I 

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. 

LUJA ́N, 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. VELA ́ZQUEZ, Mr. CARBAJAL, Mr. 

CA ́RDENAS, 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. BARRAGA ́N, Mr. KEATING, Mr. GARCI ́A 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 


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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. 

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

3 SECTION 1. SHORT TITLE; TABLE OF CONTENTS. 

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

5 ‘‘Humanitarian Standards for Individuals in Customs and 

6 Border Protection Custody Act’’. 

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

8 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. 

9 SEC. 2. INITIAL HEALTH SCREENING PROTOCOL. 

10 (a) IN GENERAL.— 

11 (1) SCREENING REQUIRED.—The Commissioner 

12 of U.S. Customs and Border Protection (referred to 


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1 in this Act as the ‘‘Commissioner’’) shall ensure that 

2 any individual whom U.S. Customs and Border Pro3 tection (referred to in this Act as ‘‘CBP’’) detains 

4 (referred to in this Act as a ‘‘detainee’’) receives an 

5 initial health screening by a medical professional— 

6 (A) to identify acute conditions and high7 risk vulnerabilities; and 

8 (B) to provide appropriate health care to 

9 subpopulations involving pediatrics, obstetrics, 

10 and geriatrics specialties. 

11 (2) TIMING.—The screening required by para12 graph (1) shall be performed within— 

13 (A) 3 hours of being initially detained for 

14 high-priority populations in accordance with 

15 subsection (d); and 

16 (B) 12 hours of being initially detained for 

17 all other populations. 

18 (b) INTERPRETERS.—To ensure that health 

19 screenings and medical care required under subsections 

20 (a) and (f) are carried out in the best interests of the de21 tainees receiving such screenings and care, the Commis22 sioner shall— 

23 (1) provide such detainees with interpreters in 

24 the detainee’s native or indigenous language; and 


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1 (2) inform detainees of the availability of inter2 pretation services. 

3 (c) CHAPERONES.—To ensure that health screenings 

4 and medical care required under subsections (a) and (f) 

5 are carried out in the best interests of the detainees receiv6 ing such screenings and care— 

7 (1) the Commissioner shall provide chaperones 

8 when necessary according to standard United States 

9 medical practice to protect a person’s dignity, cul10 ture, and gender-specific sensitivities; and 

11 (2) the physical examination of infants, tod12 dlers, children, or any minors 17 years of age or 

13 younger shall, to the extent practicable, always be 

14 performed— 

15 (A) in the presence of a parent or legal 

16 guardian; or 

17 (B) in the absence of a parent or legal 

18 guardian, in the presence of the detainee’s clos19 est present adult relative. 

20 (d) PRIORITIZATION.—The Commissioner shall en21 sure that the initial screening required by subsection (a) 

22 is prioritized and conducted within 3 hours of being ini23 tially detained for the following high-priority populations: 

24 (1) Individuals who are exhibiting signs of 

25 acute or potentially severe physical or mental illness. 


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1 (2) Pregnant women. 

2 (3) Infants. 

3 (4) Children. 

4 (5) Any minors 17 years of age or younger. 

5 (6) Elderly individuals. 

6 (7) Individuals who are visibly physically or 

7 mentally disabled. 

8 (8) Any other individual who self-identifies as 

9 having a medical condition that requires prompt 

10 medical attention, such as the following: 

11 (A) A disability. 

12 (B) A mental health issue. 

13 (C) HIV positive. 

14 (D) A chronic disease, such as diabetes. 

15 (e) STANDARDIZATION OF SCREENING.— 

16 (1) IN GENERAL.— 

17 (A) CONSULTATION AND DEVELOPMENT

18 OF GUIDELINES AND PROTOCOL.—The Commis19 sioner, in consultation with the Secretary of 

20 Health and Human Services and nongovern21 mental experts in delivery of health care in hu22 manitarian crises, shall develop guidelines and 

23 protocols for the health screenings and medical 

24 care required under subsections (a) and (f). 


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1 (B) ASSESSMENT OF APPROPRIATE LEVEL

2 OF CARE.—The guidelines and protocols re3 quired by subparagraph (A) shall require that 

4 each detainee be administered a health screen5 ing to assess and identify age-appropriate signs, 

6 symptoms, risks, and experiences, including 

7 mental health risks and distressing or trau8 matic experiences, to determine the appropriate 

9 level of care needed. 

10 (C) STANDARDIZED MEDICAL INTAKE.— 

11 The guidelines and protocols required by sub12 paragraph (A) shall ensure that each such 

13 screening makes use of a standardized medical 

14 intake questionnaire or the equivalent of such a 

15 questionnaire, such as relevant portions of the 

16 Performance-Based National Detention Stand17 ards questionnaire administered by U.S. Immi18 gration and Customs Enforcement. 

