IIB 

116TH CONGRESS 

1ST SESSION H. R. 3239 

IN THE SENATE OF THE UNITED STATES 

JULY 25, 2019 

Received; read twice and referred to the Committee on the Judiciary 

AN ACT 

To require U.S. Customs and Border Protection to perform 

an initial health screening on detainees, and for other 

purposes. 

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 


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1 SECTION 1. SHORT TITLE; TABLE OF CONTENTS. 

2 (a) SHORT TITLE.—This Act may be cited as the 

3 ‘‘Humanitarian Standards for Individuals in Customs and 

4 Border Protection Custody Act’’. 

5 (b) TABLE OF CONTENTS.—The table of contents of 

6 this Act is as follows: 

Sec. 1. Short title; table of contents. 

Sec. 2. Initial health screening protocol. 

Sec. 3. Water, sanitation and hygiene. 

Sec. 4. Food and nutrition. 

Sec. 5. Shelter. 

Sec. 6. Coordination and Surge capacity. 

Sec. 7. Training. 

Sec. 8. Interfacility transfer of care. 

Sec. 9. Planning and initial implementation. 

Sec. 10. Contractor compliance. 

Sec. 11. Inspections. 

Sec. 12. GAO report. 

Sec. 13. Rules of construction. 

Sec. 14. Definitions. 

Sec. 15. Sense of Congress. 

7 SEC. 2. INITIAL HEALTH SCREENING PROTOCOL. 

8 (a) IN GENERAL.—The Commissioner of U.S. Cus9 toms and Border Protection (referred to in this Act as 

10 the ‘‘Commissioner’’), in consultation with the Secretary 

11 of Health and Human Services, the Administrator of the 

12 Health Resources and Services Administration, and non13 governmental experts in the delivery of health care in hu14 manitarian crises and in the delivery of health care to chil15 dren, shall develop guidelines and protocols for the provi16 sion of health screenings and appropriate medical care for 

17 individuals in the custody of U.S. Customs and Border 


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1 Protection (referred to in this Act as ‘‘CBP’’), as required 

2 under this section. 

3 (b) INITIAL SCREENING AND MEDICAL ASSESS4 MENT.—The Commissioner shall ensure that any indi5 vidual who is detained in the custody of CBP (referred 

6 to in this Act as a ‘‘detainee’’) receives an initial in-person 

7 screening by a licensed medical professional in accordance 

8 with the standards described in subsection (c)— 

9 (1) to assess and identify any illness, condition, 

10 or age-appropriate mental or physical symptoms that 

11 may have resulted from distressing or traumatic ex12 periences; 

13 (2) to identify acute conditions and high-risk 

14 vulnerabilities; and 

15 (3) to ensure that appropriate healthcare is 

16 provided to individuals as needed, including pedi17 atric, obstetric, and geriatric care. 

18 (c) STANDARDIZATION OF INITIAL SCREENING AND

19 MEDICAL ASSESSMENT.— 

20 (1) IN GENERAL.—The initial screening and 

21 medical assessment shall include— 

22 (A) an interview and the use of a stand23 ardized medical intake questionnaire or the 

24 equivalent; 


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1 (B) screening of vital signs, including pulse 

2 rate, body temperature, blood pressure, oxygen 

3 saturation, and respiration rate; 

4 (C) screening for blood glucose for known 

5 or suspected diabetics; 

6 (D) weight assessment of detainees under 

7 12 years of age; 

8 (E) a physical examination; and 

9 (F) a risk-assessment and the development 

10 of a plan for monitoring and care, when appro11 priate. 

12 (2) PRESCRIPTION MEDICATION.—The medical 

13 professional shall review any prescribed medication 

14 that is in the detainee’s possession or that was con15 fiscated by CBP upon arrival and determine if the 

16 medication may be kept by the detainee for use dur17 ing detention, properly stored by CBP with appro18 priate access for use during detention, or maintained 

19 with the detained individual’s personal property. A 

20 detainee may not be denied the use of necessary and 

21 appropriate medication for the management of the 

22 detainee’s illness. 

23 (3) RULE OF CONSTRUCTION.—Nothing in this 

24 subsection shall be construed as requiring detainees 

25 to disclose their medical status or history. 


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1 (d) TIMING.— 

2 (1) IN GENERAL.—Except as provided in para3 graph (2), the initial screening and medical assess4 ment described in subsections (b) and (c) shall take 

5 place as soon as practicable, but not later than 12 

6 hours after a detainee’s arrival at a CBP facility. 

