I 

118TH CONGRESS 

1ST SESSION H. R. 5605 

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 

SEPTEMBER 20, 2023 

Mr. RUIZ 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. 

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: 


kjohnson on DSK7ZCZBW3PROD with $$_JOB
2 

•HR 5605 IH

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. 

1 SEC. 2. INITIAL HEALTH SCREENING PROTOCOL. 

2 (a) IN GENERAL.—The Commissioner of U.S. Cus3 toms and Border Protection (referred to in this Act as 

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

5 of Health and Human Services, the Administrator of the 

6 Health Resources and Services Administration, and non7 governmental experts in the delivery of health care in hu8 manitarian crises and in the delivery of health care to chil9 dren, shall develop guidelines and protocols for the provi10 sion of health screenings and appropriate medical care for 

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

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

13 under this section. 

14 (b) INITIAL SCREENING AND MEDICAL ASSESS15 MENT.—The Commissioner shall ensure that any indi16 vidual who is detained in the custody of CBP (referred 

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

18 screening by a licensed medical professional in accordance 

19 with the standards described in subsection (c)— 


kjohnson on DSK7ZCZBW3PROD with $$_JOB
3 

•HR 5605 IH

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

2 or age-appropriate mental or physical symptoms that 

3 may have resulted from distressing or traumatic ex4 periences; 

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

6 vulnerabilities; and 

7 (3) to ensure that appropriate healthcare is 

8 provided to individuals as needed, including pedi9 atric, obstetric, and geriatric care. 

10 (c) STANDARDIZATION OF INITIAL SCREENING AND

11 MEDICAL ASSESSMENT.— 

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

13 medical assessment shall include— 

14 (A) an interview and the use of a stand15 ardized medical intake questionnaire or the 

16 equivalent; 

17 (B) screening of vital signs, including pulse 

18 rate, body temperature, blood pressure, oxygen 

19 saturation, and respiration rate; 

20 (C) screening for blood glucose for known 

21 or suspected diabetics; 

22 (D) weight assessment of detainees under 

23 12 years of age; 

24 (E) a physical examination; and 


kjohnson on DSK7ZCZBW3PROD with $$_JOB
4 

•HR 5605 IH

1 (F) a risk-assessment and the development 

2 of a plan for monitoring and care, when appro3 priate. 

4 (2) PRESCRIPTION MEDICATION.—The medical 

5 professional shall review any prescribed medication 

6 that is in the detainee’s possession or that was con7 fiscated by CBP upon arrival and determine if the 

8 medication may be kept by the detainee for use dur9 ing detention, properly stored by CBP with appro10 priate access for use during detention, or maintained 

11 with the detained individual’s personal property. A 

12 detainee may not be denied the use of necessary and 

13 appropriate medication for the management of the 

14 detainee’s illness. 

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

16 subsection shall be construed as requiring detainees 

17 to disclose their medical status or history. 

18 (d) TIMING.— 

19 (1) IN GENERAL.—Except as provided in para20 graph (2), the initial screening and medical assess21 ment described in subsections (b) and (c) shall take 

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

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

24 (2) HIGH PRIORITY INDIVIDUALS.—The initial 

25 screening and medical assessment described in subVerDate Sep 11 2014 02:10 Sep 23, 2023 Jkt 039200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\H5605.IH H5605

kjohnson on DSK7ZCZBW3PROD with $$_JOB
5 

•HR 5605 IH

1 sections (b) and (c) shall take place as soon as prac2 ticable, but not later than 6 hours after a detainee’s 

3 arrival at a CBP facility if the individual reasonably 

4 self-identifies as having a medical condition that re5 quires prompt medical attention or is— 

6 (A) exhibiting signs of acute or potentially 

7 severe physical or mental illness, or otherwise 

8 has an acute or chronic physical or mental dis9 ability or illness; 

10 (B) pregnant; 

11 (C) a child (with priority given, as appro12 priate, to the youngest children); or 

13 (D) elderly. 