19 (D) CONSULTATION.—In developing the 

20 guidelines and protocols required by subpara21 graph (A), the Commissioner shall consult with 

22 the Administrator of the Health Resources and 

23 Services Administration regarding health 

24 screening and medical care under the Emer25 gency Medical Services for Children Program. 


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1 (2) CONTENTS.—The guidelines and protocols 

2 required by paragraph (1) shall require, with respect 

3 to each detainee— 

4 (A) an interview and questionnaire; 

5 (B) screening for vital signs, including 

6 pulse rate, temperature, blood pressure, oxygen 

7 saturation, and respiration rate; 

8 (C) screening for blood glucose for known 

9 diabetics; 

10 (D) weight for detainees under 12 years of 

11 age; 

12 (E) a physical exam; and 

13 (F) an assessment and development of a 

14 plan for risk-assessment, required interventions, 

15 and continued monitoring and care. 

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

17 subsection shall be construed as requiring detainees 

18 to disclose their medical status or history. 

19 (f) FURTHER CARE.— 

20 (1) IN GENERAL.—If an initial health screening 

21 of a detainee displays values outside of normal 

22 ranges per National Emergency Services Education 

23 Standards or if an individual is identified as high24 risk or is in need of medical intervention, the Com25 missioner shall ensure such detainee is provided with 


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1 an in-person or technology-facilitated medical con2 sultation with a readily available licensed emergency 

3 care professional. 

4 (2) AVAILABILITY.—The Commissioner shall 

5 ensure that— 

6 (A) a licensed emergency care professional 

7 is on call at all times with respect to detainees; 

8 and 

9 (B) appropriate emergency transportation 

10 is on site or on call to arrive on site within 30 

11 minutes of being called. 

12 (3) RE-EVALUATIONS.—Detainees who present 

13 with any abnormalities during a health screening 

14 under subsection (a) shall— 

15 (A) be re-evaluated and monitored as de16 termined by the emergency care professional 

17 and at least once every 24 hours; and 

18 (B) notwithstanding subparagraph (A), 

19 have safety health clearance prior to transpor20 tation, including reevaluation of vital signs. 

21 (g) PSYCHOLOGICAL AND MENTAL CARE.—The 

22 Commissioner shall ensure that detainees who have experi23 enced physical or sexual violence or other potentially life24 threatening events, or who have witnessed atrocities that 

25 may cause severe, traumatic, or toxic stress, are provided 


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1 psychological first aid, including a basic, humane, and 

2 supportive response to ensure that basic needs are met. 

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

5 under subsections (a) and (f) and any other medical eval6 uations and interventions for detainees are documented in 

7 accordance with commonly accepted standards in the 

8 United States for medical record documentation. 

9 (i) RELEASE FROM CBP.—Before being released 

10 from CBP custody, each detainee in a high-priority popu11 lation, or requiring intervention, or in need of health care 

12 followup upon release, shall receive medical records that 

13 outline the health screening and medical care that was 

14 conducted under this section with respect to the detainee, 

15 as well as documentation of medical issues, evaluations, 

16 interventions, and immunizations. 

17 (j) INFRASTRUCTURE, EQUIPMENT, AND PER18 SONNEL.—The Commissioner and the Administrator of 

19 General Services, as the case may be, shall ensure that 

20 each location at which a detainee is first transported after 

21 such detainee’s initial encounter with an agent or officer 

22 of CBP has the following: 

23 (1) A private space for the health screening re24 quired under subsection (a), including for any nec25 essary follow-up exam or care management. 


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1 (2) Appropriate equipment to carry out such 

2 screening, monitor health, provide emergency care, 

3 treat traumas and perform resuscitations (including 

4 paramedic bags with equipment suitable for neo5 nates, infants, and toddlers). 

6 (3) A designated area and necessary equipment 

7 to prevent the spread of communicable diseases. 

8 (4) Basic over-the-counter and prescription 

9 medications for all age groups, including all pedi10 atric age groups, including the medications nec11 essary to ensure that detainees are not deprived of 

12 their medication required to manage their chronic 

13 illness. 

14 (5) A medical professional trained and certified 

15 to conduct such health screening. 

16 (6) An emergency medicine physician or emer17 gency care provider on site, or if such a physician 

18 is not available, an emergency medicine physician or 

19 emergency care provider on call at all times for con20 sultation. 

