Illegal Immigrants Received Poor Care In Jail, Lawyers Say
Treatable Illnesses Grew Grave, They Claim

By Darryl Fears
Washington Post Staff Writer
Wednesday, June 13, 2007

At his home in East Los Angeles, Francisco Castaneda of El Salvador faces a grim truth: His cancer is spreading, from his groin to his lymph nodes and toward his stomach, a progression that could soon end his life.

As he undergoes painful chemotherapy, Castaneda's lawyers are saying that the spread of the disease could have been prevented if government doctors had aggressively treated a small lesion that grew while he was held for 10 months in a San Diego prison as an illegal immigrant facing deportation. In a recently filed federal tort claim, Castaneda's lawyers charge that the "neglect allowed the development of metastasis penile cancer that will likely cause Mr. Castaneda's death in two years."

Castaneda's case is one of several that lawyers are investigating on behalf of illegal immigrants who they say were taken into custody by U.S. Immigration and Customs Enforcement with manageable illnesses and released with infections that threatened life and limb.

The extent of poor medical treatment for illegal immigrant detainees is an open question. Tom Jawetz, a lawyer with the American Civil Liberties Union's National Prison Project, noted that detainees often speak little or no English, are unaware of their rights, have no access to appointed counsel and disappear after being deported. Still, lawyers say that scores of detainees have not received proper care, leading to disfigurement and even death.

"It's all too common in the treatment of federal detainees," said Adele Kimmel, a lawyer for Public Justice and a co-counsel in Castaneda's case. "They get treatment that you might see in a Third World country, and it's really a stain on our system of justice to treat detainees this way."

ICE officials denied claims of medical mistreatment, noting that detainees undergo physical examinations within 12 hours of entering detention. "I deny the assertion that we don't properly treat detainees," said Tim Shack, medical director for the Division of Immigration Health Services, which provides health-care services for ICE. "We deliver excellent medical care to detainees."

A December report by the Office of the Inspector General for the Department of Homeland Security said that the system is generally well run. But the report also noted that four of five facilities in its study had "instances of non-compliance" regarding health care, "including timely initial and responsive medical care."

Basic care is provided by medical staff members where detainees are housed. Shack said that tens of thousands of requests for treatment beyond basic care are submitted each year and that about 90 percent are approved. ICE allocates $70 million each year to the Division of Immigration Health Services for medical treatment, he said.

In addition to documenting injuries and illnesses, the ACLU is trying to determine whether medical negligence has contributed to 20 deaths since 2004.

Among those who died while in ICE custody were a man from Sierra Leone who collapsed at a Virginia jail after saying he did not get medicine for a kidney ailment, a woman from Barbados who died in another Virginia jail after telling her sister that she received no medicine for a uterine fibroid that caused hemorrhaging, and a South Korean woman who died after cellmates appealed to authorities for help over a period of weeks, lawyers said.

Tim Perry, assistant director of the Division of Detention Management for ICE, denied that the deaths were the result of negligence and said autopsy results will prove that.

Castaneda was taken into ICE custody in March of last year. He was scheduled to be deported for violating parole after serving time for a robbery conviction. Records show that he suffered from genital warts.

The physician who examined him requested that he see a urologist so that he could undergo a biopsy to test for cancer. Two months went by before the request was approved.

The urologist, John R. Wilkinson, said that Castaneda's wart "may represent either a penile cancer or a progressive viral based lesion" and said that it required "urgent diagnosis and treatment."

But Immigration Health Services officials denied an offer from the urologist to admit Castaneda for a biopsy as "not cost effective," according to the tort claim, a procedural step that probably will lead to a lawsuit. After the lesion started to bleed, fester and grow between June and August, the officials continued to deny doctors' requests for a circumcision and a biopsy, saying the procedures were "elective," not an emergency.

But the problem worsened. "I was surprised, because I was bleeding and it was hurting a lot," Castaneda said. "The only thing they gave me was Motrin. I couldn't sleep at night because it was hurting a lot. I was afraid for my life at that time."

After a fourth specialist ordered a biopsy in January for what he said was "most likely penile cancer," doctors scheduled the procedure. But Castaneda was released from the custody of ICE a few days before the examination, "presumably so it would not have to pay for the procedure," according to the claim.

Castaneda later went to the emergency room at Harbor-UCLA Medical Center in Torrance, Calif., where a biopsy determined he had cancer. His penis was amputated on Feb. 14, but the cancer had spread.

"I'm stressed out . . . thinking it could have been prevented," he said.

Shack said Immigration Health Services officials did not immediately schedule a biopsy because the urologists had a difference of medical opinion. "I don't see this as improper care. I think this is good care," he said. "It's just unfortunate that this had a bad outcome."

In a similar case involving a Liberian detainee in 2005, officials in York County, Pa., questioned the federal government's commitment to treating one of its detainees, Benedictus Yarzue, who was in deportation proceedings for various crimes, including manslaughter and illegal entry into the United States.

Yarzue filed a complaint at the York County Prison in March of that year: "I have a prostate problem which I am in pain. I went to see a doctor and she said I need to see a urologist." Immigration Health Services denied the request, frustrating the prison's medical staff, which referred the case to the county solicitor.

"Yarzue was very, very frustrating," said York County Solicitor Don Reihart. "INS was not providing the care we deemed was required. If they turned us down, we were put in a position to give the care and pay for it or move him somewhere else."

Shack recalled the case in a recent interview, saying the request was denied because the prison staff did not follow procedures such as educating Yarzue about correct care to avoid problems, giving him medicine and examining him to determine whether urine was properly expelled after his frequent trips to the bathroom.

York County officials feared that Yarzue had cancer. Shortly after the county sued, he was transferred to another jail. He was deported to Liberia in August, and his whereabouts are unknown.

In another case that lawyers are investigating, they claim that an illegal immigrant detainee, Martin Banderas of Mexico, might lose a leg because Immigration Health Services officials would not approve a culture to determine whether he had developed gangrene from a cut he suffered in a shower.

After the cut opened in December, doctors removed dead skin from Banderas's leg and treated him with antibiotics. During the treatment, it was discovered that Banderas, 40, was diabetic. The wound grew worse.

"It started to make bubbles around the ankle," Banderas said in an interview. "It was an orange color, and the pain was real bad. They gave medicine for the pain. I couldn't walk."

Shack responded to the charges with disbelief. "I have 173 pages of records showing that he was properly monitored," he said. Banderas was placed in an infirmary at the prison in San Diego, run by Corrections Corp. of America, where doctors and nurses work around the clock, he said.

"He was not among the general population. He was receiving 24-hour care," Shack said.

But the issue, said Conal Doyle, the lawyer for Castaneda and Banderas, was whether the leg had developed gangrene and whether a culture was needed to detect it.

"These are some of the worst cases I have seen," he said.