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42–722 PDF 2008

PROBLEMS WITH 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 

SECOND SESSION 

JUNE 4, 2008 

Serial No. 110–117 

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. ‘‘BOBBY’’ 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 

SEAN MCLAUGHLIN, Minority Chief of Staff and General 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 

JUNE 4, 2008 

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 ........................................... 4 

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

State of Michigan, and Chairman, Committee on the Judiciary ..................... 6 

The Honorable Lamar Smith, a Representative in Congress from the State 

of Texas, and Ranking Member, Committee on the Judiciary ......................... 8 

WITNESSES 

Ms. Julie Myers, Assistant Secretary, Immigration and Customs Enforcement 

(ICE), U.S. Department of Homeland Security 

Oral Testimony ..................................................................................................... 12 

Prepared Statement ............................................................................................. 15 

Mr. Philip Farabaugh, Acting Director, Division of Immigration Health Services, Immigration and Customs Enforcement (ICE), U.S. Department of 

Homeland Security 

Oral Testimony ..................................................................................................... 25 

Prepared Statement ............................................................................................. 27 

Mr. Richard M. Stana, Director, Homeland Security and Justice Issues, Government Accountability Office 

Oral Testimony ..................................................................................................... 32 

Prepared Statement ............................................................................................. 34 

Mr. Isaac Reyes, Washington Representative, U.S./Mexico Border Counties 

Coalition 

Oral Testimony ..................................................................................................... 62 

Prepared Statement ............................................................................................. 64 

Mr. Edward Harrison, President, National Commission on Correctional 

Health Care 

Oral Testimony ..................................................................................................... 66 

Prepared Statement ............................................................................................. 69 

The Reverend E. Roy Riley, Bishop of the New Jersey Synod, Evangelical 

Lutheran Church in America 

Oral Testimony ..................................................................................................... 72 

Prepared Statement ............................................................................................. 76 

Ms. Gloria Armendariz, Wife of Isaias Vasquez, former detainee 

Oral Testimony ..................................................................................................... 83 

Prepared Statement ............................................................................................. 84 

Ms. Zena T. Asfaw, former detainee 

Oral Testimony ..................................................................................................... 85 

Prepared Statement ............................................................................................. 87 

Ms. Mary Meg McCarthy, Director, National Immigrant Justice Center 

Oral Testimony ..................................................................................................... 88 

Prepared Statement ............................................................................................. 90 

Page

IV 

Ms. Ann Schofield Baker, Partner, McKool Smith, and Attorney for Amina 

Bookey Mudey, former detainee 

Oral Testimony ..................................................................................................... 97 

Prepared Statement ............................................................................................. 99 

Mr. Homer Venters, M.D., Attending Physician and Public Health Fellow, 

Bellevue/NYU Program for Survivors of Torture 

Oral Testimony ..................................................................................................... 141 

Prepared Statement ............................................................................................. 143 

LETTERS, STATEMENTS, ETC., SUBMITTED FOR THE HEARING 

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 ........................................................................................................................ 3 

Revised and Extended Remarks of 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 ................................................................................................ 6 

Prepared Statement of the Honorable John Conyers, Jr., a Representative 

in Congress from the State of Michigan, and Chairman, Committee on 

the Judiciary ......................................................................................................... 7 

Prepared Statement of the Honorable Lamar Smith, a Representative in 

Congress from the State of Texas, and Ranking Member, Committee on 

the Judiciary ......................................................................................................... 9 

Prepared Statement of the Honorable Sheila Jackson Lee, a Representative 

in Congress from the State of Texas, and Member, Subcommittee on Immigration, Citizenship, Refugees, Border Security, and International Law ....... 10 

APPENDIX 

Material Submitted for the Hearing Record .......................................................... 161 

(1) 

PROBLEMS WITH IMMIGRATION DETAINEE 

MEDICAL CARE 

WEDNESDAY, JUNE 4, 2008 

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 2:05 p.m., in Room 

2141, Rayburn House Office Building, the Honorable Zoe Lofgren 

(Chairwoman of the Subcommittee) presiding. 

Present: Representatives Lofgren, Conyers, Gutierrez, Waters, 

Sa ́nchez, Davis, Ellison, King, Goodlatte, and Lungren. 

Also Present: Representative Smith. 

Staff Present: David Shahoulian, Majority Counsel; Andre ́s Jimenez, Majority Professional Staff Member; George Fishman, Minority Counsel. 

Ms. LOFGREN. This hearing of the Subcommittee on Immigration, 

Citizenship, Refugees, Border Security, and International Law will 

come to order. 

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

hearing at any time. 

I would like to welcome the Subcommittee Members, our witnesses, and members of the public to the Subcommittee’s hearing 

on problems with immigration detainee medical care. This Committee held a hearing on this subject on October 4, exactly 8 

months ago. At that hearing we examined serious concerns with 

the provision of medical care at immigration detention facilities 

across the country. News reports of deaths and the deficient care 

that may have led to those deaths triggered that hearing. Unfortunately, here we are again. 

As was the case 8 months ago, a string of recent news reports 

has severely shaken our confidence in the health care system used 

by ICE. The reports recount story after story of detainees who received inadequate care or no care at all, and they speak of suffering 

and death. 

But this time those stories are not just reports; The Washington 

Post and 60 Minutes support those stories with internal Government documents and what appear to be many interviews with Government whistleblowers who have uncovered severe problems and 

desperately want to see them fixed. Some of the witnesses today 

will deny that these problems exist, but I believe these claims are 

2 

belied by Government officials who have reached out to the press 

and to us and by the documents that support their claims. 

The efforts of those whistleblowers tell me something, that there 

are people within our Government who really care about the medical and mental health care provided at ICE facilities. But their 

stories and documents also say something else: That their pleas 

and warnings have gone largely unheeded for far too long. 

Documents tell us that employees widely complained of severe 

staffing shortages of medical personnel. ICE tells us they are addressing these shortages now, but the documents indicate they ignored these warnings for years, failing to adequately address these 

shortages even as they ramped up enforcement and brought detention beds on line. 

Documents tell us that employees complained of certain policies 

that appear to be in violation of ICE’s detention standards. For 

some time at the San Pedro facility, for example, the clinical director prohibited medical staff from doing any lab work for detainees 

no matter what their condition until they had been detained for 

more than 30 days. As indicated by an internal DHS document, 

this policy may have played a role in the death of a detainee with 

HIV who was denied medication during her first month in detention. 

Documents show that ICE’s policy may be designed to deny care 

and save money rather than to provide care and save lives. Last 

October, Francisco Castaneda testified before our Committee concerning the medical care he received, or I should say failed to receive, during his detention. He is now dead. A quick review of his 

medical records shows that several on-site physicians recommended 

biopsy to rule out cancer, but it also shows that these requests 

were repeatedly denied over a 10-month period by managed care 

coordinators here in D.C. 

Some might say this is just one case and does not signify anything. I disagree. When several doctors say that someone needs a 

simple biopsy, but this is denied not once, not twice, but repeatedly 

over 10 months by off-site bureaucrats, something is fundamentally 

wrong. No matter how it happened, there is no question that the 

system failed Mr. Castaneda over and over again. He paid with his 

life, and now the Government is on the verge of paying millions in 

a lawsuit pursued by his family. 

In any event, that necessary treatment is repeatedly delayed or 

denied by ICE is supported by many other documents. There are 

letters and affidavits from prison wardens expressing profound exasperation with the denials of care. 

And one document, which I can’t even begin to reconcile with humane treatments, lists the amount of money ICE saved by denying 

requests for treatment. Such requests which were all submitted by 

on-site medical personnel were for such things as tuberculosis, 

pneumonia, bone fractures, head trauma, chest pain and other serious complaints. How an off-site bureaucrat can deny a request to 

treat tuberculosis or a bone fracture, I just don’t know, but the document makes it seem as if ICE is proud of that fact. 

Putting aside the inhumanity of denying necessary health care, 

the $1.3 million savings that ICE brags about in this document is 

3 

going to pale in comparison to the money that DHS will have to 

pay when courts begin to rule against it, as they already have. 

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. I hope 

that today’s hearing will help us begin to find solutions to what appears to be a very serious problem. 

[The prepared statement of Ms. Lofgren follows:] 

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

This committee already held a hearing on this subject on October 4, 2007—exactly 

8 months ago. At that hearing, we examined serious concerns with the provision of 

medical care at immigration detention facilities across the country. News reports of 

deaths—and the deficient care that may have led to those deaths—triggered that 

hearing. 

Unfortunately, here we are again. As was the case eight months ago, a string of 

recent news reports has severely shaken our confidence in the health care system 

used by ICE. The reports recount story after story of detainees who received inadequate care, or no care at all. And they speak of suffering and death. 

But this time, those stories are not just reports. The Washington Post and 60 

Minutes support their stories with internal government documents and what appear 

to be many interviews with government whistleblowers who have uncovered severe 

problems and desperately want to see them fixed. 

Some of the witnesses today will deny that these problems exist. But I believe 

these claims are belied by the numbers of government officials who have reached 

out to the press—and to us—and by the documents that support their claims. 

The efforts of those whistleblowers tell me something—that there are people within our government who really care about the medical and mental health care provided at ICE facilities. But their stories and documents also say something else— 

that their pleas and warnings have gone largely unheeded for far too long. 

Documents tell us that employees widely complained of severe staffing shortages 

of medical personnel. ICE tells us that they are addressing these shortages now. But 

the documents indicate they ignored these warnings for years, failing to adequately 

address such shortages even as they ramped up enforcement and brought detention 

beds on line. 

Documents tell us that employees complained of certain policies that appear to 

be in violation of ICE’s Detention Standards. For some time at the San Pedro facility, for example, the clinical director prohibited medical staff from doing any lab 

work for detainees—no matter what their condition—until they had been detained 

for more than 30 days. As indicated by an internal DIHS document, this policy may 

have played a role in the death of a detainee with HIV who was denied medication 

during her first month in detention. 

Documents show that ICE’s policies may be designed to deny care and save money 

rather than to provide care and save lives. Last October, Francisco Castaneda testified before our committee concerning the medical care he received, or failed to receive, during his detention. He is now dead. A quick review of his medical records 

shows that several on-site physicians recommended biopsy to rule out cancer. But 

it also shows that these requests were repeatedly denied, over a 10-month period, 

by managed care coordinators here in DC. 

Some might say that this is just one case and does not signify anything. I disagree. When several doctors say that someone needs a simple biopsy, but this is denied not once, not twice, but repeatedly over 10 months by off-site bureaucrats, 

something is fundamentally wrong. No matter how this happened, there is no question the system failed Mr. Castaneda over and over again. He paid with his life, 

and now the government is on the verge of paying millions in a lawsuit pursued 

by his family. 

In any event, that necessary treatment is repeatedly delayed or denied by ICE 

is supported by many other documents. There are letters and affidavits from prison 

wardens expressing profound exasperation with delays and denials of necessary 

care. And one document, which I can’t even begin to reconcile with humane treatment, lists the amount of money ICE saved by denying requests for treatment. Such 

requests, which were all submitted by on-site medical personnel, were for such 

4 

things as tuberculosis, pneumonia, bone fractures, head trauma, chest pain and 

other serious complaints. How an off-site bureaucrat can deny a request to treat tuberculosis or a bone fracture, I don’t know. But the document makes it seem as if 

ICE is proud of the fact. Putting aside the inhumanity of denying necessary health care, the $1.3 million 

savings ICE brags about in this document will pale in comparison to the money 

DHS will have to pay when courts begin to rule against it—as they already have. 

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. I hope that today’s hearing will help us begin to find solutions to what appears to be a very serious problem. 

Ms. LOFGREN. I now recognize our Ranking Minority Member 

Steve King for his opening statement. 

Mr. KING. Thank you, Madam Chair. 

This Subcommittee just had a hearing on the topic of immigration detainee medical care 8 months ago, and I am not sure that 

the recent media blitz alleging poor medical care in a few isolated 

instances warrants a second hearing. 

The risk of being murdered in some U.S. cities is higher than the 

risk of dying in an immigration detention facility. That means people on the streets of America are not as safe as some of the people 

that are incarcerated under ICE. For example—and these numbers 

are significantly lower than other data I have seen. For example, 

2005 FBI statistics show in the statistical metropolitan area encompassing the city of Houston, 712.6 residents per 100,000 were 

victims of violent crime, and 9.1 residents per 100,000 were murdered or victims of homicide. That is Houston. In Houston alone 

there are 334 people murdered on the streets. 

In the statistical metropolitan area including Los Angeles, 575.5 

per 100,000 were victims of violent crime; 8.8 out of every 100,000 

were victims of murder. In Los Angeles alone there were 489 people murdered in 2005. 

Some other examples would be the recent shootings in Washington, D.C. For example, my legislative counsel’s neighborhood 

had four murders in a single 24-hour period right in the same 

neighborhood. 

And in the Chicago shootings that we know about, 32 shootings 

over a weekend, at one time the death count was 6, and then it 

went to 12 or 13 in a single weekend. And we are here having a 

hearing about people incarcerated by ICE and getting medical care 

that is addressing their chronic illnesses as well that they come 

with. But during that same period of time, 2005, there were 6.8 

deaths per 100,000 immigration detainees, many of whom were 

unhealthy when they arrived, and that is in ICE facilities. The 

number has dropped in subsequent years, and the data is getting 

stronger. 

I would submit that the constituents of the Members of this 

Committee would be better served if our focus was on the high risk 

of being murdered and violently victimized on the streets of their 

own cities and own communities rather than focusing on a media 

event that doesn’t have the data to back up the necessity for this 

hearing. 

In any event, I am happy to use this opportunity to congratulate 

Ms. Myers for taking a lead role in reinvigorating ICE’s worksite 

enforcement efforts, and that includes Iowa, and I thank you. All 

of us concerned about the impact of illegal immigration on AmerVerDate Aug 31 2005 11:20 Oct 01, 2008 Jkt 000000 PO 00000 Frm 00008 Fmt 6633 Sfmt 6601 H:\WORK\IMMIG\060408\42722.000 HJUD1 PsN: 42722
5 

ican workers are grateful for your efforts. The death rate in our immigration detention facilities are low and dropping despite the fact 

that 25 percent of the detainee population already had a chronic 

illness such as hypertension, diabetes, tuberculosis, asthma, HIV/ 

AIDS and seizure disorders when they came into ICE custody because they come from places where they don’t get health care. That 

is why they are carrying chronic illnesses with them. This is the 

best and sometimes the first medical care that they have been exposed to in their lifetime. 

This is a fundamental difference between criminal incarceration 

and immigration detention. Prison inmates who have been sentenced to incarceration cannot choose when they are released. They 

are detained in order to provide punishment and rehabilitation to 

safeguard the community, and to deter other criminals. 

The medical care provided by the Bureau of Prisons ensures that 

inmates are not prevented from serving their full sentences, which 

average 9 years, because of illness. However, illegal immigrants 

and illegal aliens are in detention an average of only 371⁄2 days, 

and they hold the keys to their own cells because immigration detainees can simply agree to their own deportations. 

Why should the American taxpayer be liable for providing Rolls 

Royce-quality medical care for aliens who are doing everything in 

their power to stay detained and therefore avoid deportation? ICE 

should not have to make up for a lifetime of poor medical care during this brief period of detention. Once they enter the ICE detention system, most immigration detainees are getting by far the best 

medical care they have had in their entire lives. It has cost the 

Federal taxpayers more than $360 million to provide such care 

since ICE was created 5 years ago, $100 million in the last fiscal 

year alone. 

But let’s not forget that the full cost to American taxpayers for 

the health care of illegal immigrants is far more than the cost incurred by ICE detention. The majority of illegal aliens do not have 

health insurance. As a result, hospitals in the southwest border 

counties of Texas, New Mexico, Arizona and California alone incur 

a cost of $190 million for uncompensated emergency medical treatment to illegal aliens. 

The California Hospital Association worries that care for illegal 

aliens could tip some hospitals into bankruptcy; and, in fact, some 

have closed. The medical crisis caused by uninsured illegal immigrants clogging our emergency rooms and seeking free medical care 

is also compromising our citizens’ accessibility to emergency health 

care. On top of all of these costs, it appears that some want to give 

detained illegal immigrants a blank check written on the account 

of the American taxpayer. 

Legislation introduced by Chair Lofgren seems to require American taxpayers to pay medical bills for immigration detainees even 

after they have been released or removed to their home country. 

That is not the taxpayer’s responsibility. 

We need to make decisions in this Committee and in this Congress based upon data, not anecdotes, and to allege the inhumanity 

of denying necessary health care I don’t think can be substantiated, 

and I don’t agree with that statement, and I look forward to the 

6 

hearing. I look forward to the testimony of the witnesses. Thank 

you, Madam Chair. 

[The revised and extended remarks of Mr. King follows:] 

REVISED AND EXTENDED REMARKS OF 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

Replace this text: 

‘‘For example, 2005 FBI statistics show that in the statistical metropolitan area 

encompassing the city of Houston, 712.6 residents per 100,000 were victims of violent crime and 9.1 residents per 100,000 were murdered or victims of homicide. In 

the city of Houston alone, there were 334 people murdered in 2005. In the statistical 

metropolitan area including Los Angeles, 575.5 per 100,000 residents were victims 

of violent crime—with 8.8 per 100,000 murders and homicides. In Los Angeles 

alone, there were 489 people murdered in 2005.’’ 

With the following paragraphs: 

‘‘For example, 13 homicides took place during one week of March this year in our 

nation’s capitol, Washington DC. Not to be left behind, during a six-day period in 

April, Chicago suffered a shooting spree that left 12 dead. The 2005 U.S. Census 

Bureau statistics show that in Congressman Gutierrez’s city of Chicago, there were 

443 murders in 2005, or 15.6 deaths per 100,000. In the Chairman of the House 

Committee on the Judiciary John Conyers’ city of Detroit, Michigan 2,361 residents 

per 100,000 were victims of violent crime and there were 1,858 murders in 2005, 

or 41.4 deaths per 100,000. In Congresswomen Zoe Lofgren, Maxine Waters and 

Linda Sa ́nchez’ state of California, Los Angeles had 1,628 murders in 2005, or 12.6 

deaths per 100,000 and 821 per 100,000 residents were victims of violent crime. In 

Congresswoman Sheila Jackson Lee’s city of Houston, Texas 1,173 residents per 

100,000 were victims of violent crime and there were 860 murders, or 16.3 deaths 

per 100,000. 

While 15 detainees died while under ICE custody in 2005, and while the Members 

who represent the four cities I mentioned demanded we retreat from Iraq due to 

American loss of life, and while 676 brave American soldiers gave their lives in a 

just cause, 4,789 individuals were murdered on the streets of just four cities without 

a word of concern from the Members who represent many of the victims and their 

families. These statistics support the fact that residents of Chicago, Detroit, Los Angeles or Houston would be safer in an ICE detention facility than walking on the 

streets of these cities. Constituents of the Majority members of the House Judiciary 

Committee would be better served if our focus was on the high risk that they will 

be murdered or victimized by violent criminals in their own communities.’’ 

Ms. LOFGREN. I would just note that on the bill I have introduced, it does not require provision of care after release, but I 

would be happy to discuss that off agenda. 

I would now recognize the Chairman of the full Committee Mr. 

John Conyers. 

Mr. CONYERS. Thank you, Chairman Lofgren and Members. This 

is, I think, important. 

I want to agree to this extent with the opening statement of my 

friend Steve King. Maybe we are able, Steve, to do both things. We 

have to deal with the crime problem that you’ve reported in your 

statistics, which are accurate, and perhaps with this problem of 

how people who are brought into our custody are treated afterward. 

I want my statement to be included in the record. 

I just wanted to welcome the head of ICE, whom I hadn’t met 

before, Ms. Myers. I wanted to welcome her, and I wanted to talk 

with the Committee about this sudden breakout of mass arrests, 

the largest in history, in Iowa last month, 300 undocumented peoVerDate Aug 31 2005 11:20 Oct 01, 2008 Jkt 000000 PO 00000 Frm 00010 Fmt 6633 Sfmt 6601 H:\WORK\IMMIG\060408\42722.000 HJUD1 PsN: 42722
7 

ple arrested, going all over, raids everywhere, mass round-ups. 

Have we had a hearing on that yet? 

Ms. LOFGREN. No, Mr. Chairman, but if you are suggesting, we 

can. 

Mr. CONYERS. I would like to talk with Steve King about it first. 

I yield to the gentleman. 

Mr. KING. I thank the Chairman. I think that would be a constructive thing to do, and I would be very interested in joining together for a request for a hearing. 

Mr. CONYERS. Thank you very much. 

There is some kind of evenhandedness that ought to be required. 

Employers bring in all these people. They know who is illegal or 

undocumented or not. I think we have to start rounding some of 

them up, too. But that’s a subject for another time. 

I figure it is pretty reasonable that we look at this subject matter 

again. As my friend pointed out, it was 8 months ago we did this, 

but things keep happening, and let’s stipulate that a lot of people 

that have come here illegally need medical assistance, but the 

question is what do we do about it? 

And I will just close because I have been talking to some of my 

friends here in the Congress and on the Committee about universal 

health care, and a kind of similar issue that Steve raised comes up. 

Well, if you have universal health care, why include immigrants? 

Well, because they are going to spread disease and make it tough 

on all of us who might someday have universal health care. 

So these are the interesting questions that surround this hearing. You have brought together a great panel of witnesses, and I 

thank you for allowing my opening comments. 

[The prepared statement of Mr. Conyers follows:] 

PREPARED STATEMENT OF THE HONORABLE JOHN CONYERS, JR., A REPRESENTATIVE

IN CONGRESS FROM THE STATE OF MICHIGAN, AND CHAIRMAN, COMMITTEE ON THE

JUDICIARY

A very disturbing pattern appears to be developing at the Department of Homeland Security. First, there are revelations about medical abuses, problematic raids, 

misplaced emergency priorities, and inappropriate costumes. And, then—only after 

a formal Congressional inquiry—the Department either denies there’s a problem or 

announces plans to correct it. 

Today, we are going to continue our efforts to address one of these recurrent problems, namely, the broken medical system in our Nation’s detention facilities. As 

many of you will recall, this Subcommittee held a hearing on this issue last year 

where we heard the heartbreaking testimony of a woman who stood helpless as her 

sister died behind bars because ICE would not give her access to her medications. 

But the reports of grossly inadequate detainee medical care continue to surface. 

This callous disregard for detainee’s medical conditions must stop. 

Accordingly, I want Assistant Secretary Julie Myers, and the other witnesses to 

respond to three specific concerns. 

First, I want to hear what concrete steps DHS has taken since our hearing last 

October, and what concrete steps are will be undertaken going forward. In the eight 

months since our last hearing, it appears little has changed. That is why I am a 

proud cosponsor of Chairwoman Lofgren’s bill, the Detainee Basic Medical Care Act 

of 2008, which will address this problem. 

Second, I want hear what the DHS Inspector General has done and will do to investigate the deaths in custody, not just on a case-by-case basis, but across the 

board as well. 

Third, I want to hear DHS’s response to reports about a recent raid at a 

meatpacking plant in Iowa. 

In that raid, immigrants were penned up in a fairground and subjected to a new 

version of assembly-line justice, in which criminal charges and limited access to 

counsel replaced the normal administrative immigration charges. 

8 

I want Ms. Myers and the other witnesses to tell us today what ICE is doing to 

address health care and humanitarian concerns when these mass raids are being 

undertaken. What kind of health care was provided in Iowa? Was anyone sent back 

home without receiving any treatment? Is this just an isolated incident or can we 

expect this to become the Department’s ‘‘standard operating procedure.’’ 

DHS should ensure that basic standards of life, safety, health care, due process, 

and Constitutional rights are maintained, not just in response to public scandal. 

Ms. LOFGREN. I now recognize the distinguished Ranking Member of the full Committee, the gentlemen from Texas, Mr. Smith. 

Mr. SMITH. Madam Chairman, recent news reports detail cases 

of severe injury and even death in DHS detention facilities. Each 

of the instances as reported is heartbreaking to family members 

and of concern to all of us. However, we should not rush to judgment based on one-sided media accounts about the reported deficiencies in health care received by a few illegal immigrant detainees. Congress has a responsibility to rely on the facts in order to 

determine if there is a serious problem with the medical treatment 

provided to these detainees. 

Since 2004, 71 individuals out of over 1 million detained have 

died while in DHS custody. Many of these individuals enter detention facilities with prior medical conditions that can cause injury 

or death. 

About one-quarter of all immigration detainees are diagnosed as 

having chronic illnesses when they enter the detention facility. 

Many of these individuals are being diagnosed for the first time, 

and many of them have infectious diseases such as tuberculosis, 

which poses a serious health threat to Americans. Immigrants, at 

over 12 percent of the population now, account for more than half 

of all tuberculosis cases in the U.S. That means that immigrants 

are over four times more likely to carry that contagious disease 

than native-born Americans. 

Last year, ICE spent nearly $100 million on detention immigration health care, double the funding level that existed just 5 years 

ago. Medical facilities at all ICE-managed and -contracted detention centers are required to meet or exceed normal accreditation 

standards. Immigration detainees are provided extensive free 

health care far beyond that available to many of the American taxpayers who pay for the detainees’ health care. 

In a recent series, The Washington Post alleged that there is ‘‘a 

hidden world of flawed medical judgments, faulty administrative 

practices, neglectful guards, ill-trained technicians, sloppy recordkeeping, lost medical files and dangerous staff shortages.’’ Yet according to ICE, the Post reporters made no requests to tour a single ICE detention facility. 

A July 2007 Government Accountability Office report on alien detention standards found no systemic problems in health care delivery or any pattern of noncompliance with applicable standards. 

Substantiated allegations of improper medical care to immigration detainees should be fully investigated. If it is determined in 

a particular case that a detainee was denied appropriate treatment, was not properly monitored or received negligent care, then 

corrective measures must be taken. 

Congress should be clear that it is not the responsibility of ICE, 

or the American taxpayer, to pay for or ensure the medical care of 

aliens after they are removed from our country. Nor is it the reVerDate Aug 31 2005 11:20 Oct 01, 2008 Jkt 000000 PO 00000 Frm 00012 Fmt 6633 Sfmt 6601 H:\WORK\IMMIG\060408\42722.000 HJUD1 PsN: 42722
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sponsibility of ICE, or the American taxpayer, to keep aliens in detention solely for the purpose of providing them care. 

Today ICE and the Division of Immigration Health Services have 

an opportunity to present their side of the story. 

Holding hearings on this issue is important, but we must have 

reasonable and realistic standards. Medical care is not always perfect regardless of whether it is administered in a detention center 

prison or even the emergency room of a hospital. 

I thank you, Madam Chair, and I yield back the balance of my 

time. 

Ms. LOFGREN. Thank you, Mr. Smith. 

[The prepared statement of Mr. Smith follows:] 

PREPARED STATEMENT OF THE HONORABLE LAMAR SMITH, A REPRESENTATIVE IN

CONGRESS FROM THE STATE OF TEXAS, AND RANKING MEMBER, COMMITTEE ON THE

JUDICIARY

Recent news reports detail cases of severe injury and even death in DHS detention facilities. Each of the instances as reported is heartbreaking to family members 

and of concern to all of us. 

However, we should not rush to judgment based on one-sided media accounts 

about the reported deficiencies in health care received by a few illegal immigrant 

detainees. 

Congress has a responsibility to rely on the facts in order to determine if there 

is a serious problem with the medical treatment provided to these detainees. 

Since 2004, 71 individuals—out of one million detained—have died while in DHS 

custody. Many of these individuals enter detention facilities with prior medical conditions that can cause injury or death. 

About one-quarter of all immigration detainees are diagnosed as having chronic 

illnesses when they enter the detention facility. Many of these individuals are being 

diagnosed for the first time. And many of them have infectious diseases, such as 

tuberculosis, which pose a serious health threat to Americans. 

Immigrants at over 12 percent of the population now account for more than half 

of all tuberculosis cases in the U.S. That means that immigrants are over six times 

more likely to carry that contagious disease than native-born Americans. 

Last year, ICE spent nearly $100 million on immigration detention health care, 

double the funding level that existed five years ago. Medical facilities at all ICEmanaged and contracted detention centers are required to meet or exceed normal 

accreditation standards. 

Immigration detainees are provided extensive free health care far beyond that 

available to many of the American taxpayers who pay for the detainees’ care. 

In a recent series, the Washington Post alleged that there is ‘‘a hidden world of 

flawed medical judgments, faulty administrative practices, neglectful guards, illtrained technicians, sloppy record keeping, lost medical files and dangerous staff 

shortages.’’ Yet, according to ICE, the Post reporters made no request to tour a single ICE detention facility. 

A July 2007 Government Accountability Office (GAO) report on alien detention 

standards found no systemic problems in health care delivery or any pattern of noncompliance with applicable standards. 

Substantiated allegations of improper medical care to immigration detainees 

should be fully investigated. If it is determined in a particular case that a detainee 

was denied appropriate treatment, was not properly monitored, or received negligent care, then corrective measures must be taken. 

Congress should be clear that it is not the responsibility of ICE—or the American 

taxpayer—to pay for or ensure the medical care of aliens after they are removed 

from our country. Nor is it the responsibility of ICE—or the American taxpayer— 

to keep aliens in detention for the purpose of providing them with care. 

