Caring for Immigration Detainees

By Julie L. Myers
Tuesday, May 20, 2008

Recent media reports, including a May 11-14 Post series, have presented a misleading view of the medical care provided to detainees at U.S. Immigration and Customs Enforcement facilities. Readers deserve to hear from both sides.

ICE was formed in March 2003 with a broad mission that includes immigration and customs enforcement and management of the detention and removal processes for apprehended aliens. ICE did not create the detention or detainee health-care systems but, in fact, inherited the procedures of the former Immigration and Naturalization Service and the Division of Immigration Health Services (DIHS). Over the past 2 1/2 years, ICE has examined these decades-old practices and is making substantial improvements.

As the number of people in ICE custody has risen, demand for health care and medical services has also grown significantly. Unfortunately, many reports neglected to mention ICE's efforts to improve care at detention facilities. Some, including recent New York Times reports, focused on stories that predate these efforts.

DIHS provides medical care for routine as well as life-threatening conditions, including kidney disease, high-risk pregnancy, HIV-AIDS, hypertension and diabetes. Each detainee is medically screened upon arrival. Last year, preexisting chronic conditions were diagnosed and initially treated in 34 percent of detainees. In many cases, this marks the first time that detainees, who often do not have medical insurance, learn of their own conditions. ICE detention standards call for physical exams, sick-call visits and prescription drugs as ordered by medical providers.

The Post series focused on deaths known to have occurred at ICE detention facilities. To be clear: Any death that occurs in detention is regrettable. ICE spent nearly $100 million last year for detainee health care, double the funding of just five years ago. Our efforts are producing results.

While the number of people in ICE detention has increased more than 30 percent since 2004, the first full year for which statistics under the agency are available, the mortality rate has declined every year. In 2004, the mortality rate for ICE detainees was 10.8 per 100,000. In 2007, it was 3.5 per 100,000. The number of deaths in detention has decreased, from 29 in 2004 to seven in 2007.

ICE detainees have access to mental health care provided by qualified professionals, and staff working with detainees receive ongoing training in suicide risk and prevention techniques. Psychologists and social workers have managed a daily population of more than 1,350 seriously mentally ill detainees without a single suicide being committed in the past 15 months.

ICE has increased oversight and accountability at all its detention facilities. Progress includes establishing an independent body to review detention inspections; implementing national detention standards that are comparable to or surpass industry standards in their commitment to detainee health and comfort; retaining full-time quality assurance professionals to assess compliance with those standards; and contracting independent corrections and detention experts to audit ICE facilities. Moreover, ICE detention facilities are open to those outside the agency: We routinely conduct tours for members of Congress, representatives from nongovernmental organizations and the media.

Working with the Department of Homeland Security's Office of Health Affairs, ICE is also improving operations at DIHS, which, as the designated medical authority for ICE, is responsible for detainee health care. Since DIHS came under ICE's authority last October, a number of improvements have been implemented, and others are underway, including: selecting a new DIHS director, streamlining the hiring process to address staff shortages and moving to an enhanced electronic medical records system. We are reviewing ways to improve the treatment-authorization process. All of these steps will help enhance the quality of care and DIHS responsiveness to detainee needs. As we continue working to strengthen the detainee medical health system, we will seek recommendations from our own DHS inspector general, nongovernmental organizations and Congress, among others.

A May 14 Post article and headline said that detainees are "drugged" without medical reason, implying that involuntary sedation for deportation is routine practice. Last June, ICE enacted a policy requiring a court order before any involuntary sedation could take place, except in emergency circumstances where the detainee actively poses a threat to himself or another. In January that policy was strengthened to prohibit involuntary sedation for the purpose of facilitating a removal without a court order -- no exceptions.

Readers should know that ICE does not tolerate malfeasance or malpractice. Instances of improper behavior will be immediately and vigorously investigated; if necessary, appropriate disciplinary action will be taken.

The detention of individuals in immigration removal proceedings understandably raises strong opinions and concerns among Americans. Your readers deserve a balanced view.

The writer is assistant secretary of homeland security, U.S. Immigration and Customs Enforcement.


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