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[Congressional Bills 116th Congress]
[From the U.S. Government Publishing Office]
[H.R. 3239 Introduced in House (IH)]

<DOC>

116th CONGRESS
  1st Session
                                H. R. 3239

  To require U.S. Customs and Border Protection to perform an initial 
         health screening on detainees, and for other purposes.

_______________________________________________________________________

                    IN THE HOUSE OF REPRESENTATIVES

                             June 12, 2019

  Mr. Ruiz (for himself, Mr. Castro of Texas, Ms. Roybal-Allard, Mr. 
    Lujan, Mr. Nadler, Ms. Lofgren, Ms. Escobar, Mr. Cisneros, Mr. 
 Espaillat, Mrs. Napolitano, Ms. Mucarsel-Powell, Mr. Soto, Mr. Gomez, 
 Ms. Norton, Ms. Omar, Mr. Ted Lieu of California, Ms. Ocasio-Cortez, 
Mr. Sires, Mr. Levin of California, Mr. Brown of Maryland, Ms. Jayapal, 
   Mr. Jeffries, Mr. Aguilar, Mr. Richmond, Mr. Brendan F. Boyle of 
 Pennsylvania, Mr. Thompson of Mississippi, Mr. Cleaver, Mr. Gallego, 
 Ms. Velazquez, Mr. Carbajal, Mr. Cardenas, Ms. Lee of California, Ms. 
  Torres Small of New Mexico, Mr. Costa, Mr. Vargas, Mr. Veasey, Ms. 
 Clarke of New York, Ms. Kelly of Illinois, Mr. Payne, Mr. Takano, Mr. 
 Kildee, Mr. Suozzi, Mr. Moulton, Mr. Green of Texas, Mr. Peters, Mr. 
    Sean Patrick Maloney of New York, Ms. Haaland, Ms. Speier, Mrs. 
Dingell, Ms. Pingree, Ms. Titus, Mr. Connolly, Ms. Bass, Ms. Moore, Mr. 
     Lawson of Florida, Ms. Jackson Lee, Mr. Neal, Ms. Kaptur, Mr. 
Perlmutter, Mrs. Kirkpatrick, Mr. Swalwell of California, Mr. Schrader, 
    Mr. Casten of Illinois, Mr. Gonzalez of Texas, Ms. Brownley of 
     California, Mr. Pappas, Mr. Engel, Mr. Kennedy, Mr. Rush, Mr. 
    Blumenauer, Ms. Matsui, Mr. Thompson of California, Ms. Hill of 
     California, Mr. Rouda, Mr. Peterson, Mr. Vela, Mr. Meeks, Mr. 
 Garamendi, Mr. Pocan, Mr. Case, Mr. Cox of California, Ms. Barragan, 
 Mr. Keating, Mr. Garcia of Illinois, Mr. Lowenthal, Mr. McGovern, Ms. 
Judy Chu of California, Mr. Krishnamoorthi, Mr. Heck, Mrs. Beatty, Mr. 
Levin of Michigan, Mr. Raskin, Mrs. Trahan, Ms. Castor of Florida, Ms. 
 Schakowsky, Mr. Sarbanes, Mr. Tonko, Mr. O'Halleran, Ms. DeGette, Ms. 
Stevens, Mr. McNerney, Ms. Clark of Massachusetts, Mr. Michael F. Doyle 
 of Pennsylvania, Ms. Dean, Mr. Larson of Connecticut, Mr. Deutch, Mr. 
  Harder of California, Mr. Grijalva, Mr. Cicilline, Mr. Stanton, Mr. 
 Panetta, Mr. Kilmer, and Ms. DelBene) introduced the following bill; 
 which was referred to the Committee on the Judiciary, and in addition 
to the Committee on Homeland Security, for a period to be subsequently 
   determined by the Speaker, in each case for consideration of such 
 provisions as fall within the jurisdiction of the committee concerned

_______________________________________________________________________

                                 A BILL

 
  To require U.S. Customs and Border Protection to perform an initial 
         health screening on detainees, and for other purposes.

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

SECTION 1. SHORT TITLE; TABLE OF CONTENTS.