14 (e) FURTHER CARE.— 

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

16 health screening and medical assessment, the li17 censed medical professional conducting the screening 

18 or assessment determines that one or more of the 

19 detainee’s vital sign measurements are significantly 

20 outside normal ranges in accordance with the Na21 tional Emergency Services Education Standards, or 

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

23 of medical intervention, the detainee shall be pro24 vided, as expeditiously as possible, with an in-person 


kjohnson on DSK7ZCZBW3PROD with $$_JOB
6 

•HR 5605 IH

1 or technology-facilitated medical consultation with a 

2 licensed emergency care professional. 

3 (2) RE-EVALUATION.— 

4 (A) IN GENERAL.—Detainees described in 

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

6 hours and monitored thereafter as determined 

7 by an emergency care professional (and in the 

8 care of a consultation provided to a child, with 

9 a licensed emergency care professional with a 

10 background in pediatric care). 

11 (B) REEVALUATION PRIOR TO TRANSPOR12 TATION.—In addition to the re-evaluations 

13 under subparagraph (A), detainees shall have 

14 all vital signs re-evaluated and be cleared as 

15 safe to travel by a medical professional prior to 

16 transportation. 

17 (3) PYSCHOLOGICAL AND MENTAL CARE.—The 

18 Commissioner shall ensure that detainees who have 

19 experienced physical or sexual violence or who have 

20 experienced events that may cause severe trauma or 

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

22 and supportive psychological assistance. 

23 (f) INTERPRETERS.—To ensure that health 

24 screenings and medical care required under this section 

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


kjohnson on DSK7ZCZBW3PROD with $$_JOB
7 

•HR 5605 IH

1 Commissioner shall ensure that language-appropriate in2 terpretation services, including indigenous languages, are 

3 provided to each detainee and that each detainee is in4 formed of the availability of interpretation services. 

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

6 and medical care required under this section are carried 

7 out in the best interests of the detainee— 

8 (1) the Commissioner shall establish guidelines 

9 for and ensure the presence of chaperones for all de10 tainees during medical screenings and examinations 

11 consistent with relevant guidelines in the American 

12 Medical Association Code of Medical Ethics, and 

13 recommendations of the American Academy of Pedi14 atrics; and 

15 (2) to the extent practicable, the physical exam16 ination of a child shall always be performed in the 

17 presence of a parent or legal guardian or in the 

18 presence of the detainee’s closest present adult rel19 ative if a parent or legal guardian is unavailable. 

20 (h) DOCUMENTATION.—The Commissioner shall en21 sure that the health screenings and medical care required 

22 under this section, along with any other medical evalua23 tions and interventions for detainees, are documented in 

24 accordance with commonly accepted standards in the 

25 United States for medical record documentation. Such 


kjohnson on DSK7ZCZBW3PROD with $$_JOB
8 

•HR 5605 IH

1 documentation shall be provided to any individual who re2 ceived a health screening and subsequent medical treat3 ment upon release from CBP custody. 

4 (i) INFRASTRUCTURE AND EQUIPMENT.—The Com5 missioner or the Administrator of General Services shall 

6 ensure that each location to which detainees are first 

7 transported after an initial encounter with an agent or of8 ficer of CBP has the following: 

9 (1) A private space that provides a comfortable 

10 and considerate atmosphere for the patient and that 

11 ensures the patient’s dignity and right to privacy 

12 during the health screening and medical assessment 

13 and any necessary follow-up care. 

14 (2) All necessary and appropriate medical 

15 equipment and facilities to conduct the health 

16 screenings and follow-up care required under this 

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

18 including resuscitation of individuals of all ages, and 

19 to prevent the spread of communicable diseases. 

20 (3) Basic over-the-counter medications appro21 priate for all age groups. 

22 (4) Appropriate transportation to medical facili23 ties in the case of a medical emergency, or an on24 call service with the ability to arrive at the CBP fa25 cility within 30 minutes. 


kjohnson on DSK7ZCZBW3PROD with $$_JOB
9 

•HR 5605 IH

1 (j) PERSONNEL.—The Commissioner or the Adminis2 trator of General Services shall ensure that each location 

3 to which detainees are first transported after an initial en4 counter has onsite at least one licensed medical profes5 sional to conduct health screenings. Other personnel that 

6 are or may be necessary for carrying out the functions 

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

8 care professionals, specialty physicians (including physi9 cians specializing in pediatrics, family medicine, obstetrics 

10 and gynecology, geriatric medicine, internal medicine, and 

11 infectious diseases), nurse practitioners, other nurses, 

12 physician assistants. licensed social workers, mental health 

13 professionals, public health professionals, dieticians, inter14 preters, and chaperones, shall be located on site to the 

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

16 on call. 

