In Custody, in Pain

By Amy Goldstein and Dana Priest
Washington Post Staff Writers
Monday, May 12, 2008

FLORENCE, Ariz. -- Underneath her baggy jail-issue pants, Yong Sun Harvill feels the soft lump just below her left knee. Sometimes it tingles. Sometimes it is numb. Like her cancer felt when it arrived behind the knee a few years ago.

She noticed the lump under the thin, blue cotton in August, five months after federal immigration officers, to her amazement, took her into custody to try to deport her for buying stolen jewelry more than a decade ago. The lump grows slowly. It is now three inches across. And though she keeps asking, no one has done a test to see whether her sarcoma has come back.

Her leg is painful and swollen from hip to foot, damaged by past surgeries and radiation treatments. Some nights, liquid seeps through cracks in her distended skin. Her left ankle is three times as big as her right. For years, she relied on a leg pump to boost her circulation and keep the swelling in check. But as an immigration detainee in this desert prison town, Harvill, 52, has been unable to persuade anyone to get her a pump, or to let her family back in Florida send hers from home.

Nor has she gotten the biopsy that a doctor has told her she needs to determine whether the spots on her liver might be tumors. And it remains uncertain whether her frequent crying spells are part of bipolar disorder, as some records suggest, or a flare-up of old anxieties -- heightened now by chronic pain, bewildering medical problems, and the fact that, three decades after she arrived from South Korea as a teenage Army bride, she is in a jail far from home with the government trying to eject her from the United States.

Harvill is one of 33,000 immigration detainees in the custody of the Department of Homeland Security's Immigration and Customs Enforcement agency, known as ICE, on any given day. They are locked up in a patchwork of out-of-the-way federal detention compounds, private prisons and local jails. This unnoticed prison system was built for a quick revolving door of detainees -- into custody, out of the country. But often, people linger in detention for months or years.

These detainees, like other prisoners, are by law and regulation entitled to medical services if they are sick. But Harvill's journey through immigration detention provides a glimpse into a medical system that often fails those who need it most. It is an upside-down world where patients have no say, doctors and nurses on site have little power to administer timely treatment, and a managed-care system in Washington operates from a rulebook that emphasizes what is not covered rather than what is.

Two months after ICE agents seized Harvill in Florida, they transferred her to Arizona last May, saying a federal compound called the Florence Service Processing Center was better suited to handle her medical care. Four weeks later, they moved her, without explanation, a few miles down a cactus-lined highway to a county jail that hasn't had a full-time staff doctor since she arrived.

At Pinal County Jail, Harvill is 2,132 miles from her family outside Tampa, and even farther from her Miami lawyers. To see her, they crowd around a closed-circuit TV in an immigration courtroom in Miami, where the judge to whom her case is assigned convenes "video hearings" about once a month.

Seated at a scuffed oak table in a small courtroom in Florence for one recent hearing, facing a television screen with a video camera on top, Harvill looked older than her age. Her thick, long hair was streaked heavily with gray. Her brown eyes, sparkling in a 1999 wedding photo, were now dull. Arthritis had bent her fingertips.

On days when her hands are too stiff, Harvill dictates as other detainees write her entries in the journal that her lawyers have asked her to keep, as best she can, with the five pieces of paper the jail doles out each week. The entries tell of her leg pain, of missing her husband and her Florida cancer doctors, of wondering whether God still loves her. One entry tells of a dream in which she peered into a coffin and saw herself inside.

Her medical records, inches thick, document countless visits to jail nurses and to a public hospital in Phoenix. But many of the visits have been frustrating and unproductive.

One morning in late February, she was led from her cell at 5:15 a.m. and driven the 66 miles to the hospital to have an operation to remove polyps that were causing bleeding in her uterus. When she arrived, three workers in green scrubs told her that the doctor couldn't perform the surgery because the hospital was out of hot water.

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