brought to 

the emergency room by Krome officials was also part of his continually sub par medical attention. Also the fact that he was not permitted by Homeland Security and 

Krome officials to see loved ones, who also wanted to see him, during his final hours 

must have left him feeling less than human, at best. 

After my uncle died, the Department of Homeland Security simply gave my family 

a corpse and a cause of death-acute and chronic pancreatitis—which he’d never 

shown any symptoms of before he became ill at Krome and for which he was never 

screened, tested, diagnosed, or treated while he was at the Krome medical unit or 

at Jackson Memorial Hospital. We were given no further explanations or clarification concerning his last days. In order to receive his medical records, with the help 

of the Florida Immigrant Advocacy Center, we had to file Freedom of Information 

Act requests as well as a lawsuit. From the perspective of a family member, this 

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is a nightmare. Not only did we tragically lose our loved one, but we had to fight 

a huge bureaucracy to find out what happened to them. 

Recently in an article entitled ‘‘New Scrutiny as Immigrants Die in Custody,’’ 

Nina Bernstein, a New York Times reporter, quoted Jamie Zuieback, a spokeswoman for The Department of Homeland Security, as saying that ‘‘Anybody who violates our national immigration law is going to get the same treatment by I.C.E. regardless of their medical condition.’’ First of all, my uncle and many of the others 

who have died, and are dying in the custody of the Department of Homeland Security and I.C.E officials did not violate any immigration laws. All many of them have 

done, was request asylum, which is an internationally acknowledged human right. 

Furthermore, if this, as stated by Ms. Zuieback to the New York Times, is the general attitude of and implied policy of Department of Homeland Security and I.C.E 

officials—to criminalize the right of a person to seek asylum and then see the lack 

of medical attention and care given to them as part of the punishment—then more 

people will continue to die in their care. 

During our efforts to see my uncle in his last days, we were consistently told that 

Department of Homeland Security Officials, I.C.E and Krome officials had the right 

to make decisions in his medical care. In that type of situation, this can mean that 

they literarily have our loved ones’ lives in their hands. Therefore, if our loved ones 

are sick, they should be treated. If they need emergency care, they should get it. 

They are called detainees, but really they are prisoners. As family members we 

quickly learn that. But even prisoners deserve to be treated fairly and decently and 

humanely. This is what we consistently tell jailers of other countries. How about 

we practice some of it here ourselves? 

Immigration detention is one of the fastest growing forms of incarceration in the 

United States. Deaths in custody will only increase if we neglect to care for people 

who are withering away and dying unheard and neglected. People like my uncle 

who was not just Alien #27041999, but a father, a grandfather, a brother, and uncle, 

a friend, a clergyman, who was extraordinarily loved and greatly treasured and is 

missed every single day by those who loved him very very much.

Ms. LOFGREN. Ms. Everett, are you able to proceed now? 

TESTIMONY OF JUNE EVERETT, SISTER OF SANDRA KENLEY, 

DECEASED DETAINEE 

Ms. EVERETT. I have to. 

I would like to thank Congresswoman Lofgren and all of the 

Members of the Subcommittee for inviting me to speak today. 

My name is June Everett. My sister is Sandra Marina Kenley. 

To find out after reading the papers recently that more than 62 immigrants have died and continue to die while in U.S. custody since 

about the time of my sister’s death is shocking and disheartening. 

My sister was one of those immigrants who died in jail on the 

ICE supervision. I cannot tell you the stories of all of these other 

deceased immigrants, but I can tell you my sister’s story. 

Sandy came to America when she was 20 years old and lived 

here for nearly 33 years. 

My sister was not illegal but a legal permanent resident. She 

was not a terrorist. She was a human being, one that made mistakes like all of us. She was a—she was human enough to turn her 

life around and to pursue her dreams. She became a nurse, had 

just bought a new car and took custody over her granddaughter. 

My sister worked in this country for at least 25 years before becoming disabled. 

In 2005, Sandie visited Barbados to show off her granddaughter, 

over whom she had custody. When she returned to this country, 

she was stopped by an ICE officer and asked to report to the immigration office for questions. When she did, Sandie was asked to return without her granddaughter. When she returned a few weeks 

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later, she again brought her granddaughter. She was the child’s 

sole custodian. 