17 (k) ETHICAL GUIDELINES.—The Commissioner shall 

18 ensure that all medical assessments and procedures con19 ducted pursuant to this section are conducted in accord20 ance with ethical guidelines in the applicable medical field, 

21 and respect human dignity. 

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

23 The Commissioner shall ensure that detainees have 

24 access to— 


kjohnson on DSK7ZCZBW3PROD with $$_JOB
10 

•HR 5605 IH

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

2 person per day, and age-appropriate fluids as need3 ed; 

4 (2) a private, safe, clean, and reliable perma5 nent or portable toilet with proper waste disposal 

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

7 toilet available for every 12 male detainees, and 1 

8 toilet for every 8 female detainees; 

9 (3) a clean diaper changing facility, which in10 cludes proper waste disposal, a hand washing sta11 tion, and unrestricted access to diapers; 

12 (4) the opportunity to bathe daily in a perma13 nent or portable shower that is private and secure; 

14 and 

15 (5) products for individuals of all age groups 

16 and with disabilities to maintain basic personal hy17 giene, including soap, a toothbrush, toothpaste, 

18 adult diapers, and feminine hygiene products, as well 

19 as receptacles for the proper storage and disposal of 

20 such products. 

21 SEC. 4. FOOD AND NUTRITION. 

22 The Commissioner shall ensure that detainees have 

23 access to— 

24 (1) three meals per day including— 


kjohnson on DSK7ZCZBW3PROD with $$_JOB
11 

•HR 5605 IH

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

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

3 calories per day; and 

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

5 age of 12, a diet that contains an appropriate 

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

7 age and weight; 

8 (2) accommodations for any dietary needs or 

9 restrictions; and 

10 (3) access to food in a manner that follows ap11 plicable food safety standards. 

12 SEC. 5. SHELTER. 

13 The Commissioner shall ensure that each facility at 

14 which a detainee is detained meets the following require15 ments: 

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

17 and females shall be detained separately. 

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

19 United States with an adult relative or legal guard20 ian, such child shall be detained with such relative 

21 or legal guardian unless such an arrangement poses 

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

23 who is detained apart from an adult relative or legal 

24 guardian as a result of such safety or security con25 cerns be detained with other adults. 


kjohnson on DSK7ZCZBW3PROD with $$_JOB
12 

•HR 5605 IH

1 (3) In the case of an unaccompanied minor ar2 riving in the United States without an adult relative 

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

4 age-appropriate facility and shall not be detained 

5 with adults. 

6 (4) A detainee with a temporary or permanent 

7 disability shall be held in an accessible location and 

8 in a manner that provides for his or her safety, com9 fort, and security, with accommodations provided as 

10 needed. 

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

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

13 exceed the maximum occupancy level as determined 

14 by the appropriate building code, fire marshal, or 

15 other authority. 

16 (6) Each detainee shall be provided with tem17 perature appropriate clothing and bedding. 

18 (7) The facility shall be well lit and well venti19 lated, with the humidity and temperature kept at 

20 comfortable levels (between 68 and 74 degrees Fahr21 enheit). 

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

23 48 hours shall have access to the outdoors for not 

24 less than 1 hour during the daylight hours during 

25 each 24-hour period. 


kjohnson on DSK7ZCZBW3PROD with $$_JOB
13 

•HR 5605 IH

1 (9) Detainees shall have the ability to practice 

2 their religion or not to practice a religion, as appli3 cable. 

4 (10) Detainees shall have access to lighting and 

5 noise levels that are safe and conducive for sleeping 

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

7 and 6 a.m. 