7 (2) HIGH PRIORITY INDIVIDUALS.—The initial 

8 screening and medical assessment described in sub9 sections (b) and (c) shall take place as soon as prac10 ticable, but not later than 6 hours after a detainee’s 

11 arrival at a CBP facility if the individual reasonably 

12 self-identifies as having a medical condition that re13 quires prompt medical attention or is— 

14 (A) exhibiting signs of acute or potentially 

15 severe physical or mental illness, or otherwise 

16 has an acute or chronic physical or mental dis17 ability or illness; 

18 (B) pregnant; 

19 (C) a child (with priority given, as appro20 priate, to the youngest children); or 

21 (D) elderly. 

22 (e) FURTHER CARE.— 

23 (1) IN GENERAL.—If, as a result of the initial 

24 health screening and medical assessment, the li25 censed medical professional conducting the screening 


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1 or assessment determines that one or more of the 

2 detainee’s vital sign measurements are significantly 

3 outside normal ranges in accordance with the Na4 tional Emergency Services Education Standards, or 

5 if the detainee is identified as high-risk or in need 

6 of medical intervention, the detainee shall be pro7 vided, as expeditiously as possible, with an in-person 

8 or technology-facilitated medical consultation with a 

9 licensed emergency care professional. 

10 (2) RE-EVALUATION.— 

11 (A) IN GENERAL.—Detainees described in 

12 paragraph (1) shall be re-evaluated within 24 

13 hours and monitored thereafter as determined 

14 by an emergency care professional (and in the 

15 care of a consultation provided to a child, with 

16 a licensed emergency care professional with a 

17 background in pediatric care). 

18 (B) REEVALUATION PRIOR TO TRANSPOR19 TATION.—In addition to the re-evaluations 

20 under subparagraph (A), detainees shall have 

21 all vital signs re-evaluated and be cleared as 

22 safe to travel by a medical professional prior to 

23 transportation. 

24 (3) PYSCHOLOGICAL AND MENTAL CARE.—The 

25 Commissioner shall ensure that detainees who have 


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1 experienced physical or sexual violence or who have 

2 experienced events that may cause severe trauma or 

3 toxic stress, are provided access to basic, humane, 

4 and supportive psychological assistance. 

5 (f) INTERPRETERS.—To ensure that health 

6 screenings and medical care required under this section 

7 are carried out in the best interests of the detainee, the 

8 Commissioner shall ensure that language-appropriate in9 terpretation services, including indigenous languages, are 

10 provided to each detainee and that each detainee is in11 formed of the availability of interpretation services. 

12 (g) CHAPERONES.—To ensure that health screenings 

13 and medical care required under this section are carried 

14 out in the best interests of the detainee— 

15 (1) the Commissioner shall establish guidelines 

16 for and ensure the presence of chaperones for all de17 tainees during medical screenings and examinations 

18 consistent with relevant guidelines in the American 

19 Medical Association Code of Medical Ethics, and 

20 recommendations of the American Academy of Pedi21 atrics; and 

22 (2) to the extent practicable, the physical exam23 ination of a child shall always be performed in the 

24 presence of a parent or legal guardian or in the 


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1 presence of the detainee’s closest present adult rel2 ative if a parent or legal guardian is unavailable. 

3 (h) DOCUMENTATION.—The Commissioner shall en4 sure that the health screenings and medical care required 

5 under this section, along with any other medical evalua6 tions and interventions for detainees, are documented in 

7 accordance with commonly accepted standards in the 

8 United States for medical record documentation. Such 

9 documentation shall be provided to any individual who re10 ceived a health screening and subsequent medical treat11 ment upon release from CBP custody. 

12 (i) INFRASTRUCTURE AND EQUIPMENT.—The Com13 missioner or the Administrator of General Services shall 

14 ensure that each location to which detainees are first 

15 transported after an initial encounter with an agent or of16 ficer of CBP has the following: 

17 (1) A private space that provides a comfortable 

18 and considerate atmosphere for the patient and that 

19 ensures the patient’s dignity and right to privacy 

20 during the health screening and medical assessment 

21 and any necessary follow-up care. 

22 (2) All necessary and appropriate medical 

23 equipment and facilities to conduct the health 

24 screenings and follow-up care required under this 

25 section, to treat trauma, to provide emergency care, 


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1 including resuscitation of individuals of all ages, and 

2 to prevent the spread of communicable diseases. 

3 (3) Basic over-the-counter medications appro4 priate for all age groups. 

5 (4) Appropriate transportation to medical facili6 ties in the case of a medical emergency, or an on7 call service with the ability to arrive at the CBP fa8 cility within 30 minutes. 

