II 117th CONGRESS 2d Session S. 4096 IN THE SENATE OF THE UNITED STATES April 27, 2022 Mr. Luján (for himself, Mr. Heinrich , and Mrs. Feinstein ) 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 all detainees, and for other purposes.

1. Short title; table of contents (a) Short title This Act may be cited as the Humanitarian Standards for Individuals in U.S. Customs and Border Protection Custody Act . (b) Table of contents The table of contents for this Act is as follows: Sec. 1. Short title; table of contents. Sec. 2. Definitions. 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. Government Accountability Office report. Sec. 14. Publication of data on complaints of sexual abuse at U.S. Customs and Border Protection facilities. Sec. 15. Rules of construction. 2. Definitions In this Act: (1) CBP The term CBP means U.S. Customs and Border Protection. (2) Child The term child has the meaning given such term in section 101(b)(1) of the Immigration and Nationality Act ( 8 U.S.C. 1101(b)(1) ). (3) Commissioner The term Commissioner means the Commissioner of U.S. Customs and Border Protection. (4) Detainee The term detainee means any individual who is detained in the custody of CBP. (5) Forward operating base The term forward operating base means a permanent facility established by CBP in forward or remote locations, and designated by CBP. (6) Interpretation services The term interpretation services includes translation services that are performed either in person or through a telephone or video service. (7) U.S. customs and border protection facility The term U.S. Customs and Border Protection facility includes— (A) U.S. Border Patrol stations; (B) ports of entry; (C) checkpoints; (D) forward operating bases; (E) secondary inspection areas; and (F) short-term custody facilities. 3. Initial health screening protocol (a) In general The Commissioner, in consultation with the Secretary of Health and Human Services, the Administrator of the Health Resources and Services Administration, and nongovernmental experts in the delivery of health care in humanitarian crises and in the delivery of health care to children, shall develop guidelines and protocols for the provision of health screenings and appropriate medical care for detainees, as required under this section. (b) Initial screening and medical assessment The Commissioner shall ensure that all detainees receive an initial in-person screening by a licensed medical professional in accordance with the standards described in subsection (c)— (1) to assess and identify any illness, condition, or age-appropriate mental or physical symptoms that may have resulted from distressing or traumatic experiences; (2) to identify acute conditions and high-risk vulnerabilities; and (3) to ensure that appropriate healthcare is provided to individuals as needed, including pediatric, obstetric, and geriatric care. (c) Standardization of initial screening and medical assessment (1) In general The initial screening and medical assessment of detainees shall include— (A) an interview and the use of a standardized medical intake questionnaire or the equivalent; (B) screening of vital signs, including pulse rate, body temperature, blood pressure, oxygen saturation, and respiration rate; (C) screening for blood glucose for known or suspected diabetics; (D) weight assessment of detainees younger than 12 years of age; (E) a physical examination; and (F) a risk assessment and the development of a plan for monitoring and care, as appropriate. (2) Prescription medication (A) In general The medical professional conducting the screening pursuant to subsection (b) shall— (i) review any prescribed medication that is in the detainee’s possession or that was confiscated by CBP upon arrival; and (ii) determine if such medication should be— (I) kept by the detainee for use during detention; (II) properly stored by CBP, with appropriate access for use during detention; or (III) maintained with the detained individual’s personal property. (B) Right to medication A detainee may not be denied the use of necessary and appropriate medication for the management of the detainee’s illness. (3) Rule of construction Nothing in this subsection may be construed as requiring detainees to disclose their medical status or history. (d) Timing (1) In general Except as provided in paragraph (2), the initial screening and medical assessment described in subsections (b) and (c) shall take place as soon as practicable, but not later than 12 hours after a detainee’s arrival at a CBP facility. (2) High priority individuals The initial screening and medical assessment referred to in paragraph (1) shall take place as soon as practicable, but not later than 6 hours after a detainee’s arrival at a CBP facility if the individual— (A) reasonably self-identifies as having a medical condition that requires prompt medical attention; or (B) is— (i) exhibiting signs of acute or potentially severe physical or mental illness, or otherwise has an acute or chronic physical or mental disability or illness; (ii) pregnant; (iii) a child (with priority given, as appropriate, to the