8 (11) Officers, employees, and contracted per9 sonnel of CBP shall— 

10 (A) follow medical standards for the isola11 tion and prevention of communicable diseases; 

12 and 

13 (B) ensure the physical and mental safety 

14 of detainees who identify as lesbian, gay, bisex15 ual, transgender, and intersex. 

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

17 provide for the safety of the detained population and 

18 to prevent sexual abuse and physical harm of vulner19 able detainees. 

20 (13) The Commissioner shall ensure that lan21 guage-appropriate ‘‘Detainee Bill of Rights’’, includ22 ing indigenous languages, are posted or otherwise 

23 made available in all areas where detainees are lo24 cated. The ‘‘Detainee Bill of Rights’’ shall include 

25 all rights afforded to the detainee under this Act. 


kjohnson on DSK7ZCZBW3PROD with $$_JOB
14 

•HR 5605 IH

1 (14) Video from video-monitoring must be pre2 served for 90 days and the detention facility must 

3 maintain certified records that the video-monitoring 

4 is properly working at all times. 

5 SEC. 6. COORDINATION AND SURGE CAPACITY. 

6 The Secretary of Homeland Security shall enter into 

7 memoranda of understanding with appropriate Federal 

8 agencies, such as the Department of Health and Human 

9 Services, and applicable emergency government relief serv10 ices, as well as contracts with health care, public health, 

11 social work, and transportation professionals, for purposes 

12 of addressing surge capacity and ensuring compliance with 

13 this Act. 

14 SEC. 7. TRAINING. 

15 The Commissioner shall ensure that CBP personnel 

16 assigned to each short-term custodial facility are profes17 sionally trained, including continuing education as the 

18 Commissioner deems appropriate, in all subjects necessary 

19 to ensure compliance with this Act, including— 

20 (1) humanitarian response protocols and stand21 ards; 

22 (2) indicators of physical and mental illness, 

23 and medical distress in children and adults; 

24 (3) indicators of child sexual exploitation and 

25 effective responses to missing migrant children; and 


kjohnson on DSK7ZCZBW3PROD with $$_JOB
15 

•HR 5605 IH

1 (4) procedures to report incidents of suspected 

2 child sexual abuse and exploitation directly to the 

3 National Center for Missing and Exploited Children. 

4 SEC. 8. INTERFACILITY TRANSFER OF CARE. 

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

6 a medical facility or emergency department, the Commis7 sioner shall ensure that responsibility of care is trans8 ferred from the medical facility or emergency department 

9 to an accepting licensed health care provider of CBP. 

10 (b) RESPONSIBILITIES OF ACCEPTING PROVIDERS.— 

11 Such accepting licensed health care provider shall review 

12 the medical facility or emergency department’s evaluation, 

13 diagnosis, treatment, management, and discharge care in14 structions to assess the safety of the discharge and trans15 fer and to provide necessary follow-up care. 

16 SEC. 9. PLANNING AND INITIAL IMPLEMENTATION. 

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

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

19 Security shall submit to Congress a detailed plan delin20 eating the timeline, process, and challenges of carrying out 

21 the requirements of this Act. 

22 (b) IMPLEMENTATION.—The Secretary of Homeland 

23 Security shall ensure that the requirements of this Act are 

24 implemented not later than 6 months after the date of 

25 enactment. 


kjohnson on DSK7ZCZBW3PROD with $$_JOB
16 

•HR 5605 IH

1 SEC. 10. CONTRACTOR COMPLIANCE. 

2 The Secretary of Homeland Security shall ensure 

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

4 in accordance with the requirements of this Act. 