Today, ICE and the Division of Immigration Health Services have an opportunity 

to present their side of the story. 

Holding hearings on this issue is important. But we must have reasonable and 

realistic standards. Medical care is not always perfect, regardless of whether it is 

administered in a detention center, prison or even the emergency room of a hospital. 

Ms. LOFGREN. In the interest of proceeding to our witnesses, and 

mindful of the schedule, I ask other Members to submit their stateVerDate Aug 31 2005 11:20 Oct 01, 2008 Jkt 000000 PO 00000 Frm 00013 Fmt 6633 Sfmt 6601 H:\WORK\IMMIG\060408\42722.000 HJUD1 PsN: 42722
10 

ments for the record. Without objection, all opening statements will 

be placed into the record. 

[The prepared statement of Ms. Jackson Lee follows:] 

PREPARED STATEMENT OF THE HONORABLE SHEILA JACKSON LEE, A REPRESENTATIVE

IN CONGRESS FROM THE STATE OF TEXAS, AND MEMBER, SUBCOMMITTEE ON IMMIGRATION, CITIZENSHIP, REFUGEES, BORDER SECURITY, AND INTERNATIONAL LAW

Madam Chair, thank you for your leadership in convening today’s very important 

hearing concerning the problems with immigration detainee medical care. I would 

also like to thank the ranking member, the Honorable Steve King. This hearing will 

explore recent reports about inadequate medical care for immigrant detainees and 

deaths while in custody. 

The hearing will also examine the quality of medical and mental health care provided in detention facilities under ICE’s jurisdiction. The Subcommittee will study 

ICE’s medical and mental health care standards and procedures, and it will specifically look into the deaths of the growing number of immigration detainees that have 

died during or as a result of ICE custody, seeking to resolve the extent to which 

policies, procedures, or practice caused these deaths. Finally, the Subcommittee will 

seek recommendations to address any potential problems. 

The Bureau of Immigration and Customs Enforcement (ICE) within the Department of Homeland Security (DHS) is responsible for the arrest, detention, and removal of deportable non-citizens. In 2006, ICE detained nearly 300,000 men, 

women, and children—most of whom had no criminal history. This was three times 

the amount of immigration detainees held by ICE in 2001, when less than 100,000 

were detained. ICE holds its immigration detainees in one of over 300 detention facilities across the country. A small percentage of these detainees are housed in 8 

ICE-owned and operated service processing centers (SPCs), including the Krome 

SPC in Miami, the Florence SPC in Arizona, and the Port Isabel SPC in Texas. ICE 

also houses a small percentage of its detainees in 6 contract detention facilities 

(CDFs), which are operated by private contractors specifically for ICE. The majority 

of detainees are held with general population inmates in about 300 federal, state, 

and local jails and other facilities, which operate through intergovernmental service 

agreements (IGSAs) with ICE. In addition to these adult detention facilities, ICE 

contracts for the operation of 19 juvenile and 3 family detention facilities. 

In carrying out its detention and removal responsibilities, ICE is charged with ensuring that conditions are safe and humane in all detention facilities used to hold 

immigration detainees. These responsibilities include the provision of adequate medical and mental health care to detainees. 

On October 4, 2007, the Subcommittee held a hearing on medical care in detention facilities after a New York Times article uncovered that at least 62 people had 

died in ICE custody between 2004 and 2007. Since that hearing, major media outlets have reported additional deaths and have released documents indicating that 

some of these deaths were the result of deficient medical care. A four-part series 

recently released by the Washington Post raises similar concerns about the medical 

and mental health care system at ICE detention facilities. This series, founded on 

internal ICE documents and interviews with detention facility employees, asserts 

severe staffing shortages of medical personnel, long and routine delays in the provision of medical treatment, frequent denials of necessary medication for chronic illnesses, and a system geared to deny care rather than provide it. 

In July 2007, the U.S. Government Accountability Office (GAO) issued a report 

detailing additional problems with detention conditions. The GAO report noted that 

when off-site medical care for detainees appeared necessary, ICE determined whether to authorize such care in conjunction with a DIHS Managed Care Coordinator 

(MCC). According to the report, officials at some detention facilities reported difficulty caring for detainees who required off-site medical and mental health care because they were unable to get authorization to provide that specialty care. 

In addition, numerous media outlets—including the New York Times, The Washington Post, and 60 Minutes—have reported stories suggesting a lack of proper medical care for detainees. On June 13, 2007, the Washington Post reported on a number of cases involving immigration detainees who allegedly received inadequate 

medical care. That same day, a class action lawsuit was filed on behalf of all immigration detainees at the San Diego Correctional Facility (SDCF). The lawsuit, Woods 

v. Myers, No. 07-cv-1078 (S.D. Cal.) charged ICE, DIHS, and the Corrections Corporation of America, Inc. with failing to provide adequate medical and mental 

health care to SDCF detainees. According to the complaint, the 11 named plaintiffs 

11 

suffered from mental illness, chronic health conditions, and serious injuries that had 

not been appropriately treated while in ICE custody. 

Later in June 2007, the New York Times reported that at least 62 immigrants 

had died in ICE custody since 2004. In July, the editorial board of the Miami Herald 

called upon Congress to investigate this issue and require ICE to publicly report 

each death that occurs in custody and to adopt legally binding healthcare standards. 

Since the Subcommittee hearing in October, numerous reports from major media 

outlets have raised additional concerns with the medical and mental health care 

provided in immigration detention centers. On May 5, 2008, the New York Times 

revealed a list of 66 individuals who had died in ICE custody, reporting details on 

several of the deaths that raised serious concerns about the quality of the medical 

care they received. 

This article was followed by an extensive, four-part series on detainee medical 

care by the Washington Post in May. According to the Washington Post, this series 

of articles was based on an extensive investigation involving the review of thousand 

of internal ICE documents and interviews with numerous ICE and DIHS personnel. 

The articles—as well as the internal ICE documents produced along with the articles—reveal serious staffing shortages of medical personnel, regular delays in the 

provision of medical treatment, and frequent denials of necessary treatment. In the 

first part in the series, System of Neglect, the Washington Post summarized their 

investigation as follows: 

The most vulnerable detainees, the physically sick and the mentally ill, are 

sometimes denied the proper treatment to which they are entitled by law and 

regulation. They are locked in a world of slow care, poor care and no care, with 

panic and coverups among employees watching it happen, according to a Post 

investigation. 

The investigation found a hidden world of flawed medical judgments, faulty administrative practices, neglectful guards, ill-trained technicians, sloppy recordkeeping, lost medical files and dangerous staff shortages. It is also a world increasingly run by high-priced private contractors. There is evidence that infectious diseases, including tuberculosis and chicken pox, are spreading inside the 

centers. 

By statute and regulation, the U.S. Public Health Service (PHS) may provide 

medical, surgical, psychiatric, and dental care to immigration detainees around the 

country. However, PHS provides on-site health care to only a small percentage of 

ICE detainees. PHS officers provide on-site medical and mental health care at ICErun service processing centers (SPCs) and several of the contract detention facilities 

(CDFs) and intergovernmental service agreement facilities (IGSAs). At all other facilities, including virtually all state and county jails operating under IGSAs with 

ICE, on-site medical care is provided either by the county or a private company that 

owns or operates the facility, or by private, for-profit companies that specialize in 

correctional health care. 

ICE holds its immigration detainees in one of over 300 detention facilities across 

the country. A small percentage of these detainees are housed in 8 ICE-owned and 

operated service processing centers (SPCs), including the Krome SPC in Miami, the 

Florence SPC in Arizona, and the Port Isabel SPC in Texas. ICE also houses a small 

percentage of its detainees in 6 contract detention facilities (CDFs), which are operated by private contractors specifically for ICE. 

I look forward to hearing from today’s witnesses. I truly hope that we can understand the problems with immigration detainee medical care and that we can also 

develop some solutions. I look forward to the testimony of today’s witnesses. Thank 

you, and I yield the balance of my time. 

Ms. LOFGREN. We have two distinguished panels of witnesses 

here today to help us consider the important issues before us. Seated on our first panel is Ms. Julie Myers, Assistant Secretary for 

U.S. Immigration and Customs Enforcement (ICE). Previously she 

served as Assistant Secretary for Export Enforcement at the Department of Commerce, Chief of Staff for the Criminal Division at 

the Department of Justice, and Deputy Assistant Secretary for 

Money Laundering and Financial Crimes at the Treasury Department. 

Before entering Government service Ms. Myers was an associate 

at Mayer, Brown and Platt in Chicago, and she earned a bachelor’s 

12 

degree at Baylor University and a law degree from Cornell University. 

Next we have Dr. Philip Farabaugh, the new Acting Director of 

the Division of Immigration Health Services, or DIHS, which we 

understand was recently moved from Health and Human Services 

to the Department of Homeland Security. Prior to his position as 

Acting Director, Dr. Farabaugh was the clinical director at the Tacoma detention facility in Tacoma, Washington. 

And the final witness on our first panel is Mr. Richard Stana, Director of Homeland Security and Justice Issues for the U.S. Government Accountability Office. During his 32-year career with the 

GAO, he has directed reviews in a wide variety of complex military 

and domestic issues. Most recently he has managed GAO’s work relating to immigration and border security issues. He is a graduate 

of Cornell University and Harvard University’s JFK School of Government. He also earned a master’s degree from Kent State University. 

Given the gravity of the issues we are discussing today and the 

key roles you all play, we would appreciate you taking an oath before you begin your testimony. Would each of you please stand and 

raise your right hand. 

[Witnesses sworn.] 

Ms. LOFGREN. The clerk will note that all three witnesses have 

agreed to the oath. 

Your written statement will be made a part of the record in its 

entirety. We would ask now that you summarize your testimony in 

about 5 minutes. The little machine on the desk will flash a yellow 

light when you have 1 minute left, and when the red light goes on, 

we would ask you to conclude the testimony so we have time for 

our questions. 

Ms. Myers, we will begin with you. 

TESTIMONY OF JULIE MYERS, ASSISTANT SECRETARY, IMMIGRATION AND CUSTOMS ENFORCEMENT (ICE), U.S. DEPARTMENT OF HOMELAND SECURITY 

Ms. MYERS. Thank you very much. 

Good afternoon, Chairwoman Lofgren and distinguished Members of the Subcommittee. I appreciate the opportunity to appear 

before you today. 

Chairwoman Lofgren, you’re right, people in Government do 

care. The men and women of ICE care. The men and women of the 

DIHS care, and we work every day to ensure that those in our custody are treated in accordance with the ICE detention standards. 

As you know, ICE was formed in 2003 with the broad mission 

that includes immigration and customs enforcement and management of the detention and removal processes for apprehended 

aliens. Indeed, with such an important mission, we had to look and 

see could we have additional oversight, additional oversight not 

only for medical care, but really for all of our detention, knowing 

that there are a large number of aliens in our custody. 

I think we have worked very hard over the past couple of years 

to see where there are places where we can improve detention oversight. To that end, I think the GAO has been very helpful, the IG, 

as well as Congress and NGOs, in giving us ideas and suggestions 

13 

on how we can make sure that everyone in our custody is treated 

in accordance with the ICE detention standard. 

We have done a number of things. Just giving a few highlights 

of things that we have done for detention oversight overall, including but not limited to medical care, in February 2007 we established the Detention Field Inspection Group, and that is a group 

that is an independent arm that reports to the Office of Professional Responsibility. They can go out and do an independent inspection of a detention facility to see if they are meeting up to the 

medical standard as well as all other standards in the ICE detention standard. Before that there was no such independent group. 

In addition, we looked at our overall reviews of facilities, and we 

recognized that previously under the old INS, they used detention 

and removal officers who tried to do a good job, but they were detention and removal officers who actually did the annual compliance inspections. We changed that. We contracted with outside 

groups to do annual reviews of our facilities in order to make sure 

that we were getting the best information, and if there were deficiencies, they could be corrected. These deficiencies would include 

anything we needed to work on with respect to medical oversight. 

In addition, we have hired quality assurance specialists at 40 of 

our largest facilities. Their only job is to make sure that ICE is 

complying with the ICE detention standards. And we have also 

published our first Semiannual Report on Compliance with the ICE 

National Detention Standards. 

We created the first National Detainee Handbook, and we have 

undertaken a comprehensive review of the current National Detention Standards to see whether or not they could be improved. We 

think they could be, so we are working to make them more performance-based, working with the NGOs, the IGs, DHS, CRCL and 

so on. 

Turning specifically to detainee health care and oversight, let me begin with some context. ICE spent almost $100 million on detainee health care last fiscal year, double the funding of just 5 

years ago. And this doesn’t even include the funding providing for 

routine health care at IGSAs. During that same period, the number 

of detention beds managed by ICE has grown by approximately 30 

percent, and since ICE was established, nearly 1.5 million individuals have passed through our custody. And although the ICE detainee population has increased by more than 30 percent since 

2004, the actual number of deaths in ICE detention has declined 

from 29 in 2004 to 7 for the last calendar year, and there have 

been no suicides in the last 15 months. 

But there is still more work to do. ICE law enforcement officers 

are not medical professionals, so we have historically relied on the 

independent medical judgment of the experts, the Public Health 

Service and DIHS. 

By way of background, all detainees are required to receive an 

initial health screening within the first 12 hours and a physical examination within 14 days. And as Representative King noted, last 

year nearly 34 percent of detainees were diagnosed with a chronic 

condition. 

Despite all of this, we recognize that there is need to take additional steps. Among them was the need to strengthen the suicide 

14 

prevention process. The reality is since 2003, suicides have accounted for 18 percent of the 74 deaths of detainees in our custody. 

Even one preventable death is too many, so in the last 2 years ICE 

instituted an extensive suicide prevention program, and we have 

not had a single suicide in the last 15 months. 

We also are looking at the TAR process, and I believe there is 

room for improvement on the appeals of TARs, and so we are working with the Office of Health Affairs to see how we can strengthen 

the TARs process and provide for more oversight by independent 

individuals, as well as have the detainees have more of a role in 

that. 

We are also working with the DHS Office of Health Affairs to improve operations at DIHS. Already we have reduced the staffing 

issues from 30 percent vacancies down to 18. In addition, we have 

asked the Office of Health Affairs to assess all of DIHS’s procedures to determine whether or not there are additional things we 

can do to strengthen oversight for those who are in our custody. 

The final thing we have done is respond to suggestions that we 

need to have more transparency in the reporting of deaths. And so 

we have talked with the DOJ, and we are going to begin reporting 

voluntarily pursuant to the Deaths in Custody Reporting Act so 

that the Bureau of Justice Statistics will have our information, and 

they can access it as appropriate. 

In closing, I want to say we are committed to working with you, 

outside groups and others to improve our processes and ensure that 

those in our custody are well cared for. Thank you. 

Ms. LOFGREN. Thank you. 

[The prepared statement of Ms. Myers follows:] 

15 

PREPARED STATEMENT OF JULIE L. MYERS


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Ms. LOFGREN. Dr. Farabaugh, we would be pleased to hear from 

you. 

TESTIMONY OF PHILIP FARABAUGH, ACTING DIRECTOR, DIVISION OF IMMIGRATION HEALTH SERVICES, IMMIGRATION 

AND CUSTOMS ENFORCEMENT (ICE), U.S. DEPARTMENT OF 

HOMELAND SECURITY 

Dr. FARABAUGH. Good afternoon, Chairwoman Lofgren and Members of the Subcommittee, and thank you for allowing me to appear 

before you today. 

The Division of Immigration Health Services provides or arranges for health care and public health services in support of immigration law enforcement. As a unit within U.S. Immigration and 

Customs Enforcement, ICE, DIHS serves as the provider of medical 

and mental health care for detainees housed in DIHS-staffed detention facilities. 

DIHS oversees the financial authorization and payment for offsite specialty and emergency care for all detainees in ICE custody, 

whether in DIHS or Intergovernmental Service Agreement facilities. 

DIHS comprises medical professionals and support personnel detailed from the U.S. Public Health Service, General Schedule employees and contracted medical staffing services. The PHS is granted the authority to provide and arrange this care by virtue of section 322 of the Public Health Service Act ‘‘Care and Treatment of 

Persons Under Quarantine and Certain Other Persons.’’ 

Each individual who comes through detention facilities receives 

an initial medical screening within 12 hours of their arrival into 

custody. Those remaining in ICE supervision at least 14 days receive a comprehensive physical examination. Many of these detainees initially learn of a medical ailment or receive medical care and 

treatment for the first time through this comprehensive screening. 

Each individual receives specific treatment, as medically necessary 

according to their illness. In fiscal year 2007, of the 184,448 

screenings, approximately 34 percent, or 63,000 individuals, were 

identified as having chronic conditions, most diagnosed with hypertension or diabetes. 

To address the needs of the growing number of detainees, DIHS 

mental health staff have provided over 31,000 patient encounters 

for psychological services since April 2007. These services include 

psychological assessments and followups, individual psychotherapy 

sessions, initial psychiatric evaluations, psychiatric medication and 

medication management followup, acute mental health hospitalizations, suicide risk assessment and follow-up. This list is not all-inclusive, and applies only to those detainees in facilities where 

DIHS mental health officers and staff are assigned. 

Individuals who have acute or chronic health care needs are referred to a primary care provider for evaluation and medical treatment. Those found to have an infectious disease are placed in the 

appropriate health care setting and receive treatment for their condition. 

Patients are treated in accordance with nationally recognized 

standards and guidelines. This care may be given off site or on site, 

as appropriate for the individual patient’s clinical condition. ExamVerDate Aug 31 2005 11:20 Oct 01, 2008 Jkt 000000 PO 00000 Frm 00029 Fmt 6633 Sfmt 6601 H:\WORK\IMMIG\060408\42722.000 HJUD1 PsN: 42722
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ples of such care include imaging studies like X-rays, CT scans, 

and MRIs; surgery for broken bones, heart conditions, gallstones, 

and appendicitis; and specialty consultation with urology for a 

bladder disorder, infectious disease for a patient with HIV, and 

gastroenterology for evaluation of stomach ulcers. Pregnant detainees are referred to community obstetricians to ensure the appropriate prenatal care is delivered. 

The DIHS medical staff and epidemiology branch monitor tuberculosis cases to ensure continuity of care, whether the detainee is 

to be released from custody into the United States or returned to 

his or her country of origin. Between January 1, 2007, and May 31, 

2008, ICE coordinated the repatriations to home countries of 156 

individuals with active or suspected active tuberculosis. DIHS 

seeks to minimize stress to public health domestically and globally 

and prevent transmission of drug-resistant and multidrug-resistant 

tuberculosis. 

Each DIHS-staffed clinic has a written plan for delivery of 24- 

hour emergency health care or immediate outside medical attention. All facilities have arrangements with nearby medical facilities 

or health care providers for health care not provided within the facility. These arrangements require appropriate custodial officers to 

transport and remain with the detainee for the duration of any offsite treatment or hospital admission. When an ICE detainee is hospitalized, the hospital assumes medical decisionmaking authority, 

including the patient’s drug regimen, lab tests, et cetera. 

Each DIHS clinic has a mechanism that allows detainees to request health care services provided by a physician or other qualified medical officer in a clinical setting. Detainees, especially those 

who are illiterate or do not speak English, can receive assistance 

in filling out the request slip to access health care providers. 

Each detainee who is identified with a chronic care issue is treated and educated on self-care needs, and appropriate treatment and 

follow-up is coordinated. 

DIHS maintains accreditation from three nationally recognized 

accrediting bodies to ensure the quality of health care meets industry standards. This includes the American Correctional Association, 

the National Commission on Correctional Health Care, and the 

Joint Commission on Accreditation of Health Care Organizations, 

as well as the ICE National Detention Standards to evaluate the 

care provided to our detainees. 

All DIHS health care providers who care for detainees are required to be licensed and credentialed under the same guidelines 

as those serving the U.S. Bureau of Prisons and in other Federal 

or community facilities, and we have an ongoing credentials-monitoring program to identify and correct any noted deficiencies. 

Thank you once again for allowing me to provide testimony before your Committee today, and I am happy to answer any questions you may have. 

Ms. LOFGREN. Thank you. 

[The prepared statement of Dr. Farabaugh follows:] 

27 

PREPARED STATEMENT OF PHILIP FARABAUGH


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Ms. LOFGREN. We will turn to you now, Mr. Stana. 

TESTIMONY OF RICHARD M. STANA, DIRECTOR, HOMELAND 

SECURITY AND JUSTICE ISSUES, GOVERNMENT ACCOUNTABILITY OFFICE 

Mr. STANA. Thank you, Chairman Lofgren and Mr. King, for the 

invitation to testify at today’s hearing on ICE’s adherence to medical care standards in its detention facilities. 

As you know, ICE maintains custody of a highly transient and 

diverse population, with individuals from many countries with 

varying medical conditions and security risks; and includes males, 

females and families of every age group. The care and treatment 

of aliens while in detention is a significant challenge to ICE, as 

concerns continue to be raised by Members of Congress and advocacy groups about the treatment of the growing number of aliens 

while in ICE’s custody. 

In response to a request from the House Judiciary and Homeland 

Security Committees, we reported last summer on ICE’s adherence 

to its National Detention Standards to help ensure appropriate conditions of confinement. 

Of the 38 standards, we selected 8 for examination based on discussions with UNHCR, the ABA and the OIG. These dealt with 

telephone access, medical care, hold room procedures, use of force, 

food services, recreation, access to legal materials, and detainee 

grievance procedures. Our report did not specifically examine the 

quality of medical care issues, as that was the subject of a separate 

request from this Committee. 

I would like to discuss three main items that are germane to today’s hearing. First, at the time of our visits, we observed instances 

of noncompliance with ICE’s medical care standards at 3 of the 23 

facilities we visited, but these instances did not show a pervasive 

or persistent pattern of noncompliance across the facilities like 

those we identified with the telephone system. Specifically, at the 

San Diego facility in California, an adult detention facility, ICE reviewers that we accompanied cited PHS staff for failing to administer the mandatory 14-day physical exam to approximately 260 detainees. At the Casa de San Juan Family Shelter in California, we 

found that the facility staff did not administer medical screenings 

immediately upon admission. And at the Cowlitz County Juvenile 

Detention Center in Washington State, we found that no medical 

screening was performed at admission, and first aid kits were not 

available as required. 

Officials at some facilities told us that meeting the specialized 

medical and mental health needs of detainees was challenging. For 

example, officials at the York facility in Pennsylvania cited difficulties in obtaining ICE approval for a mammogram to evaluate a 

lump in a detainee’s breast, and the facility ultimately paid for the 

medical service itself. 

On the other hand, we observed instances where detainees were 

receiving specialized medical care, such as special breathing equipment for a detainee at the Krome facility in Florida where we were 

told that the detainee had sleep apnea. And a detainee at the 

Hampton Roads facility in Virginia received treatment from a kidney dialysis machine. 

33 

Second, ICE’s own compliance inspections also showed noncompliance with medical standards. The most recently available 

annual inspection reports for 20 of the 23 detention facilities that 

we visited showed that ICE reviewers had identified a total of 59 

deficiencies, 4 of which involved medical care. The Wakulla County 

Sheriff’s Office in Florida had sick call request forms that were 

available only in English, whereas the population was largely 

Spanish-speaking. The Cowlitz County Juvenile Facility did not 

maintain alien medical records on site. The San Diego facility, in 

addition to the physical exam deficiency I just mentioned, failed to 

obtain informed consent from the detainee when prescribing psychiatric medication, and the Broward Transitional Center in Florida did not have medical staff on site to screen detainees arriving 

at 5 p.m. and did not have a properly locked medical cabinet. 

I should also note, though, that we observed three ICE inspection 

teams reviewing facilities and found that one was very good, but 

the two others were less thorough. 

My last point relates to grievance procedures and the grievances 

and complaints filed by detainees at the facilities on a range of 

issues including the lack of timely response for requests for medical 

treatment. We found that ICE grievance standards were not followed at 4 of the 23 facilities we visited, and noncompliance ranged 

from issues like not having the grievance procedures in the handbook that is handed out to the persons upon entry, not having a 

grievance log at all, and not recording all grievances in the log. But 

the primary mechanism for detainees to file external complaints is 

directly with the IG, either in writing or by phone using the OIG 

complaint hotline. 

Our review of the approximately 750 detainee complaints in the 

OIG database showed that about 11 percent involved issues relating to medical care such as being denied access to specialized treatment. But in testing the phone system, we found that the OIG complaint hotline telephone number was blocked or otherwise restricted at 12 of the 23 facilities that we visited. So the number of 

reported allegations may not reflect all detainee complaints. 

Many complaints sent to the OIG were referred to ICE’s DRO for 

action, but we could not determine the number, nature or disposition of these cases because DRO’s complaint database was not sufficiently reliable for audit purposes. 

In closing, our work noted various deficiencies in compliance with 

ICE detention standards, but there was not a persistent or pervasive pattern regarding medical standards at the locations we visited. Importantly, it should be noted that our review did not examine quality of care issues or ICE decisionmaking on specific detainee medical cases. Nonetheless, our work showed the need for 

ICE to address a number of internal control weaknesses to help ensure that it is in a much better position to identify and address existing and potential deficiencies. 

This concludes my oral statement, and I would be happy to answer any questions that the Subcommittee Members may have. 

Ms. LOFGREN. Thank you. 

[The prepared statement of Mr. Stana follows:] 

34 

PREPARED STATEMENT OF RICHARD M. STANA


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Ms. LOFGREN. All of the witnesses, this is the time when Members of the Committee can pose questions. I will begin. 

Ms. Myers, I would like to ask about the managed care structure 

in the Department. It is my understanding that there are three 

nurses here in Washington who are charged with reviewing all 

medical treatment requests that are submitted by the physicians 

who are actually examining patients who are detainees at the various sites. 

I am not aware of any other system that permits nurses to overrule the judgment of the on-site physician who has actually examined a patient. Do you know of any other system that uses this? 

Ms. MYERS. Thank you for that question. That will allow me to 

explain a little more about the TAR process and also about the 

independence that physicians have on site. 

As a point of clarification, the TAR process is not used for routine medications or other decisionmaking that is made by physicians or other officials on site. The TAR process is used when there 

is something that is nonroutine or nonemergency. The TAR process 

is used after an emergency just for reimbursement. It is not an authorization for emergency care. So if there is a particular thing 

that appears to be, where you need an outside provider, the managed care coordinators are the ones that review that to see whether 

it falls within the benefits package. 

I would say that ICE did not set up the managed care system. 

That is under the Public Health Service and DIHS, which has a 

managed care system not just for ICE, but also for the Bureau of 

Prisons and the United States Marshals Service which are also 

under that. They are the ones that placed that organization. 

Ms. LOFGREN. If I may, there have been numerous complaints 

that have been brought to the Committee’s attention not only by 

individuals, but through the press. For example, in The Washington Post series, which I assume you have read, there are several 

instances in which on-site medical personnel expressed their frustration by the refusal to authorize necessary medical care. And in 

the case of the York County prison, the county actual sued ICE for 

not authorizing care. 

In the July 2007 GAO report, the GAO wrote, ‘‘Officials at some 

facilities told us that the special medical and mental health needs 

of detainees can be challenging. Some also cited difficulties in obtaining approvals for outside medical and mental health care as 

also presenting problems in caring for detainees.’’ 

Are you familiar with other facilities that have expressed concern 

about denial of care to detainees? 

Ms. MYERS. The letter you referenced from the York County facility actually involved a 2005 letter, and it is our understanding 

Dr. Farabaugh and others just reached out to the York County facility yesterday, and maybe as soon as I finish my answer, I will 

have him go into more details with respect to that. 

On the TAR process, generally it is less than 10 percent that are 

denied. I believe we need to look at the 10 percent that may be denied. Some may be properly denied. We have instances where we 

get a submission for an individual who is not in ICE custody. It 

would not be a good use of taxpayer money to pay for that, or 

something that is obviously elective. 

47 

Ms. LOFGREN. Was Mr. Casteneda’s biopsy denied under the 

TARs system? 

Ms. MYERS. That case is in litigation. 

Ms. LOFGREN. But the Government has admitted liability. 

Ms. MYERS. The Government has admitted liability, but I believe 

there is room for improvement in the TAR appeal process, and that 

is why we have asked the Office of Health Affairs, working in conjunction with the Division of Immigration Health Service, to look 

at how does the TAR appeal process work, and how do we make 

sure the alien has a role in that process. 

Ms. LOFGREN. Let me ask you about forced sedation. In its fourpart series, The Washington Post cited what they said was 250 

medically unnecessary instances since 2003 in which ICE sedated 

a deportee against their will with what they called a ‘‘preflight 

cocktail,’’ Haldol. It is my understanding on January 9 of this year, 

ICE headquarters issued a written guideline stating that the field 

offices may no longer request a medical escort from DIHS for involuntary sedation to facilitate deportation unless the Federal Government has obtained a Federal district court order authorizing sedation, and that there was to be no exception to this policy. 

The ICE memorandum, I understand, further recommends that 

the court appoint counsel for aliens who are not represented or who 

are unable to obtain counsel. 

Since this policy has been issued, how many Federal court orders 

have been issued authorizing sedation for deportation? 