The officer sent her away and told her to return without her 

granddaughter. My sister again reported to the authorities for 

questioning, as requested. Three times she went to Dulles airport 

to answer immigration questions. This time she did not return. 

Her son, who is here today, and I were with her the day she was 

taken into custody. Sandie was detained for an old misdemeanor 

drug charge for which she hadn’t even served any jail time. She 

also had already fulfilled the court’s requirement for that charge. 

She completed her probation early and never went back on drugs. 

At the airport, we told the ICE officer of my sister’s medical condition. She was disabled. She had a bleeding fibroid that needed 

surgery. She had a date set for that surgery. She had high blood 

pressure and high cholesterol and took medication for those conditions. Despite all of this, ICE determined that she needed to be detained. 

Sandie wasn’t a threat to anyone, and she was not a flight risk, 

proving that going back three times. She had her whole family in 

this country and had just shown up for questions three times. 

Sandie was taken to the Pamunkey Regional Jail in Virginia. I 

know she complained constantly about not getting her medicine. 

When the prison officer finally gave her her pills after many weeks, 

they were the wrong ones, not the ones we had given the ICE official that day at Dulles airport. 

Those pills made her very sick. She was hemorrhaging nonstop. 

Blood pouring down her legs and spilling on the floor of her cell. 

My sister was scared and suffering unnecessarily. My sister did everything she could to get help, but no one would do anything. Then, 

on December 18, 2005, I received a call saying my sister had died 

in jail. 

I have so many questions about Sandie’s death, and ICE has 

made it so very difficult for me to learn what happened. There 

needs to be some transparency, some oversight, and ultimately 

some accountability. 

Sandie died trying to do the right thing. She died because the 

American system failed her—a system we believed in, a system 

that needs fixing before more lives are lost unnecessarily. What am 

I supposed to tell my grandniece, Nakita, about her grandmother’s 

death? What am I supposed to tell Nakita about American principles? 

I am here because I believe that what happened to my sister 

ought not happen to anyone else. I urge you to conduct the necessary oversight over my sister’s tragic and preventible death and 

fix the problem of inadequate medical care in immigration detention centers that has resulted in too many avoidable deaths. 

Sandie’s death was one that was avoidable from the onset. 

I thank you for your time. 

Ms. LOFGREN. Thank you, Ms. Everett. 

[The prepared statement of Ms. Everett follows:]

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PREPARED STATEMENT OF JUNE EVERETT


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Ms. LOFGREN. Mr. Jawetz. 

TESTIMONY OF TOM JAWETZ, IMMIGRATION DETENTION 

STAFF ATTORNEY, ACLU NATIONAL PRISON PROJECT 

Mr. JAWETZ. My name is Tom Jawetz. I am the immigration detention staff attorney for the National Prison Project of the American Civil Liberties Union. 

The ACLU is currently involved in a class action lawsuit regarding inadequate medical care for immigration detainees at the San 

Diego Correctional Facility. I would like to thank Chairwoman 

Lofgren and Members of the Subcommittee for inviting me here 

today to speak about a serious and growing problem in immigration detention—horribly inadequate medical care that leads to unnecessary suffering and death. 

This issue lies at the center of one of our country’s most basic 

principles: that everyone is entitled to fair and humane treatment. 

Today, the ACLU requests that this Committee do the following 

four things: 

One, eliminate the procedural hurdles that prevent on-site, treating clinicians from providing necessary medical care to detained 

immigrants; 

Two, fix the serious substantive deficiencies in the DIHS Covered 

Services Package to ensure that detainees receive adequate and appropriate medical care; 

Three, require immigration authorities to publicly report every 

death; and 

Four, codify improved and binding detention standards, including 

legislation prohibiting retaliatory transfers of detainees who complain about poor medical care and conditions of confinement. 

ICE detains nearly 300,000 people each year; approximately onequarter are identified as suffering from some chronic health condition. Detainees are scattered across the country in hundreds of 

county jails and in a handful of facilities run by ICE or private 

prison companies. Some are detained for weeks, many are detained 

for months or years. 

Recent reports from the DHS Office of Inspector General and the 

Government Accountability Office confirm that there are nationwide problems with medical care and detention. The policies that 

were testified to today are not being followed, and these reports 

demonstrate that. 

