Immigration Detention Health Care System

Background

While the United States has a history of immigration detention dating back to Ellis Island, immigration detention as we know it today can be traced back to the 1990s and post-9/11 policies. In 1996, the Illegal Immigration Reform and Immigrant Responsibility Act was passed, which increased regulations on immigration and detention (Fragomen, 439). Shortly after the terrorist attacks in 2001, the USA PATRIOT Act—short for United and Strengthening America by Providing Appropriate Tools Required to Intercept and Obstruct Terrorism—was passed, which gave border patrol “broader detention powers” (Rhoad, 12). Also following the 9/11 attacks was the establishment of the Department of Homeland Security (DHS). ICE, or the U.S. Immigration and Customs Enforcement, is the largest division in the DHS and is the division in charge of immigration detention (Venters, 951). The United States has the “largest national immigration detention system in the world,” holding more than 400,000 people each year at a cost of $2 billion per year (Long, 13). In fact, the U.S. detention population has more than doubled in the past 15 years. This can be attributed to the “bed quota” implemented by Congress for the DHS, which is currently set at 34,000 detention beds, “regardless of enforcement needs” (Long, 14).  According to the Government Accountability Office, ICE oversees detention of individuals at over 500 facilities (Rhoad, 12). These facilities include “state prisons, county jails, private detention centers, and a small number of facilities run by ICE” (Venters, 951). Detention centers are where detained immigrants must wait to be called to immigration court, where their claims are judged to be credible or not credible. The average length of detention is between one and two months, but this varies greatly depending on the individual’s case (Venters, 952). Private prison companies have spent large amounts of money lobbying Congress to influence debate on immigration reform and detention. During Trump’s presidential campaign, his rhetoric and approval for private prison companies helped them achieve high stock prices (Long, 15). According to ICE, the majority of people in immigration detention are held in privately-run facilities (Long, 16). Prior to the Trump administration, detention centers were subject to one of four different sets of standards. The Trump administration decided to replace these standards with an “18-page checklist used by the U.S. Marshals Service for federal criminal defendants” (Long, 17).

This interactive map is provided by Community Initiatives for Visiting Immigrants in Confinement (CIVIC) and shows the immigration detention centers across the country. Each facility is marked by categorization (private-run, ICE-run, county/city-run), and clicking on a facility will reveal more information about it. Source: CIVIC.

Click here to see ICE’s map of facilities, which shows significantly fewer facilities.

Health Care in Detention Centers

Though detention centers share many similarities with the prison system in the United States, one of the most visible differences is that incarcerated people have a right to medical care, whereas detained immigrants do not. Because ICE does not readily release information about the health and treatment of their detainees, not much is officially known about this population and their experiences. However, ICE has publicly stated that “one-third of detainees suffer from a chronic medical condition such as diabetes or hypertension” (Venters, 951). In 2007, ICE estimated the amount of money spent on health care as $100 million, drastically lower than the amount of money spent on health care in U.S. prison facilities.

Each detention center, regardless of the type, has a medical unit where detainees are initially screened for medical problems. Each detainee is mandated to receive this initial screening within two weeks of detention. Additionally, each facility must have a “sick call” system, where detainees can request medical attention to be given on-site. If a detainee is in need of outside medical care, emergent situations do not require prior authorization. ICE defines an emergency as “a condition that is threatening to life, limb, hearing or sight.” On the other hand, non-emergent situations require authorization by the ICE Health Service Corps (formerly known as the Division of Immigration Health Services, DIHS). These non-emergent situations include visits to specialists or diagnostic tests and are defined as medical conditions that “if left untreated during the period of ICE/BP custody, would cause deterioration of the detainee’s health or uncontrolled suffering affecting his/her deportation status” (Venters, 952). Though the ICE Health Service Corps has primary responsibility for medical care in detention centers (Library of Congress, 2), they only provide on-site medical services at 21 facilities (Rhoad, 14). Their website boasts “we provide compassionate medical attention to the men and women in ICE’s care” (“ICE Health Service Corps”). In addition, the facilities that receive direct on-site service from ICE Health Service Corps personnel have a “36 percent vacancy rate for medical staff”. At the remaining facilities, “medical care is contracted out,” for example with private health care companies (Rhoad, 14), or is provided by the local government (Long, 22). The ICE Health Service Corps “nonetheless regulates the medical care available at all facilities through an ICE detention standard on medical care,” to ensure that all individuals detained by ICE receive the same level of care regardless of location (Rhoad, 15). While companies are required to provide medical care, Human Rights Watch found that “there is little consistency in the terms set forth in the contracts and the specifics of what is required.” Such requirements include certifications for the physicians and nurses and work hours/times of availability for medical staff (Long, 22). In addition, they argue that “for-profit companies and county governments receiving payments form ICE for holding immigrants in detention have a financial incentive to reduce costs related to both on-site and off-site care, with little risk of real penalties for medical care that does not meet the applicable detention standards” (Long, 23). The cost of care that ICE pays in facilities not run by ICE ranges from $40-100 per detainee per day, correlating to a $10-50 profit per detainee per day for the facility (Venters, 952).