    (a) Short Title.--This Act may be cited as the ``Humanitarian 
Standards for Individuals in Customs and Border Protection Custody 
Act''.
    (b) Table of Contents.--The table of contents of 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. Rule of construction.

SEC. 2. INITIAL HEALTH SCREENING PROTOCOL.

    (a) In General.--
            (1) Screening required.--The Commissioner of U.S. Customs 
        and Border Protection (referred to in this Act as the 
        ``Commissioner'') shall ensure that any individual whom U.S. 
        Customs and Border Protection (referred to in this Act as 
        ``CBP'') detains (referred to in this Act as a ``detainee'') 
        receives an initial health screening by a medical 
        professional--
                    (A) to identify acute conditions and high-risk 
                vulnerabilities; and
                    (B) to provide appropriate health care to 
                subpopulations involving pediatrics, obstetrics, and 
                geriatrics specialties.
            (2) Timing.--The screening required by paragraph (1) shall 
        be performed within--
                    (A) 3 hours of being initially detained for high-
                priority populations in accordance with subsection (d); 
                and
                    (B) 12 hours of being initially detained for all 
                other populations.
    (b) Interpreters.--To ensure that health screenings and medical 
care required under subsections (a) and (f) are carried out in the best 
interests of the detainees receiving such screenings and care, the 
Commissioner shall--
            (1) provide such detainees with interpreters in the 
        detainee's native or indigenous language; and
            (2) inform detainees of the availability of interpretation 
        services.
    (c) Chaperones.--To ensure that health screenings and medical care 
required under subsections (a) and (f) are carried out in the best 
interests of the detainees receiving such screenings and care--
            (1) the Commissioner shall provide chaperones when 
        necessary according to standard United States medical practice 
        to protect a person's dignity, culture, and gender-specific 
        sensitivities; and
            (2) the physical examination of infants, toddlers, 
        children, or any minors 17 years of age or younger shall, to 
        the extent practicable, always be performed--
                    (A) in the presence of a parent or legal guardian; 
                or
                    (B) in the absence of a parent or legal guardian, 
                in the presence of the detainee's closest present adult 
                relative.
    (d) Prioritization.--The Commissioner shall ensure that the initial 
screening required by subsection (a) is prioritized and conducted 
within 3 hours of being initially detained for the following high-
priority populations:
            (1) Individuals who are exhibiting signs of acute or 
        potentially severe physical or mental illness.
            (2) Pregnant women.
            (3) Infants.
            (4) Children.
            (5) Any minors 17 years of age or younger.
            (6) Elderly individuals.
            (7) Individuals who are visibly physically or mentally 
        disabled.
            (8) Any other individual who self-identifies as having a 
        medical condition that requires prompt medical attention, such 
        as the following:
                    (A) A disability.
                    (B) A mental health issue.
                    (C) HIV positive.
                    (D) A chronic disease, such as diabetes.
    (e) Standardization of Screening.--
            (1) In general.--
                    (A) Consultation and development of guidelines and 
                protocol.--The Commissioner, in consultation with the 
                Secretary of Health and Human Services and 
                nongovernmental experts in delivery of health care in 
                humanitarian crises, shall develop guidelines and 
                protocols for the health screenings and medical care 
                required under subsections (a) and (f).
                    (B) Assessment of appropriate level of care.--The 
                guidelines and protocols required by subparagraph (A) 
                shall require that each detainee be administered a 
                health screening to assess and identify age-appropriate 
                signs, symptoms, risks, and experiences, including 
                mental health risks and distressing or traumatic 
                experiences, to determine the appropriate level of care 
                needed.
                    (C) Standardized medical intake.--The guidelines 
                and protocols required by subparagraph (A) shall ensure 
                that each such screening makes use of a standardized 
                medical intake questionnaire or the equivalent of such 
                a questionnaire, such as relevant portions of the 
                Performance-Based National Detention Standards 
                questionnaire administered by U.S. Immigration and 
                Customs Enforcement.
                    (D) Consultation.--In developing the guidelines and 
                protocols required by subparagraph (A), the 
                Commissioner shall consult with the Administrator of 
                the Health Resources and Services Administration 
                regarding health screening and medical care under the 
                Emergency Medical Services for Children Program.
            (2) Contents.--The guidelines and protocols required by 
        paragraph (1) shall require, with respect to each detainee--
                    (A) an interview and questionnaire;
