In Custody, In Pain
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, canceled 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.
I showed him my stomache, he told me he could not take care of that, that I needed to see a GI doctor. I told him about my leg swollen, and also he told me I had to see another doctor for that.
Still another runaround began when a different doctor said Harvill urgently needed a biopsy of her uterus lining to find out why, well after menopause, she was bleeding heavily. In early October, when an immigration officer took her back to the hospital for that test, a receptionist said it had been canceled and rescheduled for a month later. The officer, Harvill put in her journal, was stunned and told the receptionist that he "had the order for today." Instead, hospital workers did a CAT scan of her uterus.
She had already had a CAT scan of her uterus. I told them I had a lump on my knee, if they could do a scan on that and they said they didn't have an order for that. . . . We got out of hospital and the ICE officer said he felt bad for me, because he has taken me to the hospital 4 or 5 times and they never do anything for me.
It was early November when Harvill had the biopsy of her uterus, three months after it was ordered. She was told to come back for the results in two weeks, although the lab report was ready the next day, according to her medical records. Yet it wasn't until late January that she learned what was wrong: The bleeding was being caused by polyps that needed to be removed. The surgery, she was told, would be within two or three weeks. Four months later, it has not been done.
Late last week, after her attorneys gave them authorization to talk about her case, Maricopa hospital officials said that medical privacy law prohibited them from even confirming, without Harvill's personal consent, that she has been a patient. But she could not give consent because neither her attorneys nor anyone else is allowed to telephone her in the jail.
Over a weekend in mid-April, Harvill was told not to eat solid food for two days in preparation for a colonoscopy to try to find out why she had blood in her stool. First thing that Monday, she again boarded the van for the 66-mile drive to the hospital, where she was told that the procedure had been rescheduled.
Ten days later, she went to the hospital and had the test. It found a growth in her colon. The doctor said there was a chance it is cancerous and sent a sample for a biopsy. She does not know the result.
The liver biopsy still has not taken place. And no one has tested the lump below her knee.
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Whether the gaps in Harvill's treatment are by accident or by design is difficult to discern. Yet it is clear that the obscure federal agency that oversees detainees' medical care, the Division of Immigration Health Services (DIHS), operates with a top priority of limiting care and saving money. Its medical mission is only to keep people healthy enough to be deported.
At Harvill's jail, and everywhere else immigration detainees are held, doctors and nurses must get permission from the agency's headquarters before treating patients. Except in emergencies or for the most routine care, they must send written requests to Washington, where, for the entire system of 33,000 detainees across the country, four managed-care nurses in a downtown office building decide what treatments to allow.
These care managers rule on what are known in the bureaucratic lexicon as treatment authorization requests, or TARs. In a recent month, they had to rule on 3,000 requests. They work five days a week, not on weekends, and are unavailable to handle requests that come in later than 4 p.m. Washington time, even though many large detention centers are in other time zones.
The agency touts this as an efficient form of managed care, similar to health plans familiar to patients in the outside world. But a 36-page manual that describes the "detainee covered services package" underscores how unusual it is, with rules designed to prevent people from getting too much help.
The health services division, the manual says, allows treatment mainly for emergencies that are "threatening to life, limb, hearing or sight." If a detainee has medical problems that "would cause deterioration of the detainee's health or uncontrolled suffering affecting his/her deportation status," treatment is not guaranteed. Instead, the manual says, the detainee "will be assessed and evaluated for care."
Instead of listing, as most health plans do, the services available to patients, the manual specifies services that are "usually not covered" for allergies, heart problems and other illnesses. Cancer is not mentioned at all.
Internal government documents obtained by The Post show that most requests are approved. But the documents also show that, when requests come in for people with serious problems, there can be pressure to cut costs. One chart, covering October 2005 to September 2006 -- seven months before Harvill became an immigration detainee -- is labeled "TAR Cost Savings Based on Denials."