Ms. MYERS. If I can clarify just a little bit the information contained in your question, first of all, the policy directive that I requested be issued in June of last year said that we cannot do involuntary sedation absent a court order except in emergencies. And 

then in January of this past year, I said there is no emergencies, 

you know, court order, no matter what. 

It is my understanding, on information and belief, that since 

June of last year, I believe there are four applications that did go 

to court, and I believe they are all still pending. But I would request the opportunity to put that in responses to the record to 

make sure that I accurately describe the answers to your question. 

I will also add, I think this is just one of many areas in which 

ICE is examining decades-long practices and putting in enhanced 

oversight for things that have gone on for years, and where DIHS 

is very helpful. 

Ms. LOFGREN. I am going to turn now to the Ranking Member 

Mr. King for his questions. 

Mr. KING. Thank you, Madam Chairman. 

It occurs to me as I listen to the testimony and some of the comments made, including my own, that if someone is incarcerated in 

an ICE facility, one can self-deport and simply say, send me home; 

I am not satisfied with the food or the bunk or the medical care. 

Ms. Myers, have you ever had that happen? 

Ms. MYERS. There are occasions in which an individual is going 

through immigration proceedings, and they decide to terminate the 

proceedings, and so that does happen, yes. 

Mr. KING. Does it ever happen with a complaint about the facilities, the food or the health care, or anything that has to do with 

48 

the environment that they are in other than the fact that they 

aren’t free to travel? 

Ms. MYERS. I have no specific knowledge, but I will get back to 

you in writing. 

Mr. KING. I would very much like a response to that. It would 

be some interesting insight. 

If it is so horrible, has anybody asked to leave because of the conditions they are in rather than just to avoid the legal process? 

As I look at some memos that I have here, it shows that of the 

27,500 ICE detention beds, 65 percent are located in State and 

local prisons or jail facilities; 19 percent commercial contract facilities; 14 percent are ICE-owned and operated; 2 percent Federal Bureau of Prisons. Has anyone broken down the data on the deaths 

during incarceration with regard to those separate categories? 

The reason I ask the question would be, let’s just say if it is a 

Federal prison or a State or a county, are they more likely to die 

in any of those facilities, or is it scattered across the board, or is 

there enough data for it to be significant? I ask you first, Ms. 

Myers. 

Ms. MYERS. We would have to go back and make sure that we 

go through the statistics to give an accurate reporting. 

But we expect individuals, no matter where they are housed, we 

expect individuals to live up to ICE standards. If they don’t, we 

will do just like we did last year: We will move individuals out of 

those facilities, and in some instances even shut facilities down if 

we can’t ensure that individuals in our custody are being treated 

in accordance with the ICE detention standards. 

Mr. KING. I appreciate that. 

Mr. Stana, could you discern any distinction between the data on 

let me say unhappy health results with regard to whether it would 

be a State or a local prison or a contract facility or an ICE-owned 

service? 

Mr. STANA. We didn’t make that distinction. Every location we 

went to, we asked if there had been a death in the facility. And 

of the 23 we went to, I believe 2 had a death in the facility. We 

didn’t do a whole lot of probing, but in one case the person died 

in their sleep apparently of natural causes. And the other case, I 

believe, was a heart attack. 

Ms. MYERS. If I can add one point to that, we are starting this 

reporting under the Death in Custody Reporting Act. I believe the 

Bureau of Justice Statistics will be able to do the same kind of 

metrics that they do with other facilities in terms of looking at statistical deviances and so on. So that will be one measure going forward that I think will be useful on that front. 

Mr. KING. I will submit that if we are dealing with between 

230,000 and 311,000 inmates a year, that there should be some statistical data that would point to a facility or a type of facility or 

something other than a random cross-section here. And one of 

these things I have here is our 2004 and 2005 mortality rate in our 

U.S. jails and prisons at 550 deaths in 2004 per 100,000; 540 

deaths per 100,000 in 2005; and we are looking at ICE numbers 

of 10.8 or 6.8. Can you explain that, Ms. Myers? 

Ms. MYERS. I am not a statistician, but we see that even the flat 

numbers of deaths that we are having, and any death is regretVerDate Aug 31 2005 11:20 Oct 01, 2008 Jkt 000000 PO 00000 Frm 00052 Fmt 6633 Sfmt 6601 H:\WORK\IMMIG\060408\42722.000 HJUD1 PsN: 42722
49 

table, the numbers of deaths we are having is going down, even 

though the number of detainees are going up. 

Some jails have very low lengths of stay, lower than in ICE custody, which is about 371⁄2 days. Certainly there is a comparable 

thing there. 

But many more detainees may not have health insurance than 

individuals who come into other facilities. All of these statistics are 

reasons why we have asked the Bureau of Justice Statistics to look 

at this as we start reporting. 

We do have instances, unfortunately, like last year where someone was in our custody for about 72 minutes, and they had swallowed some cocaine while in State custody. It exploded within 

them, and they passed away. 

Mr. KING. In your opinion would it be rational or irrational for 

this Congress to take action on a major policy change within ICE 

health care without answering these questions as to why there is 

a significantly lower death rate among ICE inmates than there are 

among inmates across the broad spectrum in other American prisons? 

Ms. MYERS. I certainly think it makes sense to evaluate all of 

those things, and I think it also makes sense to consider whether 

or not in the proposed bill it is actually requesting a higher level 

of services than those provided to U.S. citizens or aliens who are 

detained in U.S. Marshals Service custody who have not yet primarily been convicted of a crime. I think it is important to look at 

those things, look at the costs, and get a sense of what kind of services are requested or expected. 

Mr. KING. It is irrational to look at the data before making a decision. 

Ms. LOFGREN. As I turn to Mr. Gutierrez, I want to correct for 

the record, under the Administration prior to the current Administration, there actually was a requirement that there be no sedation 

whatsoever on deportation, and that was changed. 

I yield now to Mr. Gutierrez. 

Ms. MYERS. May I just respectfully ask to respond to that? 

Ms. LOFGREN. No, but you will have an opportunity to respond. 

Ms. MYERS. I would like to respond to that statement prior to the 

end of the hearing. 

Mr. GUTIERREZ. Thank you very much. 

I think once again what we see here is we have a hearing, and 

then we blame the victim, those detained by ICE. We hear again 

the demonization of immigrants. They are all sick; 34 percent. Now 

we have an argument between Ms. Myers and the Ranking Member whether it is 34 or 25 percent. 

They talk about chronic illnesses, hypertension. I am not afraid 

of anybody with hypertension or diabetes. They then repeat ad 

nauseam tuberculosis, something that is a contagious disease, to 

make it appear after this testimony they are all dangerously ill 

coming to this country. 

I find it amazing that these very same people who are so dangerously ill are the same people who are taking away the jobs from 

Americans, showing up to work every day doing hard work, intense 

labor at meat-packing plants, picking up the food out in the fields 

under intense heat, and yet, well, a third of them have a chronic 

50 

illness. I wonder if that is the way it is for the rest of the American 

population. 

It makes it feel like you offer, Ms. Myers, Rolls Royce health 

care. That is what we just hear from the Ranking Member, Rolls 

Royce health care. I almost feel after listening to the Minority that 

it is safer. I should maybe when I go to Chicago not check into my 

house, check into an ICE facility. It is probably safer there, according to the Minority, than it is on the streets of Chicago. 

Mr. KING. Will the gentleman yield? 

Mr. GUTIERREZ. I will not yield. 

Mr. KING. It probably is. 

Mr. GUTIERREZ. I said I will not yield. 

It appears it is safer for me. Again, the demonization, the criminalization, we hear it all the time. 

Let me ask Ms. Myers a question. How many people did you detain on the streets in work sites in America last year that you ultimately deported? 

Ms. MYERS. I will have to get back to you in writing. 

Last year we arrested administratively in work site 4,667 or so. 

In addition, we had 863 criminal arrests. 

We take our responsibility extremely seriously. 

Mr. GUTIERREZ. I know you want to control the hearing, but I 

have limited time, and I want to ask my questions. 

How many people did you detain on the streets of America and 

deport last year? 

Ms. MYERS. We deported almost 300,000. 

Mr. GUTIERREZ. Three hundred thousand people, and you had 

more money to do that last year than you have had in previous 

years? 

Ms. MYERS. Congress gave us more money to do that. 

Mr. GUTIERREZ. And you have more money for next year so you 

can increase the level of deportations? 

Ms. MYERS. Our responsibility is to enforce the immigration 

laws. 

Mr. GUTIERREZ. Do you expect to have the capacity to deport 

more people next year than you did last year? 

Ms. MYERS. Yes, I do expect that. 

Mr. GUTIERREZ. What increase—do you think you will go from 

300 to 330, so you have a 10 percent increase, a 20 percent increase? What do you think it is going to be? 

Ms. MYERS. I will say that the number of aliens we charge in 

jail—we expect to charge over 200,000 aliens in jails this year. 

Mr. GUTIERREZ. Okay, 200,000 this year. So next year you expect 

to deport at least 300,000 people next year? 

Ms. MYERS. Well, not all of the aliens who are in jail, who are 

charged, who are going through immigration procedures, will get 

out of jail this year. But once they get out, assuming their orders 

are removed and not allowed to adjust in any way, yes—— 

Mr. GUTIERREZ. I know you want to emphasize on the criminalization of the population that you deal with. I am just asking you 

a general question, and I would really appreciate a specific answer 

to the question. 

51 

How many—according to ICE, how many undocumented workers 

or illegally present people are there in the United States of America? 

Ms. MYERS. You know, I don’t believe—— 

Mr. GUTIERREZ. You don’t know. 

Ms. MYERS [continuing]. There is a number on that. 

Mr. GUTIERREZ. You don’t know. You have no idea. You have no 

idea, and there is no documentation in ICE, under oath, that—you 

have no idea, and you have never in ICE or at Homeland Security 

come up with a number of undocumented workers in the United 

States. 

That’s your testimony? 

Ms. MYERS. Well, certainly the Bureau of Immigration Statistics 

looks at—— 

Mr. GUTIERREZ. And they say there are how many? 

Ms. MYERS. You know, that’s not within my agency, so I am 

going to have to reflect—— 

Mr. GUTIERREZ. Fine. I will not comment on what has been statistically shown, since you don’t know. You are the head person at 

ICE and don’t have a number. 

You know, I would think that if I had a population of people that 

I needed to police, I would at least have an estimate of how many 

people it was I had to police and deal with as part of my Federal 

responsibilities. 

But it’s your testimony here today that you cannot answer that 

question because you don’t have a number. 

Ms. MYERS. No, no, no. 

Mr. GUTIERREZ. And because my time—let me finish. And because my time is up, it begs the question once again. What are we 

doing? 

Ms. LOFGREN. The gentleman’s time has expired. 

Mr. GUTIERREZ. Because you know as well as I know that there 

have been estimates of between 12 and 20 million. 

Ms. LOFGREN. The gentleman’s time has expired. 

Mr. GUTIERREZ. And at a rate of 300,000 a year, which you have 

been doing with lots of gusto, it would take us 25—with not one 

more coming in, which begs the—— 

Ms. LOFGREN. The time of the gentleman has expired. 

Mr. LUNGREN. Privilege of the Chair, Madam Chairman. 

Ms. MYERS. May I please respond to that question? 

Ms. LOFGREN. The gentleman’s time has expired. 

I am going to take the privilege of the Chair to give you a minute 

to comment on the Bush administration’s policy of requiring a 

court order in every case to sedate, to deport, which I promise to 

give you an opportunity to comment on, as well as a very brief response, before turning to Mr. Lungren. 

Ms. MYERS. I appreciate that very much. 

First, I will say upon information and belief—and we certainly 

would look forward to getting back to this in writing to you, I am 

not aware that that was the policy in the previous Administration 

and the former INS. 

That was not my experience, which was why I believed that it 

was important to issue the directive which I did last summer. 

52 

If I could also respond to Congressman Gutierrez, what I said related to the U.S. for an estimate of individuals working, as opposed 

to an estimate of individuals who are currently here. Certainly the 

Office of Immigration Assistance, as well as the Pew Research Center—it does have—I can give those statistics to you. 

I am going to turn now to the Ranking Member, Mr. Smith. I 

will give you the White House memo that outlines the Clinton policy. 

Ms. MYERS. Well, it does follow the question that I had. 

Ms. LOFGREN. I turn now to the Ranking Member of the full 

Committee, the honorable gentleman from Texas. 

Mr. SMITH. Thank you, Madam Chair. Before we get back to the 

subject matter at hand, Secretary Myers, I don’t want the record 

to misrepresent your knowledge. 

Of course, you have a range of millions of people you know who 

are in the country illegally. Just because you can’t give a precise 

figure actually points to a lack of a failure or a failure to enforce 

immigration laws; that’s why we don’t know how many people are 

coming into the country illegally. 

But if you were to be asked, you would probably agree that there 

are 12 to 20 million people who are here in the country illegally, 

would you not? 

Ms. MYERS. I would. 

What I was responding to—his question was the individuals who 

were working. I believe there were some independent studies to 

talk about what percent of illegal aliens are working. They are not 

ICE studies. 

I can’t vouch for the Pew Center’s numbers, but certainly I am 

aware of that. 

Mr. SMITH. There are no specific numbers. All we have is sort of 

orders of magnitude. But, again, that points to the failure or inability to enforce immigration laws. 

Let me get back to the subject at hand. You made the point earlier in your opening estimate that the number of deaths in detention facilities had traumatically declined over the last couple of 

years. What were those figures again? 

Ms. MYERS. In calendar year 2007, there were seven deaths in 

our facilities. We had a detainee population of 323,000 individuals. 

In calendar year 2006, there were 16 deaths in our facility. 

If you look back to calendar year 2004, there were 29 deaths. 

Mr. SMITH. The trend is dramatically down. 

Ms. MYERS. The trend is dramatically down and the record-keeping is up. 

Mr. SMITH. Right. 

Ms. MYERS. When I look back at the—— 

Mr. SMITH. Was that true or reported in any of the critical articles, the substantial reduction in deaths? 

Ms. MYERS. You know, certainly we had challenges with respect 

to The Washington Post, the implications that were there. We disagree with a number of them. We have a long letter into the office—— 

Mr. SMITH. Would it have been a more balanced approach to 

show the progress you have been making and compared how few 

deaths there were compared to past years, would it not? 

53 

Ms. MYERS. I think it would. That’s why we have a formal complaint in. 

Mr. SMITH. What else does your complaint encompass? Were 

there other inaccuracies or omissions that should have been included? 

Ms. MYERS. There are a number of those. If you read the article, 

it implies suicides are up. Obviously, as my testimony indicated, we 

haven’t had a suicide in the last 15 months. We are working very 

hard to do what we can to ensure that we have quality medical 

care. 

The series didn’t focus on the fact that we actually took over in 

a more direct fashion the administration of DIHS in order to ensure greater oversight. The Washington Post series failed to compare the treatment that DIHS provides with the Marshal Service 

system. Instead, it claimed that DIHS provided inadequate service 

and so on. 

We certainly have a 5-page letter which I would be happy to provide to the Committee, if you would like. 

Mr. SMITH. I would like to have a copy of that. I would also like 

to make it part of the record. It seems to me at the very least you 

are owed a correction or retraction on the basis of that article. 

Ms. LOFGREN. Without objection, we will put into the record the 

articles as well as the letter. 

Mr. SMITH. Thank you, Madam Chairman. 

Mr. Stana, let me go back to your work at the GAO. You said, 

I think, that you only found examples of noncompliance, and I 

would say that some of them might be accurately described as 

minor in 3 of the 23 facilities that you visited; is that correct? 

Mr. STANA. That is correct. 

Mr. SMITH. In only three did you find the noncompliance of 

standards. 

You also said they were not pervasive. Is that accurate as well? 

Mr. STANA. These were the medical care standards. There is a 

distinction between quality of care. I wanted to point that out. But 

this involves things like, was the proper equipment on site, did 

they have access to a doctor, did they have medical emergency procedures? Were inmates given the opportunity to go to a sick call? 

Were there suicide watch procedures? Those kinds of things. 

Mr. SMITH. In those 3 out of 23 facilities, 13 percent of the facilities, would you describe the problems that you found as comprising 

a hidden world of faulty administrative practices, sloppy recordkeeping and lost medical files; or is that a slight exaggeration as 

to what you found in those 23 facilities? 

Mr. STANA. I can tell you what we found at the 23 facilities. 

We found some differences between the large ones and the small 

ones as to how much equipment was on hand. We found that they 

were clean, they were well attended to. 

We did find there were some employee grievances—not employee 

grievances. There were detainee grievances. If there is an Achilles’ 

heel to this whole process, it’s the handling of those grievances. 

We are talking about what the scale of this problem is. One way 

to find out is to use the grievance and the monitoring and the compliance mechanisms as the canary in the coal mine, because it is 

not reliable. 

54 

Mr. SMITH. Right. Again, no systematic noncompliance in those 

facilities? 

Mr. STANA. We didn’t find it, not at the facilities we were at. 

Mr. SMITH. Great. Thank you very much. 

I will yield back the balance of my time. 

Ms. LOFGREN. The gentleman yields back. 

I would now recognize my colleague from California, the 

gentlelady, Ms. Sa ́nchez. 

Ms. SA ́ NCHEZ. I thank the Chairwoman. Again, I just want to 

start—before I start questioning, I just want to point out something. 

Much was made about the fact that detainees can voluntarily 

choose to leave if the food or the medical care treatment is that 

bad. 

I might point out to my colleagues on the dais, if they didn’t already know this, that there are many countries with whom we 

don’t have repatriation agreements. It would be pretty hard for 

somebody to allow—voluntarily allow themselves to be deported to 

a country that we essentially can’t send them back to, and that 

there are many asylum seekers that end up in detention facilities. 

They are not exactly anxious to go back to war-torn places where 

they may be targeted for death or other kinds of threats. 

So I just wanted to make sure my colleagues on the dais understand it’s not necessarily as easy as saying, well, pack me up and 

send me home because the medical care here is substandard. 

In terms of questions, Ms. Myers, both The Washington Post and 

the Office of the Inspector General have cited the debilitating 

shortages of medical staff at detention centers. And at some facilities, vacancies in medical positions range anywhere from 20 to 50 

percent. 

Is that degree of lack of staff in compliance with the standards 

of the American Correctional Association or the National Commission on Correctional Health Care? 

Ms. MYERS. Thank you for that question. 

We certainly agree that there were some concerns with respect 

to staffing, and we had some issues at ICE with respect to moving 

along as quickly as we would like with ICE and getting the staffing 

up. That’s why in October of 2007 we actually took DIHS over more 

formally for—and the administrative side to really work on the 

staffing. 

Last January—— 

Ms. SA ́ NCHEZ. But my question was—— 

Ms. LOFGREN. I am going to interrupt. We have just been notified 

that an alarm has gone off, that a tornado is heading for the Capitol, and that we should stay away from windows and stay inside. 

Since there are three windows right in back of us, I think that 

probably we should recess this hearing temporarily and move into 

that hallway. 

Thank you. We are in recess. 

[Recess.] 

Ms. LOFGREN. That’s the first time I have ever had to recess a 

hearing for a tornado. As a Californian, that’s kind of a new thing 

for me. 

55 

We are trying to find Congresswoman Sa ́nchez to let her know 

we are back in session, and also the other Members who recessed, 

to let them know that we are back. 

So we will not use your time frivolously, I wonder, Mr. Davis, if 

you would like to begin your questioning while we notify other 

Members that we are back in session. Then we will let Ms. Sa ́nchez 

resume her questioning when she returns. 

So I would turn now to Mr. Davis. 

Mr. DAVIS. Thank you, Madam Chairwoman. 

Ms. Myers, I am from Alabama so I am not scared of tornados. 

You notice these California folks ran. The Iowan and the Alabaman 

stuck around. 

Let me, Ms. Myers, try to get us refocused a little bit. I was reading your opening statement—didn’t have a chance to hear you—but 

I was reading your opening statement or the transcript of it. And 

you talked for a moment about the quality assurance professionals 

who inspect the largest ICE facilities, and I want to ask you pointblank, how many of these quality assurance professionals are doctors? 

And, as they conduct their quality assurance review, are they 

evaluating the facilities for their medical quality? 

Ms. MYERS. Thank you for that question. I am from Kansas, and 

I am scared of tornados, being from Kansas. 

But to be clear, the quality assurance professionals that are in 

our 40 largest facilities, those are focused on overall compliance 

with all our detention standards, so it’s not solely on medical care. 

So these are individuals to make sure, if there is any issue with 

any particular detention center, they are there. 

We do have a detention field inspection group, which is this independent arm operating under the Office of Professional Responsibility. They have a medical professional within that group, so they 

are able to go out and do target reviews. 

But I think we can do more. That is the reason—— 

Mr. DAVIS. Well, you frankly said what I thought you would say. 

My sense, from reading your testimony and from reading the testimony of the other witnesses, is that it’s a quality assurance review 

that is far more generalized and the medical review so that—— 

And, also, given your concession that we can do more, I make a 

proposal to you: Why not have the American Medical Association, 

a respected group of doctors, the equivalent of the ABA for lawyers, 

why not ask the AMA to appoint a panel of professionals to come 

in, review these facilities or to review at least perhaps 20 of them? 

Ms. MYERS. Well, what—actually, what we have asked to do 

which is similar to that, but not precisely that, is to ask the Office 

of Health Affairs to look at—some experts that could do an overall 

review of all of DIHS processes. So they are finding experts, recognized medical experts, who can look and see, as DHS has taken 

over greater administrative control of the DIHS, what works, what 

doesn’t work, where have things changed, where can we really do 

best practices? 

So this is our review that is starting now. 

Mr. DAVIS. Well, slow down for 1 second. 

Ms. MYERS. Oh, sure. 

56 

Mr. DAVIS. That’s a perfectly reasonable suggestion, but what 

about my AMA suggestion? Good idea or bad idea? 

Ms. MYERS. Well, I think—I thought that some sort of—some 

sort of review, once we took DIHS over, was appropriate. That’s 

why we conducted a baseline review of our own—— 

Mr. DAVIS. AMA, good idea or bad idea? 

Ms. MYERS. What? 

Mr. DAVIS. AMA, good idea or bad idea? 

Ms. MYERS. Yeah. I think that—the OHA review that is going on, 

I think really encompasses—and so I think that is sufficient to do 

the kinds of things that both you and I want to do. 

Mr. DAVIS. Not to be contentious, but I do want to try to get an 

answer because I mean it as a good-faith suggestion. 

The AMA is an enormously respected entity that I assume is the 

equivalent of the ABA. I certainly don’t think they are known as 

a partisan or democratic leaning entity in any sense of the word. 

What’s wrong with having the AMA come in and do a review? 

Listen to what I think the advantage would be: having somebody 

other than the Federal Government take a look at the Federal Government, having somebody outside the governmental process come 

in. Because I think—and I think this is the concern that others 

have driven home to you, I think, Ms. Myers—that we can go back 

and forth on what’s the quality of care and all of that. 

I am going to ask you some questions about that in a moment, 

but if you are serious, and I take you at your word that you are 

serious about improving the quality of care at these facilities, it 

would seem that the best way to do that, is, frankly, not to have 

an intragovernmental review or even to have another Government 

agency conduct a review, but to frankly have an assessment by 

medical professionals. 

I am going to move on as my time is about up, but I would seriously encourage you to give some thought to the idea of an outside 

medical entity such as the AMA coming in and doing analysis. 

A final set of questions: Are you a lawyer, Ms. Myers? 

Ms. MYERS. Yes, I am. Not a practicing lawyer. 

Mr. DAVIS. What do you believe is the standard of care for the 

individuals who are held in these facilities? 

Ms. MYERS. I believe that DIHS has a responsibility to provide 

medically necessary health care while at the same time ensuring 

proper obligation of Federal funds, to ensure that we don’t overpay 

for anything. 

Mr. DAVIS. Well, I would be curious in hearing—and perhaps in 

writing would be a better place for discussion on this, given the 

time limits, but I am seriously concerned about what DIHS considers to be the standard of care toward these individuals. 

Is it analogous, for example, to the standard of care for people 

who are in Federal prison? 

Ms. MYERS. Well, I think you raise an excellent point. I believe 

it is analogous to the standard of care for U.S. Marshal Service 

prisoners, individuals who are coming into Marshal Service custody 

who have not yet been convicted of a crime. 

There may have been areas where it differs, but overall, it appears that that standard of care is very consistent. But, as I said, 

I am not a doctor. 

57 

Mr. DAVIS. Is that current policy? Is what you just said current 

policy? 

Ms. MYERS. That is my understanding. But let me say that’s why 

we asked the Office of Health Affairs to actually consult with outside professionals—not just to do an intragovernmental review— 

but to consult with outside Government officials and look at all the 

DIHS system processes and see where there’s room for improvement. 

I can see myself where there’s room, but the doctors may have 

additional advice of counsel. 

Mr. DAVIS. I see my time has expired. 

Ms. LOFGREN. The time of the gentleman has expired. 

We will turn now to the gentleman from Virginia, Mr. Goodlatte. 

Mr. GOODLATTE. Thank you, Madam Chairman. 

Ms. Myers, I would like to ask about one of the provisions in 

H.R. 5950 that has been introduced by the Chairman to address 

some of the concerns. That bill appears to require the Department 

of Homeland Security to provide continuity of care for a reasonable 

period of time after removal. 

Do you read that to mean that the Department would be responsible for providing care to a detainee even after they are removed 

from the United States? 

Ms. MYERS. Well, certainly. And I would caveat this with, obviously our lawyers are going to take a thorough assessment of the 

bill. The Administration will then take a position. But I do believe 

the language is vague in that it is just, you know, kind of what exactly is the continuity of care. 

By the way, we do already provide continuity of care in certain 

instances. But I think we need to look at the language and understand what is expected. 

Ms. LOFGREN. Would the gentleman yield? 

Mr. GOODLATTE. I would be happy to yield. 

Ms. LOFGREN. I don’t have a copy of the bill in front of me, but 

the intent, and if we get to a markup, it for example, the medical 

records should be provided to the person if they are removed, and 

things of that sort; that there should be planning, not just dumping 

somebody. 

Mr. GOODLATTE. But you wouldn’t be contemplating providing actual health care after they are no longer under the jurisdiction? 

Ms. LOFGREN. No. In fact, we have strongly suggested that for 

those individuals who are in custody with serious health care problems, that they be provided alternatives to detention standards, so 

they could bill their own insurance, instead of the Federal Government. 

For example, if you have a chronic condition, and you are applying for a political asylum, why not put on an ankle bracelet and 

get your own care instead of being in detention? 

But I thank the gentleman for yielding so I could clarify that. 

Mr. GOODLATTE. I thank the Chairwoman for that guidance. I 

hope the language in the bill will be clarified to make it clear we 

are not providing care to people after they have been deported from 

the United States. 

Ms. Myers, in your opinion, what is the maximum amount of 

time that would comply with the, quote, ‘‘reasonable period of time’’ 

58 

requirement that’s described in the bill during which the Department of Homeland Security must ensure continuity of care for detainees after release or removal? 

Ms. MYERS. You know, I couldn’t really provide a precise number 

at this time, but I think both points are very valid that we would 

need to look at kind of what is expected. 

Right now, in many instances we assist with follow-up appointments. We provide detainees, for example, with several days’ worth 

of medication so that they could then go and find an additional doctor back in their own country or back in the United States. 

With respect to asylum seekers, very few asylum seekers are detained. Of course, we do have our parole policy which provides that 

after they go through the considerable peer process they are considered for parole. 

Mr. GOODLATTE. I also have concern about the phrase, ‘‘serious 

medical or mental health conditions,’’ which are not defined anywhere in the bill, that would raise some questions about how you 

would draw the line between serious medical or mental health conditions and nonserious conditions. 

Ms. MYERS. I think that’s exactly right. The bill also talks about 

more comprehensive dental care and vision care than is provided 

to prisoners in the United States Marshal Service custody. 

So I think there are a number of things that I think we should 

consider. What does the Congress want to find? We, as ICE, will 

implement, of course, whatever the Congress decides. 

Mr. GOODLATTE. Let me ask you if the Department has considered the use of telemedicine to improve the quality of care that detainees receive while saving the taxpayer dollars. We have seen 

this utilized all across the country in prisons, in jails, and other 

places where having doctors immediately available, especially specialists, would be a considerable expense. 

Ms. MYERS. I am going to have the doctor, if that’s okay, respond 

to that. 

Dr. FARABAUGH. We are actually actively pursuing a telemedicine 

system for our agency. This would mainly be utilized within DIHS 

facilities. Obviously we can’t put equipment in every—you know, 

all 350 IGSA facilities out there that are used, but we can concentrate them with our own facilities to enhance the care that’s 

provided. 

Mr. GOODLATTE. Well, good. We hope you will do that, because 

I have seen it used very effectively in rural areas. 

Let me also say that I am stunned by the progress that you have 

made in reducing fatalities, deaths in your facilities, but even more 

so by the comparison of mortality rates in U.S. jails and prisons 

and in your facilities. I see 10.8 per 100,000 a year in facilities and 

550 in prisons. And in 2005, 6.8 compared to 540. 

Is there some explanation for why your mortality rate is dramatically lower than it is in prisons? 

Ms. MYERS. You know, I think certainly we are very pleased that 

we have been able to reduce the number of deaths, although absolutely any death is regrettable, I think. I am very proud of the care 

that DIHS provides the professionals that are there and the work 

that we do in order to make sure people get the best medical care. 

