In Custody, In Pain
At night, to anyone driving southeast from Phoenix through the dark Sonoran Desert, the sky over Florence glows white with prison floodlights.
This county seat, once a center of copper mining and cotton, greets motorists today with road signs that say "State prison. Do not stop for hitchhikers." Every February, motorcyclists roar through town for the Hells Angels Florence Prison Run. And the first business along Butte Avenue, the main street leading into the small downtown, is E&E Outfitters, with its "UNIFORM" sign in the window and, inside, racks of guards' outfits in khaki, black and olive green. "Detention polo shirts from $28.50," says the sale sign over one circular rack.
Of the 25,500 people who live in Florence, about 17,000 are behind bars. The incarcerated included an average of more than 700 immigration detainees in fiscal 2007, divided among a federal compound, two private prisons and the county jail. An additional 1,500 were housed nearby in a compound outside the town of Eloy, giving Pinal County the largest concentration of foreign detainees in the nation.
At the town's northern edge, just beyond an RV park for retirees, rows of concertina wire surround the federal Florence Service Processing Center. During World War II, it was the site of a prison camp for Italian and German POWs. Now it is a tidy brown-brick compound with cactuses and giant crests of the Department of Homeland Security out front. This is where Harvill arrived last May after a flight from Florida, panicky, her nose bleeding, her stomach upset, an officer on each side.
The day after she arrived, Harvill saw a nurse and a doctor for a checkup that all new detainees are supposed to have, but don't always get. "Numerous issues," they wrote in her medical chart. History of sarcoma. Hepatitis C. High blood pressure. The nosebleeds. Panic attacks. "Borderline bipolar." And lymphedema, painful fluid buildup in her left leg.
Elizabeth Fleming, a lieutenant commander in the U.S. Public Health Service who was Florence's clinical director, showed concern about Harvill. She noted that Harvill needed a leg pump -- a compression device that inflates and deflates -- to help the circulation in her leg. She also requested records from Harvill's longtime cancer doctors in Tampa. And she managed to persuade administrators in Washington to let Harvill have three outside consultations at Maricopa Medical Center, the public hospital in Phoenix.
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"Will likely need to order . . . pump and may require transfer to [another immigration detention center] with infirmary," the doctor wrote in her patient's chart.
The pump never arrived. Still, Fleming saw Harvill a dozen times over the next month, records show. By mid-June, the doctor wrote, her patient was "smiling, cheerful," and her nausea and leg pain were "much improved."
Harvill did not know that would be the last time Fleming would treat her. The next day, Harvill was moved down the road to the county jail. The government never explained the move, although she and her lawyers have asked repeatedly.
Last week, ICE officials told The Post: "Florence is not well equipped to provide long term medical care for female detainees. Female detainees are transferred from Florence to Pinal because of its better capability to provide long-term medical care to women. Ms. Harvill received appropriate medical care at Pinal with physician oversight."
Harvill lives in Cell 323 in Pod E300, part of a wing built for an eventual 600 detainees whom the federal government pays the county to house.
Her isolation at the county jail is almost complete. Her lawyers cannot call. Family members, if they came to visit, would not be allowed to see her in person, not even through plexiglass. The jail allows only "video visits," with visitor and detainee in separate parts of the building. Harvill, while longing for her family, has told them it is not worth the trip. She hasn't seen her husband in a year.
Most of her moments outside come when immigration officers take her in a white van on a three-minute ride to a little courtroom at the Florence federal compound for video hearings with her Miami immigration judge, and when they take her to the public hospital, an hour and 20 minutes away, where, as likely as not, little will get done.
Harvill gets shuttled back and forth to the hospital in Phoenix because the jail does not have a doctor on its staff. There is no hospital within 30 miles of Florence, despite its thousands of prisoners. The Central Arizona Medical Center, on the city's outskirts, has been closed since 1999, and the small hospital building is empty. On a white sign out front, the blue lettering that says "clinic" has almost faded away.
One morning last summer, Harvill was taken up the road to the Florence compound for a repeat session to take photographs and fingerprints that immigration officers told her had gotten lost. Before she went inside, she later put in her journal, she noticed Fleming, the doctor who had treated her when she first arrived, going by "in a little golf cart."
I was glad to see her I had so much to ask her. Nurse here says that she is still my doctor and that all that happens to me goes to her. . . . I asked to talk to her for a minute. She told me that she was very busy, that she would try to talk to me later. I knew she wouldn't talk to me because she has not seen me for the last 2 months I was so sad. . . . Actually I felt as though she was angry with me. I stood there with tears in my eyes, but I had to go with the officer to get my fingerprints done.
The fleeting encounter with Fleming disturbed Harvill. The closest thing to a doctor she has seen at the jail during her 11 months there -- apart from a psychiatrist who has prescribed lithium and other drugs, but has not really diagnosed her -- was a physician assistant.
Fleming resigned days later.
According to internal government documents, one-third of the 29 medical positions at the Pinal County Jail were vacant as of February. The jail, the Florence compound and the large compound in nearby Eloy each had no full-time doctor.
In such an environment, complaints sometimes surface about the shortages and their effects. Last summer, two Eloy nurses sent a memo to headquarters in Washington, laying out the working conditions that were leading them to resign.
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."
Key terms and acronyms from the Careless Detention series.
Read the original government documents related to the people and cases detailed in this story.
Based on confidential medical records and other sources, The Washington Post identified 83 deaths of immigration detainees between March 2003, when the federal Immigration and Customs Enforcement agency was created, and March 2008.