The ICE Health Service Corps has a Medical Dental Detainee Covered Services Package, which outlines the types of outside services available and covered by ICE for detainees. Though updated in 2005, the Medical Dental Detainee Covered Services Package included a half-page entry entitled “Other Services” that included “asthma, hypertension, diabetes, mental health, HIV/AIDS, seizure disorder, and TB/INH,” which noted that follow-up services will be determined by the on-site health care provider. Their list of “Other Services” also included screening tests for several types of cancer. However, the services package explicitly mandated that “detainees must be in ICE/BP custody at least 12 months with no indication of imminent removal” to be eligible for these screenings (Venters, 953). In addition, the original covered services package had very little information on “basic mental health services, physical therapy…as well as hearing aids, glasses and prostheses.” In 2005, when the ICE Health Service Corps (formerly, DIHS) changed the package to an even more restrictive version, creating more loopholes of prior-authorization for medical provider visits; allowing for providers to “follow individual plans of care for chronic diseases,” which can be harmful to many patients who benefit from standardized care protocols; and changing the health and cancer screenings from the already restrictive 12-month requirement to a case by case basis (Venters, 954).

ICE also has a Detention Operations Manual, last updated in 2011, which outlines the standards for immigration detention, including medical care. These standards are not law, “thus detainees do not have legal recourse for violations of the standards” (Library of Congress, 6). In 2008, the Detainee Basic Medical Care Act was introduced in Congress, which required the DHS to establish actual procedures and require them to provide these health services. The bill was ultimately not enacted. The Detention Operations Manual outlines expected practices:

1. “Initial medical, mental health and dental screening
2. Medically necessary and appropriate medical, dental and mental health care and pharmaceutical services
3. Comprehensive, routine and preventive health care, as medically indicated
4. Emergency care
5. Specialty health care
6. Timely responses to medical complaints, and
7. Hospitalization as needed within the local community
8. Staff or professional language services necessary for detainees with limited English proficiency (LEP) during any medical or mental health appointment, sick call, treatment, or consultation” (U.S. Immigration and Customs Enforcement, 4.3)

Women’s Health Care in Detention Centers

The ICE Detention Operations Manual outlines expected medical practices in regards to women’s health:

1. “Pregnancy services, including pregnancy testing, routine or specialized prenatal care, postpartum follow up, lactation services and abortion services as outlined herein;
2. counseling and assistance for pregnant women in keeping with their express desires in planning for their pregnancy, whether they desire abortion, adoptive services or to keep the child; and
3. routine, age-appropriate, gynecological health care services, including offering women’s specific preventive care” (U.S. Immigration and Customs Enforcement, 4.4)

In 2008, a female detainee at an Arizona detention center wrote a letter to an immigration attorney and Human Rights Watch explaining the conditions in the center:

“Medical care that is provided to us is very minimal and general…. If you do not speak English, you cannot fuss, the only thing you can do is go to bed & suffer…. We have no privacy when our health record is being discussed…. When we’ve complained to the nurses, we get ridiculed with replies like: ‘You should have made better choices…ICE is not here to make you feel comfortable…our hands are [tied]…Well, we can’t do much you’re getting deported anyway…learn English before you cross the border…Mi casa no es su casa.’…. Our living situation is degrading and inhuman” (Rhoad, 1).

Female detainees have told human rights organizations about their difficulties in receiving proper medical care, including lack of knowledge of available women’s health services, delayed or denied requests for service, breached confidentiality of medical information, difficulty persuading guards that they need medical treatment, lack of interpreters during exams, and even fear of “retaliation or negative consequences to their immigration cases if they sought care” (Rhoad, 3). Additionally, they have no option to refuse medication or treatment that they do not want.