                    (B) screening for vital signs, including pulse 
                rate, temperature, blood pressure, oxygen saturation, 
                and respiration rate;
                    (C) screening for blood glucose for known 
                diabetics;
                    (D) weight for detainees under 12 years of age;
                    (E) a physical exam; and
                    (F) an assessment and development of a plan for 
                risk-assessment, required interventions, and continued 
                monitoring and care.
            (3) Rule of construction.--Nothing in this subsection shall 
        be construed as requiring detainees to disclose their medical 
        status or history.
    (f) Further Care.--
            (1) In general.--If an initial health screening of a 
        detainee displays values outside of normal ranges per National 
        Emergency Services Education Standards or if an individual is 
        identified as high-risk or is in need of medical intervention, 
        the Commissioner shall ensure such detainee is provided with an 
        in-person or technology-facilitated medical consultation with a 
        readily available licensed emergency care professional.
            (2) Availability.--The Commissioner shall ensure that--
                    (A) a licensed emergency care professional is on 
                call at all times with respect to detainees; and
                    (B) appropriate emergency transportation is on site 
                or on call to arrive on site within 30 minutes of being 
                called.
            (3) Re-evaluations.--Detainees who present with any 
        abnormalities during a health screening under subsection (a) 
        shall--
                    (A) be re-evaluated and monitored as determined by 
                the emergency care professional and at least once every 
                24 hours; and
                    (B) notwithstanding subparagraph (A), have safety 
                health clearance prior to transportation, including 
                reevaluation of vital signs.
    (g) Psychological and Mental Care.--The Commissioner shall ensure 
that detainees who have experienced physical or sexual violence or 
other potentially life-threatening events, or who have witnessed 
atrocities that may cause severe, traumatic, or toxic stress, are 
provided psychological first aid, including a basic, humane, and 
supportive response to ensure that basic needs are met.
    (h) Documentation.--The Commissioner shall ensure that the health 
screenings and medical care required under subsections (a) and (f) and 
any other medical evaluations and interventions for detainees are 
documented in accordance with commonly accepted standards in the United 
States for medical record documentation.
    (i) Release From CBP.--Before being released from CBP custody, each 
detainee in a high-priority population, or requiring intervention, or 
in need of health care followup upon release, shall receive medical 
records that outline the health screening and medical care that was 
conducted under this section with respect to the detainee, as well as 
documentation of medical issues, evaluations, interventions, and 
immunizations.
    (j) Infrastructure, Equipment, and Personnel.--The Commissioner and 
the Administrator of General Services, as the case may be, shall ensure 
that each location at which a detainee is first transported after such 
detainee's initial encounter with an agent or officer of CBP has the 
following:
            (1) A private space for the health screening required under 
        subsection (a), including for any necessary follow-up exam or 
        care management.
            (2) Appropriate equipment to carry out such screening, 
        monitor health, provide emergency care, treat traumas and 
        perform resuscitations (including paramedic bags with equipment 
        suitable for neonates, infants, and toddlers).
            (3) A designated area and necessary equipment to prevent 
        the spread of communicable diseases.
            (4) Basic over-the-counter and prescription medications for 
        all age groups, including all pediatric age groups, including 
        the medications necessary to ensure that detainees are not 
        deprived of their medication required to manage their chronic 
        illness.
            (5) A medical professional trained and certified to conduct 
        such health screening.
            (6) An emergency medicine physician or emergency care 
        provider on site, or if such a physician is not available, an 
        emergency medicine physician or emergency care provider on call 
        at all times for consultation.
            (7) Other professionals to meet the requirements of this 
        section, such as physicians specializing in pediatrics, family 
        medicine, emergency medicine, obstetrics and gynecology, 
        geriatric medicine, internal medicine, and infectious diseases; 
        nurse practitioners; other nurses; physician assistants; 
        licensed social workers; mental health professionals; public 
        health professionals; and dieticians.
            (8) Interpreters on site, or if an interpreter is not 
        available, an interpreter on call at all times.
            (9) The capability to provide appropriate transportation in 
        the case of a medical emergency on site or on call to arrive on 
        site within 30 minutes.
    (k) Ethical Guidelines.--The Commissioner shall ensure that all 
medical assessments and procedures conducted pursuant to this section--
            (1) are conducted in accordance with ethical guidelines in 
        the applicable medical field; and
            (2) respect human dignity.