The system for providing necessary medical care suffers from 

several fatal flaws: 

First, detainees may not receive specialty services such as a biopsy or an MRI unless on-site medical personnel obtain authorization from off-site managed care coordinators with the Division of 

Immigration Health Services in Washington, D.C. This results in 

unreasonable delays in medical care and unjustifiable refusals to 

provide authorization. 

My statement is based not only on my experience and the experience of the ACLU with our clients, but also on the criticisms of jail 

officials whose hands are often tied by the DIHS bureaucracy. In 

York County, Pennsylvania, where detainees have been housed for 

years, the deputy warden wrote in a letter to a local ICE officer 

that DIHS had, quote, ‘‘set up an elaborate system that is priVerDate 0ct 09 2002 12:47 Dec 17, 2007 Jkt 000000 PO 00000 Frm 00057 Fmt 6633 Sfmt 6601 H:\WORK\IMMIG\100407\38115.000 HJUD1 PsN: 38115
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marily interested in delaying and or denying medical care to detainees. There is nothing easy about working with DIHS. If something can be delayed, it is delayed. If it can be denied, it is denied. 

If something can be made difficult, it is made difficult.’’

Second, the treatment authorization decisions made by those 

managed care coordinators, who are the nurses, not doctors—and 

there are three of them in D.C. for the entire country—are made 

in accordance with deeply flawed policies. Those policies emphasize 

that detainees primarily receive emergency care only literally when 

life or limb is at stake. This policy is blatantly inconsistent with 

established principles of constitutional law and basic notions of decency. 

The terrible consequence of poor medical care for ICE detainees 

is that it can result in death. Recently, ICE revealed that 62 people 

have died in their custody since 2004. Since that announcement, at 

least three other detainees have died. 

In their written testimony, they say 62 and in—64, rather; 64, 

I think it is; in the oral testimony today it was 66. I don’t really 

know what the right answer is, what the right number is. 

Since that announcement, at least three others have died. Some 

of these deaths were undoubtedly the result of poor health care, yet 

ICE appears to have no legal obligation to publicly report deaths 

that take place in their custody and concedes that not every in-custody death is investigated. 

Congress must rectify this problem to ensure some amount of 

transparency and accountability. 

Two and a half months ago, Victoria Arellano passed away after 

spending 8 weeks in detention. Ms. Arellano was a transgender, 

HIV-positive detainee who, by all appearances, had her disease 

well under control before she entered ICE custody. 

In detention, she was taken off of the HIV medication she required to fend off opportunistic infections and her health quickly 

began to deteriorate. She developed a high fever, complained of severe pain, nausea, stomach cramps, and began vomiting blood and 

suffering from diarrhea. Nevertheless, it was fellow detainees and 

not qualified medical personnel who took care of her in the weeks 

preceding her death. 

After Ms. Arellano’s death became public, detainees quoted in 

the press about her lack of care were transferred to facilities across 

the country, as far as away as Texas. Such transfers have taken 

place following other deaths. They appear retaliatory, they hinder 

investigations, and they intimidate other detainees into silence. 

The ACLU has called on the Department of Homeland Security 

Office of Inspector General to investigate Ms. Arellano’s death and 

the suspicious transfer of these detainees. 

Congress ought to pass legislation requiring the detainees receive 

adequate treatment. This grossly deficient care is inexcusable and 

immoral, but is often common and often unchecked. While ICE has 

issued standards for the treatment of detainees, they are not enforceable regulations. Comprehensive immigration reform may 

have stalled in the Senate, but Congress cannot remain idle while 

innocent people detained by the Federal Government continue to 

suffer unnecessary pain and death. 

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I applaud the efforts of the Chairwoman and Members of the 

Subcommittee to perform the oversight that the executives is either 

unable or unwilling to perform, and I urge this Committee to reform a broken health care delivery system that allows people to 

die. 

Congress should fix the procedural and substantive barriers that 

now prevent detainees from receiving adequate care, and require 

immigration authorities to publicly report every detainee death. 

Congress should also pass legislation to codify and improve binding 

immigration detention standards. 

On behalf of the ACLU, I would like to thank the Subcommittee 

for taking the time to explore this important issue, and I look forward to the opportunity to answer your questions. 