21 (7) Other professionals to meet the require22 ments of this section, such as physicians specializing 

23 in pediatrics, family medicine, emergency medicine, 

24 obstetrics and gynecology, geriatric medicine, inter25 nal medicine, and infectious diseases; nurse practiVerDate Sep 11 2014 00:24 Jun 19, 2019 Jkt 089200 PO 00000 Frm 00010 Fmt 6652 Sfmt 6201 E:\BILLS\H3239.IH H3239

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1 tioners; other nurses; physician assistants; licensed 

2 social workers; mental health professionals; public 

3 health professionals; and dieticians. 

4 (8) Interpreters on site, or if an interpreter is 

5 not available, an interpreter on call at all times. 

6 (9) The capability to provide appropriate trans7 portation in the case of a medical emergency on site 

8 or on call to arrive on site within 30 minutes. 

9 (k) ETHICAL GUIDELINES.—The Commissioner shall 

10 ensure that all medical assessments and procedures con11 ducted pursuant to this section— 

12 (1) are conducted in accordance with ethical 

13 guidelines in the applicable medical field; and 

14 (2) respect human dignity. 

15 SEC. 3. WATER, SANITATION, AND HYGIENE. 

16 The Commissioner shall ensure that a detainee has 

17 access to the following: 

18 (1) Not less than one gallon of drinking water 

19 per day, including age-appropriate fluids. 

20 (2) A private, safe, clean, and reliable toilet 

21 with proper waste disposal and a hand washing sta22 tion, with not less than one toilet available for every 

23 12 male detainees, and 1 toilet per 8 female detain24 ees. 


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1 (3) A clean diaper changing facility, which in2 cludes proper waste disposal, a hand washing sta3 tion, and unrestricted access to diapers. 

4 (4) Accommodations to ensure hygiene for el5 derly individuals and individuals with disabilities. 

6 (5) The opportunity to bathe every day in a pri7 vate and secure manner. 

8 (6) Adult diapers, in the case of an individual 

9 who is incontinent. 

10 (7) Products to maintain basic personal hy11 giene, including— 

12 (A) soap, a toothbrush, toothpaste, and 

13 feminine hygiene products; and 

14 (B) proper handling and disposal methods 

15 for used products. 

16 SEC. 4. FOOD AND NUTRITION. 

17 The Commissioner shall ensure that a detainee has 

18 access to the following: 

19 (1) In the case of an individual age 12 or older, 

20 a diet that contains not less than 2,000 calories per 

21 day. 

22 (2) In the case of a child who is under the age 

23 of 12, a diet that contains an appropriate number of 

24 calories per day based on the child’s age and weight. 

25 (3) Three meals per day. 


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1 (4) Accommodations for any dietary need or re2 striction in the case of a pregnant or breastfeeding 

3 woman, an infant, a child, an elderly individual, an 

4 individual with a disability, an individual with a food 

5 allergy, or an individual with religious dietary re6 strictions. 

7 (5) Access to food in a manner that follows ap8 plicable food safety standards. 

9 SEC. 5. SHELTER. 

10 The Commissioner shall ensure that each facility at 

11 which a detainee is detained meets the following require12 ments: 

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

14 and females shall be detained separately. 

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

16 United States with an adult relative or legal guard17 ian, such child shall be detained with such relative 

18 or legal guardian, with family cohesion maintained— 

19 (A) unless this arrangement incites safety 

20 or security concerns; and 

21 (B) in no case shall such minor be de22 tained apart from such adult relative or legal 

23 guardian, pursuant to subparagraph (A), with 

24 other adults. 


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

2 United States without an adult relative or legal 

3 guardian, such child— 

4 (A) shall be detained in an age-appropriate 

5 facility; and 

6 (B) shall not be detained with adults. 

7 (4) A detainee with a disability, including a 

8 temporary disability, shall be held in a manner that 

9 provides for his or her safety, comfort, and security. 

10 (5) There shall be no less than 2 square meters 

11 of space for each detainee. 

12 (6) Each detainee shall be provided with tem13 perature appropriate clothing and bedding. 

14 (7) The facility shall be well lit and well venti15 lated, with the humidity and temperature kept at 

16 comfortable levels (between 68 and 74 degrees Fahr17 enheit). 

18 (8) Detainees shall have access to the outdoors 

19 for not less than 1 hour during the daylight hours 

20 during each 24-hour period. 

21 (9) Detainees shall have the ability to practice 

22 their religion or not to practice a religion, as appli23 cable. 

24 (10) Detainees shall have access to sufficient 

25 time for sleeping without unnecessary disturbances 


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1 (including light and noise) throughout the night, be2 tween the hours of 10 p.m. and 6 a.m. 

3 (11) Officers, employees, and contracted per4 sonnel of CBP shall— 

5 (A) follow medical standards for the isola6 tion and prevention of communicable diseases; 

7 and 

8 (B) ensure the physical and mental safety 

9 of lesbian, gay, bisexual, transgender, and 

10 intersex detainees. 