9 (j) PERSONNEL.—The Commissioner or the Adminis10 trator of General Services shall ensure that each location 

11 to which detainees are first transported after an initial en12 counter has onsite at least one licensed medical profes13 sional to conduct health screenings. Other personnel that 

14 are or may be necessary for carrying out the functions 

15 described in subsection (e), such as licensed emergency 

16 care professionals, specialty physicians (including physi17 cians specializing in pediatrics, family medicine, obstetrics 

18 and gynecology, geriatric medicine, internal medicine, and 

19 infectious diseases), nurse practitioners, other nurses, 

20 physician assistants. licensed social workers, mental health 

21 professionals, public health professionals, dieticians, inter22 preters, and chaperones, shall be located on site to the 

23 extent practicable, or if not practicable, shall be available 

24 on call. 


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1 (k) ETHICAL GUIDELINES.—The Commissioner shall 

2 ensure that all medical assessments and procedures con3 ducted pursuant to this section are conducted in accord4 ance with ethical guidelines in the applicable medical field, 

5 and respect human dignity. 

6 SEC. 3. WATER, SANITATION AND HYGIENE. 

7 The Commissioner shall ensure that detainees have 

8 access to— 

9 (1) not less than 1 gallon of drinking water per 

10 person per day, and age-appropriate fluids as need11 ed; 

12 (2) a private, safe, clean, and reliable perma13 nent or portable toilet with proper waste disposal 

14 and a hand washing station, with not less than 1 

15 toilet available for every 12 male detainees, and 1 

16 toilet for every 8 female detainees; 

17 (3) a clean diaper changing facility, which in18 cludes proper waste disposal, a hand washing sta19 tion, and unrestricted access to diapers; 

20 (4) the opportunity to bathe daily in a perma21 nent or portable shower that is private and secure; 

22 and 

23 (5) products for individuals of all age groups 

24 and with disabilities to maintain basic personal hy25 giene, including soap, a toothbrush, toothpaste, 


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1 adult diapers, and feminine hygiene products, as well 

2 as receptacles for the proper storage and disposal of 

3 such products. 

4 SEC. 4. FOOD AND NUTRITION. 

5 The Commissioner shall ensure that detainees have 

6 access to— 

7 (1) three meals per day including— 

8 (A) in the case of an individual age 12 or 

9 older, a diet that contains not less than 2,000 

10 calories per day; and 

11 (B) in the case of a child who is under the 

12 age of 12, a diet that contains an appropriate 

13 number of calories per day based on the child’s 

14 age and weight; 

15 (2) accommodations for any dietary needs or 

16 restrictions; and 

17 (3) access to food in a manner that follows ap18 plicable food safety standards. 

19 SEC. 5. SHELTER. 

20 The Commissioner shall ensure that each facility at 

21 which a detainee is detained meets the following require22 ments: 

23 (1) Except as provided in paragraph (2), males 

24 and females shall be detained separately. 


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1 (2) In the case of a minor child arriving in the 

2 United States with an adult relative or legal guard3 ian, such child shall be detained with such relative 

4 or legal guardian unless such an arrangement poses 

5 safety or security concerns. In no case shall a minor 

6 who is detained apart from an adult relative or legal 

7 guardian as a result of such safety or security con8 cerns be detained with other adults. 

9 (3) In the case of an unaccompanied minor ar10 riving in the United States without an adult relative 

11 or legal guardian, such child shall be detained in an 

12 age-appropriate facility and shall not be detained 

13 with adults. 

14 (4) A detainee with a temporary or permanent 

15 disability shall be held in an accessible location and 

16 in a manner that provides for his or her safety, com17 fort, and security, with accommodations provided as 

18 needed. 

19 (5) No detainee shall be placed in a room for 

20 any period of time if the detainee’s placement would 

21 exceed the maximum occupancy level as determined 

22 by the appropriate building code, fire marshal, or 

23 other authority. 

24 (6) Each detainee shall be provided with tem25 perature appropriate clothing and bedding. 


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1 (7) The facility shall be well lit and well venti2 lated, with the humidity and temperature kept at 

3 comfortable levels (between 68 and 74 degrees Fahr4 enheit). 

5 (8) Detainees who are in custody for more than 

6 48 hours shall have access to the outdoors for not 

7 less than 1 hour during the daylight hours during 

8 each 24-hour period. 

9 (9) Detainees shall have the ability to practice 

10 their religion or not to practice a religion, as appli11 cable. 

12 (10) Detainees shall have access to lighting and 

13 noise levels that are safe and conducive for sleeping 

14 throughout the night between the hours of 10 p.m. 

15 and 6 a.m. 