Ms. LOFGREN. Thank you very much. 

[The prepared statement of Mr. Jawetz follows:]

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PREPARED STATEMENT OF TOM JAWETZ


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Ms. LOFGREN. Doctor. 

TESTIMONY OF ALLEN S. KELLER, M.D., ASSOCIATE PROFESSOR OF MEDICINE, NEW YORK UNIVERSITY SCHOOL OF 

MEDICINE 

Dr. KELLER. Thank you for the opportunity to testify here today. 

I am here on behalf of the Bellevue/NYU Program for Survivors 

of Torture and Physicians for Human Rights. I am here as a physician who has cared for many immigrants and refugees, including 

many who have been in immigration detention. I am also here as 

a scientist who conducted a study looking at the health of asylum 

seekers in immigration detention. 

In this study, done in June 2003, more than 4 years ago—that 

is when it was released—we documented high levels of psychological distress that worsened the longer that individuals were in 

detention. We also documented inadequate access to mental health 

services as well as inadequate medical and dental services. 

Unfortunately, recent reports demonstrate that the problems we 

identified more than 4 years ago remain uncorrected; and I think 

it is crucial to remember there is a lot more to suffering and morbidity than death. Clearly, that is an important thing to look at, 

but there is a lot more to the picture. 

It is important to remember that like other immigration detainees, asylum seekers are civil detainees, not criminal detainees; and 

repeatedly we heard from the individuals we interviewed that 

never did they think when they came to this country, seeking safety and to build a better life, that they would be treated like criminals, placed in facilities such as the Elizabeth Detention Center, a 

windowless converted warehouse. And these harsh prison conditions were confirmed in a study we conducted with the U.S. Commission on International Religious Freedom for which I serve as an 

expert. 

Access to mental health services was woefully lacking. Furthermore, there were clear disincentives for individuals to report depressive symptoms such as suicidal thoughts because detainees believed, and rightfully so, that if they did, they would be held in solitary confinement if they informed their jailers of these thoughts; 

and this issue remains a concern today. 

In addition to inadequate mental health services, more than half 

of the individuals we interviewed reported having serious health 

problems for which they had significant difficulty accessing medical 

care. 

Many detainees complained of difficulty obtaining specialized 

care, including for chronic conditions. This raises important questions about what care is appropriate and what can reasonably be 

delayed. 

The fundamental problem that we saw appears to persist today, 

and the health care provided in these facilities that we found then, 

and now, seems at best a short-term, stopgap ‘‘jail mentality’’; that 

is, medical care seems based on the assumption that the patients 

will be detained for only a few days or weeks while, in fact, many 

of the individuals we interviewed are detained for much longer. In 

fact, it would seem that this is going to worsen, given that the 

trend seems to be to detain more individuals rather than fewer. 

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In the individuals that we interviewed, for example, one detainee 

who told us that he was shot in the groin while attending a peaceful demonstration, while in detention his groin pain worsened, he 

was told that he would have to wait until he was out of detention 

to get that bullet removed. He remained in detention for 21⁄2 years. 

Numerous individuals we talked to describe pain and suffering 

from dental problems that went unaddressed for months, if not 

years. 

One recent case that I reviewed highlights a number of the problems regarding poor health care—including both medical and psychiatric—involves a woman I will refer to as LC who was from an 

African country where she suffered repeated trauma, she suffered 

female genital mutilation, she was raped, she witnessed the murder of several family members. She fled to this country seeking 

safety. She was imprisoned and recently granted asylum, but she 

was imprisoned for approximately 6 months. Not surprisingly, 

when she arrived in this country she was exhausted, and when she 

learned she was going to be detained she panicked and she subsequently collapsed. At the detention center, she was misdiagnosed 

as being psychotic. And it should be clear that at that evaluation 

and as best I could tell from the medical records, these evaluations 

were done without the use of interpreters, although this woman 

spoke barely any English. 

She was put on a medication Risperdal, an antipsychotic. She 

had profound significant side effects including lethargy, confusion, 

and also lactation—production of breast milk. And despite these 

symptoms, her medications were increased. Finally, she refused to 

take them and her symptoms improved. Later on when she had severe abdominal pain, she went weeks without proper evaluation, 

and it was only when her lawyers filed a habeas corpus case that 

she received medical care. And even then, she wasn’t informed of 

what care she received. 

