In Custody, in Pain

The checkups required for all arriving detainees were "never staffed with enough people," wrote the nurses, Catherine Rouse and Patricia O'Brien. Nurses would be told to expect five new arrivals, "but that could easily change to greater than 100 non-English speaking sick and injured frightened people," they wrote. The nursing shortage was particularly severe on nights and weekends. And one pharmacist and an assistant "process over 4,000 prescriptions a month. They try their best to have thing[s] complete before they leave on Friday. However, serving 1,500 people is an impossible task."

Last year, the Arizona State Board of Nursing heard that nurses at Eloy were being required, without enough training, to take the chest X-rays that new detainees are supposed to get to check for tuberculosis. The board sent ICE a terse, two-sentence letter. "Nurses are not radiologists," it said. "Taking X-rays is out of the scope of practice for a nurse, and a nurse who does so is violating the Nurse Practice Act and will be subject to discipline on his/her license."

The response from Washington: "Nurses working in federal government facilities are not subject to state licensing requirements."

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At first, Harvill would get excited on the mornings of her trips to Maricopa Medical Center, but she learned soon that the visits usually were disappointments.

On July 26, she rode in the van to the hospital's cancer clinic. That same day, by coincidence, a doctor from the H. Lee Moffitt Cancer Center in Tampa, where she had been treated for more than a decade, wrote a letter at the request of Harvill's lawyers, warning that she "will need continued care at a facility familiar with [her] types of tumors, as they will continue to recur and progress. If not treated properly, they can become life-threatening."

It was from the Moffitt Center that Fleming had gotten records of Harvill's three previous episodes of cancer and her treatment. But no one had sent copies to Maricopa Medical Center. Starting from scratch, a doctor there ordered a CAT scan of her pelvis and her swollen left leg. The test, according to a radiology report, found a mass in an ovary and a cyst on her cervix, but there is no indication that her leg was scanned.

By late July, her records show, another Maricopa doctor had ordered a biopsy to determine whether unexplained "densities" on her liver might be tumors. But when Harvill went for the procedure a few weeks later, the records show, someone in the radiology department did an ultrasound as a first step and, when he saw cysts on her liver, cancelled the biopsy. "Liver Biopsy report received. . . . Biopsy not done," says a notation from a few days later in her jail records.

A month later, when Harvill saw the doctor who had ordered the biopsy, he asked whether it had been done.

I told him no because they told me it was just a cyst not a tumor. He was upset. . . . He still wanted a biopsy, she wrote in her journal.

By now, the soft lump had begun to grow under her knee, and her abdomen had started to swell and become hard. As an officer drove her to the hospital one day in mid-August, she hoped the appointment would address one of those problems. As it turned out, she was there to see a gynecologist, who wanted to do a Pap smear.

Harvill pointed out that she'd had one a month before.