59 

Of course, individuals in jails may be in for a much shorter period of time than individuals in ICE custody. Individuals in prison 

may be in there for a much longer period of time than individuals 

in ICE custody. 

So even—there are some variances, as well as the number of individuals with insurance; it may be much lower for individuals who 

come into our custody than for individuals who come into other 

custodies. 

There are a number of factors, but I am very proud of the work 

that they do. 

Ms. LOFGREN. The gentleman’s time has expired. 

Mr. Smith had asked to make a unanimous consent request to 

make a correction to his opening statement. I will recognize Mr. 

King for that purpose. 

Mr. KING. Thank you, Madam Chairman. 

I appreciate being recognized on behalf of Mr. Smith, who wishes 

to correct a statistic he cited in his opening statement. 

The correct figure is that immigrants are over six times more 

likely to have tuberculosis than native-born Americans, not four 

times. 

He appreciates your indulgence. I yield back. 

Ms. LOFGREN. Without objection. 

I understand that Ms. Sa ́nchez would like to yield her remaining 

3 minutes to Mr. Davis to continue his questions. 

We are going to have votes pretty soon, so we will have to say 

goodbye to this panel. 

Mr. DAVIS. Thank you, Madam Chairwoman. I will try to not 

take the 3 minutes. 

Let me pick up, conveniently enough, on the last question Mr. 

Goodlatte asked about the decreasing mortality rate, which you 

contend is a very low mortality rate. You made this point, but 

frankly, you made it at a rapid pace. I want to slow down and 

make sure that everyone gets this. 

I think it is enormously difficult to compare the ICE population 

with the prison population. One reason I suspect that people stay 

in American prisons a lot longer than people stay in ICE facilities: 

What’s the average length of stay for someone at one of your detention facilities? 

Ms. MYERS. The average length of stay in ICE facilities is actually between 33 and 37 days. Jails, in some American jails, the average length of stay is also in the 30 days—in that time period. But 

absolutely, in prisons it can be much longer. 

Mr. DAVIS. So that’s one reason. Obviously, very few people get 

sentences of 30 days in the American prison system, so that’s one 

comparison. 

You mentioned another having to deal with the level of the uninsured. I would suspect there are also some age differences. What’s 

the average age of people in the ICE facilities? 

Ms. MYERS. You know, I am going to have to get back to you on 

that in writing, so I can be positive. 

I have seen, in jails, the average age—I think—in the Bureau of 

Prisons, I believe, the average age is 38, so, you know, kind of midlife. 

60 

But let me say, I agree with you that having a more robust analysis of the statistics would be useful. That’s why we have asked the 

Bureau of Justice Statistics to take our statistics and look at them 

with all the other statistics under the Deaths in Custody Reporting 

Act. They can do the analysis, they have the statisticians. They can 

draw the comparisons that maybe we can’t as effectively draw. 

Ms. LOFGREN. Would the gentleman yield for a question? 

Mr. DAVIS. Yes. 

Ms. LOFGREN. One of the differences between people in your ordinary, for example, State prison and ICE detentions, number one, 

the ICE detention people aren’t criminals. But, number two, the 

ICE detention people are oftentimes moved around whereas the 

prison population tends to be sedentary. 

How do you—we have had a lot of complaints that medical files 

and medication don’t get moved with detainees. How do you make 

sure that happens so that the medical care isn’t deficient or, at the 

next facility, the person has to start over from scratch? 

Ms. MYERS. Well, there are a couple of things that we do more 

generally, and a couple of initiatives, to make sure that we are 

comprehensively addressing this problem. 

I think more generally if we have specific instances that are 

brought to our attention, we address them, we look at them. Obviously, the detainee standard addresses this as well as some of the 

standards that apply to DIHS. 

But we are looking at our performance-based standards that are 

out for review by the Inspector General where we receive comments from the NGOs and other groups to make sure that the 

transfer standards make it clear about the transfer of the 

record—— 

Ms. LOFGREN. But there is a standard right now. Do you require 

that the files be sent with the inmate? 

Ms. MYERS. A file—or in cases where we don’t have access to a 

complete file, a summary of that information. Absolutely. 

Ms. LOFGREN. And that their medication be transferred with 

them? 

Ms. MYERS. That their medication be—— 

Ms. LOFGREN. That’s what you require? 

Ms. MYERS. That’s what we require. 

I believe there is some room for improvement on some of these, 

certainly in the IT area, the—you know, the DIHS IT system has 

a lot of room for improvement. 

Ms. LOFGREN. Okay. Our time has expired, and we are out of 

Members who want to ask questions. So we will thank this witness 

for your presentation today. 

The record will be open for 5 legislative days. There may be additional questions that we will forward to you in writing, and we 

would ask that those questions be promptly answered, if that happens. 

We will now ask the next panel to come forward. I would like to 

introduce all of them. 

First, I am pleased to welcome Dr. Homer Venters, Attending 

Physician at the Bellevue/NYU Program For Survivors of Torture, 

as well as a Public Health Fellow at New York University. 

61 

As part of Doctors of the World, Dr. Venters sees detained asylum seekers who are victims of torture, and his research involves 

health care for detained immigrants. Dr. Venters first became involved with immigration health care as a health volunteer while in 

the Peace Corps in Togo. His most recent publications deal with 

public acceptance of torture in the United States and health care 

for detained immigrants. 

Next, I would like to introduce Ann Schofield Baker, a principal 

in the New York office of the law firm of McKool Smith, where she 

is the head of the firm’s national trademark litigation practice. 

Along with her diverse practice, Ms. Schofield Baker maintains an 

active pro bono practice, through which she represented Amina 

Mudey, an asylee from Somalia who was detained at the Elizabeth 

Detention Center in New Jersey. 

She is admitted to the New York, Washington D.C., and Massachusetts bars, and to the Federal District Courts in the Southern 

and Eastern Districts of New York. 

Our next witness is Mary Meg McCarthy, Executive Director of 

the National Immigrant Justice Center, which she has led since 

1998. NIJC serves approximately 8,000 asylum seekers, trafficking 

victims, unaccompanied immigrant children, detained adults, and 

other low-income immigrants each year, drawing on a network of 

1,000 pro bono attorneys. Prior to joining NIJC, Ms. McCarthy 

practiced civil litigation at the law firm of Horvath & Lieber and 

served as a pro bono attorney for NIJC’s asylum project. 

Our next witness is Zena Asfaw, a former immigration detainee. 

Zena was born in Addis Ababa, Ethiopia, where she worked for 

Ethiopian Airlines. Having endured persecution at the hands of the 

Ethiopian Government, she fled Ethiopia and made her way to the 

United States, where she applied for asylum. 

Upon arriving in the U.S., Zena was detained and held for 5 

months in an ICE detention center. She was finally released when 

an immigration judge granted her application for asylum. She currently lives in Los Angeles and is employed by the Sheraton 

Delfina in Santa Monica. 

Next, I would like to introduce Gloria Armendariz. Gloria is a 

U.S. citizen and is here to testify concerning her common-law husband, Isaias Vasquez, a veteran of the Armed Forces, who was detained for about 18 months in several detention facilities. After his 

release, Isaias was granted U.S. citizenship based on his military 

service. 

Our next witness is the Reverend Roy Riley, Bishop of the New 

Jersey Synod of the Evangelical Lutheran Church in America, the 

largest Lutheran denomination in the United States. Bishop Riley 

serves on the board of directors of Lutheran Immigration and Refugee Services, which serves and advocates on behalf of refugees, 

asylum seekers, unaccompanied children, immigrants in detention, 

families fractured by migration, and other vulnerable populations. 

Next is Mr. Edward Harrison, President of the National Commission on Correctional Health Care, a not-for-profit organization that 

provides standards and independent accreditation of correctional 

health services. Mr. Harrison advocates for a better understanding 

of the importance of appropriate medical and mental health care in 

62 

corrections facilities, and the relationship between correctional 

health care and the public’s health. 

He has been employed by NCCHC since 1986 and has been its 

president since 1993. He earned his Master’s degree from Northwestern University’s J.L. Kellogg Graduate School of Management 

and his undergraduate degree from the University of Illinois. 

Our final witness is Mr. Isaac Reyes, partner with the government relations firm of Austin, Copelin & Reyes, which represents 

the U.S./Mexico Border Counties Coalition. Mr. Reyes spent 7 years 

working on Capitol Hill, most recently as policy adviser at the Senate Democratic Policy Committee, a leadership office of the former 

Democratic Leader of the Senate, Tom Daschle. Mr. Reyes received 

a Bachelor of Arts, with a major in political science, from California 

Polytechnic University at San Luis Obispo. 

Each of your written statements will be made part of the record 

in its entirety. We are going to ask you to give about 5 minutes 

of oral testimony. But we are going to ask you to do this when we 

come back from voting. 

All of those bells and whistles mean that on the floor of the 

House right now there is a vote going on. We have about 10 minutes left to get over there, and then I think there are four additional 5-minute votes. So what that means is at about 4:30, if we 

are lucky, we will be back here to hear your testimony. 

So, relax, I think there’s a coffee shop down the stairs if you 

want. We will be back, we hope, about 4:30. We are in recess until 

that time. 

[Recess.] 

Ms. LOFGREN. We have finished our voting for the next 2 or 3 

hours. I would like to wait for the Ranking Member to arrive before 

we begin the testimony. 

However, perhaps we could go through the formality of swearing 

each of you in. If so, would you stand and raise your right hands. 

I will read the oath, and you can say, yes, if you agree at the end. 

[Witnesses sworn.] 

Ms. LOFGREN. We notice that all of the witnesses have indicated 

in the affirmative. 

Because several witnesses have transportation issues, I am going 

to ask that we get started, since the Ranking Member is on his way 

in. If we can start at the end with Mr. Reyes and then move right 

along, Mr. Harrison and the like. 

So we are going to start with Mr. Reyes. 

TESTIMONY OF ISAAC REYES, WASHINGTON REPRESENTATIVE, U.S./MEXICO BORDER COUNTIES COALITION 

Mr. REYES. Thank you, Chairwoman Lofgren, Ranking Member 

King and Members of the Subcommittee, for inviting me for to testify about the U.S./Mexico Border Counties Coalition findings on 

the costs of providing medical care to undocumented immigrants. 

The Border Counties Coalition is a nonpartisan policy and technical forum comprised of the elected officials from the 24 governments located on the Southwest border. Our efforts at the Federal 

level are focused on increasing the reimbursement levels for the 

costs associated with undocumented immigration resulting from 

the failure of the Federal Government to secure our borders. 

63 

Because of their proximity to the border, our member counties 

bear a disproportionate share of these costs. My testimony this 

afternoon is about the cost to border counties for providing health 

care to undocumented immigrants. 

It is awkward to be discussing fiscal costs related to undocumented immigration when many of the witnesses this afternoon 

are addressing the loss of life and the horrific treatment of people 

in custody. 

The focus of this hearing, the treatment of immigrants in detention, most of whom were, up to the time of their jailing, working 

and contributing members of their communities, whose only crime 

was to be living and working in the U.S. without permission, is an 

issue that needs more congressional oversight, and I urge continued examination of this problem. 

Let me say clearly that our organization does not oppose the delivery of health care to undocumented immigrants. What we are 

saying is that the Federal Government should be responsible for 

these costs, not counties. 

The Federal Government controls our Nation’s borders and has 

the sole responsibility for developing and enforcing the immigration 

policy. The Federal Government’s success or failure in protecting 

the Nation’s borders directly affects State and local governments, 

particularly Southwest border counties. 

Border counties receive pennies on the dollar when it comes to 

reimbursements from the Federal Government, whether we are 

talking about the State Criminal Alien Assistance Program, the 

Southwest Border Prosecution Initiative or Section 1011 Funds for 

Emergency Health Care reimbursement. 

These three pots of money, developed as reimbursement programs, did not come close to making border counties whole. From 

1999 to 2006, the 24 counties along the border spent a cumulative 

$1.23 billion to process criminals, undocumented immigrants, 

through the law enforcement and criminal justice systems. During 

that same time border counties only received $54 million in reimbursements from the Federal Government. Again, the costs were 

$1.23 billion, and only $54 million in reimbursements from the 

Federal Government. 

In fiscal year 2006 alone the cost was 192 million. Of that 192, 

border counties received only $1.47 million. These are staggering 

costs, considering the rural nature and poverty level of most of 

these border counties. 

Our 2002 study, entitled ‘‘Medical Emergency: Who Pays the 

Price for Uncompensated Emergency Medical Care Along the 

Southwest Border?’’ provides an estimate of the costs for providing 

emergency hospital and transportation services to undocumented 

immigrants. Our study determined that undocumented immigrants 

cost border hospitals $189.6 million in uncompensated emergency 

medical costs during 2000. To put this figure in context, total reported uncompensated costs at border hospitals were 831 million, 

meaning that costs attributable to undocumented immigrants comprised almost 25 percent of the uncompensated emergency room 

care. 

In addition, we estimate that emergency medical service providers had 13 million in uncompensated costs, bringing the total to 

64 

more than 200 million in uncompensated emergency medical costs 

during 2000. Our study found that the former INS brought injured 

and ill-undocumented entrants to hospital and emergency rooms or 

called ambulances without arresting them, so that the Federal Government would not bear the cost of treatment. 

Although the Federal Government reimbursed the States and 

counties for part of the costs they incurred for providing federally 

mandated and mercy health care services to undocumented immigrants, Southwest border counties are absorbing a significant and 

disproportionate amount of the costs. 

The position of the Border counties Coalition is that the Federal 

Government should support the medical treatment of undocumented immigrants and pay for 100 percent of these costs. The 

Federal Government is responsible for the costs associated with undocumented immigration, not counties. 

The costs to process undocumented immigrants come at the expense of basic, vital services to county residents. The unmet needs 

include libraries, jails, courtrooms, parks and basic infrastructure 

to colonias’ new developments, flood prevention, social service programs for abused children and women, child care and after-school 

programs, but the overwhelming needs expressed by our elected officials are related to health care. 

They need more ambulances, clinics, more indigent health care 

funding and more funding for comprehensive health care programs. 

These are basic services that lift the quality of life and communities. And the residents of border counties should not be asked to 

go without them because of the failure of the Federal Government 

to fully reimburse them. 

Thank you for the opportunity to present the findings of our report, and I will be happy to answer any questions. 

Ms. LOFGREN. Thank you very much. 

[The prepared statement of Mr. Reyes follows:] 

PREPARED STATEMENT OF ISAAC A. REYES

Chairwoman Lofgren, Ranking Member King, members of the subcommittee, 

thank you for inviting me to testify about the U.S./Mexico Border Counties Coalition 

findings on the costs of providing medical care to undocumented immigrants. I am 

the Washington representative of the Border Counties Coalition, a nonpartisan, policy and technical forum compromised of the elected officials from the twenty-four 

county governments located on the U.S./Mexico border. Our efforts at the federal 

level are focused on increasing the reimbursement levels for the costs associated 

with undocumented immigration resulting from the failure of the federal government to secure our borders. Because of their proximity to the border, our member 

counties bear a disproportionate share of these costs. 

My testimony this afternoon is about the costs to border counties for providing 

health care to undocumented immigrants. It is awkward to be discussing fiscal costs 

related to undocumented immigration when most of the witnesses this afternoon are 

addressing the loss of life and horrific treatment of people in custody. The focus of 

this hearing—the treatment of immigrants in detention—most of whom were, up to 

the time of their jailing, working and contributing members of their communities 

whose only ‘‘crime’’ was to be living and working in the U.S. without permission— 

is an issue that needs more Congressional oversight and I urge continued examination of this problem. 

The federal government controls our nation’s borders, and has sole responsibility 

for developing and enforcing immigration policy. The federal government’s success 

or failure at protecting the nation’s borders directly affects state and local governments, particularly southwest border counties. Border counties receive pennies on 

the dollar when it comes to reimbursements from the federal government, whether 

we are talking about the State Criminal Alien Assistance Program, the Southwest 

65 

Border Prosecution Initiative, or Section 1011 funds for Emergency Health Care Reimbursement. These three pots of money, developed as reimbursement programs, do 

not come close to making border counties whole. 

From 1999 through 2006, the 24 counties along the border spent a cumulative $1.23 billion on services to process criminal undocumented immigrants through the 

law enforcement and criminal justice system. During that same time, border counties received only $54.8 million in reimbursements from the federal government. In 

fiscal year 2006 alone, the cost was $192 million. Of that $192 million, border counties received one percent of the SCAAP appropriation—only $4.7 million came back 

to them. These are staggering costs considering the rural nature and poverty level 

of most of these border counties. 

Many members of this subcommittee are well aware of the problems associated 

with SCAAP and are trying to improve that program. The recent passage of H.R. 

1512, sponsored by Representative Sanchez and approved by this subcommittee, will 

bring more SCAAP funds to our counties and we thank you for your efforts and recognition of the problem. 

Our 2002 study, entitled ‘‘Medical Emergency: Who Pays the Price for Uncompensated Emergency Medical Care Along the Southwest Border?’’ provides an estimate 

for the cost of providing emergency hospital and transportation services to undocumented immigrants. Our study determined undocumented immigrants cost border 

hospitals $189.6 million in uncompensated emergency medical costs during 2000. To 

put this figure in context, total reported uncompensated costs at border hospitals 

were $831 million, meaning that costs attributable to undocumented immigrants 

comprised almost 25 percent of the uncompensated emergency room care. In addition, we estimate that emergency medical service providers had $13 million in uncompensated costs, bringing the total to more than $200 million in uncompensated 

emergency medical costs during 2000. The $200 million broke down in the following 

manner: $79 million in California, $74 million in Texas, $31 million in Arizona, and 

$6 million in New Mexico. Our study also found that the former Immigration and 

Naturalization Service brought injured and ill undocumented entrants to hospital 

emergency rooms or called ambulances without arresting them so that the federal 

government would not bear the cost of treatment. Yet, this $200 million figure does not represent the total costs borne by southwest 

border counties and local medical providers. Costs incurred for preventive, acute, extended or rehabilitative healthcare, and non-emergency medical transportation are 

not included in our estimate since these services fall outside the federal definition 

of an ‘‘emergency’’ and were therefore beyond the scope of our analysis. Furthermore, services delivered by a physician in a hospital’s emergency department that 

are not paid by or through the hospital are billed separately and cannot be captured 

by examining uncompensated hospital costs. As such, costs incurred by physicians 

attending an undocumented immigrant in a medical emergency also are not included in our cost estimate. 

The problem of uncompensated emergency services has far reaching implications 

beyond loss of hospital revenues. Health care costs and insurance premiums are rising, due in part to burgeoning levels of uncompensated care. Rising health insurance premiums are threatening business’ ability, particularly small business, to 

offer employees affordable health care benefits. High liability costs and low levels 

of compensation are threatening the viability of emergency rooms and emergency 

transportation providers along the border. Some counties with high rates of uncompensated care can no longer afford to provide ‘‘charity’’ care for local needy residents. In some instances, high levels of unpaid medical bills related to undocumented immigrants have forced local healthcare providers to reduce staffing, increase rates, and cut back services. 

The border counties health and health care systems face a much different set of 

issues than the rest of the nation. In 2007, the Border Counties Coalition released 

a report entitled, ‘‘At The Cross Roads: U.S./Mexico Border Counties in Transition.’’ 

This report provided an in-depth analysis of the 24 border counties and compared 

them to the 50 states in our country. In terms of health care, the report found that 

if the border counties were considered a 51st state, it would rank last in the presence of health care professionals. Border counties would rank as the 50th state out 

of 51 in insurance coverage for adults and children. The prevalence of tuberculosis 

per 100,000 persons among residents of all border counties (10.4) is twice that of 

the United States (5.1) as a whole. Border county populations suffer higher rates 

of diseases, such as asthma, adult diabetes, and hepatitis, which are compounded 

by the low socioeconomic status characteristic of the population and a large migrating population between the United States and Mexico that relies heavily on public 

and charity health programs. As a significant segment of the population moves back 

and forth across the border, they become transfer agents of contagions and potential 

66 

illnesses. It is clear that border counties could use the money spent on health care 

for undocumented immigrants for health care needs for their own residents. 

There has been a lot of heated debate about whether or not undocumented immigrants should receive free emergency medical care. Let me point out that Congress 

mandated this policy. In 1996, Congress passed two major laws that affect the delivery and financing of emergency services to undocumented immigrants. The first is 

the Emergency Medical Treatment and Active Labor Act (EMTALA), which requires 

hospitals and emergency personnel to screen, treat and stabilize anyone who seeks 

emergency medical care regardless of income or immigration status. The second law, 

the Personal Responsibility and Work Opportunity Reconciliation Act of 1996 

(PRWORA), among other things, limits Medicaid benefits for undocumented immigrants to emergency health services and non-Medicaid funded public health assistance (e.g., immunizations, communicable disease treatment). In addition, PRWORA 

requires states that want to provide non-emergency medical assistance to ‘‘nonqualified’’ immigrants to pass affirmative legislation before providing such services, 

even if the state already had such a law in place prior to the federal Act’s passage. 

Although the federal government reimburses states and counties for part of the 

costs they incur providing federally-mandated emergency health services to undocumented immigrants, southwest border counties are absorbing a significant and disproportionate amount of costs. The position of the Border Counties Coalition is that 

the federal government should support the medical treatment of undocumented immigrants and pay for 100 percent of the costs. The federal government is responsible 

for the costs associated with undocumented immigration, not counties. Few state resources are made available to help counties with this burden, so costs fall heavily 

on local taxpayers in these 24 counties along the border. 

The costs to process undocumented immigrants come at the expense of basic, vital 

services to county residents. The unmet needs include libraries, jails, courtrooms, 

parks, and basic infrastructure to colonias, new developments, flood prevention, social service programs for abused children and women, childcare, and after school 

programs. But the overwhelming needs expressed by our elected officials are related 

to health care—ambulances, clinics, more indigent healthcare funding, and more 

funding for comprehensive healthcare programs. These are basic services that lift 

the quality of life in communities and the residents of border counties should not 

be asked to go without because of the failure of the federal government to fully reimburse them. 

Thank you for the opportunity to present the findings of our report and for giving 

you a glimpse into the situation facing border counties. I will be happy to answer 

any questions. 

Ms. LOFGREN. Mr. Harrison. 

TESTIMONY OF EDWARD HARRISON, PRESIDENT, NATIONAL 

COMMISSION ON CORRECTIONAL HEALTH CARE 

Mr. HARRISON. Thank you. I am pleased to be with you today to 

describe our organization’s standards setting and accreditation 

processes. 

The National Commission on Correctional Health Care is a notfor-profit organization that grew out of a project begun at the 

American Medical Association in the early 1970’s. Our board of directors is made up of representatives of 38 major supporting organizations, including the AMA, the American College of Physicians, 

the American Nurses Association, the National Association of counties, the American Dental Association, the American Bar Association, the American Public Health Association and the National 

Sheriffs’ Association. There was some comment earlier about getting the AMA or the ABA involved, and they are involved through 

our organization. 

We are solely and completely dedicated to improving health services in our Nation’s jails, prisons and juvenile confinement facilities. Our pioneering work began even before the Supreme Court’s 

position in Estelle v. Gamble that inmates have a constitutional 

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67 

prove over time and have helped the correctional systems and correctional health care professionals adapt to new challenges that 

were unheard of 30 years ago. 

Our standards are based on three basic principles: that inmates 

should have access to necessary medical and mental health care, 

that assessment and treatment should be done by competent health 

care professionals, and that health care ordered by clinicians 

should be delivered without undue delay or interference. These 

principles may seem obvious and simple, but adhering to the standards is often complicated by the institutional nature of corrections. 

Our standards are available to anyone. They have been used by 

State medical societies who have been contracted to review local 

correctional health care services. They have been used by the Department of Justice in its investigation into civil rights violations 

in correctional facilities, and by numerous consultants and other 

third parties hired by correctional systems to help evaluate and improve the quality of their care. 

Even correctional systems accredited by other organizations, 

when confronted with growing problems, have asked us to conduct 

a review of their own facility and to make recommendations for improvement based on the NCAC standards. 

Our organization advocates continuous quality improvements, 

CQI, as a great way for correctional systems to improve their operations. CQI, which is one of our standards, dictates that service 

staff actively seek out areas in need of improvement. The model 

embraces the discovery of problems as an opportunity to improve. 

From the thousands of correctional system reviews we have done 

over the past 30 years, I can say that what distinguishes the best 

systems from the mediocre is this culture of quality. 

We never come across a perfect system. Indeed, the whole notion 

of CQI is that there is always room for improvement. 

In the case of ICE facilities, ICE has taken the step of not only 

seeking accreditation from our organization, but from The Joint 

Commission on Accreditation of Health Care Organizations and 

others, and it is unusual in our field to see an organization take 

that step to seek multiple accreditations. 

Several years ago I had the chance to go into an ICE facility, and 

I saw tremendous cooperation between the custody staff and the 

health staff. And that interplay between custody and health is a 

key component in a good correctional health care system. 

Patient safety in this country, not just in corrections, is a huge 

problem. The Institute for Health Care Improvement estimates 

that each year as many as 15 million patient injuries occur in 

health care settings and between 100,000 to 200,000 deaths 

fromunintended injury. This is more deaths than would occur if a 

747 jumbo jet crashed each and every day. So within the profession 

of health care we are well aware that unintended problems arise 

when treating patients. Within the world of corrections, as I mentioned earlier, treatment can be more complicated and, therefore, 

more susceptible to problems in the community. 

I have read a number of press reports about the medical problems in some ICE detention facilities. It is always deeply troubling 

to hear about neglect and suboptimal care. Reports of these kinds 

require careful investigation and the warranted changes to improve 

68 

the system. Some of the reported problems had to do with custody 

staff action or inaction, which is not my organization’s area of expertise. If there were critical performances involved, we were very, 

very concerned. 

While we recognize that not every problem can be anticipated, 

we strongly believe that a correctional facility should be proactive 

in implementing patient safety systems to prevent near-miss and 

adverse critical events. 

There should be an error reporting system for health staff to report, to voluntarily report in a nonpunitive environment, errors 

that affect patient safety; and all deaths should be reviewed 

promptly, both administratively and critically. In the cases of suicide, a psychological autopsy should also be conducted. Importantly, treating staff should be informed of any review findings and 

necessary corrective actions needed to be implemented. 

Ms. LOFGREN. Mr. Harrison, could you sum up at this point? 

Your 5 minutes are up and we have many witnesses. 

Mr. HARRISON. Thank you very much. I appreciate the opportunity to be here. I understand that some of the steps that ICE has 

taken, and I think that making improvements in systems is always 

possible. We will be glad to help the Committee and ICE. 

Ms. LOFGREN. We do very much appreciate that offer of help. 

Mr. HARRISON. Thank you. 

[The prepared statement of Mr. Harrison follows:] 

69 

PREPARED STATEMENT OF EDWARD HARRISON


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Ms. LOFGREN. I now turn to Bishop Riley. 

TESTIMONY OF THE REVEREND E. ROY RILEY, BISHOP OF THE 

NEW JERSEY SYNOD, EVANGELICAL LUTHERAN CHURCH IN 

AMERICA 

Reverend RILEY. I am E. Roy Riley, Bishop of the New Jersey 

Synod of the Evangelical Lutheran Church of America, the largest 

Lutheran denomination the United States, about 5 million members, many good members in Iowa. 

I thank Chairman Lofgren and Ranking Member King for the invitation to be here today. 

Deeply woven into the Christian faith is love and concern for all 

of our brothers and sisters in the human family. The Bible is clear: 

Welcome one another just as Christ welcomed you. The bishops of 

the ELCA hold a special concern for the treatment of individuals 

held in the U.S. immigration detention system. 

In just the past month, seven of my fellow bishops have visited 

three detention facilities in the States of Virginia, Michigan and 

Washington. I personally visited the detention system facilities in 

Elizabeth, New Jersey, and in New York. 

Since the detention facility opened in Elizabeth, New Jersey, Lutheran Church members have been providing ministry to immigration detainees through weekly visits and have been providing ministry and pastoral care through a glass partition and over a twoway telephone as best they could. 

In the course of these visits, our visitors have become aware of 

the very serious lack of appropriate medical care for detainees. 

These reports are documented in my written testimony and supported in various media reports. In fact, this very week a woman 

who came to this country seeking asylum from Nigeria and who 

was released from the Elizabeth Detention Center with full asylum 

9 months after detention reported to me her story of inadequate 

medical treatment. 

The reports of inadequate medical care for detainees and confiscation of needed medicines and medical equipment at arrest have 

foreshadowed the worst news of all that since 2003 at least 80 persons have apparently died either in detention or as a result of the 

lack of appropriate medical care while they were in detention. 

Members of the synod I serve are troubled that it has required 

evidence of people dying to move Congress to take action. Of even 

greater concern to us is that a Nation that has so prided itself on 

the compassion expressed by that statue in New York Harbor 

could, by its own Government, treat immigrants and asylum seekers, our fellow human beings, in such a punitive way. 

Three years ago, in 2005, the New Jersey Synod Assembly 

passed a resolution decrying the treatment of immigrants. Tomorrow, on June 5, our synod will convene again in annual assembly 

and we will consider adopting a resolution expressing our grave 

concern about the growing number of ICE raids targeting immigrants and, especially, the devastating effect these raids have on 

families, children and communities. 

