Dying for Decent Care: Bad Medicine in Immigration Custody february 2009 3000 Biscayne Boulevard, Suite 400 Miami, Florida 33137 Tel (305) 573-1106 Fax (305) 576-6273 www.fiacfla.org To protect and promote the basic rights of immigrants dying for decent care: bad medicine in immigration custody Dedication Rev. Joseph Dantica, an 81-year-old Baptist minister, fled Haiti after he was targeted for persecution. Gangs had burned and ransacked his home and church. Although Rev. Dantica had a valid visa to enter the United States, where he had traveled many times, he was detained at the Miami airport when he told officials he sought political asylum. At the Krome immigration detention center, he was accused of “faking” his illness and later transferred to the prison ward of Miami’s public hospital in leg restraints. Rev. Dantica died there alone five days after his arrival in October 2004. His family was allowed to see him only after his death. Since March 2003 more than 80 people have died in or soon after leaving immigration custody, and poor medical care could have contributed to at least 30 of those deaths, according to an investigative report by the Washington Post. No one knows how many others have died unreported or after being deported. Immigration authorities are not required to report the deaths of detainees in their custody. There also is no telling how many detainees have received inadequate or no medical care and will have to cope with pain, paralysis, loss of limbs and other health consequences for the rest of their lives. This report was written in memory of Rev. Dantica and all other detainees who have lost their lives and health in immigration detention. The true measure of our society is how it treats those who cannot take care of themselves. If we are ever to become the society that he dreamed of when he came to the United States, the Department of Homeland Security and its Immigration and Customs Enforcement (ICE) arm must protect the health and human rights of people like Rev. Dantica. This means providing them humane, life-saving medical treatment in their time of need. Florida Immigrant Advocacy Center’s report documents the urgent crisis in medical care for ICE detainees. Our aim is to inspire real changes and prevent more needless deaths and suffering. dying for decent care: bad medicine in immigration custody Acknowledgements FIAC is extremely grateful to The Ford Foundation, The Florida Bar Foundation, Lutheran Immigration and Refugee Services, Equal Justice Works, and Herb Block Foundation. This report would not have been possible without their support. Dying for Decent Care: Bad Medicine in Immigration Custody was inspired by the thousands of immigration detainees who have complained about medical care to FIAC staff during 13 years of visits to immigration detention facilities. It began as the written testimony of Cheryl Little, FIAC executive director, for the U.S. House Immigration Subcommittee’s hearing, Detention and Removal: Immigration Detainee Medical Care, on October 4, 2007. The information in this report was obtained through interviews, phone conversations and correspondence with detainees, as well as jail and immigration officials. It also includes information from U.S. government materials, newspaper articles and other data. FIAC thanks Steptoe & Johnson, Carlton Fields and Shook, Hardy & Bacon who have provided pro bono legal representation to ill detainees. FIAC is most grateful for the assistance of physicians who have contributed countless hours reviewing the medical records of detainees and providing their expertise in order to advocate for better medical treatment. FIAC also wishes to recognize the remarkable dedication of its staff in providing legal representation and advocacy on behalf of detainees. Finally, FIAC extends its deepest thanks to the men, women and children in immigration detention who are the subject of this report, for their remarkable courage and for the privilege of representing many of them. Florida Immigrant Advocacy Center Florida Immigrant Advocacy Center, Inc. (FIAC) was founded in January of 1996 in anticipation of the drastic changes in the availability of legal services to immigrants due to federal funding restrictions on Legal Services Corporation. It is a non-profit law firm whose mission is to protect and promote the basic rights of immigrants through advocacy and legal services for low-income clients. For further information contact: Cheryl Little, Executive Director Susana Barciela, Policy Director Charu Newhouse al-Sahli, Statewide Director Sharon Ginter, Administrative Assistant to the Executive Director Florida Immigrant Advocacy Center 3000 Biscayne Boulevard, Suite 400 Miami, Florida 33137 Tel (305) 573-1106 Fax (305) 576-6273 www.fiacfla.org dying for decent care: bad medicine in immigration custody Acronyms and Abbreviations ACLU: American Civil Liberties Union Annex: Women’s Detention Center in Miami BTC: Broward Transitional Center, ICE-contracted detention facility north of Fort Lauderdale DHS: The U.S. Department