II 

116TH CONGRESS 

1ST SESSION S. 2135 

To require U.S. Customs and Border Protection to perform an initial health 

screening on detainees, and for other purposes. 

IN THE SENATE OF THE UNITED STATES 

JULY 17, 2019 

Mr. UDALL (for himself, Mr. BROWN, and Mr. HEINRICH) introduced the following bill; which was read twice and referred to the Committee on the 

Judiciary 

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 for 

8 this Act is as follows: 

Sec. 1. Short title; table of contents. 

Sec. 2. Definitions. 


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Sec. 3. Initial health screening protocol. 

Sec. 4. Water, sanitation, and hygiene. 

Sec. 5. Food and nutrition. 

Sec. 6. Shelter. 

Sec. 7. Coordination and surge capacity. 

Sec. 8. Training. 

Sec. 9. Interfacility transfer of care. 

Sec. 10. Planning and initial implementation. 

Sec. 11. Contractor compliance. 

Sec. 12. Inspections. 

Sec. 13. GAO report. 

Sec. 14. Rule of construction. 

1 SEC. 2. DEFINITIONS. 

2 In this Act: 

3 (1) INTERPRETATION SERVICES.—The term 

4 ‘‘interpretation services’’ includes translation serv5 ices that are performed either in-person or through 

6 a telephone or video service. 

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

8 given the term in section 101(b)(1) of the Immigra9 tion and Nationality Act (8 U.S.C. 1101(b)(1)). 

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

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

12 Protection Facility’’ includes— 

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

14 (B) ports of entry; 

15 (C) checkpoints; 

16 (D) forward operating bases; 

17 (E) secondary inspection areas; and 

18 (F) short-term custody facilities. 

19 (4) FORWARD OPERATING BASE.—The term 

20 ‘‘forward operating base’’ means a permanent facilVerDate Sep 11 2014 23:54 Jul 22, 2019 Jkt 089200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\S2135.IS S2135

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1 ity established by CBP in forward or remote loca2 tions, and designated as such by CBP. 

3 SEC. 3. INITIAL HEALTH SCREENING PROTOCOL. 

4 (a) IN GENERAL.—The Commissioner of U.S. Cus5 toms and Border Protection (referred to in this Act as 

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

7 of Health and Human Services, the Administrator of the 

8 Health Resources and Services Administration, and non9 governmental experts in the delivery of health care in hu10 manitarian crises and in the delivery of health care to chil11 dren, shall develop guidelines and protocols for the provi12 sion of health screenings and appropriate medical care for 

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

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

15 under this section. 

16 (b) INITIAL SCREENING AND MEDICAL ASSESS17 MENT.—The Commissioner shall ensure that any indi18 vidual who is detained in the custody of CBP (referred 

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

20 screening by a licensed medical professional in accordance 

21 with the standards described in subsection (c)— 

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

23 or age-appropriate mental or physical symptoms that 

24 may have resulted from distressing or traumatic ex25 periences; 


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

2 vulnerabilities; and 

3 (3) to ensure that appropriate healthcare is 

4 provided to individuals as needed, including pedi5 atric, obstetric, and geriatric care. 

6 (c) STANDARDIZATION OF INITIAL SCREENING AND

7 MEDICAL ASSESSMENT.— 

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

9 medical assessment required under subsection (b) 

10 shall include— 

11 (A) an interview and the use of a stand12 ardized medical intake questionnaire or the 

13 equivalent; 

14 (B) screening of vital signs, including pulse 

15 rate, body temperature, blood pressure, oxygen 

16 saturation, and respiration rate; 

17 (C) screening for blood glucose for known 

18 or suspected diabetics; 

19 (D) weight assessment of detainees who 

20 are younger than 12 years of age; 

21 (E) a physical examination; and 

22 (F) a risk assessment and the development 

23 of a plan for monitoring and care, as appro24 priate. 


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1 (2) PRESCRIPTION MEDICATION.—The medical 

2 professional conducting the initial screening and 

3 medical assessment shall review any prescribed 

4 medication that is in the detainee’s possession or 

5 that was confiscated by CBP upon arrival and deter6 mine if the medication may be kept by the detainee 

7 for use during detention, properly stored by CBP 

8 with appropriate access for use during detention, or 

9 maintained with the detained individual’s personal 

10 property. A detainee may not be denied the use of 

11 necessary and appropriate medication for the man12 agement of the detainee’s chronic illness. 

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

14 subsection may be construed as requiring detainees 

15 to disclose their medical status or history. 

16 (d) TIMING.— 

17 (1) IN GENERAL.—Except as provided in para18 graph (2), the initial screening and medical assess19 ment required under this section shall take place as 

20 soon as practicable, but not later than 12 hours 

21 after a detainee’s arrival at a CBP facility. 

22 (2) HIGH-PRIORITY INDIVIDUALS.—The initial 

23 screening and medical assessment required under 

24 this section shall take place as soon as practicable, 

25 but not later than 6 hours after a detainee’s arrival 


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1 at a CBP facility if the individual reasonably self2 identifies as having a medical condition that requires 

3 prompt medical attention or is— 

4 (A) exhibiting signs of acute or potentially 

5 severe physical or mental illness, or otherwise 

6 has an acute or chronic physical or mental dis7 ability or illness; 

8 (B) pregnant; 

9 (C) a child (with priority given, as appro10 priate, to the youngest children); or 

11 (D) elderly. 