So clearly the problems with health care and immigration which 

have received recent attention are not new. Many of the problems 

described, including difficulties and delays, were ones we identified 

4 years ago. Congress must do its job of overseeing immigration detention and providing this critical oversight. 

It is also essential that there be humane alternatives to detention whenever possible. This, in addition to being morally the right 

thing to do, is cost effective. Health problems for immigrant detainees need to be adequately addressed from a health perspective, including the pain and suffering and potential morbidity of the individual, as well as from a medical ethics perspective. It does not and 

should not matter whether a condition is preexisting or began during immigration detention. The individual is in Government custody, and with that comes the responsibility to provide appropriate 

and needed health services. Thank you. 

Ms. LOFGREN. Thank you very much, Dr. Keller. 

[The prepared statement of Dr. Keller follows:]

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PREPARED STATEMENT OF ALLEN S. KELLER


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Ms. LOFGREN. And, finally, Ms. Little. 

TESTIMONY OF CHERYL LITTLE, EXECUTIVE DIRECTOR, 

FLORIDA IMMIGRANT ADVOCACY CENTER 

Ms. LITTLE. Thank you so much. Good afternoon, and thank you 

for the opportunity to testify about an extremely important issue 

that, as we have just heard, profoundly affects the lives of so many 

people. 

As you mentioned, Congresswoman Lofgren, the Florida Immigrant Advocacy Center provides free legal services to immigrants 

of all nationalities, including many in Immigration and Customs 

Enforcement detention, ICE detention in Florida and elsewhere. 

Lack of access to adequate medical care is one of their chief complaints. Recent reports of more than 60 deaths in immigration detention since 2004 have shed new light on a system in crisis. FIAC 

is working to try to prevent further deaths, although at times this 

seems a difficult battle. Detainees report undue delays in obtaining 

proper medical care or outright denial of such care. Even emergency treatment is delayed or ignored. 

Recently, FIAC took the case of Yong Sun Harvill, a 51-year-old 

South Korean woman who has a history of cancerous tumor, chronic lymphedema, hepatitis C, liver disease, and mental health 

issues. Yong is currently detained at the Pinal County Jail in Florence, Arizona. There is no on-site physician there. In late September 2007, a board-certified hematologist, oncologist and internist, Dr. Gotardo Rodrigues, reviewed Yong’s medical records and, 

in a letter that has been forwarded to ICE, he concluded, and I am 

now quoting from the letter, ‘‘The consequences of continued, incomplete, and superficial care of Mrs. Harvill may include chronic 

infections, disability, recurrence and progression of tumors, deteriorating physical and mental health, and other complications that 

could even lead to her death.’’

This letter followed a similar letter written by Dr. Rodrigues on 

July 10, 2007 that was submitted to ICE. 

Yong has kept a journal since her transfer to a jail from South 

Florida to Arizona. On August 29, 2007 she wrote, ‘‘I’m afraid, because I have seen in the news how many people have died because 

they don’t get medical care. I don’t want to be the next one. They 

deny special tests that I need. I wish my judge can see how frightened I am. In the meantime, I can only pray to God to help me.’’

Another of FIAC’s clients had been diagnosed with cancer before 

he was detained at the Krome Detention Center in July 2006. Although a physician recommended that he urgently be referred for 

prostate surgery in October 2006, it was not until late December 

of that year, and after FIAC was preparing to sue, that he had surgery. 

Sometimes it practically takes an act of Congress for a detainee 

to receive medical attention. On March 8, 2002, one of FIAC’s clients who was detained at the Turner Guilford Knight Correctional 

Center in Miami was spitting up blood in the presence of an officer. 

Despite attempts by both the officer and FIAC staff to get the detainee appropriate medical care, this was not done until Congressman John Conyers visited the jail and insisted she be seen by a 

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doctor. That same day, she was taken to the hospital, 1 month and 

2 days after she began spitting blood. 

Women often do not receive regular gynecological and obstetric 

care. One woman who was detained at the Broward Transitional 

Center in Pompano Beach first brought her symptoms to the attention of the medical staff on December 18, 2003. Although she had 

the classic symptoms of an ectopic pregnancy, a painful and potentially fatal condition, her concerns were ignored. On several occasions she was simply given Tylenol and told her pain was normal. 