I fully expect the synod assembly to adopt that resolution, which 

will continue to provide guidance for thousands of our members 

75 

and help them as they work with their own legislative representatives. 

Most of what is driving this discussion today is rooted in our own 

fears, primarily the fear for our own security and our own economic 

stability. When we are so driven by fear, it becomes something that 

is no longer helpful and, in fact, causes us to act in ways that are 

not true to our best selves. 

On May 12, in the little town of Postville, IA, Government agents 

stormed into a workplace and arrested hundreds of people, 

handcuffing them and herding them to the Cattle Congress yards 

in Waterloo. In the process, hundreds of children were left not 

knowing where their parents were. The children were traumatized, 

both the immigrant children and children whose families had lived 

in Iowa forever. At the end of the day, teachers and administrators 

and citizens looked at each other and said, What happened here? 

What country is this? 

It’s time for us to act with common sense and good judgment and 

compassion, not just for the sake of immigrant men, women and 

children, but for our sake as human beings and citizens of a country that is supposed to be a model for human rights. 

In light of these serious, systemic problems, I urge the Subcommittee to consider the following. 

One, improve medical treatment and immigration detention. H.R. 

5950 is a good step; 

Two, improve conditions of detention; and 

Three, cap expansion of detention and provide alternatives to detention. There are alternatives. 

What I have said today will make no difference at all for 50-year 

Boubacar Bah, 35-year-old Francisco Castaneda, 45-year-old Sandra Kenley or 50-year-old Abdolai Sall. They and others like them 

have died in ICE-sponsored detention or as a result of the lack of 

appropriate medical care while in detention. What I have said will 

make no difference for them. 

I have spoken today for the men and women and children who 

are still living, but being held in prison-like conditions as asylum 

seekers or immigrants without clear documentation. On behalf of 

the church I serve, I am lifting them up as brothers and sisters 

who need our help, the help of this Government. 

But I am lifting up before you also the citizens of this country, 

myself included. We all need help in finding a just and sensible solution to the issue of immigration. 

I thank you for your kind attention. 

Ms. LOFGREN. Thank you, Bishop. 

[The prepared statement of Reverend Riley follows:] 

76 

PREPARED STATEMENT OF REVEREND E. ROY RILEY


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Ms. LOFGREN. We would now be honored to hear from you, Ms. 

Armendariz. 

TESTIMONY OF GLORIA ARMENDARIZ, 

WIFE OF ISAIAS VASQUEZ, FORMER DETAINEE 

Ms. ARMENDARIZ. I’d like to thank the Committee for inviting 

me. It’s an honor for me on behalf of Isaias Vasquez. 

My name is Gloria Armendariz, and I am a United States citizen. 

I reside in San Antonio, TX, with Isaias Vasquez, who immigrated 

to the United States from Mexico when he was 2-years old, served 

in the United States Army during the Vietnam War, and recently 

became a naturalized U.S. citizen. I have lived with Isaias for 

over—for more or less 30 years. 

After many years of suffering from mental illness, he was diagnosed in 1990 with schizophrenia, was hospitalized over 18 years 

at the Audie Murphy Memorial Veterans Hospital. He was also 

hospitalized and received treatment for schizophrenia at the North 

Texas State Hospital following an arrest for possession of marijuana. 

Isaias’ conviction for drug possession led to the detention and removal proceedings in November of 2004 by the Department of 

Homeland Security. Until August 2005, he was detained in San 

Antonio at the GEO facility. 

I visited Isaias every week while he was detained in San Antonio, and a number of times I was concerned he was not receiving 

adequate medical attention. Isaias complained that he was having 

side effects from the medication he received and was fainting. He 

said that the detention staff did not believe him. He was mentally 

ill or fainted. On two occasions, I learned that he fell and hit his 

head. When I complained to the detention staff, I was told that 

Isaias was fine and did not need additional medical attention. 

In August of 2005, Isaias won his immigration case. When the 

immigration judge granted his application under the Convention 

Against Torture, the judge found that Isaias would likely suffer torture in Mexico due to the mental illness. 

DHS did not appeal from the judge’s decision, but Isaias was not 

released and was, instead, transferred to the South Texas Detention Complex at Pearsall, TX. There his condition became much 

worse. I was unable to see Isaias as often because of the distance 

from San Antonio to Pearsall. It was a hardship for me. But Isaias 

complained that he was not receiving his medications and that he 

was not fed properly and that he was being punished and put in 

segregation. 

When I saw him, he was frail and undernourished. He seemed 

unstable and disoriented. A few times I tried to see Isaias, but I 

was told that he did not want to see me. 

In January 2006, I learned that the DHS believed Isaias did not 

have schizophrenia, and it was trying to get the immigration judge 

to rescind the order allowing Isaias to stay in the United States. 

Later I found out that in November 2005 the medical staff at the 

detention center diagnosed Isaias with unspecified personality disorder and that thereafter they decided to take Isaias off his medication for schizophrenia and depression. Isaias became very sick 

and was put on suicide watch. 

84 

He smeared feces and spit in his cell. He became very disoriented 

and refused his other medications for diabetes and high blood pressure. He was punished by the detention staff. They put him in solitary confinement and gassed him. This was like 6, 7 months in 

there. 

I tried the best I could to get help for Isaias. Our immigration 

lawyer made requests to DHS to release Isaias. I called Advocacy, 

Inc., an organization which helps individuals with disabilities. I 

spoke to the detention center warden. I contacted my congressman’s office a lot of times. I filed complaints with the FBI, six, 

seven times. Suddenly, in May 2006, DHS, our lawyer, was told 

that Isaias was being released. 

I drove to Pearsall, TX, to get him. I was stunned at his condition. And, when I got there, Isaias was very thin. His feet were 

swollen. He was covered with sores and was ranting. I was afraid 

of him because he was so sick, disoriented, and they also told me 

that he had TB. 

I asked the Dr. Johnson to transfer Isaias to the VA hospital to 

transport him, because I was afraid, and he refused and said Isaias 

was not sick. I don’t have it here, but there was like a SWAT team 

all around me—the warden, a lady taking a videotape of us. And 

I was pleading to them, Don’t, I am afraid to take him, but I still 

had to leave with him. 

So I drove him straight to the VA in San Antonio, I learned when 

I got there that Dr. Johnson had already called the VA and told 

them that there was nothing wrong with Isaias. So at first the VA 

would not admit him though for many years he had been treated 

for schizophrenia at that hospital. 

I refused to take him. When Isaias became violent, the VA staff 

had to subdue him. And several people on the staff, they had to 

subdue him and finally they admitted him to the psychiatric ward. 

Isaias remained there for about 2 months and was put on the 

medications which had been discontinued at Pearsall. 

On January 30, 2007, at a hearing with the immigration, DHS 

agreed to dismiss the removal case so Isaias could apply for naturalization. On September 27, 2007, Isaias was granted naturalization based on his military service. 

Now he has good and bad days, but he still suffers from the 

treatment memories of Pearsall. 

[The prepared statement of Ms. Armendariz follows:] 

PREPARED STATEMENT OF GLORIA A. ARMENDARIZ

My name is Gloria Armendariz. I am a United States citizen and I reside in San 

Antonio, Texas with Isaias Vasquez, who immigrated to the United States from 

Mexico when he was 2 years old, served in the U.S. Army during the Vietnam War, 

and recently became a naturalized U.S. citizen. I have lived with Isaias for over 30 

years. After many years of suffering from mental illness, he was diagnosed in 1990 

with schizophrenia. Isaias was hospitalized over 18 times at the Audie L. Murphy 

Memorial Veteran’s Hospital (VA) in San Antonio, Texas. He was also hospitalized 

and received treatment for schizophrenia at the North Texas State Hospital following an arrest for possession of marijuana. 

Isaias’s conviction for drug possession led to his detention and removal proceedings in November, 2004 by the Department of Homeland Security (DHS). Until 

August, 2005, he was detained in San Antonio at the GEO facility. I visited Isaias 

every week while he was detained in San Antonio, and a number of times I was 

concerned that he was not receiving adequate medical attention. Isaias complained 

that he was having side effects from the medication he received and was fainting. 

85 

He said that the detention staff did not believe he was mentally ill or had fainted. 

On two occasions I learned he fell and hit his head. When I complained to the detention staff I was told that Isaias was fine and did not need additional medical attention. 

In August, 2005, Isaias won his immigration case when the Immigration Judge 

granted his application under the Convention Against Torture. The judge found that 

Isaias would likely suffer torture in Mexico due to his mental illness. DHS did not 

appeal the judge’s decision, but, Isaias was not released and was instead transferred 

to the South Texas Detention Complex at Pearsall, Texas. There his condition became much worse. I was unable to see Isaias as often because of the distance from 

San Antonio to Pearsall, but Isaias complained that he was not receiving his medication, that he was not fed properly and that he was being punished and put in 

segregation. When I saw him he was frail and undernourished. He seemed unstable 

and disoriented. A few times I tried to see Isaias, but I was told that he did not 

want to see me. 

In January, 2006 I learned that DHS believed Isaias did not have schizophrenia 

and it was trying to get the Immigration Judge to rescind the order allowing Isaias 

to stay in the United States. Later I found out that in November, 2005 the medical 

staff at the detention center diagnosed Isaias with ‘‘unspecified personality disorder’’, and that thereafter, they decided to take Isaias off his medication for schizophrenia and depression. Isaias became very sick and was put on suicide watch. He 

smeared feces and spit in his cell. He became very disorientated and refused his 

other medication for diabetes and high blood pressure. He was punished by the detention staff—they put him in solitary confinement and gassed him. 

I tried the best I could to get help for Isaias. Our immigration lawyer made requests to DHS to release Isaias. I called Advocacy Inc., an organization which helps 

individuals with disabilities. I spoke to the detention center warden, contacted my 

congressman’s office, and filed complaints with the FBI 

Suddenly, in May, 2006 DHS our lawyer was told that Isaias was being released. 

I drove to Pearsall, Texas to get him and I was stunned at his condition when I 

got there. Isaias was very thin, his feet were swollen, he was covered with sores 

and he was ranting. I was afraid of him because he was so sick, and I asked the 

doctor, Dr. Johnson, to transfer Isaias to the VA hospital. He refused and said that 

Isaias was not sick. So, I drove him straight to the VA hospital in San Antonio. I 

learned when we got there that Dr. Johnson had called to the VA and told the staff 

that there was nothing wrong with Isaias. So, at first the VA would not admit him, 

even though for many years he had been treated for schizophrenia at that hospital. 

I refused to take him home, and when Isaias became violent, the VA staff had to 

subdue him and he was finally admitted to the psychiatric ward. Isaias remained 

at the VA hospital for several weeks and was put back on the medications which 

had been discontinued at Pearsall. 

On January 30, 2007 at a hearing with the Immigration Judge, DHS agreed to 

dismiss the removal case so Isaias could apply for naturalization. On September 27, 

2007 Isaias was granted naturalization based on his military service. Now, he has 

his good and bad days, but he still suffers from the memories of his treatment at 

Pearsall. 

Ms. LOFGREN. Thank you very much for sharing your story. 

Ms. Asfaw? 

TESTIMONY OF ZENA T. ASFAW, FORMER DETAINEE 

Ms. ASFAW. Good afternoon. My name is Zena Asfaw. I am a political refugee from Ethiopia. 

I arrived in the United States November 15, 2006, fleeing persecution from my home country. Upon arrival, I asked for political 

asylum in the United States. I was taken into custody by immigration officials and remained in custody for about 5 months until the 

immigration judge granted my political asylum application on April 

10, 2007. 

Because of the trouble and difficulty I endured in my country, I 

will never regret making the decision to leave. I am alive, safe, and 

I am grateful to the United States for giving me refugee. 

I was transferred to the immigration detention center in San 

Pedro, California, after complaining about being unable to sleep beVerDate Aug 31 2005 11:20 Oct 01, 2008 Jkt 000000 PO 00000 Frm 00089 Fmt 6633 Sfmt 6601 H:\WORK\IMMIG\060408\42722.000 HJUD1 PsN: 42722
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cause I was nervous about being deported. I was seen by a psychologist. He prescribed medication that was supposed to relax me and 

allow me to sleep the night. 

One day, I had a near-death experience due to the negligence of 

the attending nurse. On this day, between 7 and 8 p.m., the attending nurse gave me seven pills to take at the same time. In the 

evening, I was only supposed to take two pills. 

Also, the pills she was giving me were different in color and 

shape than my regular pills. I asked her if she was sure those were 

my pills. She became angry and told me loudly to swallow them. 

Then she instructed the security guard to check my mouth to make 

sure that I did not hide the pills in my mouth. The guard used a 

flashlight to examine my mouth. I believe I was forced to take the 

medication that I am not sure were not mine. 

Immediately my body started shaking. I feel so cold. I thought 

I was freezing to death, but at the same time I was sweating. I 

went to my bed to lay down. Within a minute, I had a seizure and 

my body began to shake so violently that I fell off the bed on the 

floor. 

I was taken to the immigration center medical unit where the 

same nurse who had given me the wrong pills examined me. She 

took my blood pressure, gave me another four pills, and ordered 

the guard to take me back to my bed. I spent the entire night shaking and sweating. 

In the morning, a different nurse came to give me my pills. She 

noticed that I was shaking and sweating, and she asked me what 

was wrong. I told her what happened the night before. The ICE officer immediately took me to the hospital. At the hospital, I had my 

stomach pumped. I was taken back to the detention center. 

The next day, I was still feeling sick. I was vomiting continuously. I lost control of myself and fainted. I start bleeding from my 

mouth and my private parts. A fire department ambulance came 

and took me to the hospital. I was still vomiting. 

At the hospital, numerous tests were done on me. The examining 

doctor came and informed me that the test results showed damage 

on my liver, and he said he needed to do more tests. He said ICE 

would be informed about the results. 

It took about a month for me to feel better. I needed help from 

other detainees to dress, bathe and walk. During this month, I was 

only given medication to manage my pain. I couldn’t even go to the 

bathroom by myself. 

I had my attorney call ICE and request my medical record. He 

was refused and told that I personally had to request these documents. I have requested all of my medical record on numerous occasions. To date, I have not received any of my records to this day. 

I am not sure to what extent my health has been damaged. I was 

never officially told that I was given the wrong medication. It was 

only in passing that one of the male nurses told me that he was 

sorry that I had been given the wrong medication. 

I have repeatedly request that I be informed about my test result, especially regarding my liver. I have just recently obtained 

health insurance and have taken tests. 

Ms. LOFGREN. It’s all right. Take your time. Take a breath. 

87 

Ms. ASFAW. I hope that those tests will finally allow me to find 

out what, if any, permanent damage was done to my health while 

I was in detention by ICE. 

I hope that my testimony helps this Committee to evaluate the 

state of medical care within the ICE detention centers. Thank you. 

[The prepared statement of Ms. Asfaw follows:] 

PREPARED STATEMENT OF ZENA T. ASFAW

Hello, my name is Zena Asfaw. I am a political refugee from Ethiopia. I arrived 

in the United States on November 15, 2006, fleeing persecution from my home country. Upon arrival, I asked for political asylum in the United States. I was taken into 

custody by Immigration officials, and remained in custody for about five (5) months 

until an Immigration Judge granted my political asylum application on April 10, 

2007. 

I had never considered coming to the United States until I was jailed, beaten, and 

sexually assaulted after being arrested by the Ethiopian government. In late June 

of 2005, after the May elections in my country, the government arrested me for 

what they believed was my participation in the opposition party. There were many 

demonstrations regarding the legitimacy of the elections. Many believed that the 

government had committed fraud to win the election and to retain power. The government began to crack down on opposition party members as well as anyone they 

believed might be involved with the opposition. I was arrested after a police officer 

grabbed my cell phone and found some messages that had been sent to me by someone who did not support the government. 

I was held for 12 days and released after I was forced to sign a document stating 

that I would not involve myself in any political movements. After I was released, 

I went to the hospital because I was having physical/female problems because of the 

sexual assault. I was given some medication for my symptoms. 

I tried to put what happened to me at the jail out of my mind. I tried to move 

on with my life, continuing to work. In late October of 2005, there was a riot that 

happened after a demonstration. People were demonstrating once again against the 

government because of the fraudulent elections. The government began to arrest 

and detain opposition party members and anyone they suspected of being such. Soon 

after this, I received a letter from the police asking me to report for questioning regarding the riots. I decided to flee my country in order to save my life. I fled first 

to Kenya on October 27, 2005 and arrived in Los Angeles on November 15, 2006. 

It took me 13 months, traveling through 17 countries to arrive here. 

Because of the troubles and difficulties I endured in my country, I will never regret making the decision to leave. I am alive and safe and I am grateful to the 

United States for giving me refuge. 

Upon arrival in the United States, I was photographed, fingerprinted, X-rayed 

and then transferred to the Immigration detention center located in San Pedro, CA. 

Upon arrival at the detention center I went to the medical unit and reported having 

female problems. I was given some antibiotics, which did not help. 

After complaining about not being able to sleep because I was nervous about 

being deported, I was seen by a psychologist. The psychologist concluded that these 

problems were because of what I had experienced in Ethiopia, together with the 

stress of being under deportation proceedings. He prescribed medication that was 

supposed to relax me and allow me to sleep at night. 

After taking this medication for about four or five days I found it difficult to wake 

up and get involved in the daily activities of simply dressing and feeding myself. 

I told the attending nurse of the problems I was having because of the medication 

and informed her that I would no longer take them. I requested to see the psychologist. Within a couple of days I saw the psychologist and told him how the medication was affecting me. He changed the prescription. The new medications were 

working for me. I remained on them for over a month. 

One day I had a near death experience due to the negligence of the attending 

nurse. As is the procedure, it is the attending nurse that gives all the detainees 

their medication. On this day, between 7 and 8 pm, the attending nurse gave me 

seven pills to take at the same time. In the evening, I was only supposed to take 

two pills. Also the pills she was giving me were different in color and shape than 

my regular pills. I asked her if she was sure that those were my pills and told her 

that I was supposed to only take two at night. She became angry and told me loudly 

to swallow them. Then she instructed the security guard to check my mouth to 

make sure I did not hide the pills in my mouth. The guard used a flashlight to exVerDate Aug 31 2005 11:20 Oct 01, 2008 Jkt 000000 PO 00000 Frm 00091 Fmt 6633 Sfmt 6621 H:\WORK\IMMIG\060408\42722.000 HJUD1 PsN: 42722
88 

amine my mouth. I believe I was forced to take medications that I am sure were 

not mine. 

Immediately my body started shaking. I felt so cold that I thought I was freezing 

to death, but at the same time I was sweating. I went to my bed and lay down. 

Within minutes I had a seizure and my body began to shake so violently that I fell 

off the bed onto the floor. 

The other detainees became alarmed and thought that I was dying. They yelled 

and made all kinds of noise to get the attention of the security guards. The guards, 

sensing the severity of the situation, cleared the room. I was taken to the detention 

center medical unit where I was seen by the same nurse who had given me the 

wrong pills. She took my blood pressure, gave me another four pills and ordered the 

guards to take me back to my bed. I spent the entire night shaking and sweating. 

In the morning a different nurse came to give me my pills. She noticed that I was 

shaking and sweating and asked me what was wrong. I told her what had happened 

the night before. She looked at my chart and immediately locked up all the medication she was going to dispense and called ICE officers. The officers immediately took 

me to the hospital. At the hospital, I had my stomach pumped so that I would throw 

up the medication that was inside me. The doctor asked me why I was taking so 

many medications. I told him that I was only taking medication for depression and 

for sleeping. I remember that he said there was some kind of allergy medication 

that had been given to me. I was then taken back to the detention center. 

The next day I was still feeling sick. I was vomiting continuously. I lost control 

of myself and fainted. Again, the other detainees started making noise and yelling 

as they had done before. Emergency was called and two nurses came. I was taken 

to the medical unit at the facility by wheelchair and examined. They gave me an 

I.V. and I started bleeding from my mouth and my private parts. The nurses noticed 

the severity of my situation and ordered a lock up of the detention facility. A fire 

department ambulance came and took me to the hospital again. I was still vomiting. 

At the hospital numerous tests were done on me. The examining doctor came and 

informed me that the test results showed damage to my liver and said he needed 

to do more tests and that ICE would be informed about the results. 

It took about a month for me to feel better. I needed help from other detainees 

to dress, bathe and walk. During this month I was only given medication to manage 

my pain. I couldn’t even go to the bathroom by myself. The other detainees needed 

to help me with just about everything. Sometimes the guards would also help me. 

Also during this time the detainees and myself were told to sign some document 

which absolved the facility from liability for dispensing medications related to depression and difficulty sleeping. I refused to sign. 

I had my attorney call ICE and request my medical records. He was refused and 

told that I personally had to request these documents. I requested all my medical 

records on numerous occasions. To date, I have not received any of my records. 

To this day, I am not sure to what extent my health has been damaged. I was 

never officially told that I was given the wrong medication. It was only in passing 

that one of the male nurses told me that he was sorry that I had been given the 

wrong medication. I have repeatedly requested that I be informed about my test results, especially regarding my liver. I have just recently obtained health insurance 

and have taken some tests. I hope that these tests will finally allow me to find out 

what if any permanent damage was done to my health while I was detained by ICE. 

I hope that my testimony helps this committee to evaluate the state of medical 

care within the ICE detention centers around the country. 

Ms. LOFGREN. Thank you so much. I know that your testimony 

was difficult to give. 

Ms. McCarthy? 

TESTIMONY OF MARY MEG McCARTHY, DIRECTOR, 

NATIONAL IMMIGRANT JUSTICE CENTER 

Ms. MCCARTHY. Thank you, Madam Chairwoman and Members 

of the Subcommittee. I am grateful for this opportunity to testify 

in support of the Detainee Basic Medical Care Act of 2008. I have 

submitted my written testimony for the record, and I would like to 

offer the following prepared remarks and then take your questions. 

I think the testimony of my colleagues here has been very moving and powerful and illustrates so many of the issues that we see 

at the National Immigrant Justice Center. 

89 

I am the director of the National Immigrant Justice Center, a 

program of Heartland Alliance For Human Needs and Human 

Rights, based in Chicago, Illinois. The National Immigrant Justice 

Center coordinates the largest network of pro bono attorneys in the 

country, providing legal representation to approximately 8,000 individuals each year, including low-income immigrants, refugees, victims of human trafficking, unaccompanied children and asylum 

seekers. Our diverse client base and firsthand observation of different detention facilities gives us a unique perspective on detainee 

health care. 

Across the country, U.S. Immigration and Customs Enforcement 

contracts with more than 300 local county jails to detain noncitizens held in administrative custody. Many of these facilities are located in remote, rural areas, far from lawyers and other service 

providers. 

In Illinois and Wisconsin, the National Immigrant Justice Center 

regularly visits county jails under contract with ICE to offer legal 

rights orientations, conduct individual intake, and accept individual cases for representation. 

In the thousands of detention cases that the National Immigrant 

Justice Center has handled during the past 10 years, we have witnessed a constant stream of complaints about the denial of adequate medical care. These complaints range from treating common 

colds to managing serious, permanent illnesses, such as issues relating to reproductive health care, to diagnosing and treating the 

physical and mental trauma resulting from torture. 

I think it is also very important that we look at the numbers of 

days that individuals are staying in detention. We have heard this 

afternoon that the average length of stay is approximately 37 days. 

However, as my colleagues have testified today, that is not always 

the case. 

In those cases where individuals are detained for longer periods 

of time, it is critical that those individuals have access to adequate 

medical care. In fact, the General Accounting Office statistics indicate that approximately 5,660 detainees of the 283,000 who were 

deported in fiscal year 2006 that were detained for more than 210 

days, or roughly 7 months. 

And as my colleagues testified today, many of those individuals 

are not here illegally. They have legal claims. Many were granted 

relief. They were granted immigration status in the United States. 

I briefly want to talk about one particular case from the Midwest. My written comments explore a wide range of areas regarding health care, but the one particular case I will describe involved 

an Algerian asylum seeker, Ms. Hassiba Belbachir who came to the 

United States seeking asylum. She was taken into custody in 

McHenry County Jail in Illinois. 

She suffered from severe depression, she told a nurse of her desire to take her own life, and repeated this cry for help to a social 

worker shortly thereafter. Instead of scheduling an emergency appointment with a psychiatrist, the nurse put Ms. Belbachir on a 

list to see the psychiatrist at his routine weekly jail visit 4 days 

later. Ms. Belbachir committed suicide before that appointment. 

The jail-issued socks wrapped around her neck asphyxiated her. 

90 

Ms. Belbachir’s story shows what is wrong with our detainee 

health-care system. She was an asylum seeker with a serious mental health problem. Because she had no effective advocate and because, like the other 30,000 noncitizens detained by ICE on a daily 

basis, her case was all but invisible to the public and any number 

of civic organizations or even State agencies that might have come 

to her aid. In addition, the county jail did not comply with ICE detention standards. Staff did not conduct a comprehensive initial 

medical screening upon Ms. Belbachir’s arrival. Her subsequent 

care was inappropriate. 

ICE authorities knew that this facility had a history of failing to 

provide adequate screening to immigrants and failed to adequately 

train staff. And while ICE has detention standards, it has steadfastly refused to codify them. Thus, the standards are legally unenforceable, leaving immigrant detainees and their advocates little 

recourse. 

How do we prevent future deaths and ensure that immigrant detainees receive proper medical care? The Detainee Basic Medical 

Care Act is a necessary first step. Among its requirements, each 

immigrant in ICE custody must receive a comprehensive medical 

and mental health screening upon arrival at a facility and a comprehensive examination. Appropriate personnel must have access 

to medical records to ensure proper treatment. 

Ms. LOFGREN. Could you summarize at this point? 

Ms. MCCARTHY. Yes, I’ll be happy to wrap up. 

In conclusion, adequate health care is a critical component of humane detention conditions. When lives hang in the balance, maintaining humane detention conditions will depend upon oversight, 

transparency and accountability, from Washington, DC, to local 

ICE contract facilities. Lifting the veil of secrecy shrouding the immigration detention system and starting an honest discussion 

about its humanity and fairness would be a great start. 

Thank you for this opportunity. 

[The prepared statement of Ms. McCarthy follows:] 

PREPARED STATEMENT OF MARY MEG MCCARTHY

I. INTRODUCTION

Thank you, Madame Chairwoman and members of the Subcommittee. My name 

is Mary Meg McCarthy. I have served as Executive Director of the National Immigrant Justice Center, a program of Heartland Alliance for Human Needs & Human 

Rights, for 10 years. Prior to joining the organization, I represented asylum seekers 

as a pro bono attorney. I am grateful for the opportunity to testify in support of 

the Detainee Basic Medical Care Act of 2008. 

Madame Chairwoman and members of the Subcommittee, medical care for people 

who are detained in this country is in critical condition. It is but one symptom of 

a dysfunctional immigration system. 

This afternoon, I would like to provide a brief overview of the broken health care 

system for immigrant detainees, detail examples of the battles fought by the National Immigrant Justice Center to obtain health care and urgent treatment for immigrants in detention, and make recommendations for reform. The Detainee Basic 

Medical Care Act will greatly improve the quality and delivery of care to detained 

asylum seekers and other men and women in administrative detention. In addition 

to this critical function, it will remove the veil of secrecy that shrouds the deeply 

flawed immigration detention system. 

The National Immigrant Justice Center, or NIJC, is a legal aid organization based 

in Chicago. In addition to direct service, NIJC litigates in the federal courts and advocates for systemic reform with policy makers. NIJC and its pro bono partners provide legal representation to approximately 8,000 individuals annually, including 

91 

1 According to the Washington Post’s recent series on health care in immigration detention, 

only one in ten detained immigrants have legal representation. Dana Priest and Amy Goldstein, 

‘‘As Tighter Immigration Policies Strain Federal Agencies, The Detainees in Their Care Often 

Pay a Heavy Cost,’’ Washington Post, May 11, 2008. In fiscal year 2006, only 48% of all non- citizens were represented by counsel in immigration court proceedings. United States Department of Justice, Executive Office for Immigration Review, FY 2006 Statistical Year Book, G1 

(2007). 2 Jorge Bustamante, Report of the United Nations Special Rapporteur on the Human Rights 

of Migrants, Mission to the United States of America, A/HRC/7/12/Add.2, 5 March 2008, at 11. 3Testimony of Gary Mead, before the House Subcommittee on Immigration, Hearing on ‘‘Problems with ICE Interrogation, Detention, and Removal Procedures,’’ February 13, 2008. 4For a list of CDFs and SPCs, see ‘‘Semiannual Report on Compliance with ICE National Detention Standards January-June 2007,’’ U.S. Immigration and Customs Enforcement Office of 

Detention & Removal (released May 2008). 

low-income immigrants, refugees, victims of human trafficking, unaccompanied minors, and asylum seekers. During the past 25 years, NIJC has developed the largest 

network of pro bono attorneys in the United States, totaling more than 1,000 attorneys from leading law firms. 

Throughout most of the nation, the U.S. Immigration and Customs Enforcement, 

or ICE, contracts with local county jails to detain non-citizens held in administrative 

custody. Many of these facilities are located in remote rural areas, far from immigration lawyers and social service providers. Strict secrecy regarding the disclosure 

of information regarding administrative detainees keeps them further isolated. 

