The Grapes of Wrath: On the Health of Immigration Detainees

INTRODUCTIONOn April 6, 2015, Raul Ernesto Morales-Ramos, a forty-four-year-old Salvadoran national who had been in U.S. Immigration and Customs Enforcement ("ICE") custody since 2010, died of intestinal cancer. 1 The Adelanto Immigration Center in Adelanto, California ("Adelanto"), which ignored Morales-Ramos's complaints of severe abdominal pain, uncontrollable leakage of urine, and diarrhea, refused to provide the detainee any medical care. 2On March 4, 2012, Fernando Dominguez Valdivia, a fifty-eight-yearold Mexican national, died of multiple organ failure caused by an infection that spread to his bloodstream following one hundred days in ICE custody, also at Adelanto. 3 Following an investigation of his death, the Federal Office of Detention Oversight ("ODO") determined that Adelanto's medical staff failed to properly examine Dominguez Valdivia, failed to create medical records that would ensure the continuity of his health care, and failed to access available, off-site health care. 4 The ODO concluded that the care Dominguez Valdivia received was unacceptable and that his death was preventable.5Morales-Ramos and Dominguez Valdivia are two of 153 detainees who died in ICE custody between October 2003 and October 2015. 6 Other detainees who died during this time period include Tiombe Kimana Carlos, a thirtyfour-year-old woman with schizophrenia from Antigua and Barbuda who hanged herself on October 23, 2013, at York County Jail in York, Pennsylvania, where she had been detained for more than two-and-a-half years. 7 An ICE report investigating Carlos's death found a series of lapses in care by the jail, including a failure to conduct a health examination within a reasonable time of detention and a failure to implement a treatment plan with measurable goals and objectives. 8This Article tackles a problem that is broad in scope; that is, individuals' general lack of access to physical and mental health care while in detention. Using contemporary health care standards applicable to voluntary and involuntary health care providers as a reference point, 9 this Article proposes to replace the unenforceable health care guidelines currently set forth in ICE's detention standards10 with rigorous federal regulations. 11T his Article proceeds as follows: Part I examines immigration detainees' lack of access to adequate physical and mental health care. 12 Using publicly available information, including ICE's List of Deaths in ICE Custody, 13 as well as internal detention center investigation reports, autopsy reports, and other inter-agency memoranda, Part I identifies the immediate causes of detainee deaths, including untreated staph infections, sepsis, tuberculosis, pneumonia, meningitis, emphysema, aneurysms, hypertension, diabetes complications, HIV complications, cancer, seizure disorders, liver failure, renal failure, and multiple organ failure, as well as electrocution, drowning, rabies, cardiac arrest, shock, traumatic brain injury, methamphetamine intoxication, suicide by hanging, and suicide by other forms of strangulation. 14 These deaths are clinically unsurprising; that is, many individuals are extremely physically and emotionally vulnerable at the time of initial detention due to a history of torture and trauma, which may include human trafficking, sexual violence, political oppression, psychosocial trauma, and acculturative stress. 15 Detention can exacerbate preexisting vulnerabilities and contribute to severe physical and mental illness without proper diagnosis and treatment. 16Using internal ICE memoranda as well as interviews with detainees conducted by human rights organizations, P art I also identifies the underlying, or root, causes of these deaths, including: detainees' lack of access to comprehensive physical and mental health examinations within a reasonable period of time following detention; individualized plans of care with measureable goals and outcomes; timely and proper treatments and followup care; protections from and treatments for infectious diseases; and effective suicide precautions, including suicide prevention, monitoring, and intervention. …