SEC. 3. WATER, SANITATION, AND HYGIENE.

    The Commissioner shall ensure that a detainee has access to the 
following:
            (1) Not less than one gallon of drinking water per day, 
        including age-appropriate fluids.
            (2) A private, safe, clean, and reliable toilet with proper 
        waste disposal and a hand washing station, with not less than 
        one toilet available for every 12 male detainees, and 1 toilet 
        per 8 female detainees.
            (3) A clean diaper changing facility, which includes proper 
        waste disposal, a hand washing station, and unrestricted access 
        to diapers.
            (4) Accommodations to ensure hygiene for elderly 
        individuals and individuals with disabilities.
            (5) The opportunity to bathe every day in a private and 
        secure manner.
            (6) Adult diapers, in the case of an individual who is 
        incontinent.
            (7) Products to maintain basic personal hygiene, 
        including--
                    (A) soap, a toothbrush, toothpaste, and feminine 
                hygiene products; and
                    (B) proper handling and disposal methods for used 
                products.

SEC. 4. FOOD AND NUTRITION.

    The Commissioner shall ensure that a detainee has access to the 
following:
            (1) In the case of an individual age 12 or older, a diet 
        that contains not less than 2,000 calories per day.
            (2) In the case of a child who is under the age of 12, a 
        diet that contains an appropriate number of calories per day 
        based on the child's age and weight.
            (3) Three meals per day.
            (4) Accommodations for any dietary need or restriction in 
        the case of a pregnant or breastfeeding woman, an infant, a 
        child, an elderly individual, an individual with a disability, 
        an individual with a food allergy, or an individual with 
        religious dietary restrictions.
            (5) Access to food in a manner that follows applicable food 
        safety standards.

SEC. 5. SHELTER.

    The Commissioner shall ensure that each facility at which a 
detainee is detained meets the following requirements:
            (1) Except as provided in paragraph (2), males and females 
        shall be detained separately.
            (2) In the case of a minor child arriving in the United 
        States with an adult relative or legal guardian, such child 
        shall be detained with such relative or legal guardian, with 
        family cohesion maintained--
                    (A) unless this arrangement incites safety or 
                security concerns; and
                    (B) in no case shall such minor be detained apart 
                from such adult relative or legal guardian, pursuant to 
                subparagraph (A), with other adults.
            (3) In the case of a minor child arriving in the United 
        States without an adult relative or legal guardian, such 
        child--
                    (A) shall be detained in an age-appropriate 
                facility; and
                    (B) shall not be detained with adults.
            (4) A detainee with a disability, including a temporary 
        disability, shall be held in a manner that provides for his or 
        her safety, comfort, and security.
            (5) There shall be no less than 2 square meters of space 
        for each detainee.
            (6) Each detainee shall be provided with temperature 
        appropriate clothing and bedding.
            (7) The facility shall be well lit and well ventilated, 
        with the humidity and temperature kept at comfortable levels 
        (between 68 and 74 degrees Fahrenheit).
            (8) Detainees shall have access to the outdoors for not 
        less than 1 hour during the daylight hours during each 24-hour 
        period.
            (9) Detainees shall have the ability to practice their 
        religion or not to practice a religion, as applicable.
            (10) Detainees shall have access to sufficient time for 
        sleeping without unnecessary disturbances (including light and 
        noise) throughout the night, between the hours of 10p.m. and 
        6a.m.
            (11) Officers, employees, and contracted personnel of CBP 
        shall--
                    (A) follow medical standards for the isolation and 
                prevention of communicable diseases; and
                    (B) ensure the physical and mental safety of 
                lesbian, gay, bisexual, transgender, and intersex 
                detainees.
            (12) The facility shall have video-monitoring--
                    (A) to provide for the safety of children and 
                disabled individuals, or any safety need 
                considerations; and
                    (B) to prevent the sexual abuse or physical harm of 
                vulnerable detainees.