16 (11) Officers, employees, and contracted per17 sonnel of CBP shall— 

18 (A) follow medical standards for the isola19 tion and prevention of communicable diseases; 

20 and 

21 (B) ensure the physical and mental safety 

22 of detainees who identify as lesbian, gay, bisex23 ual, transgender, and intersex. 

24 (12) The facility shall have video-monitoring to 

25 provide for the safety of the detained population and 


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1 to prevent sexual abuse and physical harm of vulner2 able detainees. 

3 (13) The Commissioner shall ensure that lan4 guage-appropriate ‘‘Detainee Bill of Rights’’, includ5 ing indigenous languages, are posted or otherwise 

6 made available in all areas where detainees are lo7 cated. The ‘‘Detainee Bill of Rights’’ shall include 

8 all rights afforded to the detainee under this Act. 

9 (14) Video from video-monitoring must be pre10 served for 90 days and the detention facility must 

11 maintain certified records that the video-monitoring 

12 is properly working at all times. 

13 SEC. 6. COORDINATION AND SURGE CAPACITY. 

14 The Secretary of Homeland Security shall enter into 

15 memoranda of understanding with appropriate Federal 

16 agencies, such as the Department of Health and Human 

17 Services, and applicable emergency government relief serv18 ices, as well as contracts with health care, public health, 

19 social work, and transportation professionals, for purposes 

20 of addressing surge capacity and ensuring compliance with 

21 this Act. 

22 SEC. 7. TRAINING. 

23 The Commissioner shall ensure that CBP personnel 

24 assigned to each short-term custodial facility are profes25 sionally trained, including continuing education as the 


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1 Commissioner deems appropriate, in all subjects necessary 

2 to ensure compliance with this Act, including— 

3 (1) humanitarian response protocols and stand4 ards; 

5 (2) indicators of physical and mental illness, 

6 and medical distress in children and adults; 

7 (3) indicators of child sexual exploitation and 

8 effective responses to missing migrant children; and 

9 (4) procedures to report incidents of suspected 

10 child sexual abuse and exploitation directly to the 

11 National Center for Missing and Exploited Children. 

12 SEC. 8. INTERFACILITY TRANSFER OF CARE. 

13 (a) TRANSFER.—When a detainee is discharged from 

14 a medical facility or emergency department, the Commis15 sioner shall ensure that responsibility of care is trans16 ferred from the medical facility or emergency department 

17 to an accepting licensed health care provider of CBP. 

18 (b) RESPONSIBILITIES OF ACCEPTING PROVIDERS.— 

19 Such accepting licensed health care provider shall review 

20 the medical facility or emergency department’s evaluation, 

21 diagnosis, treatment, management, and discharge care in22 structions to assess the safety of the discharge and trans23 fer and to provide necessary follow-up care. 


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1 SEC. 9. PLANNING AND INITIAL IMPLEMENTATION. 

2 (a) PLANNING.—Not later than 60 days after the 

3 date of enactment of this Act, the Secretary of Homeland 

4 Security shall submit to Congress a detailed plan delin5 eating the timeline, process, and challenges of carrying out 

6 the requirements of this Act. 

7 (b) IMPLEMENTATION.—The Secretary of Homeland 

8 Security shall ensure that the requirements of this Act are 

9 implemented not later than 6 months after the date of 

10 enactment. 

11 SEC. 10. CONTRACTOR COMPLIANCE. 

12 The Secretary of Homeland Security shall ensure 

13 that all personnel contracted to carry out this Act do so 

14 in accordance with the requirements of this Act. 

15 SEC. 11. INSPECTIONS. 

16 (a) IN GENERAL.—The Inspector General of the De17 partment of Homeland Security shall— 

18 (1) conduct unannounced inspections of ports of 

19 entry, border patrol stations, and detention facilities 

20 administered by CBP or contractors of CBP; and 

21 (2) submit to Congress, reports on the results 

22 of such inspections as well as other reports of the 

23 Inspector General related to custody operations. 

24 (b) PARTICULAR ATTENTION.—In carrying out sub25 section (a), the Inspector General of the Department of 

26 Homeland Security shall pay particular attention to— 


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1 (1) the degree of compliance by CBP with the 

2 requirements of this Act; 

3 (2) remedial actions taken by CBP; 

4 (3) the health needs of detainees; and 

5 (4) the degree of compliance with part 115 of 

6 title 6, Code of Federal Regulations (commonly 

7 known as the ‘‘Standards To Prevent, Detect, and 

8 Respond to Sexual Abuse and Assault in Confine9 ment Facilities’’). 

10 (c) ACCESS TO FACILITIES.—The Commissioner may 

11 not deny a Member of Congress entrance to any facility 

12 or building used, owned, or operated by CBP. 