12 (e) FURTHER CARE.— 

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

14 health screening and medical assessment, the li15 censed medical professional conducting the screening 

16 or assessment determines that 1 or more of the de17 tainee’s vital sign measurements are outside normal 

18 ranges in accordance with the National Emergency 

19 Services Education Standards, or if the detainee is 

20 identified as high-risk or in need of medical inter21 vention, the detainee shall be provided, as expedi22 tiously as possible, with an in-person or technology23 facilitated medical consultation with a licensed emer24 gency care professional. 

25 (2) RE-EVALUATION.— 


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1 (A) IN GENERAL.—Detainees described in 

2 paragraph (1) shall be reevaluated within 24 

3 hours and monitored thereafter as determined 

4 by an emergency care professional. 

5 (B) REEVALUATION PRIOR TO TRANSPOR6 TATION.—In addition to the reevaluations 

7 under subparagraph (A), detainees shall have 

8 all vital signs reevaluated and be cleared as safe 

9 to travel by a medical professional before being 

10 transported. 

11 (3) PYSCHOLOGICAL AND MENTAL CARE.—The 

12 Commissioner shall ensure that detainees who have 

13 experienced physical or sexual violence or who have 

14 experienced events that may cause severe trauma or 

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

16 and supportive psychological assistance. 

17 (f) INTERPRETERS.—To ensure that health 

18 screenings and medical care required under this section 

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

20 Commissioner shall ensure that language-appropriate in21 terpretation services, including indigenous languages, are 

22 provided to each detainee and that each detainee is in23 formed of the availability of interpretation services. 


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

2 and medical care required under this section are carried 

3 out in the best interests of the detainee— 

4 (1) the Commissioner shall establish guidelines 

5 for and ensure the presence of chaperones for all de6 tainees during medical screenings and examinations 

7 consistent with relevant guidelines in the American 

8 Medical Association and American Association of 

9 Pediatrics Code of Medical Ethics; and 

10 (2) to the extent practicable, the physical exam11 ination of a child shall always be performed in the 

12 presence of a parent or legal guardian or in the 

13 presence of the detainee’s closest present adult rel14 ative if a parent or legal guardian is unavailable. 

15 (h) DOCUMENTATION.—The Commissioner shall en16 sure that the health screenings and medical care required 

17 under this section, along with any other medical evalua18 tions and interventions for detainees, are documented in 

19 accordance with commonly accepted standards in the 

20 United States for medical record documentation. Such 

21 documentation shall be provided to any individual who re22 ceived a health screening and subsequent medical treat23 ment upon release from CBP custody. 

24 (i) INFRASTRUCTURE AND EQUIPMENT.—The Com25 missioner or the Administrator of General Services shall 


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1 ensure that each location to which detainees are first 

2 transported after an initial encounter with an agent or of3 ficer of CBP has— 

4 (1) a private space that provides a comfortable 

5 and considerate atmosphere for the patient and that 

6 ensures the patient’s dignity and right to privacy 

7 during the health screening and medical assessment 

8 and any necessary follow-up care; 

9 (2) all necessary and appropriate medical equip10 ment and facilities to conduct the health screenings 

11 and follow-up care required under this section, to 

12 treat trauma, to provide emergency care, including 

13 resuscitation of individuals of all ages, and to pre14 vent the spread of communicable diseases; 

15 (3) basic over-the-counter medications appro16 priate for all age groups; and 

17 (4) appropriate transportation to medical facili18 ties in the case of a medical emergency, or an on19 call service with the ability to arrive at the CBP fa20 cility within 30 minutes. 

21 (j) PERSONNEL.—The Commissioner or the Adminis22 trator of General Services shall ensure that each location 

23 to which detainees are first transported after an initial en24 counter has onsite at least 1 licensed medical professional 

25 to conduct health screenings. Other personnel that are or 


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1 may be necessary for carrying out the functions described 

2 in this section, such as licensed emergency care profes3 sionals, specialty physicians (including physicians special4 izing in pediatrics, family medicine, obstetrics and gyne5 cology, geriatric medicine, internal medicine, and infec6 tious diseases), nurse practitioners, other nurses, physi7 cian assistants, licensed social workers, mental health pro8 fessionals, public health professionals, dieticians, inter9 preters, and chaperones, shall be located on site to the 

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

11 on call. 

12 (k) ETHICAL GUIDELINES.—The Commissioner shall 

13 ensure that all medical assessments and procedures con14 ducted pursuant to this section are conducted in accord15 ance with ethical guidelines in the applicable medical field, 

16 and respect human dignity. 