SEC. 6. COORDINATION AND SURGE CAPACITY.

    The Secretary of Homeland Security, acting through the Commissioner 
or an operational commander or other appropriate official within the 
Department of Homeland Security, shall enter into memoranda of 
understanding with appropriate Federal agencies, such as the Department 
of Health and Human Services, the Federal Emergency Management Agency, 
and applicable emergency government relief services, and contracts with 
health care, public health, social work, and transportation 
professionals, for purposes of coordinating--
            (1) compliance with this Act; and
            (2) addressing surge capacity.

SEC. 7. TRAINING.

    The Commissioner shall ensure that personnel of CBP are 
professionally trained to focus on the following:
            (1) Annual humanitarian response and standards training to 
        comply with this Act.
            (2) Evidence of physical and mental illness, including 
        common signs of high-risk and medical distress in children and 
        high-priority populations.
            (3) Vulnerabilities and indicators of child sexual 
        exploitation and effective responses to missing migrant 
        children including by leveraging the resources of the National 
        Center for Missing and Exploited Children.
            (4) Procedures to report incidents of suspected child 
        sexual abuse and exploitation directly to the CyberTipline of 
        the National Center for Missing and Exploited Children (or any 
        successor tipline).

SEC. 8. INTERFACILITY TRANSFER OF CARE.

    (a) Transfer.--When a detainee is discharged from a medical 
facility or emergency department, the Commissioner shall ensure a 
transfer of responsibility of care from the medical provider at such 
medical facility or emergency department to an accepting licensed 
health care provider of CBP.
    (b) Responsibilities of Accepting Provider.--Such accepting 
licensed health care provider shall review the medical facility or 
emergency department's evaluation, diagnosis, treatment, management, 
and discharge care instructions--
            (1) to assess for the safety of the discharge and transfer; 
        and
            (2) to provide necessary follow-up care.

SEC. 9. PLANNING AND INITIAL IMPLEMENTATION.

    (a) Planning.--No later than 30 days after the date of enactment of 
this Act, the Secretary of Homeland Security shall submit a detailed 
plan to the Congress delineating the timeline, process, and challenges 
of carrying this Act.
    (b) Implementation.--The Secretary of Homeland Security shall 
ensure that this Act is implemented not later than 6 months after the 
date of enactment of this Act.

SEC. 10. CONTRACTOR COMPLIANCE.

    The Secretary of Homeland Security shall ensure that all personnel 
contracted to carry out this Act do so in accordance with the 
requirements of this Act.

SEC. 11. INSPECTIONS.

    (a) In General.--The Inspector General of the Department of 
Homeland Security shall--
            (1) conduct unannounced inspections of ports of entry, 
        border patrol stations, and detention facilities of or 
        administered by CBP or contractors of CBP; and
            (2) submit to the Congress reports on the results of the 
        inspections under paragraph (1) and other reports of the 
        Inspector General related to custody operations.
    (b) Particular Attention.--In carrying out subsection (a), the 
Inspector General of the Department of Homeland Security shall pay 
particular attention to--
            (1) the degree of compliance by CBP with the requirements 
        of this Act;
            (2) remedial actions taken by CBP; and
            (3) the health needs of the detainees.

SEC. 12. GAO REPORT.

    (a) In General.--The Comptroller General of the United States 
shall--
            (1) not later than 6 months after the date of enactment of 
        this Act, commence a study on implementation of, and compliance 
        with, this Act; and
            (2) not later than 1 year after the date of enactment of 
        this Act, submit a report to the Congress on the results of 
        such study.
    (b) Issues To Be Studied.--The study required by subsection (a) 
shall examine the management and oversight by CBP of ports of entry, 
border patrol stations, and other detention facilities, including the 
extent to which CBP and the Department of Homeland Security have 
effective processes in place to comply with this Act.

SEC. 13. RULE OF CONSTRUCTION.

    Nothing in this Act shall be construed to authorize CBP to detain 
individuals for longer than 72 hours.
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