youngest children); or (iv) elderly. (e) Further care (1) In general If, as a result of the initial health screening and medical assessment described in subsections (b) and (c), the licensed medical professional conducting such screening or assessment determines that 1 or more of the detainee’s vital sign measurements are significantly outside normal ranges, in accordance with the National Emergency Services Education Standards, or if the detainee is identified as high risk or in need of medical intervention, the detainee shall be provided, as expeditiously as possible, with an in-person or technology-facilitated medical consultation with a licensed emergency care professional. (2) Reevaluation (A) In general Each detainee described in paragraph (1)— (i) shall be reevaluated not later than 24 hours after the consultation required under such paragraph; and (ii) (I) shall be monitored thereafter as determined by an emergency care professional; or (II) if the detainee is a child, shall be monitored thereafter as determined by a licensed emergency care professional with a background in pediatric care. (B) Reevaluation before travel In addition to the reevaluations required under subparagraph (A), detainees described in paragraph (1), before travel— (i) shall have all of their vital signs reevaluated; and (ii) shall be cleared by a medical professional as being able to travel safely. (3) Pyschological and mental care The Commissioner shall ensure that detainees who have experienced physical or sexual violence or who have experienced events that may cause severe trauma or toxic stress, are provided access to basic, humane, and supportive psychological assistance. (f) Interpreters To ensure that health screenings and medical care required under this section are carried out in the best interests of the detainee, the Commissioner shall ensure that— (1) language-appropriate interpretation services, including interpretation of indigenous languages, are provided to each detainee; and (2) each detainee is informed of the availability of such interpretation services. (g) Chaperones To ensure that health screenings and medical care required under this section are carried out in the best interests of the detainee— (1) the Commissioner shall establish guidelines for, and ensure the presence of, chaperones for all detainees during medical screenings and examinations in accordance with relevant guidelines in the American Medical Association Code of Medical Ethics and recommendations of the American Academy of Pediatrics; and (2) to the extent practicable, the physical examination of a child shall always be performed in the presence of— (A) a parent or legal guardian; or (B) the detainee’s closest present adult relative, if a parent or legal guardian is unavailable. (h) Documentation The Commissioner shall ensure that— (1) the health screenings and medical care required under this section 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; and (2) such documentation is provided to any individual who received a health screening and subsequent medical treatment upon release from CBP custody. (i) Infrastructure and equipment The Commissioner or the Administrator of General Services shall ensure that each location to which detainees are first transported after an initial encounter with an agent or officer of CBP has— (1) a private space that— (A) provides a comfortable and considerate atmosphere for the patient; and (B) ensures the patient’s dignity and right to privacy during the health screening and medical assessment and any necessary follow-up care; (2) all necessary and appropriate medical equipment and facilities— (A) to conduct the health screenings and follow-up care required under this section; (B) to treat trauma; (C) to provide emergency care, including resuscitation of individuals of all ages; and (D) to prevent the spread of communicable diseases; (3) basic over-the-counter medications appropriate for all age groups; and (4) appropriate transportation to medical facilities in the case of a medical emergency, or an on-call service with the ability to arrive at the CBP facility within 30 minutes. (j) Personnel The Commissioner or the Administrator of General Services, as the case may be, shall ensure that each location to which detainees are first transported after an initial encounter has— (1) at least 1 licensed medical professional on site to conduct health screenings; and (2) other personnel that are or may be necessary for carrying out the functions described in subsection (e), such as licensed emergency care professionals, specialty physicians (including physicians specializing in pediatrics, family 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, dieticians, interpreters, and chaperones, on site to the extent practicable, or, if not practicable, available on call. (k) Ethical guidelines The Commissioner shall ensure that all medical assessments and procedures conducted pursuant to this section are conducted in accordance with ethical guidelines in the applicable medical field and respect human dignity. 