17 SEC. 4. WATER, SANITATION, AND HYGIENE. 

18 The Commissioner shall ensure that detainees have 

19 access to— 

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

21 day, and age-appropriate fluids as needed; 

22 (2) a private, safe, clean, and reliable perma23 nent or portable toilet with proper waste disposal 

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


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1 toilet available for every 12 male detainees, and 1 

2 toilet for every 8 female detainees; 

3 (3) a clean diaper changing facility, which in4 cludes proper waste disposal, a hand washing sta5 tion, and unrestricted access to diapers; 

6 (4) the opportunity to bathe daily in a perma7 nent or portable shower that is private and secure; 

8 and 

9 (5) products for individuals of all age groups 

10 and with disabilities to maintain basic personal hy11 giene, including soap, a toothbrush, toothpaste, 

12 adult diapers, and feminine hygiene products, as well 

13 as receptacles for the proper storage and disposal of 

14 such products. 

15 SEC. 5. FOOD AND NUTRITION. 

16 The Commissioner shall ensure that detainees have 

17 access to— 

18 (1) 3 meals per day including— 

19 (A) in the case of an individual who is at 

20 least 12 years of age, a diet that contains not 

21 less than 2,000 calories per day; and 

22 (B) in the case of a child who is younger 

23 than 12 years of age, a diet that contains an 

24 appropriate number of calories per day based 

25 on the child’s age and weight; 


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1 (2) accommodations for any dietary needs or 

2 restrictions; and 

3 (3) access to food in a manner that follows ap4 plicable food safety standards. 

5 SEC. 6. SHELTER. 

6 The Commissioner shall ensure that each facility at 

7 which a detainee is detained meets the following require8 ments: 

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

10 and females shall be detained separately. 

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

12 United States with an adult relative or legal guard13 ian, such child shall be detained with such relative 

14 or legal guardian unless such an arrangement poses 

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

16 who is detained apart from an adult relative or legal 

17 guardian as a result of such safety or security con18 cerns be detained with other adults. 

19 (3) In the case of an unaccompanied minor ar20 riving in the United States without an adult relative 

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

22 age-appropriate facility and shall not be detained 

23 with adults. 


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1 (4) A detainee with a temporary or permanent 

2 disability shall be held in a manner that provides for 

3 his or her safety, comfort, and security. 

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

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

6 exceed the maximum occupancy level as determined 

7 by the appropriate building code, fire marshall, or 

8 other authority. 

9 (6) Each detainee shall be provided with tem10 perature appropriate clothing and bedding. 

11 (7) The facility shall be well lit and well venti12 lated, with the humidity and temperature kept at 

13 comfortable levels (between 68 and 74 degrees Fahr14 enheit). 

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

16 48 hours shall have access to the outdoors for not 

17 less than 1 hour during the daylight hours during 

18 each 24-hour period. 

19 (9) Detainees shall have the ability to practice 

20 their religion or not to practice a religion, as appli21 cable. 

22 (10) Detainees shall have access to lighting and 

23 noise levels that are safe and conducive for sleeping 

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

25 and 6 a.m. 


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1 (11) Officers, employees, and contracted per2 sonnel of CBP shall— 

3 (A) follow medical standards for the isola4 tion and prevention of communicable diseases; 

5 and 

6 (B) ensure the physical and mental safety 

7 of lesbian, gay, bisexual, transgender, and 

8 intersex detainees. 

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

10 provide for the safety of the detained population and 

11 to prevent sexual abuse and physical harm of vulner12 able detainees. 

13 SEC. 7. 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. 8. 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. 9. 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 An accepting licensed health care provider receiving a de20 tainee shall review the medical facility or emergency de21 partment’s evaluation, diagnosis, treatment, management, 

22 and discharge care instructions with respect to the de23 tainee to assess the safety of the discharge and transfer 

24 and to provide necessary follow-up care. 


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1 SEC. 10. 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 a detailed plan to Congress that de5 lineates the timeline, process, and challenges of carrying 

6 out 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 the enactment of this Act. 

11 SEC. 11. 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 under this Act. 

15 SEC. 12. 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 reports to Congress that— 

22 (A) describe the results of the inspections 

23 conducted pursuant to paragraph (1); and 

24 (B) relate to custody operations. 


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1 (b) PARTICULAR ATTENTION.—In carrying out sub2 section (a), the Inspector General shall pay particular at3 tention to— 

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

5 requirements under this Act; 

6 (2) remedial actions taken by CBP; and 

7 (3) the health needs of detainees. 

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

9 not deny a Member of Congress entrance to any facility 

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

11 SEC. 13. GAO REPORT. 

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

13 United States shall— 

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

15 the enactment of this Act, commence a study on im16 plementation of, and compliance with, this Act; and 

17 (2) not later than 1 year after the date of the 

18 enactment of this Act, submit a report to Congress 

19 on the results of such study. 

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

21 under subsection (a) shall examine the management and 

22 oversight by CBP of ports of entry, border patrol stations, 

23 and other detention facilities, including the extent to 

24 which CBP and the Department of Homeland Security 

25 have effective processes in place to comply with this Act. 


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1 SEC. 14. RULE OF CONSTRUCTION. 

2 Nothing in this Act may be construed to authorize 

3 CBP to detain individuals for longer than 72 hours. 

Æ 


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