of Homeland Security DIHS: Division of Immigration Health Services FIAC: Florida Immigrant Advocacy Center, which produced this report Glades: Glades County Detention Center, an ICE-contracted facility in central Florida ICE: Immigration and Customs Enforcement, an agency of the U.S. Department of Homeland Security (DHS) INS: U.S. Immigration and Naturalization Service, the country’s immigration agency prior to the creation of DHS and ICE in 2003 Krome: Krome Service Processing Center, ICE detention facility in Miami OIG: The Department of Homeland Security Office of Inspector General ORR: The Office of Refugee Resettlement, an agency of U.S. Health and Human Services Pinal: Pinal County Jail, an ICE-contracted detention facility in Florence, Arizona MCC: Medical Care Coordinators, review, approve or deny “Treatment Authorization Requests” for DIHS San Pedro: San Pedro Service Processing Center, ICE detention facility in California TAR: Treatment Authorization Request, must be submitted to DIHS for approval to provide detainees diagnostic testing, specialty care, or surgery TGK: Turner Guilford Knight Correctional Center, a county jail in Miami Wyatt: Donald W. Wyatt Detention Facility in Central Falls, Rhode Island, contracted by ICE dying for decent care: bad medicine in immigration custody Table of Contents Executive Summary 7 Introduction 9 Deaths in Detention 13 Abuses in Medical Care 23 Unacceptable Mental-Health Treatment 33 Physically Disabled Detainees 39 Mismanaged Medication 41 Forcible Drugging to Deport 45 Language Barriers 47 Unhealthy Living Conditions 49 Detainees Treated Like Criminals 51 Denied Medical Records 55 Conclusions and Recommendations 57 Background 61 Footnotes 68 executive summary Executive Summary Immigration and Customs Enforcement (ICE) detainees are “I have to pee on myself putting a towel on my laps [sic] to prevent routinely subjected to poor, and sometimes appalling, medical the urine [from] running all over myself. When I have to do the care. These detainees are entirely at the mercy of the other necessity [it] is very uncomfortable [and] unsanitary….Don’t Department of Homeland Security. DHS officials determine you think I’m still a human being?” what medical treatment, if any, a detainee gets, when and Felipe Perez-Leon, a paraplegic detainee denied handicap where they get it, and the quality of that care. -accessible facilities while detained in an Atlanta jail. Americans who cannot afford healthcare or insurance by law Government records, news reports, and FIAC’s experience in will be treated at an emergency room, and some can get detention centers plainly indicate that healthcare in ICE financial help from families and friends. ICE patients do not custody is deteriorating, and many officials responsible for that have those choices. ICE does not even allow detainees to use care are alarmed. Regardless of its public posturing, ICE private insurance to pay for medical care that ICE denies. And funding for detainee medical care is inadequate. the great majority of detainees have no lawyer to help them obtain appropriate medical attention. At the same time, ICE’s attempts to save money – by limiting covered ailments and denying requests for needed treatment – Meanwhile, attempts by the Florida Immigrant Advocacy are counterproductive. Covered services are in essence limited Center (FIAC) and other advocates to get ICE to correct serious to emergency care, and a managed-care process requires every medical deficiencies repeatedly have been ignored. In detainees’ referral, medical exam, or treatment of a detainee to be own words, here are some complaints: approved by off-site nurses who conduct a paper review, sometimes without the full medical records. Thus, a non- “I am a 35-year-old man without a penis with my life on the line. physician can deny a treatment requested by a physician who I have a young daughter, Vanessa, who is only 14…. The thought has seen the patient. Too often, denied or botched care then that her pain – and mine – could have been avoided almost makes leads to costly complications and lawsuits that cost taxpayers this too much to bear.” more money. Francisco Castañeda, before dying of penile cancer that went untreated while he was in ICE detention in California. Many government employees responsible for the care and custody of ICE detainees are competent and dedicated. “At the clinic, I could no longer speak, only cry. A nurse told me Nonetheless, denying that problems exist places at risk the she was sorry, but that the doctor had resigned so there was no very detainees in dire need of medical care. Though some doctor. I sat in a chair and clutched my stomach…. I thought I detainees may exaggerate the hurdles they face in getting was going to die.” proper medical attention, FIAC’s experience, press reports, Miguel Bonilla Cardona, who suffered a ruptured appendix detainee medical records and statements from detention at an ICE-contracted county jail in central Florida. medical staff demonstrate that detainee complaints often are legitimate.