4. Water, sanitation and hygiene The Commissioner shall ensure that detainees have access to— (1) not less than 1 gallon of drinking water per person per day, in addition any other age-appropriate fluids that may be needed; (2) a private, safe, clean, and reliable permanent or portable toilet with proper waste disposal and a hand washing station, with not fewer than 1 toilet available for every 12 male detainees, and not fewer than 1 toilet available for every 8 female detainees; (3) a clean diaper changing facility, which includes proper waste disposal, a hand washing station, and unrestricted access to diapers; (4) the opportunity to bathe daily in a permanent or portable shower that is private and secure; and (5) products for individuals of all age groups and for individuals with disabilities to maintain basic personal hygiene, including soap, a toothbrush, toothpaste, adult diapers, feminine hygiene products, and receptacles for the proper storage and disposal of such products. 5. Food and nutrition The Commissioner shall ensure that detainees have access to— (1) 3 meals per day, including— (A) for individuals 12 years of age or older, a diet that contains not less than 2,000 calories per day; and (B) for children younger than 12 years of age, a diet that contains an appropriate number of calories per day based on the child’s age and weight; (2) accommodations for any dietary needs or restrictions; and (3) access to food in a manner that follows applicable food safety standards. 6. Shelter The Commissioner shall ensure that in each facility at which a detainee is detained— (1) except as provided in paragraph (2), males and females are detained separately; (2) for any minor child arriving in the United States with an adult relative or legal guardian, such child— (A) is detained with such relative or legal guardian unless such an arrangement poses safety or security concerns; and (B) if such child is detained apart from an adult relative or legal guardian as a result of such safety or security concerns, is not detained with adults; (3) for any unaccompanied minor arriving in the United States without an adult relative or legal guardian, such child is detained in an age-appropriate facility and not detained with adults; (4) a detainee with a temporary or permanent disability is held in an accessible location and in a manner that provides for his or her safety, comfort, and security, with accommodations provided to the extent needed; (5) no detainee is placed in a room for any period if such placement would exceed the maximum occupancy level as determined by the appropriate building code, fire marshal, or other authority; (6) each detainee is provided with temperature appropriate clothing and bedding; (7) the facility is well lit and well ventilated, with the humidity and temperature kept at comfortable levels (between 68 and 74 degrees Fahrenheit); (8) detainees who are in custody for more than 48 hours are given access to the outdoors for not less than 1 hour during the daylight hours during each 24-hour period; (9) detainees are allowed to practice their religion or to not practice a religion, as they may decide; (10) detainees are given access to lighting and noise levels that are safe and conducive for sleeping throughout the night between the hours of 10:00 p.m. and 6:00 a.m; (11) CBP officers, employees, and contracted personnel— (A) follow medical standards for the isolation and prevention of communicable diseases; and (B) ensure the physical and mental safety of detainees who identify as lesbian, gay, bisexual, transgender, or intersex; (12) the facility has video monitoring— (A) to provide for the safety of the detainees; and (B) to prevent sexual abuse and physical harm of vulnerable detainees; (13) there is posted or otherwise made available in all areas where detainees are located a language appropriate Detainee Bill of Rights (including indigenous languages), which specifies all rights afforded to detainees under this Act; and (14) the facility certifies that— (A) the video monitoring required under paragraph (12) is properly working at all times; and (B) the videos resulting from video monitoring are preserved for at least 90 days. 7. Coordination and surge capacity The Secretary of Homeland Security shall enter into memoranda of understanding with appropriate Federal agencies, such as the Department of Health and Human Services, and applicable government emergency relief services, and shall enter into contracts with health care, public health, social work, and transportation professionals, for purposes of addressing surge capacity and ensuring compliance with this Act. 8. Training The Commissioner shall ensure that CBP personnel assigned to each short-term custodial facility are professionally trained, including by receiving such continuing education as the Commissioner determines appropriate, in all subjects necessary to ensure compliance with this Act, including— (1) humanitarian response protocols and standards; (2) indicators of physical and mental illness, and medical distress in children and adults; (3) indicators of child sexual exploitation and effective responses to missing migrant children; and (4) procedures to report incidents of suspected child sexual abuse and exploitation directly to the National Center for Missing and Exploited Children. 