Though the ICE Detention Operations Manual clearly outlines expected practices, this is not always what is executed in reality. Many women complained about the arbitrary distribution of sanitary pads and their difficulty in convincing the guards to give them more (Rhoad, 49). Important health screenings, such as mammograms and Pap smears, are administered at the health care provider’s discretion rather than on a yearly basis. This is particularly harmful as women above 40 years of age are to be getting routinely monitored (Rhoad, 50). Even the National Commission on Correctional Health Care (NCCHC), which accredits many jails and prisons, recommends that certain tests such as Pap smears be given to women upon entry into the jail (Venters, 953). In regards to pregnancy, ICE claims that all detained pregnant women receive off-site care from specialists, but this varies by location. For example, women claim that the off-site physicians in Brownsville, Texas treat them well, but the case is different in Arizona where women claim their requests for prenatal services were ignored (Rhoad, 52-53). Recently, the Trump administration has rescinded an Obama-era policy that orders immigration officials to release pregnant women from federal custody. ICE is following this new policy as it follows Trump’s 2017 executive order on Border Security and Immigration Enforcement (Sacchetti). The ICE Health Service Corps lists “elective abortions” as a service that is generally not authorized. ICE does not provide funding for an elective abortion for a woman in custody; however, ICE is able to provide transportation for a woman who has arranged and paid for her own appointment. This is option is simply not possible for women who lack the money for an abortion (Rhoad, 54). However, similar U.S. prison health care system, ICE will assume the costs of abortion if the life of the mother is endangered or if the pregnancy is the result of incest or rape (U.S. Immigration and Customs Enforcement, 4.4). After a woman in custody has given birth, the ICE Health Service Corps claims that breast pumps should be made available to nursing mothers. Many women claim that they are not provided with the necessary equipment, resulting in intense fevers, chills, and pains. As a result of this mistreatment, many women are unable to breastfeed after their release, denying the mother and child of the benefit of breastfeeding (Rhoad, 56). While it is impossible to know the number of detained women who are survivors of sexual and gender-based violence, immigration authorities estimate it is a high percentage (Rhoad, 57). Though ICE has policy addressing sexual assault that takes place during ICE custody, they do not have anything to address the needs of survivors who experience these traumas before custody (Rhoad, 58). Additionally, many women have complained about denied or ignored mental health care requests to address their depression and anxiety (Rhoad, 62).

Controversy & Perspectives

Source: Human Rights Watch

         Proper health care for detainees in ICE detention centers has been intensely advocated for by human rights organizations, who believe their mistreatment constitutes human rights abuses. According to the nonprofit Community Initiatives for Visiting Immigrants in Confinement, 177 people have died in U.S. detention centers since October 2003 as a result of substandard medical care (Bethea). In reviewing cases of deaths in detention, Human Rights Watch found that substandard medical practices put many of the detainees at risk and, in some cases, caused their deaths. These practices include delays in care and emergency responses, inadequate staffing and training (including occasionally staffing unlicensed personnel), inadequate mental health care, and misuse of isolation (Long, 44). In 2008, a report to Congress noted that detained asylum seekers “often have medical and psychological issues and it is not clear how well-equipped the detention health care system is to deal with the specific…needs of asylum seekers” (Library of Congress, 19).

The issue has also caught the attention of the medical world. In their commentary on ICE’s health plan, Doctors Venters and Keller argue that the ICE health plan places “detainees at risk of receiving inadequate care, particularly if they have chronic medical problems or would benefit from routine health screening exams” (Venters, 951). In 2017, the American Medical Association released a statement adopting new policies for immigrant and refugee health. The AMA stated that “given the negative health consequences that detention has on both children and their parents, the AMA opposes family immigration detention, separation of children from their parents in detention, and any plans to expand these detention centers.” Furthermore, the AMA believes that ICE has “failed to prevent human rights abuses and substandard living conditions, and [ICE] provide[s] inconsistent access to quality medical care.” Comparisons between detention centers and the prison system can easily be drawn although there are stark differences in their respective forms of health care. The AMA called on ICE to begin using NCCHC guidelines and end partnerships with private facilities “that do not meet the standards of medical care as set by the NCCHC” (“AMA Adopts New Policies”).

