Staffing Concerns: In the summer of 2007, the detention facility in Eloy, Ariz., was reeling from a lack of staff. It continues to have staffing problems. This is an e-mail from acting DIHS director Neil Sampson trying to draw attention to these issues.
An excerpt from a meeting in which the failure of CaseTrakker, the electronic medical records system, is discussed
Parts of an e-mail about the death of Juan Guevara-Lorano. Portions of the document were blacked out by someone before it was obtained by The Washington Post.
Portions of the review of the care provided to Martin Hernandez Banderas. His leg was amputated. The reviewer, a medical doctor, says health providers failed to give Banderas the proper standard of care.
Portions of a review of circumstances surrounding the death in detention of Joseph Dantica, an 81-year-old minister from Haiti who had applied for political asylum.
Portions from Francisco Castaneda's case file, including (page one) part of a chronology put together by DIHS; a grievance form Castaneda filed (page two) and a request by a medical staffer to change that form so it did not reflect the fact that his grievance was unresolved by the time auditors came to the facility.
Excerpts from a journal that Young Sun Harvill has been keeping since last summer about her health and efforts to get medical care as an immigration detainee at Pinal County Jail in Florence, Arizona. Handwriting varies because Harvill sometimes asks other detainees to write for her when arthritis makes her hands too stiff.
Letter from ICE field office director denying request from Harvill's attorneys for her release. The letter also explains she will be transferred from Florida to Arizona in order to get better medical care.
Second ICE denial of Harvill's release and assurance that her medical needs can be addressed.
Letter from outside physician, at request of Harvill's attorneys, explaining her medical history, the care she requires, and the risks she faces if she doesn't get adequate care.
Internal document from Division of Immigration Health Services documenting how much money the agency has saved by turning down Treatment Authorization Requests (TARs) for detainees with specific medical problems. TARs are part of a managed care system, in which most medical care for detainees must be approved in advance at the agency's Washington headquarters.
Letter from a deputy warden at a Pennsylvania prison that has a contract to hold ICE detainees, complaining of "quite a few problems" with the Division of Immigration Health Services.
Letter from two nurses about their reasons for resigning from Eloy Service Processing Center, a large compound for ICE detainees near the jail where Harvill is being held.
Excerpt from the affidavit of a psychiatrist who examined Amina Mudey while she was in detention and suffering from bad side effects of Risperdal, a drug the doctor there prescribed because he incorrectly diagnosed her with psychosis; pages 2-4 is her request for her medical records from a hospital visit and for pain medication.
Portions of an e-mail from former DIHS director Gene Migliaccio, who expresses concern that Hassiba Belbachir managed to kill herself while on suicide watch, with medical record regarding her suicide. Page two is part of a suicide note, written as a poem in French on an immigration form.
Excerpts from a two-page summary of the amount of money saved by DIHS's managed care staff by denying the Treatment Authorization Requests (TARs) submitted by health providers caring for detainees at prisons throughout the country. This shows that care has been denied for the treatment of mental illness as well as highly communicable diseases such at tuberculosis, strep throat and AIDS. Health providers complained that the managed care staff too often denied legitimate requests.
Letter from a Department of Veterans Affairs staff psychiatrist concerning the diagnoses, past treatment and military service of Isaias Vasquez-Cisneros. The psychiatrist says Vazquez will likely become homeless and relapse into psychosis if he is deported. The second page is an excerpt from Vasquez's medical chart showing his deteriorating mental state, the use of force against him and the doctor's understated assessment that Vasquez suffers from "behavior problems."
Portions of the e-mail thread discussing why a detainee from Barbados cannot get the medication he needs or even an examination from the same doctor who dealt with Isaias Vasquez-Cisneros. Here an ICE officer, Jay Sparks, wonders how this is possible.
Selected responses from ICE to questions posed by The Washington Post regarding the provision of mental health care to immigration detainees.
Legal memo from the last year of the Clinton administration concluding that involuntary medication of detainees who are not mentally ill, without a court order, lacks legal support and raises ethical issues.
Based on confidential medical records and other sources, The Washington Post identified 83 deaths of immigration detainees between March 2003, when the Immigration and Customs Enforcement agency was created, and March 2008.