The Ombudsman Reacts to Feedback From U.S. Immigration and Customs Enforcement

Post: "There is evidence that infectious diseases, including tuberculosis and chicken pox, are spreading inside the centers."

ICE: Varicella (chicken pox) is a highly contagious communicable disease and very little exposure time is required for transmission to an individual who is not immunized. Most developing countries do not routinely vaccinate for chicken pox; in the United States, routine vaccination began in 1995. Therefore it is expected that individuals in our care who are not born in the U.S. have not been vaccinated. If one person enters a facility with active lesions (most likely infected in their country of nationality), and exposes other individuals who have never had Varicella and are not immune, transmission is likely to occur. Facilities with DIHS staffing have strict protocols in place for management of Varicella, including restricted movement of exposed, non-immune persons, contact investigation for the entire incubation period for exposed persons who are not immune, and vaccination. The fact that DIHS initiated a vaccination protocol is indicative that we were proactive in intervening to halt further transmission; this was an appropriate and timely intervention.

In addition, DIHS implements a state-of-the-art screening program for tuberculosis, using a digital chest radiograph to screen detainees. This system produces a result within four hours and allows providers to place patients with a finding suspicious for active tuberculosis (TB) in an airborne infection isolation room before ever being placed in the general detention population. All TB patients are managed in accordance with Centers for Disease Control guidelines. Additionally, DIHS initiated and provides national and international leadership for the Transnational Tuberculosis Continuity of Care Workgroup, which facilitates bi-national and international referrals for tuberculosis patients to enable them to continue their treatment without interruption in their countries of nationality following repatriation. This is a national initiative involving partnership with the Centers for Disease Control and Prevention, state and local health departments, nongovernmental partners, the U.S.-Mexico Border Health Commission, foreign governmental TB control programs, and foreign consulates, and is proving highly successful. In a recent evaluation, between Jan. 1, 2004, and July 31, 2006, DIHS helped 221 active TB patients complete their treatment regimen through these partnerships.

Ombudsman: You say that there are "strict protocols" for infectious diseases. There is no argument that you have protocols, but the story shows they are not always followed. In one facility in Texas, Willacy, all detainees had to be vaccinated because of a chicken pox outbreak. The ventilation system and lack of proper staff training contributed to the problem. And a detainee died of infectious meningitis in the San Pedro Center in California.

Post: "These way stations between life in and outside the United States are mostly out of sight: in deserts and industrial warehouse districts, in sequestered valleys next to other prisons or near noisy airports. Some compounds never allow detainees outdoor recreation; others let them out onto tiny dirt patches once or twice a week."

ICE: With the exception of the Varick Street Facility in Manhattan, which opened in January 2008, all ICE Service Processing Centers and Contract Detention Facilities have outside recreation areas. Further, it is factually inaccurate to say that detainees are only allowed outdoor recreation once or twice per week. Detainees are provided outside recreation five times per week, weather permitting.

Ombudsman: The reporters found there is no outdoor recreation area at the facilities in Elizabeth or Pinal County and that the Otay Mesa area is small. The reporters were told by several lawyers and many former detainees that detainees did not get outside daily in some facilities.

Post: "When doctors and nurses at the immigration compounds believe that detainees need more than the most basic treatment, they have to fax a request to the Washington office, where four nurses, working 9 to 4, East Coast time, five days a week, make the decisions."

ICE: If a detainee requires off-site care, the facility where they are housed submits a request by means of email or fax. Submissions are adjudicated by the next business day, but no more than 72 hours after receipt. If the request is urgent or emergent, the medical care is provided and the managed care requests are adjudicated after the fact.

Ombudsman: There are many examples in the story that show all cases are not handled in a timely manner nor is urgent care always given.

Post: "To this end, the agency recently increased its inspections of facilities and is in the process of creating an inspection group at headquarters to review serious incidents, including deaths or allegations that standards are not being met."

ICE: ICE implemented the Detention Facilities Inspection Group (DFIG) within the ICE Office of Professional Responsibility in February 2007. The DFIG provides objective oversight and independent validation of the detention facility inspection program. It also conducts immediate focused reviews of serious incidents involving detainees. In October 2007, ICE contracted with the Nakimoto Group to obtain their services to have full time professionals inspect each ICE facility annually, providing ICE field managers with the support of expert inspectors. Also in October 2007, ICE contracted with Creative Corrections, Inc. to provide full time, on site, quality control experts at 40 of our most active facilities.