When she began to bleed profusely, the medical staff still did not 

take her complaint seriously. On January 4, 2004, when she was 

finally seen by a doctor, she was immediately taken to the hospital 

for surgery. 

Even children have been deprived of adequate medical care in 

ICE custody. On April 10, 2003, FIAC staff observed Lormise 

Guilaume carrying her 2-year-old son, Jordan, who was visibly ill. 

FIAC requested immediate assistance, and officers called 911. Jordan was rushed to the emergency room of a local hospital. His 

health had been deteriorating for some time and medical attention, 

repeatedly requested, was inexcusably delayed. A week before Jordan was rushed to the hospital, Lormise told FIAC, and I am 

quoting, ‘‘My son has been sick for weeks. The problem was that 

I don’t speak English and the doctor didn’t speak Creole. I never 

imagined the United States would treat us like this.’’

Edwidge Danticat testified earlier about the death of her uncle, 

Reverend Danticat, while in ICE custody. Danticat’s lawyers and 

family have serious questions about the adequacy of medical care 

provided him while in ICE custody, including at Jackson Memorial 

Hospital. FIAC also believes the investigation requested by Congressman Kendrick Meek and conducted by the Office of Inspector 

General into Reverend Danticat’s death was a whitewash, and we 

wrote a detailed letter of complaint requesting the OIG to reopen 

their investigation. They declined to do so. 

It can be extremely difficult for detainees to access their own 

medical records, and can even take months for FIAC or other lawyers to access records on their clients’ behalf. The process for requesting records is different at each facility where immigrants are 

detained, but is consistently riddled with bureaucratic red tape. 

With transfers of detainees from one facility to another becoming 

more and more routine, it can take months to gather a detainee’s 

medical records. When there is a death, such as in Reverend 

Danticat’s case, it is even more difficult to obtain medical records. 

FIAC had to sue in Federal court to get his records. The medical 

records we did obtain contained 31 redacted pages on the basis of 

privacy, despite the fact that the family had requested them. 

There is a serious lack of oversight regarding the adequacy of 

medical care provided ICE detainees. ICE standards adopted in 

2000 to ensure the safe and secure treatment of detainees in immigration custody are not binding, and routinely ignored. These 

standards must have teeth. And outside independent scrutiny of 

detainees’ medical care is necessary to ensure that DHS carries out 

its moral and legal responsibility to provide for the health and safety of detainees entrusted to its care. Given the dramatic increase 

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in the use of ICE detention, the need for proper scrutiny of medical 

care afforded detainees is more critical than ever. Thank you. 

Ms. LOFGREN. Thank you, Ms. Little. 

[The prepared statement of Ms. Little follows:]

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PREPARED STATEMENT OF CHERYL LITTLE


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Ms. LOFGREN. Thank you to all of the witnesses for your compelling testimony. I will just ask a handful of questions, if I could. 

Mr. Castaneda, an incredible story, and I do appreciate that you 

are here to change things for others and I honor you for that. As 

I was listening to your story of a situation that got worse and 

worse and worse, I was trying to put—how many months were you 

in custody? When you arrived, you had a problem and it got worse 

and worse. Over what period of time were you in custody? 

Mr. CASTANEDA. Over 10 months. 

Ms. LOFGREN. It was 10 months. In 10 months’ time, it wasn’t 

until you were so sick that they essentially threw you out. 

Mr. CASTANEDA. Until they saw I was bleeding and discharging 

and couldn’t stop bleeding, and that is when they released me. 

Ms. LOFGREN. Let me ask you, Ms. Danticat, a question. There 

are a lot of myths about immigration, but as you told your story 

of your uncle, he had a valid visitor’s visa to come into the United 

States, and he had been here before. I mean, why would an 81-

year-old Baptist minister who had a valid visa even be stopped? 

And how was he treated when he was stopped when he came into 

the United States just before the detention? Do we know about 

that? 

Ms. DANTICAT. Well, I think the people who detained him would 

have to answer the why. But as to how he was treated, when he 

made known his request for asylum he was taken into custody, he 

was interviewed, and then he was brought to the Krome Detention 

Center. 