9. Interfacility transfer of care (a) Transfer When a detainee is discharged from a medical facility or emergency services department, the Commissioner shall ensure that responsibility of care is transferred from the medical facility or emergency services department to an accepting licensed CBP health care provider. (b) Responsibilities of accepting providers Each accepting licensed CBP health care provider shall review the medical facility or emergency department’s evaluation, diagnosis, treatment, management, and discharge care instructions— (1) to assess the safety of the discharge and transfer; and (2) to provide necessary follow-up care. 10. Planning and initial implementation (a) Planning Not later than 60 days after the date of the enactment of this Act, the Secretary of Homeland Security shall submit a detailed plan to Congress that describes the timeline, process, and challenges of implementing the requirements under this Act. (b) Implementation The Secretary of Homeland Security shall ensure that the requirements under this Act are implemented not later than 6 months after the date of the enactment of this Act. 11. Contractor compliance The Secretary of Homeland Security shall ensure that all personnel contracted to carry out this Act comply with the requirements under this Act. 12. 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 administered by CBP or contractors of CBP; and (2) submit to Congress— (A) reports on the results of the inspections conducted pursuant to paragraph (1); and (B) other reports related to custody operations. (b) Particular attention In carrying out subsection (a), the Inspector General shall pay particular attention to— (1) the degree of compliance by CBP with the requirements under this Act; (2) remedial actions taken by CBP; (3) the health needs of detainees; and (4) the degree of compliance with part 115 of title 6, Code of Federal Regulations (commonly known as the Standards to Prevent, Detect, and Respond to Sexual Abuse and Assault in Confinement Facilities ). (c) Access to facilities The Commissioner may not deny a Member of Congress entrance to any facility or building used, owned, or operated by CBP. 13. Government Accountability Office report (a) In general The Comptroller General of the United States— (1) not later than 6 months after the date of the enactment of this Act, shall commence a study on implementation of, and compliance with, this Act; and (2) not later than 1 year after the date of the enactment of this Act, shall submit a report to Congress containing the results of the study required under paragraph (1). (b) Issues To be studied The study required under subsection (a)(1) shall examine— (1) 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 the requirements under this Act; and (2) the extent to which CBP personnel, in carrying out this Act, make abusive, derisive, profane, or harassing statements or gestures, or engage in any other conduct evidencing hatred or invidious prejudice to or about 1 person or group on account of race, color, religion, national origin, sex, sexual orientation, age, or disability, including on social media. 14. Publication of data on complaints of sexual abuse at U.S. Customs and Border Protection facilities Not later than 90 days after the date of the enactment of this Act, the Secretary of Homeland Security, acting in coordination with the Office of Inspector General and the Office for Civil Rights and Civil Liberties of the Department of Homeland Security, shall publicly release aggregate data on complaints of sexual abuse at CBP facilities on its website on a quarterly basis, excluding any personally identifiable information that may compromise the confidentiality of individuals who reported such abuse. 15. Rules of construction Nothing in this Act may be construed as— (1) authorizing CBP to detain individuals for longer than 72 hours; (2) contradicting the March 7, 2014, Department of Homeland Security rule adopting Standards to Prevent, Detect, and Respond to Sexual Abuse and Assault in Confinement Facilities, which includes a zero tolerance policy prohibiting all forms of sexual abuse and assault of individuals in U.S. Customs and Border Protection custody, including in holding facilities, during transport, and during processing; (3) contradicting current protocols related to Department of Homeland Security background checks in the hiring process; (4) restricting the Department of Homeland Security from denying employment to, or terminating the employment of, any individual who— (A) would be or is involved with the handling or processing at holding facilities, during transport, or during processing, or care of detainees, including the care of children; and (B) has been convicted of a sex crime or other offense involving a child victim; or (5) affecting the obligation to fully comply with all applicable immigration laws, including being subject to any penalties, fines, or other sanctions.