13 SEC. 12. GAO REPORT. 

14 (a) IN GENERAL.—The Comptroller General of the 

15 United States shall— 

16 (1) not later than 6 months after the date of 

17 enactment of this Act, commence a study on imple18 mentation of, and compliance with, this Act; and 

19 (2) not later than 1 year after the date of en20 actment of this Act, submit a report to Congress on 

21 the results of such study. 

22 (b) ISSUES TO BE STUDIED.—The study required by 

23 subsection (a) shall examine the management and over24 sight by CBP of ports of entry, border patrol stations, and 

25 other detention facilities, including the extent to which 


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1 CBP and the Department of Homeland Security have ef2 fective processes in place to comply with this Act. The 

3 study shall also examine the extent to which CBP per4 sonnel, in carrying out this Act, make abusive, derisive, 

5 profane, or harassing statements or gestures, or engage 

6 in any other conduct evidencing hatred or invidious preju7 dice to or about one person or group on account of race, 

8 color, religion, national origin, sex, sexual orientation, age, 

9 or disability, including on social media. 

10 SEC. 13. RULES OF CONSTRUCTION. 

11 Nothing in this Act may be construed— 

12 (1) as authorizing CBP to detain individuals for 

13 longer than 72 hours; 

14 (2) as contradicting the March 7, 2014, De15 partment of Homeland Security rule adopting 

16 Standards to Prevent, Detect, and Respond to Sex17 ual Abuse and Assault in Confinement Facilities, 

18 which includes a zero tolerance policy prohibiting all 

19 forms of sexual abuse and assault of individuals in 

20 U.S. Customs and Border Protection custody, in21 cluding in holding facilities, during transport, and 

22 during processing; 

23 (3) as contradicting current protocols related to 

24 Department background checks in the hiring proc25 ess; 


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1 (4) as restricting the Department from denying 

2 employment to or terminating the employment of 

3 any individual who would be or is involved with the 

4 handling or processing at holding facilities, during 

5 transport, or during processing, or care of detainees, 

6 including the care of children, and has been con7 victed of a sex crime or other offense involving a 

8 child victim; or 

9 (5) as affecting the obligation to fully comply 

10 with all applicable immigration laws, including being 

11 subject to any penalties, fines, or other sanctions. 

12 SEC. 14. DEFINITIONS. 

13 In this Act: 

14 (1) INTERPRETATION SERVICES.—The term 

15 ‘‘interpretation services’’ includes translation serv16 ices that are performed either in-person or through 

17 a telephone or video service. 

18 (2) CHILD.—The term ‘‘child’’ has the meaning 

19 given the term in section 101(b)(1) of the Immigra20 tion and Nationality Act (8 U.S.C. 1101(b)(1)). 

21 (3) U.S. CUSTOMS AND BORDER PROTECTION

22 FACILITY.—The term ‘‘U.S. Customs and Border 

23 Protection Facility’’ includes— 

24 (A) U.S. Border Patrol stations; 

25 (B) ports of entry; 


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1 (C) checkpoints; 

2 (D) forward operating bases; 

3 (E) secondary inspection areas; and 

4 (F) short-term custody facilities. 

5 (4) FORWARD OPERATING BASE.—The term 

6 ‘‘forward operating base’’ means a permanent facil7 ity established by CBP in forward or remote loca8 tions, and designated as such by CBP. 

9 (5) PUBLICATION OF DATA ON COMPLAINTS OF

10 SEXUAL ABUSE AT CBP FACILITIES.—Not later than 

11 90 days after the date of enactment of this Act, the 

12 Secretary of Homeland Security, acting in coordina13 tion with the Office of Inspector General and Office 

14 for Civil Rights and Civil Liberties, shall publicly re15 lease aggregate data on complaints of sexual abuse 

16 at CBP facilities on its website on a quarterly basis, 

17 excluding any personally identifiable information 

18 that may compromise the confidentiality of individ19 uals who reported abuse. 

20 SEC. 15. SENSE OF CONGRESS. 

21 It is the sense of the Congress that the men and 

22 women of the U.S. Border Patrol should be commended 

23 for continuing to carry out their duties in a professional 

24 manner, including caring for the extraordinarily high 

25 numbers of family units, unaccompanied alien children, 


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1 and single adults processed in United States Customs and 

2 Border Protection facilities referenced in this Act. 

Passed the House of Representatives July 24, 2019. 

Attest: CHERYL L. JOHNSON, 

Clerk. 


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