The agency, the chart shows, saved $129,713 by denying 17 medical requests for people with HIV, $36,216 by denying seven requests for people with various forms of psychosis, $91,926 by denying 27 requests for people with chest pain and $9,545 by denying treatment for a case of blood in stool, one of the problems Harvill has had for months.
Asked about the chart, an immigration spokeswoman said that the vast majority of medical requests eventually are granted. Usually, she said, denials are "due to lack of information."
The supervisor of the managed-care nurses who rule on treatment requests sent a note once to a senior official about a 33-year-old detainee seen at a Nashville hospital for a recurrence of sarcoma, the same kind of cancer Harvill has had. "The process of re-diagnosis and treatment will be extensive and costly," that nurse wrote. She said she seconded the idea of releasing the detainee so the government would not have to pay for his care.
These sorts of machinations prompted the deputy warden at York County Prison in Pennsylvania, which houses many immigrant detainees, to fire off an angry letter about the health services division. "[I]n my opinion, they have set up an elaborate system that is primarily interested in delaying and/or denying medical care to detainees," the warden, Roger Thomas, wrote in late 2005. "There is nothing easy about working with DIHS. If something can be delayed, it is delayed. If it can be denied, it is denied. If it can be difficult, it is made difficult. Most importantly, if there is some bureaucratic procedure that will delay/deny treatment to a detainee . . . you can be assured that DIHS will do it."
Harvill's lawyers have tried to find out how many requests for treatment have been sent from Pinal County Jail on her behalf and how Washington has ruled on each one. They filed a Freedom of Information Act request last summer and, after two months, got an incomplete answer. In January, they left a phone message for the division's medical director. No one has called back.
But one page in Harvill's thick medical file hints at an answer. In late August, slightly more than a month before she would arrive at the hospital for a biopsy, only to be told it had been rescheduled, a jail nurse wrote this note: "TARs not approved for endometrial biopsy and lab draws. . . . Will continue to work on approvals and provide additional documentation as needed."
Finally, in early February, Harvill had a big week, riding in the van to the hospital three mornings in a row. A cancer doctor told her, yet again, that she needed a biopsy on her liver and one on the growing lump beneath her knee. A gynecologist talked with her about the surgery she needs on her uterus. A gastroenterologist spoke with her about the colonoscopy she should have.
Yet, after many months in immigration custody, Harvill understood that doctors' orders do not automatically produce tests. "It doesn't matter what the doctor says," she said in an interview.
Back at the jail after her three hospital trips, she asked a nurse what would be done with the doctors' requests. "She said she is going to send it up" to Washington, Harvill recounted at her next court hearing. "But she doesn't know when or how it is going to get approved. She doesn't know if it is going to get approved. She just said, 'Let's hope for the best.' "
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Leon Harvill sat at his mother's kitchen table in Plant City, Fla., on a Sunday night, cradling the phone to his ear. "Baby, don't cry," he said softly into the receiver. "Come on, baby. Quit crying, all right?"
He had gone to an evening service at the Church on the Rock, the first time he had been in months. He hadn't felt much like reading the Bible lately. "I just don't understand it right now," he said. "I just can't understand things that are going on that are hard to believe. Her medical care -- I just can't understand that."
The thing that makes perhaps the least sense to him is that his wife is covered under a good health insurance policy that he gets through his union, the International Brotherhood of Boilermakers, and she and her lawyers have asked whether she could use that policy to pay for her treatment by private doctors while she is detained. They have been told no.
One more problem in a life full of them.
Yong Sun Harvill's immigration troubles began in March 2007, as she was finishing 13 months in prison on a drug-possession charge. One day, a prison official summoned her to his office and handed her a phone. On the line was a man who worked in Orlando for Immigration and Customs Enforcement. She would not be going home, he told her. She would be handed over to ICE agents, who planned to send her back to South Korea, a place she had not seen for 32 years.
Harvill had been barely 19 when she came to the United States in 1975, the new wife of an American soldier who had been stationed in Seoul. Within a year, she had a baby son and her first cancer diagnosis.