NIJC regularly visits the Illinois and Wisconsin county jails under contract with 

ICE to offer legal rights orientations, conduct individual intake, and accept cases for 

representation of non-citizens held in ICE custody. Immigration detention is administrative, not criminal, in nature. Unlike individuals held in criminal detention, immigrants in administrative custody have no right to court-appointed counsel. Despite the best efforts of NIJC and other legal aid organizations, only about ten percent of detainees obtain sufficient legal counsel.1 Thus, legal rights presentations 

are often the only opportunity for detained immigrants and asylum seekers to gain 

an understanding of their legal rights and the available avenues for complaint and 

redress. 

The government has broad authority to decide who is detained and for what duration, with little oversight and virtually no checks-and-balances. As a result, the system is arbitrary and lacks transparency. NIJC’s direct representation of detained 

clients and its regular presence in the jails gives it a unique, insider’s perspective 

on ICE’s persistent failure to provide basic health care, respond to urgent needs, 

conduct vigorous oversight, and take corrective action. Despite this insight, much 

of the data obtained by NIJC related to detention conditions is garnered through 

requests under the Freedom of Information Act and federal litigation. 

The medical staff and guards at ICE contract facilities have proven to be more 

open to communication with advocates and service providers than the federal agencies. In 2003–04, NIJC conducted a program under which it educated jail staff on 

the medical and mental health needs of the immigrant detainee population, and 

trained them to better understand the unique and often tragic experiences of asylum seekers, torture survivors, and victims of domestic violence in immigration detention. This project, which was implemented in Illinois, Michigan, and Wisconsin, 

was well received by medical staff and guards at the jails, who welcomed information on areas of medicine in which they were unfamiliar, such as tropical medicine 

and infectious diseases. The project also addressed practical issues, such as conducting medical exams through interpreters. Throughout this project, NIJC staff 

tried to work with the Division of Immigration Health Services (DIHS) to share our 

findings and seek its involvement, but to no avail. DIHS all but ignored our attempts to collaborate and improve conditions for these men and women. 

II. OVERVIEW OF THE BROKEN HEALTH CARE SYSTEM FOR ICE DETAINEES

The use of administrative detention for non-citizens has skyrocketed during the 

past 12 years. In 1996, the U.S. government had a daily immigration detention capacity of 8,279 beds. By 2006, that number had increased to 27,500, with funds appropriated for future expansion.2 In fiscal year 2007, more than 322,000 non-citizens 

were held in immigration detention facilities,3 with a daily average of approximately 

33,000 detainees. According to ICE officials, approximately 350 facilities that hold 

immigrant detainees operate under Intergovernmental Service Agreements (IGSAs). 

An additional eight service processing centers (SPCs) are owned and operated by 

ICE, and seven contract detention facilities (CDFs) are operated by private contractors such as Corrections Corporation of America or the GEO Group.4 Most of the 

92 

5Dana Priest and Amy Goldstein, ‘‘System of Neglect,’’ Washington Post, May 11, 2008. 6 ICE has stated that it spent nearly $100 million in fiscal year 2007 on medical care for detainees. ICE Statement for the Washington Post, May 7, 2008, available at www.ice.gov/pi/detaineelhealthlwashlpostlstatement.htm. 7 International Covenant on Civil and Political Rights art. 10, December 19, 1966, 99 U.N.T.S. 

171. 8 Universal Declaration of Human Rights art. 5, December 10, 1948, U.N.G.A. res. 217 A(III). 

9 Convention against Torture, and Other Cruel, Inhuman or Degrading Treatment or Punishment arts. 2 and 16, December 10, 1984, 1465 U.N.T.S. 85. 10See, e.g., United Nations Standard Minimum Rules for the Treatment of Prisoners, May 13, 

1977, Economic and Social Council res. 2076 (LXII); Body of Principles for the Protection of All 

Persons under Any Form of Detention or Imprisonment G.A. res. 43/173, annex, 43 U.N. GAOR 

Supp. (No. 49) at 298, U.N. Doc. A/43/49 (1988). 

IGSA facilities are county jails that were not designed to hold a civil detainee population for what can be months or years. 

The May 2008 reports by ‘‘60 Minutes,’’ The New York Times, and The Washington Post revealed the shockingly sub-standard conditions under which many asylum seekers and other non-citizens are held in federal custody. Eighty-three immigrants have died in custody in the past five years.5 Countless others have suffered 

immeasurably while they or their loved one begged ICE to provide care. The press 

has done an admirable job of educating the public and policy makers on the sorry 

state of this system. Sadly, these reports were not news to many advocates. In 

NIJC’s extensive experience, immigration detainees frequently have to fight to obtain basic medical care and treatment for life-threatening conditions. Many never 

receive care, especially those with limited English language fluency and no legal 

representation. 

ICE detention facilities are governed by the ICE Detention Standards, which were 

negotiated between the Immigration and Naturalization Service (INS) and the 

American Bar Association, to apply to facilities that hold non-citizens in ICE custody for 72 hours or more. ICE adopted these standards when it succeeded the INS, 

but it has steadfastly refused to codify the standards in statute or regulation, leaving the standards legally unenforceable. This is a fundamental point. Immigrant detainees and their advocates have little recourse when the government refuses to enforce its own rules. 

While ICE touts its expenditure of funds on immigrant health care,6 as described 

below, only a few DIHS nurses decide whether or not to authorize the thousands 

of requests for treatment that are submitted by on-site medical care staff in these 

jails. 

III. DOMESTIC AND INTERNATIONAL HUMAN RIGHTS LAW

REQUIRES ADEQUATE HEALTH CARE

The United States is a nation that values liberty and respects the rule of law. 

We do not deprive individuals of liberty without due process of law, regardless of 

their nationality or alienage. Our due process protections include the right to humane treatment while in custody. Of course, people in immigration detention are 

in administrative, not criminal custody. Many have no criminal record whatsoever, 

having arrived on our shores seeking asylum or protection from torture. Others have 

committed only minor civil infractions and have no serious or violent history. As a 

result, our immigration detention facilities are filled to a significant degree with immigrants who pose no threat to our communities and who should be released on parole, into secure alternative programs, or under orders of supervision. 

A host of constitutional principles and international laws govern the treatment of 

individuals in custody. All individuals in this country—regardless of their legal status—are protected by the Eighth Amendment (made applicable to the states by the 

Fourteenth Amendment), which prohibits cruel and unusual punishment. International human rights law also requires that all individuals in custody be treated 

humanely, regardless of citizenship status. For example, Article 10 of the International Covenant on Civil and Political Rights (ICCPR) states that ‘‘all persons deprived of their liberty shall be treated with humanity and with respect for the inherent dignity of the human person.’’ 7 Torture and cruel, inhuman, and degrading 

treatment are outlawed by the Universal Declaration of Human Rights (UDHR) 8

and the Convention Against Torture (CAT).9 The ICCPR and CAT were both ratified 

by the United States; the UDHR is accepted as universal law. In addition, United 

Nations guidelines call for non-discrimination while in custody, prompt medical care 

and attention, access to hygiene and sanitary conditions, and health care that meets 

national and community standards.10

The United Nations High Commissioner’s Guidelines on Applicable Criteria and 

Standards Relating to the Detention of Asylum Seekers call the detention of asylum 

93 

11 ‘‘UNHCR Revised Guidelines on Applicable Criteria and Standards Relating to the Detention of Asylum Seekers,’’ United Nations High Commissioner for Refugees (February 1999), Geneva, available at http://www.unhcr.org.au/pdfs/detentionguidelines.pdf. Although UNHCR’s 

guidelines are not binding, they represent how UNHCR, the agency charged with supervising 

the application of the Refugee Convention, believes asylum seekers should be treated. 12 Id. 13 Id. 14See ICE Detention Standard on Medical Care, section I, available at http://www.ice.gov/ 

doclib/partners/dro/opsmanual/medical.pdf. 15Letter from Roger Thomas, Deputy Warden, York County Prison, to Joe Sallemi, D.A.D.D., 

ICE, regarding DIHS, dated November 28, 2005, at p. 3. 16Dana Priest and Amy Goldstein, ‘‘System of Neglect,’’ Washington Post, May 11, 2008. 17Transcript of The Diane Rehm Show, ‘‘Medical Care of Detained Immigrants,’’ WAMU Radio 

88.5 FM, (a National Public Radio affiliate in Washington, D.C), May 13, 2008, available at 

www.wamu.org. 18We understand that previously a fourth nurse reviewed requests from hospitalized detainees across the nation, but that such requests are now spread among the three remaining staff. 

See, e.g., http://www.icehealth.org/ManagedCare/ManagedCare.shtm. 

19Dana Priest and Amy Goldstein, ‘‘In Custody, In Pain,’’ Washington Post, May 12, 2008. 

seekers ‘‘inherently undesirable.’’ 11 The Guidelines recognize that there may be circumstances in which detention of asylum seekers becomes necessary.12 However, in 

those situations the Guidelines are unambiguous: ‘‘Conditions of detention for asylum seekers should be humane with respect shown for the inherent dignity of the 

person.’’ The Guidelines state that ‘‘the permissible exceptions to the rule that detention should normally be avoided must be prescribed by law.’’ 13

Due process also affords detained non-citizens the right to counsel, which has 

proven to be a near prerequisite to obtaining basic health care in immigration detention. However, rights are meaningless if they cannot be effectuated by the individuals they are meant to protect. Because non-citizens in custody are not provided 

counsel (although they are entitled to it), the right to adequate health care is a battle that many are left to fight on their own from remote and isolated detention facilities, a battle not often won. 

IV. DIHS POLICIES VIOLATE APPLICABLE LAWS AND ICE’S OWN DETENTION STANDARDS

The ICE Detention Standard on Medical Care, while far from perfect, requires 

that, ‘‘All detainees shall have access to medical services that promote detainee 

health and general well-being.’’ 14 But because the standard is not enforceable, it remains, in effect, ‘‘aspirational.’’ Unfortunately, the policy that seems to exercise 

greater influence over provision of medical care to ICE detainees is implemented by 

the Division of Immigration Health Services (DIHS) in Washington, D.C. 

As a matter of policy, DIHS errs on the side of refusing treatment to people who 

need care. The results are dangerous for detainees and frustrating to many jailers. 

In fact, the Deputy Warden of York County Prison in York, Pennsylvania, where 

federal immigration officials have held detainees for years, famously wrote to the 

local ICE office that DIHS had ‘‘set up an elaborate system that is primarily interested in delaying and/or denying medical care to detainees.’’ 15

In fact, the DIHS mission statement is contradictory to provisions of the ICE Detention Standard on Medical Care, which provides for at least basic medical care 

for the duration of detention. DIHS provides health services only for emergency 

care, defined as a ‘‘condition that is threatening to life, limb, hearing or sight.’’ In 

short, the DIHS mission, as revealed in a document obtained by The Washington 

Post, is to keep the detainee ‘‘medically ready’’ for deportation.16 This view was reiterated by Mr. Gary Mead, Acting Director of ICE Detention and Removal Operations, who questioned whether care was necessary as long as the detainee was 

‘‘medically capable’’ of being removed.17

Another significant barrier to obtaining health care is the fact that requests for 

treatment that are made by medical personnel on-site in the jails must be submitted 

to off-site DIHS Managed Care Coordinators (MCCs). These are three nurses, not 

doctors, who are based in Washington, D.C. These three MCC nurses currently receive and review the medical requests submitted by on-site staff in the jails, effectively serving all 33,000 individuals currently in ICE custody across the nation.18

According to The Washington Post, in one recent month, the MCCs received 3,000 

requests for care.19 Working five days per week, at this rate, each of the three MCC 

nurses would have to review and respond to approximately 50 requests per day. 

In a press conference on May 21, 2008, Chairwoman Lofgren described changes 

to DIHS policy that raise additional concerns about the quality of medical care provided under this system. Apparently, until 2007 an MCC nurse had the authority 

to approve requested medical care, but not to deny it. Cases that an MCC recVerDate Aug 31 2005 11:20 Oct 01, 2008 Jkt 000000 PO 00000 Frm 00097 Fmt 6633 Sfmt 6621 H:\WORK\IMMIG\060408\42722.000 HJUD1 PsN: 42722
94 

20To protect client confidentiality, most of these cases are described without using the client’s 

name. NIJC will provide this information to the Committee upon request and with client permission. 

ommended for denial had to be reviewed by the Medical Director. As Chairwoman 

Lofgren described, a policy change now allows denial of requested treatment to be 

issued by the MCCs without review by the Medical Director. As a result, off-site 

nurses may deny care that was requested by on-site jail medical personnel—potentially endangering lives, and doing so with little to no oversight by doctors. 

Chairwoman Lofgren described another change to DIHS policy that we find 

alarming. DIHS previously allowed on-site physicians or medical personnel in the 

ICE facilities to effectively appeal a denial of treatment by asking that the request 

be reviewed by three DIHS physicians, not including the Medical Director who may 

have previously authorized denial of treatment. While not fully independent, this 

process at least allowed for review by additional physicians. Chairwoman Lofgren’s 

comments in the May 21 press conference suggest that this process has been replaced with a grievance process that no longer permits independent or even quasiindependent review. 

Vigorous oversight by Congress and independent investigators must be conducted 

to measure the impact of these policy shifts with regard to the fairness of detainee 

access to treatment and the well-being of detainees. The Detainee Basic Medical 

Care Act corrects some of these problems by mandating that treatment decisions are 

based solely on professional clinical judgments and by mandating the continuity of 

care. These ensure that immigrant detainees are able to consistently obtain prescribed medicine that they were administered prior to entering ICE custody. Finally, 

the bill’s establishment of an administrative appeals process for denials of medical 

or mental health care will help to correct the dangerous DIHS policy that is in place 

today. 

V. NIJC’S CLIENTS HAVE BEEN ROUTINELY DENIED ADEQUATE HEALTH CARE

We all know that policies have consequences for real people. Policies that are carried out with a callous disregard for humane treatment, medical ethics, and international human rights standards lead to the horrific stories you have heard today 

and read in recent national press coverage. 

I would like to describe briefly several specific cases that reflect the persistent 

problems I have seen over a dozen years.20 The stories of these men and women 

illustrate the urgent need for systemic reform of the immigration detention health 

system to improve screening, comprehensive medical and mental health evaluations, 

access to medical records, and response to urgent treatment requests. Many of these 

problems can be addressed through enactment of the Detainee Basic Medical Care 

Act. 

A. Inadequate Screening 

Inadequate screening can fail to catch obvious medical conditions, including advanced stages of pregnancy, kidney stones, suicidal tendencies, and infectious disease. Early in my tenure at the National Immigrant Justice Center, a woman held 

in a county jail under contract to the INS, ICE’s predecessor agency, gave birth in 

a jail bathroom. The INS and jail staff did not know she was pregnant. Granted, 

this case occurred several years ago, but little has changed. The same detention 

standards that were adopted by the INS in 2000 are still in place and frequently 

violated. 

NIJC represented an Afghan asylum seeker who was detained for more than eight 

months in a county jail in Wisconsin. He developed kidney stones and saw the jail 

nursing staff repeatedly. On rare occasions, he was provided with Tylenol or 

ibuprofen. It took the intervention of an attorney at NIJC to obtain medical tests 

to diagnose his serious condition. Then, this asylum seeker was transferred to another facility unexpectedly, before the test results were available. 

NIJC also represented a West African asylum seeker who suffered immeasurable 

harm after being kidnapped by soldiers and held for six months as a sex slave and 

laborer. She finally escaped her captors and reached the United States, where she 

was detained in a Detroit area jail. Even though she was an asylum seeker, she was 

held with the criminal population. She was unable to obtain adequate medical 

screening or access to health care, despite the fact that she suffered from pelvic pain 

and bleeding as a result of the torture she endured in captivity. After extensive negotiations with NIJC, the government agreed to release her. NIJC arranged for her 

to obtain the medical and mental health counseling she desperately needed. She 

eventually won asylum. 

95 

21The case of Hassiba Belbachir is discussed publicly because it is the subject of federal litigation. In addition, the attorneys for the Belbachir estate authorized the use of her name in this 

testimony 22 Amended Complaint of the Estate of Hassiba Belbachir v. County of McHenry et al, Case 

1:06-cv-01392, Filed Nov. 9, 2007 (N.D.Ill.) 23 Id. 24 Id. 25See ICE Detention Standard on Medical Care, section III.N., ‘‘Transfer and Release of Detainees,’’ which states, ‘‘When a detainee is transferred to another detention facility, the detainee’s medical records, or copies, will be transferred with the detainee.’’ This standard was issued 

by the INS on September 20, 2000 and adopted by ICE along with the other Detention Standards when it succeeded the INS. 

In yet another case, a female client of NIJC exhibited signs of malaria that were 

not recognized by jail medical staff. The woman, an asylum seeker from Rwanda, 

recognized the symptoms and asked for medical care. She was provided with aspirin 

by the jail’s medical staff. NIJC attorneys intervened and educated the jail physician, who had no experience or knowledge of tropical diseases. Malaria is easily 

treated, but can be fatal if misidentified or treated incorrectly. NIJC eventually convinced the government to release our client. 

The Detainee Basic Medical Care Act requires that each immigrant in ICE custody receive a comprehensive medical and mental health screening upon arrival at 

a facility, and a comprehensive examination within 14 days of arrival. It also requires that appropriate personnel have access to medical records, an important step 

to ensuring proper diagnosis, prescriptions, and treatment. 

B. Inadequate Treatment and Deaths in Detention 

In 2005, an Algerian asylum seeker, Hassiba Belbachir was detained at McHenry 

County Jail in Woodstock, Illinois.21 According to the complaint filed in a civil rights 

and wrongful death suit brought by her estate, on March 13, 2005, Ms. Belbachir, 

who suffered from severe depression and panic attacks, told a nurse of her desire 

to take her own life. The next day, she saw a social worker and again expressed 

her suicidal feelings. The social worker recommended she see a psychiatrist. But 

rather than scheduling an emergency appointment, the nurse placed her on a list 

to see the psychiatrist at his routine weekly jail visit a full four days later. Ms. 

Belbachir committed suicide before she had an opportunity to see the psychiatrist. 

To make the situation even more tragic, on the day of her death, jail staff saw her 

lifeless body motionless on the floor of her cell in the medical pod, but did not intervene for 40 minutes, when they finally called for emergency service. By the time 

jail staff entered her cell, it was far too late. Her face was purple. The jail-issued 

knee socks knotted together and wrapped around her neck had asphyxiated her.22

Significantly, ICE authorities knew from annual inspections, before Ms. 

Belbachir’s death, that McHenry County Jail had a history of failing to provide adequate mental health and suicide screenings to ICE detainees, maintained no adequate written suicide prevention policy, and failed to adequately train staff to prevent suicides. Even so, according to the Belbachir complaint, ICE authorities did not 

enforce the Detention Standards until after Ms. Belbachir’s death.23 Further, no one 

charged with overseeing her custody and care was disciplined in any matter related 

to this gross failure of medical and mental health care and supervision.24

Such tragic and preventable cases call into question ICE’s ability to monitor its 

facilities and conduct adequate, much less vigorous, oversight of its own operations. 

The Detainee Basic Medical Care Act requires ICE to report any death in detention 

to the Offices of the Inspector General of the Department of Homeland Security and 

Department of Justice within 48 hours. It also mandates reporting to Congressional 

oversight committees. These are critical measures long overdue. Only with greater 

transparency will we achieve accountability. 

C. Failure to Transfer Medical Records When Detainees are Moved is a Persistent 

and Dangerous Problem 

Over the lifespan of NIJC’s project to educate health care practitioners in Midwestern facilities holding ICE detainees, NIJC spoke to dozens of jail staff and 

asked about their experience treating detainees. A common complaint from these 

nurses and other personnel included widespread failure to receive medical records 

when detainees were transferred from one ICE facility to another. In fact, in no case 

did a jail guard or medical professional tell NIJC that medical records were transferred to a new facility with an incoming detainee, despite the requirement in the 

ICE Detention Standards that records be transferred with each detainee.25

96 

VI. IN ITS HASTE TO DEPORT NON-CITIZENS, ICE CUTS CORNERS AND MAKES RASH

DECISIONS THAT HAVE THE POTENTIAL TO EXPOSE THE PUBLIC TO HEALTH RISKS

Last year, NIJC helped an African immigrant with infectious tuberculosis and 

AIDS seek much-needed medical treatment. This man was previously detained, but 

ICE released him on an order of supervision when it discovered he was HIV-positive. He was later diagnosed with AIDS. NIJC filed a motion for a stay of removal 

and expended extraordinary efforts to notify senior ICE officials that deportation 

would be inhumane in this case and could create a public health risk. The man was 

nonetheless put on a plane to Africa, an action that may have exposed other passengers to his infectious tuberculosis. NIJC strongly urges Congress to enact, and 

ICE to adopt, the provisions in the Detainee Basic Medical Care Act regarding continuity of care and development of discharge plans. As this case makes clear, such 

steps are not only critical for detainee health but also influence public safety. 

VII. FOR DETAINEES WITHOUT ATTORNEYS, SEEKING MEDICAL ATTENTION

CAN BE A FRUITLESS QUEST

ICE, DIHS, and congressional oversight committees must recognize that due to 

a chronic lack of legal counsel, most detained immigrants never know of their right 

to health care, much less how to exercise that right. When they do request treatment or complain about a lack of adequate care, detainees face insurmountable procedural obstacles and an accountability vacuum. A lack of transparency regarding 

who is detained, where, and for what purposes keeps claims related to health care 

and detention conditions beyond the reach of legal service providers and out of public view. Most of the stories you heard today have pierced the veil only because a 

lawyer, a social service provider, a volunteer with a religious organization, or a family member fought to hold the government accountable for the treatment of a particular individual in its custody. Like the cases revealed by Freedom of Information 

Act requests and the recent reports from The New York Times and the Washington 

Post cited above, they are powerful anecdotes that suggest broader violations. 

NIJC legal staff members routinely advocate for clients who need medical care 

and who cannot obtain it in ICE detention. Complaints about access to medical care 

are a constant theme in our conversations with detained immigrants. These grievances range from the denial of over-the-counter pain medication to a refusal to provide life-sustaining medication for chronic illnesses. In addition to general medical 

conditions, NIJC has fought on behalf of asylum seekers who have been denied 

treatment for injuries sustained from the torture and the persecution from which 

they have sought refuge in the United States. Without an attorney or an advocate, 

these individuals would never have received appropriate care. How many other detained individuals are being denied critical medical care? How can we balance the 

use of detention with the humane treatment of detainees? 

Considering alternatives to detention would be a good start. It is inhumane to detain asylum seekers and other immigrants who have experienced trauma or other 

severe medical conditions. Alternatives to detention through non-governmental and 

private entities are proven to be secure and effective. Under these programs, an immigrant in removal proceedings is released to participate in an ‘‘enhanced supervision’’ program that requires regular check-ins with a caseworker, or in some cases, 

the use of an electronic ankle bracelet. Alternatives are less expensive than ICE detention, which averages approximately $95 dollars per day. Alternatives also provide 

a wider array of medical and mental health care options. The Detainee Basic Medical Care Act recognizes this humane and common sense approach by prioritizing 

the parole or bond of immigration detainees who have serious medical or mental 

health conditions. 

VIII. CONCLUSION

ICE and DIHS must provide screenings to all detainees in a timely manner and 

make decisions about treatment based on medical conditions, and not on the individual’s immigration status. Providing adequate medical care is part of a broad range 

of detention conditions that the government must monitor and for which it must be 

accountable. 

Accordingly, decisions about health care must be made by on-site attending medical professionals, and not by a team of bureaucrats in Washington, D.C. An appeals 

process must be established for the review of request denials from detainees by onsite medical professionals in detention facilities. The medical and mental health requirements, appeal process for denial of care, and increased oversight in the Detainee Basic Medical Care Act will facilitate care for all detained immigrants. In 

97 

many cases, alternatives to detention may be both the most humanitarian and fiscally responsible actions. 

Like any other area of government responsibility, where lives hang in the balance, 

maintaining humane detention conditions will depend upon oversight, transparency 

and accountability. 

Thank you for the opportunity to testify today. I request that my full statement 

be made part of the record and would be pleased to answer your questions. 

Ms. LOFGREN. Thank you very much for your testimony. 

Ms. Baker, we would be pleased to hear from you. 

TESTIMONY OF ANN SCHOFIELD BAKER, PARTNER, McKOOL 

SMITH, AND ATTORNEY FOR AMINA BOOKEY MUDEY, 

FORMER DETAINEE 

Ms. BAKER. Thank you. I am Ann Schofield Baker. I am a principal at the law firm of McKool Smith in charge of their trademark 

litigation practice. Thank you to Congresswoman Lofgren and this 

Subcommittee for inviting me to testify today. 

As an intellectual property trial lawyer, I will admit I knew very 

little about asylum law or about the inner workings of detention 

centers until I agreed to represent pro bono Amina Mudey, a 29- 

year-old torture survivor from Somalia who sought asylum in the 

United States. Amina suffered unspeakable torture, abuse and loss 

in Somalia, as evidenced by her scars and four murdered family 

members. 

In April of 2007, Amina fled to America and sought asylum. She 

was incarcerated in the Elizabeth Detention Center in New Jersey, 

which is run by CCA. 

When I took Amina’s case, I had no idea that I was destined to 

spend over 600 hours in the first 3 months focusing not on her asylum case but on battling DIHS, ICE and CCA to ensure that 

Amina didn’t die in their care. 

Amina has authorized me to testify before you today. 

During Amina’s 5-month ordeal in ICE custody, she experienced 

repeated incidents of medical mistreatment, incompetence and neglect that threatened her life, her health and her asylum case. In 

fact, there were two separate incidents in which her life was 

threatened because of poor medical treatment. 

When Amina first arrived at the CCA, she had a panic attack 

and fainted. She didn’t speak English at the time, and DIHS medical staff examined her without an interpreter. They wrote in her 

medical records that, ‘‘Patient complains that she has epilepsy and 

has seizures once or twice a week for 5 years.’’ When I had the aid 

of an interpreter, I asked her, ‘‘What’s this all about?’’ And she 

said, ‘‘I don’t have epilepsy. I was trying to tell them I’ve had headaches once or twice a week for last 5 years.’’ 

Then detention center doctors misdiagnosed her as being psychotic. They placed her on a powerful antipsychotic drug called 

Risperdal that had cataclysmic side effects on her, and they are 

telltale side effects of Risperdal. She started to lactate. She started 

to drool and convulse like she had Parkinson’s disease. She fell off 

her chair. She stopped getting a period. She started to drool. You 

can’t miss these side effects. She became dizzy and confused. 

Amina had no idea what was happening to her since no one ever 

gave her treatment with an interpreter. She showed the nurse that 

milk was coming out of her breasts, and she gave her a pregnancy 

98 

test and gave her a cup to go get a urine sample. And since she 

couldn’t speak English, she started giving them a milk sample from 

her breasts. 

Two weeks after this incident—it actually took 2 weeks for a doctor to evaluate her after she began to exhibit signs of lactation. 

What was his reaction? To increase her dosage of the Risperdal. 

She was still on Risperdal when I took her case 2 months later. 

And I brought in two outside doctors to examine her on her underlying asylum case. Dr. Katherine Falk wrote in her sworn affidavit in the case, ‘‘The diagnosis given to her by the doctor seeing 

her at the detention center is post-traumatic stress disorder, psychosis and depression. There is no evidence of psychosis, and there 

is absolutely nothing in the notes to indicate that she had any 

symptoms that would lead a medical doctor to be able to diagnose 

psychosis. She is not psychotic and should not be taking Risperdal.’’ 

Dr. Laurie Goldstein wrote in her affidavit, ‘‘At the time of my 

exam of Ms. Mudey, I was alarmed at the side effects that I witnessed due to the medications she was being prescribed at the Elizabeth Detention Center. And I advised her to refuse the Risperdal.’’ 

Both doctors submitted handwritten notes to the detention center 

doctors explaining their credentials, explaining that they had given 

a full examination, that the Risperdal was wrong, ‘‘Please contact 

me if you want to discuss the issue.’’ 

The doctor became angry at Amina and said, ‘‘You need to keep 

taking this drug.’’ Thankfully she refused, because the side effects 

she was exhibiting—if you go on Risperdal’s Web site, they are all 

right there—the side effects were potentially permanent and lifethreatening. 

Well, about 6 weeks later, as I was trying to prepare Amina to 

testify during my lawyerly duties, she developed symptoms of a serious abdominal illness that required immediate medical attention, 

but DIHS medical professionals ignored her pleas for help for 

weeks. A guard threatened to throw her in the SHU, CCA’s solitary 

confinement chamber, if she continued to request medical attention 

and exhibit signs of sickness. 

She called me in tears, doubled over in pain, and asked me to 

intervene. I called the CCA and spoke to a medical professional 

and alerted them that she had someone inside the facility that 

needed to go to a hospital immediately or else I was going to call 

911. And the person on the other end of the phone eventually said, 

‘‘Okay, fine, we will go and look in on her and see what is wrong 

with her.’’ 

Amina called me back 2 days later to say that nobody had had 

come to see her. And I didn’t call 911 because the person on the 

other end of the phone told me, if you call 911, we won’t let them 

into the facility. 