Ms. LOFGREN. Ms. Everett, when your sister was at the airport, 

she already had the fibroid problem and she had scheduled surgery, in fact. Did she tell the ICE agents that she had surgery 

scheduled, do you know? 

Ms. EVERETT. Yes. And we also gave them copies of the appointment card for the people that she was seeing that were preparing 

her for that, in addition to the appointment card for her surgery. 

Ms. LOFGREN. And they simply just ignored it? 

Ms. EVERETT. Just ignored it completely. 

Ms. LOFGREN. Well, this is a little sideline. California State Prison System Health Care is now being run by Bob Sillen, the guy 

who used to be in charge for Santa Clara County Jails when I was 

on the board of supervisors. And this sounds like the sort of situation where either we get our act together, or some Federal judge 

is going to take somebody like Bob Sillen and say, You are in 

charge now. And I think those are the two choices. Certainly, we 

want to get to the bottom of whether there are things that have 

not been reported. But, obviously, Mr. Castaneda has suffered a 

tremendous amount and he would not show up in a statistic. 

And so I think the suggestions made, Mr. Jawetz, are excellent 

ones. 

Certainly, Ms. Little, the need to make mandatory changes, not 

just advisory, are obviously important. 

And, Dr. Keller, your testimony particularly, I have always 

thought it was a mistake—and I didn’t vote for it when we changed 

the rules—that the default is that someone seeking freedom in the 

U.S. is incarcerated. 

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You know, our policy is that we are the beacon of hope and freedom in the world, and that those people who are fleeing from oppression, from communism can come to this free place and breathe 

free air. And now our policy is: and then go to jail. So certainly 

there need to be rules in place so that you have people who show 

up, who aren’t gaming the system. That has happened in some 

cases. But it is not necessary to incarcerate people in every case. 

And certainly people who have been traumatized and abused are 

not going to do well in a custodial setting many, many times. 

So I would just like to say that this is, I think, one of the most 

important hearings that I have had an opportunity to participate 

in, in the 13 years that I have been in Congress, and I hope that 

it will be the first step in making necessary changes. 

And I appreciate all of you, especially those who have lost a loved 

one, for sharing a very painful part of your life in an effort to set 

things right. And I can’t promise success, but I can promise efforts 

that are equal to the sacrifice you have made to be here and to 

share your thoughts. 

So, with that, thank you, on behalf of the Subcommittee, and this 

hearing is adjourned. 

[Whereupon, at 4:23 p.m., the Subcommittee was adjourned.] 

(119)

A P P E N D I X 

MATERIAL SUBMITTED FOR THE HEARING RECORD

PREPARED STATEMENT OF THE HONORABLE ZOE LOFGREN, A REPRESENTATIVE IN

CONGRESS FROM THE STATE OF CALIFORNIA, AND CHAIRWOMAN, SUBCOMMITTEE ON

IMMIGRATION, CITIZENSHIP, REFUGEES, BORDER SECURITY, AND INTERNATIONAL

LAW

I would like to welcome the Immigration Subcommittee Members, our witnesses, 

and members of the public to the Subcommittee’s hearing on immigration detainee 

medical care. 

According to the General Accounting Office (GAO), nearly 300,000 men, women, 

and children were detained by Immigration and Customs Enforcement (ICE) in 

2006, triple the amount in 2001 when less than 100,000 were detained. 

With the large increase of detainees in ICE custody, it is incumbent upon this 

Congress to ensure that ICE is properly executing its responsibility of providing safe 

and humane treatment of detainees in their custody. 

Recent reports suggest that ICE is not doing its job. 

In just the last few months, there have been several reports of individuals detained by ICE that suggest unsafe and inhumane treatment in ICE or contracted 

detention facilities. For example, the Boston Globe recently reported the case of a 

man who died in ICE custody due to epilepsy complications, despite the fact that 

his sister twice attempted to provide necessary medication to detention officials, according to his family. His sister says she was turned away both times. Another reported case involves Victoria Arellano who was taken off HIV drugs while in custody 

and subsequently died after serious complications and lack of appropriate medical 

care for several months. Reports indicate that fellow inmates tended to as much 

care as they could possibly provide on their own and repeatedly informed detention 

officials of Arellano’s illness. 