She divorced her first husband -- who hit her sometimes when he drank, according to Harvill, her lawyers, two friends and her medical records -- and then her second one, who hit her sometimes when he was high on drugs.
Nine years ago, she married Leon Harvill, a childhood friend of her second husband. He isn't much of a talker. She is loud and chatty. She felt protected by him. He loved how she cared for children and how her smile lighted up a room.
After all her years in Florida, she would still drive to Tampa once a month to buy rice at a Korean grocery, but she also loved collard greens and black-eyed peas, was a die-hard Tampa Bay Buccaneers fan, and knew the lyrics to all of Brooks & Dunn's country tunes.
In 2004, while she was riding with a friend, police stopped them for driving with expired tags. The car belonged to her friend, but the marijuana and methamphetamine on the floor were Harvill's.
She pleaded guilty to drug possession and served her time. Ordinarily, that would have been that. But ICE had begun scouring jails and prisons nationwide for people it might be able to deport, and a check of Harvill's criminal history turned up a decade-old felony conviction for buying stolen jewelry. Her lawyer insisted she'd had no idea it was stolen. A judge suspended the sentence and put her on probation, which was terminated early for good behavior.
A 1996 law had given the government new leverage to deport foreigners, including people living in the country legally as U.S. residents, if they had committed a crime at any time in the past, and the Bush administration was wielding that power aggressively. The law expanded the list of crimes defined as "aggravated felonies" that are grounds for deportation. It also for the first time required people to be locked up during their deportation cases -- including permanent legal residents such as Harvill, who is not a citizen but has had a green card ever since she came to the United States.
On March 22, 2007, instead of going home, Harvill was handed an orange uniform at the Palm Beach County jail to await deportation. Her parents are dead. She lost track of her sisters long ago. She has no idea where or how she would live in South Korea, particularly because she has not held a job for years because she cannot put weight on her leg for too long.
She has been fighting the deportation with the help of Cheryl Little and Kelleen Corrigan, lawyers at the Florida Immigrant Advocacy Center in Miami. They have applied for a visa available to foreigners with firsthand knowledge of crimes -- in Harvill's case, the abuse by her first two husbands. Meanwhile, they have repeatedly asked federal officials to let Harvill go home on bond because she is so ill.
Corrigan has a postcard on her office door with the words "Free Yong!" over a photo of a younger, happier-looking Harvill.
At church that Sunday night, Leon Harvill did not open the prayer book. But during the silent prayer, he leaned forward, his hands resting on the pew in front of him, and closed his eyes. He prayed for his wife to get medical treatment, to find peace, to come back.
He raced home after church, knowing she would call.
At 9:14 p.m. the kitchen phone rang. "I love you, too, baby," her husband said. "Things are going to get better. Come on, baby. Something is going to happen soon."
Before dawn the next morning, he would leave the house of his mother, Margaret Kersey, with whom he had been staying to save money, for the Tampa airport and a flight to Hawaii, where he had found a welding job with better pay. It had been hard lately to save, with work scarce in central Florida and money flowing out for his wife's phone cards and canteen treats, and for the "Free Yong!" postcards he'd printed so friends could mail them to the government. Most of all, he thought, he needed to save money so he would have some to send her if someday she were deported to South Korea.
Deportation had been on Yong Sun Harvill's mind, too. Sometimes, she is so depressed that she thinks about quitting her fight and signing the papers that would let the government send her out of the country. And she has been missing the one real friend she made in a jail, a younger Korean woman who would rub menthol ointment, when she could get some, on Harvill's swollen leg and write the journal entries when Harvill's hands stiffened too much.
A few weeks before this January night, her friend was deported.
But on this night, Harvill listened to her husband describe the path he would take to Hawaii the next day. "I have a layover in Phoenix," Leon Harvill said into the phone.
She told him to look at the desert as he landed.
"I'll get a look at it tomorrow," he told her. "We'll be that close."
Staff researcher Julie Tate contributed to this report.
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.