Well, after I found out that no one had come to see her, I prepared a Federal lawsuit to force them to take her to a hospital because I was afraid she would be dead by the end of the weekend. 

And the only reason they took her to a hospital is that they found 

out that I was going to file this complaint. 

To this day, they have refused to tell me what hospital they took 

her to, and I don’t have her medical records, and I haven’t seen 

99 

medical records from her since June. I wonder why they don’t want 

to give them to me. Can you figure it out? 

This is how ICE treated a torture survivor who fled to the U.S. 

in search of safety. Amina and other asylum seekers simply don’t 

have the option to just go home. 

I look forward to taking your questions. 

[The prepared statement of Ms. Baker follows:] 

PREPARED STATEMENT OF ANN SCHOFIELD BAKER


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Ms. LOFGREN. Thank you very much. 

Finally, Dr. Venters? 

TESTIMONY OF HOMER VENTERS, M.D., ATTENDING PHYSICIAN AND PUBLIC HEALTH FELLOW, BELLEVUE/NYU PROGRAM FOR SURVIVORS OF TORTURE 

Dr. VENTERS. Thank you, and good afternoon. My name is Homer 

Venters, and I am an attending physician at the Bellevue/NYU 

Program for Survivors of Torture, as well as a public health fellow 

with the CDC and New York University. I would like to thank the 

Chairwoman and other Members of the Committee to speak here 

today. 

Together with my colleague, Dr. Allen Keller, I have conducted 

an analysis of the ICE health-care system for the last 8 months. 

Contrary to public statements by ICE, it is our conclusion that this 

health system and the care it allows for detainees may be getting 

worse, not better. 

The central thesis of my remarks is that, behind confusing and 

unreliable statistics concerning detainee deaths, the ICE healthcare system contains key elements that may jeopardize detainee 

health. I will briefly review the flaws of the statistics provided by 

ICE, refer to several specific failures in the ICE health plan, and 

conclude with our specific recommendations for improving the system. 

ICE reports falling detainee mortality rates, but their figures are 

based on unreliable calculations. The most important failure is the 

lack of adjustment for average length of detention. Adjusting for 

risk exposure, such as length of detention, is a fundamental practice of both medicine and epidemiology, and failure to do so reflects 

flawed methodology. 

Figures for average length of detention are available for 2006 

and 2007. That is why I present these years. When appropriate adjustment is applied to ICE’s own mortality figures, one sees that 

length-adjusted mortality has increased 29 percent from 2006 to 

2007. 

Other misleading statistics published by ICE include hollow comparisons between deaths among detainees and among prison populations and the general U.S. population without any adjustment for 

age, disease prevalence or, again, length of detention. 

ICE mortality figures reveal two important pieces of information. 

First, the length-adjusted mortality for detainees increased from 

2006 to 2007. The cause of this increase is unclear, and mortality 

likely under-represents problems with detainee health care. Morbidity is a better marker. But it is certainly not the case the mortality has dramatically fallen during this time. 

Secondly, reliance by ICE on unsound statistical methods that 

consistently present a more positive picture of detainee health 

should generate concerns about the ability of ICE to adequately access and improve its own health-care system. 

This Committee has heard tragic and compelling testimony concerning the deaths of ICE detainees. I would like to mention four 

specific aspects of the ICE health plan that establish an unacceptable level of care for detainees and must be addressed if similar 

tragedies are to be averted. 

142 

First, the ICE health plan was recently changed to eliminate 

chronic care visits every 3 months. This change will mean that less 

care and less consistent care is provided to the one-third of detainees who suffer from chronic medical problems. And this is in stark 

contrast to the proven medical standard of establishing systemwide protocols for chronic disease management. 

Another harmful practice is requiring the inclusion of nonmedical 

criteria in referring detainees for outside care, including whether 

or not failure to treat will impact deportation. This inappropriately 

limits cares for detainees, creates ethical jeopardy for ICE providers, and I will mention is different than the standard for the 

Marshals Service. 

A third problem pertains to health screening. The ICE health 

plan, again, was very recently changed to allow basic health 

screening tests, such as mammograms and pap smears, and I 

quote, ‘‘on a case-by-case basis subject to clinical findings.’’ Screening tests are, by definition, applied to an entire nonsymptomatic 

portion of a population. To wait until clinical suspicion or symptoms appear completely undermines the screening aspect of the 

test. It deprives detainees of the accepted medical standard of early 

detection and treatment, and it lets diseases such as cervical, 

breast and prostate cancer develop to the point of symptoms. 

A final critical point regarding the ICE health plan involves the 

treatment authorization request, or TAR. ICE has recently 

scrapped the TAR appeals process but has also given off-site nurses 

the ability to reject TARs by detention center physicians. So now 

physicians in detention centers may have their treatment authorization requests rejected by off-site nurses, and they have lost the 

ability to effectively appeal such decisions. 

We recommend the following specific changes to the ICE health 

plan as well as the larger infrastructure of ICE. 

The ICE health plan must be altered so that health screening 

tests and care for chronic disease are routinely available and reflect 

accepted medical standards. Nonmedical criteria must be eliminated from this health plan as part of thereferral process. And detention center providers should not have TARs rejected by off-site 

nurses without physician review and without possible appeal. 

Other changes to the larger ICE health system should include 

mandatory reporting of vital health statistics, including morbidity, 

not just mortality, to a body outside Homeland Security and routine consideration of parole for seriously ill detainees. 

Finally, the health-care system for ICE detainees must be guaranteed and defined as a matter of law. Many of the deaths reported 

among ICE detainees involve poor adherence to existing ICE guidelines. 

Unfortunately, the present response of ICE to the overwhelming 

evidence of inhumane health care for detainees shows that officials 

are more concerned with public relations than confronting a grim 

medical reality suffered daily by immigrants in detention. 

I thank you, and I’d be happy to take any questions. 

[The prepared statement of Dr. Venters follows:] 

143 

PREPARED STATEMENT OF HOMER D. VENTERS, M.D. 

Good Afternoon. My name is Dr. Homer Venters. I am an attending physician at 

the Bellevue/NYU Program for Survivors of Torture as well as a Public Health Fellow with New York University. I am testifying today on behalf of the Bellevue/NYU 

Program for Survivors of Torture and the NYU School of Medicine Center for Health 

and Human Rights. I would like to thank Congresswoman Lofgren and members of 

the Subcommittee for inviting me to testify on immigrant detainee healthcare. My 

area of research as a Public Health Fellow is the medical care provided to Immigration and Customs Enforcement (ICE) detainees. Together with my colleague, Dr. 

Allen Keller (Director of the Torture Survivors Program and the Center for Health 

and Human Rights) I have conducted analysis of the ICE healthcare system, including the mortality statistics recently released by ICE and the specific provisions of 

the ICE health plan. My comments today focus on these two areas and I will provide 

recommendations for improvements of the ICE healthcare system. The central thesis of my remarks is that behind confusing and unreliable statistics concerning detainee deaths, the ICE healthcare system contains key elements that may jeopardize 

detainee health. Contrary to public statements by ICE, it is our conclusion that this 

health system, and the care it allows for detainees, is getting worse not better. 

I. Misleading Mortality Statistics 

I would like to begin with the recent discussion of detainee mortality reported by 

ICE. I am referring to the ICE fact sheet on detainee deaths dated May 2008 1 as well as the Op-Ed by Assistant Secretary Myers in the Washington Post.2 In these 

documents, ICE relies on inappropriate use of basic epidemiologic terms and inaccurate comparisons between populations known to be radically different. The lack 

of standardized mortality or morbidity reported in these documents provokes grave 

concern for the welfare of ICE detainees and the ability of ICE to monitor the quality of its own health care system. 

ICE reports falling detainee ’mortality’ rates but their figures are based on unreliable calculations. In Fiscal Year 2006 ICE detained approximately 250,000 people 

while in 2007, that number rose to 310,000. Because the total number of detainee 

deaths dropped from 17 to 11 during those periods, ICE claims that the mortality 

rate fell from 6.7 to 3.5 per 100,000 detentions, a 49% decrease.3 However this conclusion neglects a very basic and essential issue, the length of detention. From 2006 

to 2007, the average length of ICE detention decreased from 90 days to 37. Adjusting for risk of exposure (such as length of detention) is a fundamental practice of 

both medicine and epidemiology and failure to do so reflects flawed methodology. 

For instance, no physician would make conclusions about a patient’s risk from 

smoking without including how long that patient had been a smoker. Taking ICE’s 

same fiscal year numbers, but correctly adjusting for average length of detention, 

it is clear that the length-adjusted mortality actually increased between 2006 and 

2007 from 27 to 34 per 100,000 detention-years, a 29% increase (see Table 1 for side 

by side comparison).4 Consequently, the statistics presented by ICE tend to present 

an unduly rosy picture of detainee mortality. 

A second glaring weakness in the ICE statistics is found in their comparison between deaths of ICE detainees and those in a general prison population. Again, the 

lack of standardization for length of detention makes this a flawed comparison, 

since prisoners are typically held for a longer period of time in a given year than 

are ICE detainees. For example, imagine that ICE detained 300,000 people per year 

for one day each and U.S. prisons detained 300,000 people each for a full year. It 

would be incorrect to conclude that because fewer people died in ICE custody than 

in prison custody, the healthcare provided to ICE detainees was somehow superior. 

The fact that the average ICE detainee spends so much less time in custody than 

the average prisoner in a given year must be factored in to provide any meaningful 

results. 

Aside from lacking standardization over a given year, any comparison of ICE detainees to prisoner populations is dubious because prisoners are incarcerated for 

much longer periods of time in total than ICE detainees. Prison research has shown 

that mortality rates increase with time of incarceration, so even if ICE had standardized for time detained in a given year, prisoners who have accumulated years 

of prior detention are known to have higher rates of mortality.5 Also, when ICE favorably compares mortality of detainees to those of prisoners and the general population, there is no adjustment for age or disease prevalence. For example, U.S. prisoners have high rates of infectious disease, and the general U.S. population may be 

older, suffering from higher rates of heart disease and cancer than the ICE population. Without correct adjustment for these types of possible differences, the figures 

provided by ICE are unreliable. 

144 

To be clear, mortality is an imprecise method for appraising healthcare in a transitional population. Because death is rare and detention is short, mortality likely 

under-represents problems with health care delivery among ICE detainees. Morbidity, which refers to sickness or having a disease, is a better measure of the efficacy of ICE healthcare since by ICE estimates, at least 34% of detainees suffer from 

chronic diseases.6 Consequently, complications from poorly controlled chronic disease, such as diabetes, HIV, asthma or hypertension are more sensitive health care 

measures. Unfortunately, ICE makes reports no specific information about morbidity of detainees. However, even morbidity may under-represent adverse effects of 

this system. As with mortality, shorter detentions will tend to produce fewer adverse events. In thinking of ICE detention as a risk factor, as ICE detention time 

shortens, the likelihood is that adverse events caused by this risk will occur afterwards. This may have been the case with Juan Guillermo Guerrero, 37, who was 

denied his seizure medicines while detained by ICE and died of complications from 

seizures shortly after being deported to Mexico.7

This discussion of ICE detainee mortality reveals two important pieces of information. First, the length-adjusted mortality for detainees has increased from 2006 to 

2007. The causes or significance of this increase are unclear but it certainly is not 

the case that detainee mortality is dramatically falling, as ICE has asserted. Second, the reliance by ICE on unsound statistical methods that consistently present 

a more positive picture of detainee health should generate concerns about the ability 

of ICE to adequately assess and improve its own healthcare system. Our review of 

the ICE health plan, including recent changes, suggests that ICE detainees are receiving medical care that is increasingly limited and inconsistent with current 

standards of medical practice. 

II. An Acute Care Health System for a Population in Need of Much More 

The healthcare provided for ICE detainees is directed by a set of rules under the 

Detention Management Control Program of the Department of Homeland Security 

(DHS). This program creates procedures for ICE detention operations but does not 

carry the force of law. Particular medical policies and reimbursement guidelines are 

determined by the Division of Immigration Health Services (DIHS), recently incorporated into DHS from the Health Resources and Services Administration of the 

U.S. Department of Health and Human Services. DIHS guidelines then become part 

of the overall set of ICE rules for detention operations.8 Despite acknowledging the 

substantial burden of chronic disease among detainees, the ICE health plan maintains a steadfast focus on an acute care model. The 1/3 of detainees with medical 

problems that require ongoing, skilled care for problems such as diabetes, hypertension, asthma and HIV find themselves in a medical setting geared towards addressing ankle sprains, cuts and bruises and calling 911 in case of emergency. Unfortunately, the ICE health plan is clearly not crafted to care for a population with 

significant chronic medical or mental health needs. The introduction of the ICE plan 

explains ‘‘The DIHS Medical Dental Detainee Covered Services Package primarily 

provides health care services for emergency care. Emergency care is defined as ’a 

condition that is threatening to life, limb, hearing or sight.’’ 9

This institutional aversion to caring for detainees with chronic disease is evidenced in recent detainee deaths. One year ago, a 23 year old transgender woman, 

Victoria Arellano was detained by ICE.10 Ms. Arellano had AIDS and was taking 

a life saving medicine to prevent opportunistic infections that could quickly cause 

pneumonia and death were she to stop. These medicines are essential for people 

with AIDS and even a brief interruption risks sickness and death for a patient. Despite reporting her medical history and her medication when detained (and throughout her detention), Ms. Arellano was refused her medicine. Over the following 

weeks, Ms. Arellano developed a cough and fever, which should have prompted hospitalization and evaluation. Instead, Ms. Arellano was given an inappropriate antibiotic by the detention center medical staff, was still refused her needed medication, 

and returned to her cell. By the time Ms. Arellano’s cellmates staged a protest to 

draw attention to her deteriorating condition, she had become very ill and died soon 

thereafter, comatose and shackled to her bed. Faced with a common chronic disease, 

ICE medical staff withheld the correct medicines, gave inappropriate medicines and 

failed to seek more competent care for Ms. Arellano. The care that Ms. Arellano required would be routine in almost any medical clinic or hospital in the United 

States. 

Among the most prevalent chronic diseases from which detainees suffer may be 

depression and anxiety. The prevalence of these conditions is difficult to gauge in 

part because detainee may fear being placed in segregation should they report mental health symptoms. This fear was documented in study conducted jointly by the 

145 

Bellevue/NYU Program for Survivors of Torture and Physicians for Human Rights 

in 2003 among asylum seekers (admittedly, a small subset of all detainees). This 

report found that ‘‘the mental health of asylum seekers interviewed for this study 

was extremely poor and worsened the longer that individuals were in detention.’’ In 

this study, symptoms of depression were present in 86% of the 70 detained asylum 

seekers, and anxiety was present in 77% and PTSD in 50%.11 The study also documented significant difficulties for immigrant detainees accessing health services for 

painful and sometimes dangerous health problems. Unfortunately, recent reports by 

the Washington Post and New York Times demonstrate that the problems with detainee healthcare documented in 2003 are not new and have not been corrected. In 

fact the concerns are even greater today, given that current immigration policies 

continue to dramatically expand immigration detention. 

The fear of arbitrary and inhumane segregation is not hypothetical and has real 

bearing on the health of ICE detainees. In 2007, a 52 year old man from Guinea, 

Boubacar Bah, fell while in ICE custody and sustained a head injury.12 Mr. Bah 

was transferred to the medical unit of the detention center but when he became agitated, confused and vomited, Mr. Bah was written up for disobeying orders and 

transferred to segregation (a euphemistic term for solitary confinement) with approval of medical staff. The behavior that served as an excuse for disciplinary transfer to solitary confinement was in reality a sentinel sign of intracranial bleeding. 

The most shocking aspect of this case is that Mr. Bah was actually in the medical 

unit, under the care of ICE medical staff when the ill-conceived idea to place him 

in solitary confinement was approved. Mr. Bah’s condition deteriorated steadily 

under the watch of ICE personnel until 14 hours after his fall, foaming at the mouth 

and unresponsive, he was transferred to a hospital. Mr. Bah was quickly diagnosed 

with a fractured skull, multiple spots of bleeding in his brain and ICE notified his 

family five days later of his condition. Mr. Bah died several months later without 

ever regaining consciousness and ICE medical staff originally reported his cause of 

death as ’aneurysm’ without any mention of his fractured skull. While most detainees who are inappropriately placed in solitary confinement do not die, this case illustrates how very basic medical judgment can be abandoned in the detention setting. A man who had just fallen and lost consciousness, already inside the medical 

unit, was somehow judged to be ’disobeying orders’ instead of manifesting a clearly 

recognizable sign of head trauma. Solitary confinement is obviously inappropriate 

for someone who is ill, but this case and others call into question the very practice 

of placing detainees in such a setting. 

III. Specific Weakness in the ICE Health Plan Imperil Detainees 

In addition to the broad institutional problems facing detainees who require medical care, there are very specific aspects of the ICE health plan that warrant concern. DIHS has altered the Covered Services Package several times in the past few 

years, limiting the scope of medical care for detainees. Publicly reported deaths of 

detainees have included cases in which persons with chronic diseases were refused 

access to care outside their respective detention centers.13 The refusal for this care 

comes in the form of a Treatment Authorization Request (TAR) submitted by local 

medical staff at a detention center and denied by DIHS. Before 2005, the Covered 

Services Package entitled detained with chronic medical problems to ’chronic care’ 

visits every three months. In 2005, the Covered Services Package was changed in 

the following manner: ‘‘we have clarified to providers that DIHS does not mandate 

the frequency a detainee is seen or what testing needs to be done by the onsite physician. The responsibility will lie with the provider.’’ 14 In stark contrast to these recent changes by ICE, there is clear and convincing evidence that establishing system-wide protocols for chronic disease diagnosis and treatment (including pre-approved visits, tests and treatments) results in decreased mortality and morbidity.15,16,17 Because this change eliminated any notion of standard of care (such 

as a set protocol for treating specific diseases), and further increased the burden of 

securing prior approval for outside care, the net effect may have been to limit care 

for detainees with chronic medical problems. One tragic example is Francisco 

Castaneda, a 34 year old man from El Salvador, who was detained for 11 months 

by ICE with bleeding penile lesions. Despite numerous physicians documenting concern that his lesions were cancerous, DIHS refused the TAR for biopsy labeling the 

test ’elective’. After being released from detention, Mr. Castaneda was finally able 

to receive appropriate evaluation and treatment. But by then it was too late and 

Mr. Castaneda died shortly after beginning treatment for metastatic penile cancer.18

Another potential threat to detainee medical care is the requirement of the Covered Services Package that mandates that detention center medical providers include non-medical criteria in any potential referral for outside care. The Covered 

146 

Services Package allows non-emergent care with the following explanation: ‘‘Other 

medical conditions which the physician believes, if left untreated during the period 

of ICE/BP custody, would cause deterioration of the detainee’s health or uncontrolled suffering affecting his/her deportation status will be assessed and evaluated 

for care.’’ 19 With these conditions, ICE simultaneously demands that a care provider 

estimate the length of detention for a detainee and assess whether or not deterioration of the condition might impact deportation. Both of these non-medical criteria 

potentially limit the care provided to detainees and likely create ethical (and potentially legal) jeopardy for ICE providers. In contrast, the U.S. Marshals Service relies 

on medical necessity alone in establishing criteria for outside referral.20

A third problem with the care allowed under the Covered Services Package pertains to health screening. Originally (prior to the 2005 changes), the plan approved 

basic health screening tests such as mammograms and pap smears only after one 

year in detention. This guideline was substandard because many detainees likely 

had little or no prior health screening and would have benefited from indicated 

health screening tests (as is the standard at Rikers Island Jail in New York City, 

where average length of stay is shorter than average ICE detention).21 But even 

this substandard coverage was further reduced in 2005 when the Covered Services 

Package substituted diagnostic criteria for what they continued to call screening 

tests. The new guidelines stated: ‘‘screening for disease processes (e.g., breast, cervical, prostatic, colorectal cancer) are considered on a case by case basis, subject to 

clinical findings . . . In other words, clinical findings must support the need for the 

requested screening. This change will remove the impression that these tests are 

automatically approved for a detainee who is in custody for over 12 months.’’ 22

Screening tests are by definition, applied to the entire non-symptomatic portion of 

a population. For example, in discussing Pap smears, the U.S. Preventative Services 

Task Force recommends screening for cervical cancer in women who have been sexually active and have a cervix.23 There is no reference to symptoms or clinical suspicion in this, or any other screening recommendation and to wait until clinical suspicion or symptoms appear completely undermines the ’screening’ aspect of the test. 

This difference is enormously important because while ICE continues to call these 

tests ’screening’, they are in fact forcing tens of thousands of people to forgo some 

of the most beneficial and cost-effective measures of modern medicine. By waiting 

until detainees show symptoms or arouse clinical suspicion of a disease, ICE deprives detainees of the accepted medical practice of early detection and treatment 

in favor of letting diseases such as cervical, breast and prostate cancer develop to 

the point of symptoms. 

A final but critical problem with the ICE health plan involves changes in how 

each Treatment Authorization Request (TAR) is processed. Prior to changes in 2005, 

detention center medical staff could submit a TAR and if it was rejected by DIHS, 

they could appeal this refusal. These appeals were reviewed by a team of 3 DIHS 

physicians. This formal appeal process was scrapped in 2005 in favor of a ’grievance’ 

process that eliminated the physician review component. In addition, in 2007 ICE 

changed the guidelines for refusing TAR’s so that DIHS nurses could reject a TAR 

without any input from the DIHS medical director. Such oversight by the medical 

director was required for rejection of TAR’s prior to this change. The net effect of 

these two changes is that physicians in detention centers may have their TAR’s rejected by off-site nurses and they have lost the ability to appeal such decisions to 

a group of physicians. 

IV. Recommendations 

We recommend several specific changes to the DIHS Medical Dental Detainee 

Covered Services Package as well as to the larger health infrastructure if ICE. 

Without these changes, we are concerned that all detainees held by ICE face an unacceptably low standard of medical care that will adversely affect their health. 

1. The DIHS Medical Dental Detainee Covered Services Package must be altered 

in the following ways: 

A. Care for chronic disease must be routinely available and reflect community 

standards for the care of HIV, diabetes, hypertension and other common 

chronic diseases. Part of these improvements must include pre-approval for 

standard, foreseeable care. 

B. Health screening tests must be made available based on prevailing medical 

standards and any mention of ’clinical suspicion’ or ’symptoms’ must be 

eliminated from criteria for these tests. 

C. Non-medical criteria must be eliminated from the process of detention center medical staff seeking a TAR for detainees. Specifically, the mandate that 

147 

ICE providers balance a deteriorating condition and uncontrolled suffering 

against the ability to deport the detainee or estimate a detainee’s length of 

detention must be eliminated from the health plan. 

D. TARs generated by physicians should not be rejected by nurses without review by a physician. Any TAR rejected by DIHS should be open to a genuine 

appeal, including review by physicians 

2. ICE should be mandated to report vital health statistics (including deaths, disease complications, accidents and forcible medical actions against detainees) to 

a body outside DHS with expertise in public health and epidemiology. One possible solution would be to return DIHS to the Health Resources and Services 

Administration of the Department of Health and Human Services and include 

an ICE medical monitoring division. 

3. Detainees with serious medical ailments requiring high levels of care should 

be routinely considered for parole. The correctional setting is an inefficient and 

inhumane venue for persons with medical problems requiring high levels of ongoing medical care. 

4. Healthcare for ICE detainees must be guaranteed and defined as a matter of 

law. Many of the deaths reported among ICE detainees involve poor adherence 

to existing ICE guidelines. Greater accountability is needed to ensure compliance in healthcare standards across the wide spectrum of detention centers. 

These improvements will require substantial effort, including financial investment. Currently, ICE argues that the number of medical visits, procedures and 

overall medical budget ($100 million) demonstrate a high degree of care for detainees. But these details tell us nothing about key factors in care delivery, including 

delays in treatment and the nature of visits. Several detainee deaths involved 

delays in care and the explosive increase in immigration detainees has outpaced increases in medical spending. Moreover, $100 million may be a low health care budget for a system that detains 300,000 people per year. By comparison, Rikers Island 

Jail in New York City detains roughly half the people annually and on any given 

day that ICE detains, but has spent over $100 million annually on healthcare for 

over a decade for a population that is generally detained for less time than ICE detainees. Without transparency from ICE on basic health outcomes or costs, ICE’s 

raw expenditures tell us little about the efficacy of this system of care. 

We believe that the most basic principles of decency and sound medical practice 

demand that an adequate standard of health care for detainees be legally mandated 

aggressively enforced and that basic health outcomes among detainees be reported 

for evaluation outside ICE. Unfortunately, the present response of ICE to the overwhelming evidence of inhumane healthcare for detainees shows that officials are 

more concerned with public relations than confronting the grim medical reality suffered daily by immigrants in detention. 

REFERENCES

1. Immigration and Customs Enforcement, Office of Public Affairs. Fact sheet: 

Mortality rates at ICE detention facilities. Office of Public Affairs, U.S. Department of Homeland Security; 2008. 

2. Myers JL. Caring for immigration detainees. Washington Post. 5/20/08 

2008;A13. 


Venters.eps
148 

3. mmigration and Customs Enforcement, Office of Public Affairs. Fact sheet: Mortality rates at ICE detention facilities. Office of Public Affairs, U.S. Department 

of Homeland Security; 2008. 

4. If one were to use the calendar year deaths for 2006 and 2007 (16 and 7), then 

the length-adjusted mortality does fall slightly from 25 to 22 per 100,000 detention-years. However, this calculation is unreliable since it mixes fiscal and calendar year numbers at a time of rapid changes in numbers and length of detentions. Length of detention numbers were unavailable for years other than 2006 

and 2007. 

5. Mumola CJ. Department of Justice, Bureau of Justice Statistics. Medical causes 

of death in state prisons, 2001–2004. 2007; ncj216340. 

6. Myers JL. Caring for immigration detainees. Washington Post. 5/20/08 

2008;A13. 

7. Bernstein N. Few details on immigrants who died in custody. New York Times. 

May 5, 2008 2008;A. 

8. Jawetz, T. (American Civil Liberties Union) 2007, Medical Care and Deaths in 

ICE Custody, House Subcommittee on Immigration, Citizenship, Refugees, Border Security, and International Law. 

9. Government Accountability Office 2007, Alien Detention Standards, 

Governemtn Accountability Office, Washington D.C. 

10. Human Rights Watch 2007, Chronic Indifference: HIV/AIDS Services for Immigrants Detained by the United States. 

11. Physicians for Human Rights/Bellevue/NYU Program for Survivors of Torture 

2003, From Persecution to Prison: The health consequences of Detention for 

Asylum seekers. 

12. Bernstein N. Few details on immigrants who died in custody. New York Times. 

May 5, 2008 2008;A. 

13. Lutheran Immigration and Refugee Service and Detention Watch Network 

2007, Overview of U.S. Detention; Briefing materials for the United Nations 

Special Rapporteur on the Human Rights of Migrants, Detention and Deportation Working group. 

14. Division of Immigration Health Services (DIHS) 2005a, DIHS Medical Dental 

Detainee Covered Services Package, Division of Immigration Health Services 

(DIHS). 

15. Solberg, L.I., Asche, S.E., Pawlson, L.G., Scholle, S.H. & Shih, S.C. 2008, ‘‘Practice systems are associated with high-quality care for diabetes’’, The American 

Journal of Managed Care, vol. 14, no. 2, pp. 85–92. 

16. Tsai, A.C., Morton, S.C., Mangione, C.M. & Keeler, E.B. 2005, ‘‘A meta-analysis 

of interventions to improve care for chronic illnesses’’, The American Journal of 

Managed Care, vol. 11, no. 8, pp. 478–488. 

17. ‘‘Supplement 1. American Diabetes Association: clinical practice recommendations 2000’’, 2000, Diabetes care, vol. 23 Suppl 1, pp. S1–116. 

18. Priest, D. and Goldstein, A. System of neglect. Washington Post. May 11, 2008 

2008;A1. 

19. Division of Immigration Health Services (DIHS) 2005a, DIHS Medical Dental 

Detainee Covered Services Package, Division of Immigration Health Services 

(DIHS). 

20. U.S. Marshalls Service 2008, Prisoner Health Care Standards. Available: 

http://www.usmarshals.gov/prisoner/standards.htm. 

21. Fein, E. September 19, 1997, Deal to Brink Rikers Inmates Managed Care, New 

York Times,A. 

22. Division of Immigration Health Services (DIHS) 2005b, Summary of Changes to 

the DIHS Detainee Covered Services Package, Division of Immigration Health 

Services (DIHS). 

23. U.S. Preventive Services Task Force. Screening for cervical cancer. 2003 

Ms. LOFGREN. Thank you, Dr. Venters and all of the witnesses. 

This is a time when we have an opportunity to ask a few questions. I have several. 

First, Ms. Armendariz, your testimony is so hard to listen to due 

what occurred. He had been treated at the VA for years, because 

he was a veteran, and they had diagnosed him with schizophrenia. 

Ms. ARMENDARIZ. Fifteen years. 

Ms. LOFGREN. Okay. So that is a Federal facility with Federal 

medical records. Were those records ever made available to ICE? 

149 

Ms. ARMENDARIZ. I guess it didn’t mean anything to them at that 

time. I told them—or his attorney told them. 