These and other cases have spawned questions from several Members of Congress, but so far, few answers have been provided. 

There are two critical questions I hope we can address today. First, are the medical care standards employed by ICE satisfactory so as to create an environment 

that supports safe and humaen treatment of individuals in ICE custody? Second, if 

those standards are adequate, are they being implemented in an appropriate manner? 

After a preliminary review of the standards and the various reports on the administration of medical care, it appears we have problems on both levels. 

The DIHS Medical Dental Detainee Covered Services Package specifically states 

that medical care in ICE detention facilities is to be provided primarily for emergency care. Care for ‘‘[ac]cidental or traumatic injuries incurred while in the custody 

. . . and acute illnesses’’ is not required, but simply ‘‘reviewed for appropriate care.’’ 

Care for other illnesses, including pre-existing illnesses that are serious but not lifethreatening, is also not automatic, but simply reviewable for appropriate care. Furthermore, these reviews are conducted in Washington, D.C. by nurses, not physicians, who are away from the patient and simply reviewing paperwork submitted 

by other health care professionals recommending such care. 

With this policy, it is no wonder there are reports of unsafe and inhumane medical treatment in ICE custody. This policy fails to recognize a fundamental principle 

of medical care in detention—the patient is detained and there is no other option 

but care authorized by ICE. Yet, the policy only insures emergency care and considers other care, even in serious cases, on a case-by-case basis. 

I hope that today’s hearing will help us further understand and clarify the problems that exist in providing medical care to those in ICE custody so that we may 

begin to find solutions to what appears to be a very serious problem.

120

PREPARED STATEMENT OF THE HONORABLE JOHN CONYERS, JR., A REPRESENTATIVE

IN CONGRESS FROM THE STATE OF MICHIGAN, AND CHAIRMAN, COMMITTEE ON THE

JUDICIARY

I have read reports collected regarding medial care provided to individuals in ICE 

custody and, frankly, I am very concerned. 

There is the case of Reverand Joseph Nosius Dantica, a courageous man who 

was a minister for decades in Port-a-Prince, Haiti. After watching his neighbors get 

killed and gang members threatening his life, Rev. Dantica, at the age of 81 and 

after 50 years of service to his community, fled Haiti to seek safe haven in the United 

States where he was a frequent visitor for 30 years. When he arrived in the United 

States, he had a valid passport and visa, but decided that this time he would need 

to seek asylum. He was immediately arrested and detained and his heart medication 

was confiscated. He tried and tried to let as many people know about his need for 

medication to no avail. The problems that followed are more than gruesome. 15 minutes went by before medical care was provided when Rev. Dantica appeared to be 

having a seizure and vomited. A nurse accused him of faking his illness and there 

was inadequate care at a hospital hours later. With this lack of medical attention, 

it wasn’t long before Rev. Dantica passed away. 

Then there’s the case of Mr. Abdoullai Sall, who, I am told, also died in detention after being denied necessary medication despite several requests by him and his 

attorney. Mr. Sall eventually collapsed and died in detention without ever receiving 

his medication. I am told that efforts to investigate the case by the ACLU have been 

stymied by DHS. 

There’s the case of Victoria Arellano, a transgender, HIV-positive individual 

who was held in ICE custody for two months without medication she was taking 

prior to detention. Weeks before her death, medical staff told her that her T cells were 

down and simply prescribed an antibiotic, a drug that doctors say is not the choice 

for HIV patients. I am told that over the next few days, Arellano began vomiting 

blood and suffering from diarrhea and fellow detainees took care of her. They lodged 

numerous complaints about the lack of medical care, and ultimately began chanting 

‘‘hospital’’ until she was finally taken to the hospital, where she died on July 20, 

2007. Again I am told that DHS has stymied efforts to get answers on this case, including the transfer of two detainees who spoke to the press about also being denied 

access to their own HIV medications. 

Sadly, the list of horror stories goes on. I want answers to these horrendous cases. 

How is this possible in American detention centers and what can we do to prevent 

this? 

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RESPONSES TO POST-HEARING QUESTIONS FROM U.S. IMMIGRATION AND CUSTOMS

ENFORCEMENT


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Æ


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