ICE detainees die preventably – Questions and answers with a medical researcher about systemic errors

The Department of Homeland Security’s 2024 budget proposal increased funding for U.S. Immigration and Customs Enforcement to deal with an expected day by day prisoner population of 41,500in comparison with a median of 34,000 in recent times.

But recent studies have revealed cracks that decision into query the agency’s ability to offer medical care to the inmates entrusted to it, including inhumane conditions, high suicide rates, structural problems akin to using prisons to deal with prisoners, delayed or interrupted medical care and overcrowded conditions. Research also shows that the pandemic years have these inequalities.

A recently released report by three nonprofit advocacy groups blames preventable deaths of ICE detainees on inadequate investigations and flawed agency systems. The report: Fatal failurespublished on June 25, 2024 by the American Civil Liberties Union, American Oversight, and Physicians for Human Rights, documents inadequacies in diagnosis, treatment, and emergency care. It points to suicides that would have been prevented with adequate psychiatric care and properly dosed medication. And it describes the underlying problems – understaffing and lack of interpreter and translation services.

The Conversation asked Cara Buchanan, emergency physician and clinical fellow in health policy and social emergency medicine on the Harvard Kennedy School, their research The report cites research by her team and others in the sphere, ICE's track record in providing medical care to detainees, and what must be done to enhance medical take care of people in ICE custody.

What insights have you ever and your colleagues gained from investigating the medical care of detainees within the custody of U.S. Immigration and Customs Enforcement?

Our research shows that preventable deaths of individuals in ICE custody are sometimes preceded by failures to make use of a standardized, consistent, and competent approach to medical triage, including identifying and escalating the necessity for emergency care.

What has other recent research on this area revealed?

Research in lots of disciplines, including medicine, law, politics, criminal justice, health economics, human rights and public health, correlates structural design features of immigration detention centres results in negative health consequences for the detainees. This includes using Solitary confinementwhich is related to an increased risk of self-harm amongst detainees in ICE custody.

The COVID-19 pandemic has exposed significant health inequalities in immigration detention facilities. Many facilities not provided appropriate basic, preventive And Emergency medical care.

Studies also show a persistent lack of transparent details about Conditions in ICE facilities which continues to steer to persistent calls for more control and accountability to deal with the systemic causes of poor health outcomes.

The ultimate failure of the immigration detention system to guard the health and safety of detainees is the results of preventable deaths. Publicly available reports of ICE detainee deaths Provide basic details about timelines before death. independent investigations and analyses The investigation into the circumstances of those deaths has shown widespread and systemic negligence.

Billions of dollars in congressional appropriations proceed to flow to expand ICE detention facilities and to personal prisons which might be contracted to offer services to detained immigrants. report profit margins within the billions.

How did your work fit into the recently published report?

“Deadly Failures” explains our research findings thus far in a comprehensive and broad context.

The report provides clear policy recommendations to key stakeholders – the Department of Homeland Security, the Department of Justice, Congress, and native and state governments.

These recommendations range from doable to ambitious and description actions that will prevent preventable deaths in ICE custody. Suggested actions include immediately housing detainees with medical and mental health issues, limiting the physical and financial expansion of detention facilities, investing in community-based services, banning solitary confinement, passing laws to make sure accountability for standards of care in detention facility contracts, and establishing mechanisms for normal public reporting. The report also calls on ICE to abolish the system of mass immigrant incarceration altogether.

I used to be particularly encouraged by the second line of the book Deadly Failures. Summarywhich highlights probably the most striking finding of our research – the disturbing trend of immigration enforcement (ICE) releasing people from custody immediately before their death.

Why does this occur?

ICE regulations require the agency to report, confirm and publish the death of an alien in custody in a timely manner. But the language within the regulations regarding individuals who die immediately after being released from custody is vague and doesn’t include a timeline for reporting or a proposed mechanism for accountability for such deaths.

If we examined To determine the whole variety of deaths in ICE custody during fiscal years 2021 through 2023, our research team matched published ICE death reports with press releases from investigative journalists and immigration groups. Our review of public records and available legal documents confirmed 4 deaths that weren’t included within the 11 death reports ICE published from those years.

Through this investigation now we have found a pattern of detainees who were released from ICE custody while hospitalized after being deemed seriously unwell and death clinically imminent. When we reviewed these detainees' medical records, we found deaths that would have been prevented. In certainly one of these cases, a detainee contracted COVID-19 while in custody and suffered a series of complications, including multiple hospitalizations for recurrent infections. Concerns raised by the power's medical director in regards to the patient's ongoing critical condition went unaddressed, and after the patient eventually suffered a stroke, he was placed on life support. ICE released the unconscious patient from custody shortly before his death. This technical release from custody allowed ICE to avoid mandatory public reporting of this case and its details.

Officially ICE has said that the federal government continues to guage the enforcement of health standards and seeks ways to enhance health care.

The key advice of our research team, also highlighted by the authors of Deadly Failures, is to incorporate all deaths of people that occur inside 30 days of release from ICE custody within the mandatory public reporting of ICE statistics and death reports. This is a very important transparency and accountability measure.

What should Immigration and Customs Enforcement do to stop unnecessary deaths during its term in office?

Time in ICE custody is linked to preventable deathsIndividuals detained in ICE facilities needs to be released as soon as possible in order that their medical needs may be transitioned to more continuous and long-term care.

Triage also needs to be standardized. Detainees exhibiting signs and symptoms of great illness needs to be rapidly evaluated and transported to the local emergency department as soon as possible for further evaluation and treatment. Strict oversight and accountability needs to be established for all staff in ICE facilities and for the clinical outcomes of detained patients.

Are you continue to searching for answers to your questions on the prisoners? If so, what are you searching for?

ICE's ability to gather, record, and share high-quality data in regards to the capability of ICE facilities, the scope of obtainable health services, and the health outcomes of those in ICE custody is severely limited. The lack of knowledge leaves a flood of unanswered questions on the conditions that contribute to poor health outcomes. In my view, ICE detention facilities, like other large medical care systems, needs to be held to standards of transparency and accountability to the federal government and the general public.

Is there anything that has surprised you in your discoveries over the previous few years?

The Cases of inadequate skilled language servicesincluding interpretation and translation, for people in ICE custody is surprising. It flies within the face of a federal mandate that establishes a patient's right to receive health information at no cost of their preferred language. That right is exercised each day in U.S. hospitals and clinics across the country for non-detainees with in-person interpreters or readily accessible technology.

Ultimately, while disheartening, it shouldn’t be surprising that extensive research continues to exhibit deteriorating standards of take care of people held in ICE custody.