Ms. LOFGREN. Okay. So that answers one question, that the medical records we were told this morning that always follow, there is 

a problem there, it appears. 

Ms. ARMENDARIZ. The first facility, because he was in San Antonio, the first facility, he fell down. And his face, I thought they had 

beaten him, and it was because they gave him strong Thorazine. 

It had side effects. And that is when I got advocacy involved. 

Ms. LOFGREN. Right. 

Ms. Asfaw, you have been granted political asylum here in the 

United States. You received very abusive treatment in your home 

country. When you were put into custody after you made your indication to apply for asylum known, was there any effort to provide 

information or care to you to deal with the things that had been 

done to you that you had escaped? 

Ms. ASFAW. Yes. 

Ms. LOFGREN. And what were those things? 

Ms. ASFAW. Back in my country? 

Ms. LOFGREN. No, here in the ICE facility, did anybody in the 

ICE facility try to help you cope with the things that had been 

done to you in Ethiopia? 

Ms. ASFAW. Yes. 

Ms. LOFGREN. And what were those things? 

Ms. ASFAW. I don’t understand. 

Ms. LOFGREN. Okay. That is all right. I will follow up in writing 

with you on that. That will be easier. 

Let me ask you, Ms. Baker, your testimony is very compelling. 

First, 600 hours is a lot of billable hours. I think it is pretty admirable that you have donated and your firm has donated that kind 

of time on a pro bono basis. 

You, I think, were here this morning to hear the testimony of 

Ms. Myers. How does her testimony compare to what you saw as 

an attorney with a client last year? 

Ms. BAKER. You mean as opposed to the Rolls Royce of medical 

treatment? 

Ms. LOFGREN. Correct. 

Ms. BAKER. There are very clear systemic problems, as evidenced 

by my client’s case and by a number of other people’s cases who 

have testified here today. 

Number one, there are no interpreters. In the 5 months that 

Amina was in ICE detention, she didn’t once have a medical examination or treatment with an interpreter. 

Ms. LOFGREN. Did you offer to provide that for her? 

Ms. BAKER. I offered to provide—as soon as I came into the case, 

I realized that there were glaring miscommunications, and I offered 

to provide them with an interpreter for months in writing, and no 

one ever called. They refused to do it. 

I still to this day, as I have said, have not seen her medical 

records. I think the medical care that she was provided, I mean, 

even if you can look the other way at a misdiagnosis in the first 

place and say they thought maybe she was psychotic but really 

wasn’t, when you have the side effects that she was exhibiting, it’s 

just inexplicable that none of the medical professionals got it. 

150 

A gynecologist who I brought in instantly figured out that she 

was on an antipsychotic drug. And the psychiatrist figured out it 

was Risperdal, because at the time we didn’t have her medical 

records, when Dr. Kathy Falk examined her. So the side effects 

were just catastrophic, and they completely either missed them or, 

worse, knew about them and increased the dosage anyway. 

Ms. LOFGREN. Well, you provided them with a second opinion 

with outside physicians, right? 

Ms. BAKER. Two second opinions. They actually wrote full letters 

to them. I didn’t get to this in my testimony, but later on—and I 

started writing letters, too, saying, ‘‘I’m Amina Mudey. I don’t 

speak English. And I demand my medical records. My lawyer is 

writing this on my behalf.’’ The inside doctor eventually gave all of 

the letters back, including at least one letter written by the doctor, 

told Amina, ‘‘Tell your lawyer to stop writing me letters.’’ 

Ms. LOFGREN. Ms. McCarthy, before my time runs out, your 

agency is in a lot of facilities doing pro bono assistance. You heard 

the testimony this morning from Ms. Myers. Does that, sort of, rosy 

picture that was given to us comport with what you are seeing in 

the facilities? 

Ms. MCCARTHY. Unfortunately, no. I think what is really alarming is the lack of attorneys available to represent detainees, the 

number of which is increasing dramatically. 

The three stories that we have heard today are stories of people 

who had legal representation and advocates. Just imagine what it 

is like for those individuals who do not have legal advocates. Unfortunately, Ms. Belbachir was one of those individuals. She was a suicidal asylum seeker who had no one from outside the ICE facility 

to advocate for her. 

There is no court-appointed counsel available for immigrants who 

are detained or placed in legal proceedings. Individuals are detained and deprived of their liberty and their only option for medical help, as the system is set up right now, is through Immigration 

and Customs Enforcement. 

Ms. LOFGREN. Thank you very much. 

My time has expired, so I’ll turn to the Ranking Member, Mr. 

King, for his questions. 

Mr. KING. Thank you, Madam Chair. 

In listening to the testimony, I want to say that I surely don’t 

doubt the testimony that’s before us here, and I don’t doubt that 

there are tragic human circumstances that take place. There are 

300 million people in America and 6 billion people on the planet, 

and there are going to be many, many of these stories. And it is 

a small sampling that you have delivered here today. 

One of our jobs is to evaluate the policy that exists against the 

policy that’s proposed and see where the data that’s delivered to us 

matches up to that and also see where the anecdotes that are delivered to us matches up to that. 

And with that in mind, I’d turn first to Ms. Baker and ask you: 

What in Ms. Lofgren’s bill, that is really part of the subject here 

today, even though it’s not formally the bill that’s before us in the 

hearing, what in that bill would have alleviated the circumstances 

that you testified with regard to today regarding your client, Ms. 

Mudey? 

151 

Ms. BAKER. The bill, as I understand it—and I have to admit 

that I only read it once about 2 weeks ago, so I’m not fully prepared to discuss the terms of it today—but that it creates a standard for the care that’s provided. It’s effectively like a bill of rights, 

as I understand it, that these kinds of situations just simply can’t 

be swept under the carpet, that there needs to be some kind of 

standard set for the care provided to these people. 

Mr. KING. And so, to summarize that answer, and I understand 

it this way too, that it provides a cause of action and perhaps a 

means of appeal. But it probably would have not have intervened 

before these circumstances took place. That’s a point that I think 

we need to keep in mind here. And I appreciate the balance of your 

answer. 

And I’d turn to Bishop Riley. I’m, of course, very interested in 

your testimony and very respectful of you as a man of the cloth and 

the tone that you bring here as well. 

And I have a question that drifts in my mind with regard to, let’s 

just say, human dignity. Human dignity is, in my judgment, a 

basic human right that should be provided to every human being 

regardless of their citizenship or whether they are lawfully present 

or whether they are not. 

Do you draw a distinction between human dignity and human 

rights in any way that you’d like to describe to this panel? 

Reverend RILEY. I think that human dignity is a human right. 

It’s one of the rights. 

Dignity—let me give you an example of a lack of dignity. One of 

the things that often happens is that when our detention facilities 

like the one in Elizabeth fills up, then folks are farmed out to the 

county jail. If you are farmed out to the county jail, such as Monmouth County, no matter what you’re there for, if you’re an asylum 

seeker or whatever, then you wind up being stripped searched for 

drugs with the rest of the criminal population. 

Mr. KING. Reverend Bishop, wouldn’t that also be true for someone who was, let’s just say, someone who was lawfully or unlawfully present in the United States? Because that is the next piece 

of this question. 

Let me make it—there’s four parts. I think there is a distinction 

between human dignity, which should be provided to all people, but 

then between that and human rights and between human rights 

and the distinction between those lawfully present and those unlawfully present in the United States, as well as the distinction between the rights of U.S. citizens. 

Those four definitions, do they have a distinction in your mind? 

And do you draw those distinctions, as far as supporting the laws 

of this Nation with regard to immigration? 

Reverend RILEY. As you pointed out when you started this question, I come at this from a little bit different perspective, in that 

I look at all of the people as part of the family of God and the children of God. And so everyone in that vision is equal. 

I believe that the country has to have and maintain its laws, no 

question about that. And I think those laws need to be applied 

equally across the board. 

But I think it’s also true that at the heart of our law is respect 

for human beings, wherever they come from, whoever they are. 

152 

And I think that’s at the crux of this matter, is that our own failed 

laws, frankly—— 

Mr. KING. Well, and I appreciate your point. 

Reverend RILEY [continuing]. Put us in this situation. 

Mr. KING. And so I’m asking you, do you believe that it’s possible 

for ICE to enforce current immigration law and still provide for 

human dignity and still provide for the human rights that you and 

I believe in? 

Reverend RILEY. If ICE is an extension of this Government that 

is me, because this Government is by the people, then I expect ICE 

to do this. 

I don’t believe ICE is conforming to its own policies. I think 

that’s why we are here today, is that law is going to have to be 

enacted to get ICE to respond to its own written policies in terms 

of its standards of care. 

Mr. KING. But you do believe it is possible to enforce the law and 

still provide for human dignity and human rights under the current law? 

Reverend RILEY. I would hope that it is. 

Mr. KING. I would, too, Reverend. Thank you for your testimony. 

And thank you all for your testimony. 

I yield back the balance of my time. 

Ms. LOFGREN. The gentleman’s time has expired. 

I turn now to the Chairman of the Judiciary Committee, Chairman Conyers. 

Mr. CONYERS. Thank you very much. 

I commend the witnesses. 

Steve King and I have agreed to send a letter to the lady that 

was the head—— 

Ms. LOFGREN. Ms. Myers. 

Mr. CONYERS. Yes, Ms. Myers, with the testimony of Ms. 

Armendariz and ask her to respond to it so we can find out where 

she comes down on it. 

This is one of the times I would’ve liked to have had this panel 

go first and see how that might have affected her testimony or 

what comments she would’ve had about this at all. But anyway, I 

think this has to be continued. 

You know, this doesn’t sound like this is in America this kind of 

thing is happening, to me. I mean, if you told me—I could name 

a number of countries that if you said this, I’d say it’s awful and 

it’s too bad they do things like that over there. But this is happening right under our nose. 

And I am beyond shock now, having been in this body enough 

years. But this is stunning testimony that needs to be followed up 

on. 

Now, could I ask anybody that knows what type of physician or 

physicians are on staff at the ICE facilities? 

Yes, sir? 

Dr. VENTERS. I have interacted with some of the medical staff 

when I do my evaluations. And so, generally, they’re internists. I 

think Elizabeth Detention Center right now has a cardiologist who 

was trained as an internist and then has specialist care in cardiology. But, generally, internists or family practitioners, if they are 

153 

physicians. However, a great many of the smaller facilities may 

have a physician’s assistant or a nurse. 

I think the goal is to have a physician there during business 

hours, for a lot of these facilities, and then they have someone else 

to cover the evening and weekends. 

Mr. CONYERS. Well, I guess the first thing the Committee might 

want to do is find out what kind of medical practitioners or health 

providers are at each facility. That would help us get off the 

ground. 

And dare I ask, are there any psychiatrists or psychologists at 

any of these facilities that we know of? 

Ms. BAKER. I cannot state with certainty that my client was seen 

by a psychiatrist. However, in reviewing her medical records, it 

said something like ‘‘seen by psych.’’ But the person’s name was 

never identified, as far as I can tell, so I’m not sure who prescribed 

the Risperdal to my client. There may have been a psychiatrist, but 

I can’t say for sure. 

Mr. CONYERS. Well, what else are we to make, Attorney Baker, 

of the way you were treated? I mean, for goodness sake, how many 

people, if they had counsel, would have people of your professional 

caliber making regular, logical interventions with questions and so 

forth? And they were shrugging you off like, please get out of my 

way. 

Ms. BAKER. They were sick of me, I will tell you that much. They 

definitely were sick of me. 

But the thing that bothers me most in all of this—well, there are 

many, but one of the things that bothers me the most is the audacity of the person on the other end of the phone when I called and 

said, ‘‘I’m about to call 911 because you have someone who is doubled over in pain, who has not been seen by a doctor for 2 weeks,’’ 

and I had a doctor on the phone who prepared an affidavit who 

identified that this was a life-threatening, potentially anyway, a 

life-threatening situation, as much as she could tell over the phone. 

And then 2 days went by before anybody went to see her. And they 

went to see her only after my colleague, Adam Pearl, and I got 

back to the phone and started saying, ‘‘Hey, you told me someone 

was going to go and see what was wrong with my client,’’ and nobody ever did. 

Mr. CONYERS. Well, one last intervention here. Ms. McCarthy, 

Attorney Baker, how do we deal with this lack of legal representation problem? This isn’t going to be cured by pro bono. There are 

not enough lawyers and law firms in America that they can 

produce the Bakers around here to provide—we are in a hell of a 

situation. 

What do you tell the Congress to do? 

Ms. MCCARTHY. Well, I think there are a number of issues, but 

I think the most significant issue, as I said in my comments, is the 

overuse of the immigration detention system. Is it necessary to 

have all of these individuals locked up at taxpayer expense? This 

is administrative detention; this is not criminal detention. 

I question whether it’s necessary that we lock up men and 

women who are, many times, hardworking members of our community, need access to medical careoutside of the immigration detention system, or are asylum seekers merely seeking protection. 

154 

Mr. CONYERS. Do you have some studies or proposals or essays 

that suggest that the answer is, no, that we shouldn’t be locking 

up so many? 

Ms. MCCARTHY. The Vera Institute of Justice has conducted a 

study in which it followed individuals who were released from detention to determine what the outcome of their immigration proceedings was. The study demonstrated successful results, because 

upon release from detention the immigrants were paired up with 

attorneys, they had access to health care, they had access to social 

services, and they had access to religious communities that supported them. So I think it’s a very, very viable model. 

Mr. CONYERS. Well, maybe King and I can work on analyzing 

this. The window of opportunity is closing here in the 110th Congress, but maybe we can work on getting some more information 

about what’s going on and whether it is necessary or is this overkill. 

I mean, this sounds like we’re in a country other than America 

about what’s going on here. 

Ms. BAKER. I would definitely support the notion of having more 

of these asylum seekers paroled, certainly. 

My client actually investigated trying to get parole, but this is 

an interesting fact, is that the document that her deportation officer or one of the deportation officers gave me to fill out included 

a very onerous financial statement and obligation on the part of 

the parolee that said they would—— 

Mr. CONYERS. That it would cost them? 

Ms. BAKER. Yes. It was something to the effect that if you were 

going to sponsor someone for parole, you had to sign a document 

that said, I’m going to support this person for 10 years. 

And I’m told—remember, I’m the newbie on the panel. This is my 

first asylum case. And if I get something wrong, I’m sure my colleague will correct me. 

But it’s my understanding that the form I was given by the ICE 

official was created for a completely different purpose other than 

parole of an asylee. 

So she had someone who was willing to house her in the interim, 

but I couldn’t get her out because that person didn’t make enough 

money. 

Ms. MCCARTHY. I might just add to this discussion because I 

know Ms. Myers spoke today about the asylum parole process, but 

I think there are some serious flaws in that parole process. It needs 

to be reviewed and monitored. When ICE issues a decision to deny 

parole, that decision should automatically and immediately be reviewed by a Federal court judge. That review does not exist today. 

Mr. CONYERS. Thank you very much. 

Ms. LOFGREN. Thank you, Mr. Chairman. 

I’ll turn now to my colleague, Mr. Gutierrez. 

Mr. GUTIERREZ. Well, thank you very much, Madam Chairwoman, for putting together this hearing. I think the testimony has 

been very eloquent and very clear. 

I’d like to say hello to Ms. McCarthy from Chicago, say a special 

hello to her, and like to thank the witnesses who have come forward, Ms. Armendariz, for their personal testimony in this case. 

155 

Look, you were here, the witnesses were here, and I think the 

members of the panel were here. We heard the representatives of 

the Federal Government. I’ve been in Congress now for 16 years. 

I’ve had many witnesses, few of them as belligerent, as questioning 

of our authority as we’ve had here this morning. 

I would share with my colleagues on this panel that that has 

been my experience with ICE. In the Chicago area, when the head 

of ICE was asked, ‘‘Did you actually pick up every Latino male between 18 and 35 regardless of any other information?’’, she said 

yes, and she said she did it proudly, that that was her mission, enforcement. I mean, this is the police in the strictest sense of the 

word, and I won’t go any further in terms of defining them. 

ICE works with our Justice Department. You think that they 

only hold the parolees? Then they call the Justice Department, and 

the Justice Department fights in the court to deport those parolees 

after they’ve asked for asylum. 

So I think we have a great problem here. The eloquence of the 

witnesses who have suffered so much here today at the hands of 

ICE and our justice system are but the tip of the iceberg. We receive cases like this almost every week that come into our office, 

people pleading. 

It is very difficult to believe that we can trust an agency—and 

I think there was a question asked earlier about the AMA and having an outside agency come in and intervene and use standards 

outside. It is very difficult to watch the Federal Government watch 

the Federal Government when the Federal Government’s mandate 

almost is to deport as many people as quickly as possible regardless of the consequences. 

How do we take the testimony seriously about health care 

when—we are going to ask, Mr. Chairman—I think you and Mr. 

King should write that letter. We wrote a letter asking about ICE 

sitting across the country, outside of child care centers. That is 

where they put ICE agents. And we got a letter back from them 

basically telling us, ‘‘Send us some more information.’’ If there had 

been a little more time, I would have asked her: Did you actually 

ask the ICE agent if they are sitting outside? 

I mean, one of the purposes should be to make us safer, to make 

us more secure. I don’t know that having ICE agents sitting outside of daycare centers makes us—I’ll tell you who it doesn’t make 

more secure. It doesn’t make the moms and the dads that have to 

take their children to those daycare centers feel more secure. What 

they do, Mr. Chairman and Madam Chairwoman, is they take 

those children to work with them. 

I mean, we had this wonderful raid, and we should really, really 

have a hearing on this raid in Iowa because there were serious allegations of sexual abuse on the part of the managers and owners 

of the facility, not paying them wages, serious child labor infractions. And while one hand of the Federal Government, the Department of Labor, is investigating very serious allegations against the 

owners and the managers of a meat plant, guess what happens? 

ICE comes in, arrests everybody, deports over 145 people, and all 

of the witnesses are gone. 

I mean, you can exploit this labor as readily as possible as long 

as you have an ICE institution that will come in and cause a raid. 

156 

I mean, 98 percent of the prosecutions that ICE conducted were 

against individuals, not against the owners of the factories, last 

year, but against the individual people. 

And let me just end with this. I would like to just join Bishop 

Riley in this sense. Not all of us think all human beings should be 

treated differently because they are American citizens or because 

of their legal status in this country. I have heard many of my colleagues speak eloquently about their great faith and their great 

faith in the Christian faith. And I’m not a theologian, but, you 

know, I went to Catholic school for a few years. I remember two 

fundamental lessons: to love God above everything else and to love 

my neighbor as I love myself. 

Now, when I go to church on Sunday, the undocumented sit in 

the pews. They receive the body and the blood of Christ with me 

as we go up, and we don’t ask them. And if I really love my neighbor as I love myself, if I am an American citizen and I have guarantees of this country as an American citizen, and I love my neighbor as I love myself, then I want them to have better and greater 

guarantees than the ones that I have. 

And I think that that is really the mission of this panel and the 

Congress of the United States, to make sure we treat everyone as 

well as we expect to be treated, that is here in this country. 

And I thank the gentlelady, Chairwoman for the extension of the 

time. 

Ms. LOFGREN. Thank you. 

I yield now to Mr. Ellison. 

Mr. ELLISON. Let me join with my colleagues in thanking all of 

the very compelling, very informative testimony. 

And I also just want to add a very favorable support for the level 

of passion that the advocates possess. We need you to help our 

country run better, and I thank you for what you’ve done and what 

you’ve said today. 

You know, I practiced criminal law for 16 years. I never was an 

immigration lawyer, so I don’t really know the process. I know that 

when I appear with a client, the prosecutor would argue that they 

were a flight risk or that they were a danger to public safety, and 

I would usually argue that they weren’t, and the judge would make 

a decision. 

What are the criteria you use when a person who is in detention, 

when the question of their release is before the court? What’s it 

like? 

Just I think it is good for the record and for people watching to 

know what kind of analysis the magistrate is going to apply in deciding to let a person be on parole or have a person stay in custody. 

Ms. MCCARTHY. This a very important point. The fundamental 

difference between criminal detention and the detention system of 

immigrants, is that immigration detention is an administrative 

process. So, unlike the criminal system, in the administrative detention system of immigrants there is no judge who reviews the individual’s detention. Detention typically is an administrative decision initially reviewed by Immigration and Customs Enforcement. 

In some cases, an immigration judge may have an option to review that and set bond. But even if an immigration judge sets 

157 

bond, the Government has the option to stay that bond if it chooses 

to do so. 

For example, I had a client for whom the immigration judge 

granted a $5,000 bond. The Government stayed that decision and 

the client remained detained for 3 years while seeking judicial review of the administrative decision. 

Mr. ELLISON. So these are folks—I think it’s important to be 

clear on the record, we are talking about people who are not even 

alleged to have harmed anyone or be a danger to the public. We 

are talking about people who are like Ms. Asfaw, for example, who 

had been a victim of political and physical torture herself, she is 

detained for, what, 5 months, was it? 

Did the fact that she hadn’t hurt anybody or wasn’t a threat or 

it would even be cheaper for the Government to just let her be in 

the community, does that come up when the decisions about detention are evaluated? 

Did that come up in your case, Ms. Asfaw? 

Could somebody help her? 

Ms. MCCARTHY. Yes, I can answer the question. I am not sure 

with respect to her case, but for asylum seekers in general the Government does have the option to review whether or not that individual should remain detained. So after the individual passes 

what’s called a ‘‘credible fear’’ interview, the Government agency, 

ICE, could review whether or not Ms. Asfaw should have remained 

detained. And what ICE should consider is exactly what you mentioned: whether she’s a flight risk or a danger to the community. 

But ICE has added another element to this review: whether or not 

it is in the public interest that the asylum seeker be released into 

the community. ICE added this irrelevant factor that makes it difficult for an asylum seeker to be released. 

As lawyers representing asylum seekers, we identify sponsors 

and individuals who the asylum seeker could possibly be released 

to, and then advocate for their release. But even in those situations, where the detainee meets the criteria, ICE denies release of 

the asylum seeker and there is no judicial review of the decision. 

ICE has complete discretion over the asylum seeker’s release. 

Mr. ELLISON. Does the question of extant medical need ever arise 

in the detention-release calculus? I mean, if somebody has a serious medical problem and it’d brought to the attention of the decision-maker, does that mitigate in favor of them being released into 

the community where they can get their medical needs met? 

Ms. MCCARTHY. It does, yes. 

Mr. ELLISON. How often does that come up? It sounds like, based 

on the testimony we’ve heard, that it’s not being very well heeded 

by the decision-maker. Am I wrong? 

Ms. MCCARTHY. I think your point is well-taken. Yes, I think 

that’s one of the issues. And I think Ms. Armendariz’s case is a 

very strong example of that. Her husband continued to be detained 

des[ote his medical conditions. This case illustrates that that medical humanitarian factors are not taken seriously into consideration 

by ICE. 

Mr. ELLISON. If we had judicial judges doing the evaluating, 

would we probably get better outcomes? 

158 

Ms. MCCARTHY. I think you’re absolutely right. And, as Ms. 

Baker mentioned, she was ready to file a habeas petition in her client’s case, which is an option, but there are many hurdles to habeas relief. So if we can build into the law some type of judicial review of the continued detention of the individual, I think that 

would be very valuable. 

Mr. ELLISON. As Americans, we value liberty. We consider liberty 

an important value. It doesn’t matter whether you are documented 

or undocumented. Whether you have a right to remain in the country is what is to be determined, right, later? 

Ms. MCCARTHY. Absolutely. 

Mr. ELLISON. So it seems to me a somewhat strange anomaly in 

the law that when it comes to people who are trying to enter the 

country, that we would have even less discretion than a criminal 

defendant, who at least there is some probable cause for. 

Anyway, that’s just my editorial. 

Let me ask you this. What are the implications for overcrowding? 

What about when we get into jails, county jails, other kinds of facilities when people can’t be at a detention facility, which I would 

imagine is somewhat suited to meet the need that it’s designed for, 

what about the overflow when—I mean, do we have people who are 

immigrants waiting to be determined about their status—— 

Ms. LOFGREN. I will give Mr. Ellison an additional minute so 

that question can be answered. 

Mr. ELLISON. Thank you, Madam Chair—in the county jails? 

Ms. MCCARTHY. Well, Immigration and Customs Enforcement 

enters into contracts with county jails throughout the country. 

They have over 300. 

Mr. ELLISON. Are they are mixed in? 

Ms. MCCARTHY. There are occasions when the immigration detainees are mixed in with the criminal detainees, although the detention standards provide that they should not be mixed in. But 

what happens in reality is that due to the increase of the number 

of detainees, there is a great deal of overcrowding. You hear about 

people sleeping on the floor, people not having access to proper hygienic materials, as well as adequate food and proper treatment. 

Mr. ELLISON. Thank you for your testimony. 

Thank you, Madam Chair. I yield back. 

Ms. LOFGREN. Thank you. 

And thanks to all of the witnesses. 

Mr. Harrison had to leave early to catch his flight, but we will 

certainly appreciate his offer of continuing help, Mr. Reyes as well, 

Bishop. 

Ms. Armendariz, yes, certainly you can speak. 

Ms. ARMENDARIZ. May I just make a point? Isaias had just 

served a year and a half in prison. I didn’t see the point of keeping 

him in ICE. They could have saved money by him waiting for his 

hearing—he was on Social Security. Where was he going to go? 

They could find him. So I think it could have saved them money 

and wait for the process, and that shouldn’t have happened. That 

could be one—— 

Ms. LOFGREN. Thank you. It would save the Government money 

and maybe be a little more respectful of that Vietnam-era vet. 

159 

I thank you, Ms. McCarthy, Dr. Venters, for your excellent suggestions. 

Ms. Baker, it was fascinating to hear your story, and I hope that, 

in addition to doing IP litigation, you will have time to put your 

new knowledge of asylum cases to work again. 

The record will remain open for 5 legislative days. We may have 

additional questions for you. If so, we will forward them to you and 

ask, if at all possible, that you respond promptly if that occurs. 

With that, we will follow up with this hearing, as Mr. Conyers 

and Mr. King have agreed to solicit comments from Ms. Myers. We 

may need additional hearings, we don’t know. But this is very serious to me, to hear these stories. 

The GAO was not able, actually, to go in and do the study because of the litigation involved. But, certainly, we have received 

substantial information that there is a substantial problem. Everybody in America is entitled to due process of law, and I have very 

serious concerns about whether that is, in fact, occurring in this 

area of the law. 

And, certainly, wherever we stand on the issue of immigration, 

we all need to know that there are civilized requirements for the 

Government when individuals are held in custody. Those people 

who are in custody don’t have the option of going across town to 

their doctor any more than, you know, we have to feed them because they don’t have the option of going across town to Burger 

King, too. So there are some obligations we undertake when we incarcerate. And, certainly, we need to take a look at what are the 

alternatives to that system. 

So we do thank you for your patience with our voting schedule, 

for your important testimony. 

And this hearing is now adjourned. 

[Whereupon, at 6:15 p.m., the Subcommittee was adjourned.] 

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A P P E N D I X 

MATERIAL SUBMITTED FOR THE HEARING RECORD

PREPARED STATEMENT OF KAREN LONG, RN, APN,C, CWOCN, MEMBER OF FIRST

FRIENDS, ELIZABETH DETENTION CENTER VISITOR PROJECT, BOARD MEMBER OF

THE INTERFAITH REFUGEE ACTION TEAM-ELIZABETH

I have been a visitor at the Elizabeth Detention Center for the past four years 

with an organization called First Friends. During this time I have met many detainees from all over the world in the same dire situation. 

During these visits there were often health complaints which were usually minor 

such as a headache, generalized fatigue or stomach upset. I would often find myself 

telling the detainees that I was visiting that they should go to the medical clinic 

to get treatment. I said this even though I was sure I knew the answer. I would 

get a smirk of some sort and would be told something to the effect ‘‘Oh what’s the 

use, they don’t do anything for you anyway.’’ Many would mention getting the ‘‘red 

pill’’ and being sent back to their dorm. Since these complaints never seemed emergent I just went on with my visit and wished them well. 

The young woman I had visited most recently is from Liberia. She is 25 years 

old. She has documented evidence of Female Genital Mutilation (FGM), which unfortunately no longer holds weight with asylum cases. This young woman kept complaining of abdominal pain. She told me that when she went to the clinic at the 

EDC all they would do is give her some pills and send her back. While in her dorm, 

when she complained of continued pain, despite ‘‘treatment’’, she would be given an 

appointment for later that week. 

As a nurse I began to be concerned that she could have a bleeding ulcer or some 

other abdominal pathology because she also was quite fatigued and was not getting 

any sleep. At one point when her case was being considered for parole I called down 

to the parole officer with my concern that she needed additional health care and 

if paroled I or a friend of hers would get her the care she needed. 

She did eventually receive parole and at a nearby hospital was diagnosed with 

pelvic Inflammatory Disease (PID), a condition that if left untreated could cause fertility problems in the future. She continues to have gynecologic problems related to 

the FGM and will most likely need continued management. 

Because of the personal nature of this story I choose not to tell her name. If the 

committee seeks further information from this young woman please let me know. 

I keep in touch with her and a family friend who continues to fight for her by spending thousands of dollars in legal fees attain asylum for her. 

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