11 (12) The facility shall have video-monitoring— 

12 (A) to provide for the safety of children 

13 and disabled individuals, or any safety need 

14 considerations; and 

15 (B) to prevent the sexual abuse or physical 

16 harm of vulnerable detainees. 

17 SEC. 6. COORDINATION AND SURGE CAPACITY. 

18 The Secretary of Homeland Security, acting through 

19 the Commissioner or an operational commander or other 

20 appropriate official within the Department of Homeland 

21 Security, shall enter into memoranda of understanding 

22 with appropriate Federal agencies, such as the Depart23 ment of Health and Human Services, the Federal Emer24 gency Management Agency, and applicable emergency 

25 government relief services, and contracts with health care, 


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1 public health, social work, and transportation profes2 sionals, for purposes of coordinating— 

3 (1) compliance with this Act; and 

4 (2) addressing surge capacity. 

5 SEC. 7. TRAINING. 

6 The Commissioner shall ensure that personnel of 

7 CBP are professionally trained to focus on the following: 

8 (1) Annual humanitarian response and stand9 ards training to comply with this Act. 

10 (2) Evidence of physical and mental illness, in11 cluding common signs of high-risk and medical dis12 tress in children and high-priority populations. 

13 (3) Vulnerabilities and indicators of child sexual 

14 exploitation and effective responses to missing mi15 grant children including by leveraging the resources 

16 of the National Center for Missing and Exploited 

17 Children. 

18 (4) Procedures to report incidents of suspected 

19 child sexual abuse and exploitation directly to the 

20 CyberTipline of the National Center for Missing and 

21 Exploited Children (or any successor tipline). 

22 SEC. 8. INTERFACILITY TRANSFER OF CARE. 

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

24 a medical facility or emergency department, the Commis25 sioner shall ensure a transfer of responsibility of care from 


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1 the medical provider at such medical facility or emergency 

2 department to an accepting licensed health care provider 

3 of CBP. 

4 (b) RESPONSIBILITIES OF ACCEPTING PROVIDER.— 

5 Such accepting licensed health care provider shall review 

6 the medical facility or emergency department’s evaluation, 

7 diagnosis, treatment, management, and discharge care in8 structions— 

9 (1) to assess for the safety of the discharge and 

10 transfer; and 

11 (2) to provide necessary follow-up care. 

12 SEC. 9. PLANNING AND INITIAL IMPLEMENTATION. 

13 (a) PLANNING.—No later than 30 days after the date 

14 of enactment of this Act, the Secretary of Homeland Secu15 rity shall submit a detailed plan to the Congress delin16 eating the timeline, process, and challenges of carrying 

17 this Act. 

18 (b) IMPLEMENTATION.—The Secretary of Homeland 

19 Security shall ensure that this Act is implemented not 

20 later than 6 months after the date of enactment of this 

21 Act. 

22 SEC. 10. CONTRACTOR COMPLIANCE. 

23 The Secretary of Homeland Security shall ensure 

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

25 in accordance with the requirements of this Act. 


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1 SEC. 11. INSPECTIONS. 

2 (a) IN GENERAL.—The Inspector General of the De3 partment of Homeland Security shall— 

4 (1) conduct unannounced inspections of ports of 

5 entry, border patrol stations, and detention facilities 

6 of or administered by CBP or contractors of CBP; 

7 and 

8 (2) submit to the Congress reports on the re9 sults of the inspections under paragraph (1) and 

10 other reports of the Inspector General related to 

11 custody operations. 

12 (b) PARTICULAR ATTENTION.—In carrying out sub13 section (a), the Inspector General of the Department of 

14 Homeland Security shall pay particular attention to— 

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

16 requirements of this Act; 

17 (2) remedial actions taken by CBP; and 

18 (3) the health needs of the detainees. 

19 SEC. 12. GAO REPORT. 

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

21 United States shall— 

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

23 enactment of this Act, commence a study on imple24 mentation of, and compliance with, this Act; and 


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1 (2) not later than 1 year after the date of en2 actment of this Act, submit a report to the Congress 

3 on the results of such study. 

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

5 subsection (a) shall examine the management and over6 sight by CBP of ports of entry, border patrol stations, and 

7 other detention facilities, including the extent to which 

8 CBP and the Department of Homeland Security have ef9 fective processes in place to comply with this Act. 

10 SEC. 13. RULE OF CONSTRUCTION. 

11 Nothing in this Act shall be construed to authorize 

12 CBP to detain individuals for longer than 72 hours. 

Æ 


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