Relation to Politics of Health

The health care in detention centers relates to politics of health through biopower, institutionalization, exclusion, and ideas of citizenship and nation. As detainees are unable to seek their own independent medical treatment while in custody, according to Foucault’s concept of biopower, their health becomes objects of state or institutional power. The detention health care system, which has allowed many preventable deaths to occur, truly holds the power to take life or let live (Foucault, 138). Furthermore, there are many who believe that undocumented immigrants should not have the right to health care. Hoffman explains that “access to health care in the United States rests on a basis of categorization and exclusion, of defining who is deserving of and able to receive what services” (Hoffman, 238). This idea of exclusion aligns perfectly with the health care system in the immigrant detention centers in the U.S., where much of the medical treatment is left to the health care provider’s discretion or on a case by case basis. Detained individuals receive such treatment because they do not fit into, as Chavez explains, the “imagined community.” Immigrants detained in ICE facilities are all detained for different reasons yet have the same underlying identity—they are not U.S. citizens. The creation of institutions that hold these individuals under the pretense of keeping society safe shows that those who do not hold legal U.S. citizenship are not worthy of the privilege of membership (Chavez, 278). Immigration detention centers show that some groups of people are not worthy of health care or of freedom like others are.

 

Works Cited

“AMA Adopts New Policies to Improve Health of Immigrants and Refugees.” AMA Adopts New Policies to Improve Health of Immigrants and Refugees | American Medical Association, American Medical Association, 12 June 2017, www.ama-assn.org/ama-adopts-new-policies-improve-health-immigrants-and-refugees.

Bethea, Charles. “A Medical Emergency, and the Growing Crisis at Immigration Detention Centers.” The New Yorker, The New Yorker, 14 Sept. 2017, www.newyorker.com/news/news-desk/a-medical-emergency-and-the-growing-crisis-at-immigration-detention-centers.

Chavez, Leo. “Imagining the Nation, Imagining Donor Recipients: Jesica Santillan and the Public Discourse of Belonging.” A Death Retold: Jesica Santillan, the Bungled Transplant, and Paradoxes of Medical Citizenship, University of North Carolina Press, 2006, pp. 276–296.

“Detention Facility Locator.” ICE, www.ice.gov/detention-facilities.

Farmer, Megan. “PHOTOS: A Rare Look inside Tacoma’s Immigration Jail.” PHOTOS: A Rare Look inside Tacoma’s Immigration Jail, Tacoma, 11 July 2017, kuow.org/post/photos-rare-look-inside-tacoma-s-immigration-jail.

Foucault, Michel. “The history of sexuality, volume I.” New York: Vintage (1978).

Fragomen, Austin T. “The Illegal Immigration Reform and Immigrant Responsibility Act of 1996: An Overview.” The International Migration Review, vol. 31, no. 2, 1997, pp. 438–460. JSTOR, JSTOR, www.jstor.org/stable/2547227.

Hoffman, Beatrix. “Sympathy and Exclusion: Access to Health Care for Undocumented Immigrants in the United States.” A Death Retold: Jesica Santillan, the Bungled Transplant, and Paradoxes of Medical Citizenship, University of North Carolina Press, 2006, pp. pp. 237–254.

“ICE Health Service Corps.” ICE, Department of Homeland Security, 3 Jan. 2018, www.ice.gov/ice-health-service-corps.

“Immigration Detention Map & Statistics.” Endisolation, www.endisolation.org/resources/immigration-detention/.

Long, Clara, and Grace Meng. Systemic Indifference: Dangerous & Substandard Medical Care in US Immigration Detention. New York City. Human Rights Watch, 2017, pp. 1–105.

Library of Congress. Congressional Research Service. Health Care for Noncitizens in Immigration Detention. [S.n.], 2008.

Rhoad, Meghan, et al. Detained and Dismissed: Women’s Struggles to Obtain Health Care in United States Immigration Detention. New York City. Human Rights Watch, 2009, pp. 1–77.

Sacchetti, Maria. “Trump administration ends automatic release from immigration detention for pregnant women.” Washingtonpost.com, 29 Mar. 2018. Academic OneFile, http://link.galegroup.com/apps/doc/A532777208/AONE?u=tel_a_vanderbilt&sid=AONE&xid=3de4a9ad. Accessed 14 Apr. 2018.

“US: Detention Hazardous to Immigrants’ Health.” Human Rights Watch, Human Rights Watch, 9 May 2017, www.hrw.org/news/2017/05/08/us-detention-hazardous-immigrants-health.

U.S. Immigration and Customs Enforcement. (2011). Performance-Based National Detention Standards 2011. Department of Homeland Security.

Venters, Homer D., M.D., and Allen S. Keller M.D. “The Immigration Detention Health Plan: An Acute Care Model for a Chronic Care Population.” Journal of health care for the poor and underserved 20.4 (2009): 951-7. ProQuest. Web. 14 Apr. 2018.

 

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