5 SEC. 11. INSPECTIONS. 

6 (a) IN GENERAL.—The Inspector General of the De7 partment of Homeland Security shall— 

8 (1) conduct unannounced inspections of ports of 

9 entry, border patrol stations, and detention facilities 

10 administered by CBP or contractors of CBP; and 

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

12 of such inspections as well as other reports of the 

13 Inspector General related to custody operations. 

14 (b) PARTICULAR ATTENTION.—In carrying out sub15 section (a), the Inspector General of the Department of 

16 Homeland Security shall pay particular attention to— 

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

18 requirements of this Act; 

19 (2) remedial actions taken by CBP; 

20 (3) the health needs of detainees; and 

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

22 title 6, Code of Federal Regulations (commonly 

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

24 Respond to Sexual Abuse and Assault in Confine25 ment Facilities’’). 


kjohnson on DSK7ZCZBW3PROD with $$_JOB
17 

•HR 5605 IH

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

2 not deny a Member of Congress entrance to any facility 

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

4 SEC. 12. GAO REPORT. 

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

6 United States shall— 

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

8 enactment of this Act, commence a study on imple9 mentation of, and compliance with, this Act; and 

10 (2) not later than 1 year after the date of en11 actment of this Act, submit a report to Congress on 

12 the results of such study. 

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

14 subsection (a) shall examine the management and over15 sight by CBP of ports of entry, border patrol stations, and 

16 other detention facilities, including the extent to which 

17 CBP and the Department of Homeland Security have ef18 fective processes in place to comply with this Act. The 

19 study shall also examine the extent to which CBP per20 sonnel, in carrying out this Act, make abusive, derisive, 

21 profane, or harassing statements or gestures, or engage 

22 in any other conduct evidencing hatred or invidious preju23 dice to or about one person or group on account of race, 

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

25 or disability, including on social media. 


kjohnson on DSK7ZCZBW3PROD with $$_JOB
18 

•HR 5605 IH

1 SEC. 13. RULES OF CONSTRUCTION. 

2 Nothing in this Act may be construed— 

3 (1) as authorizing CBP to detain individuals for 

4 longer than 72 hours; 

5 (2) as contradicting the March 7, 2014, De6 partment of Homeland Security rule adopting 

7 Standards to Prevent, Detect, and Respond to Sex8 ual Abuse and Assault in Confinement Facilities, 

9 which includes a zero tolerance policy prohibiting all 

10 forms of sexual abuse and assault of individuals in 

11 U.S. Customs and Border Protection custody, in12 cluding in holding facilities, during transport, and 

13 during processing; 

14 (3) as contradicting current protocols related to 

15 Department background checks in the hiring proc16 ess; 

17 (4) as restricting the Department from denying 

18 employment to or terminating the employment of 

19 any individual who would be or is involved with the 

20 handling or processing at holding facilities, during 

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

22 including the care of children, and has been con23 victed of a sex crime or other offense involving a 

24 child victim; or 


kjohnson on DSK7ZCZBW3PROD with $$_JOB
19 

•HR 5605 IH

1 (5) as affecting the obligation to fully comply 

2 with all applicable immigration laws, including being 

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

4 SEC. 14. DEFINITIONS. 

5 In this Act: 

6 (1) INTERPRETATION SERVICES.—The term 

7 ‘‘interpretation services’’ includes translation serv8 ices that are performed either in-person or through 

9 a telephone or video service. 

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

11 given the term in section 101(b)(1) of the Immigra12 tion and Nationality Act (8 U.S.C. 1101(b)(1)). 

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

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

15 Protection Facility’’ includes— 

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

17 (B) ports of entry; 

18 (C) checkpoints; 

19 (D) forward operating bases; 

20 (E) secondary inspection areas; and 

21 (F) short-term custody facilities. 

22 (4) FORWARD OPERATING BASE.—The term 

23 ‘‘forward operating base’’ means a permanent facil24 ity established by CBP in forward or remote loca25 tions, and designated as such by CBP. 


kjohnson on DSK7ZCZBW3PROD with $$_JOB
20 

•HR 5605 IH

1 (5) PUBLICATION OF DATA ON COMPLAINTS OF

2 SEXUAL ABUSE AT CBP FACILITIES.—Not later than 

3 90 days after the date of enactment of this Act, the 

4 Secretary of Homeland Security, acting in coordina5 tion with the Office of Inspector General and Office 

6 for Civil Rights and Civil Liberties, shall publicly re7 lease aggregate data on complaints of sexual abuse 

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

9 excluding any personally identifiable information 

10 that may compromise the confidentiality of individ11 uals who reported abuse. 

Æ 


kjohnson on DSK7ZCZBW3PROD with $$_JOB