ICE detainees suffer preventable deaths

The 2024 Homeland Security appropriations bill increased funding
for U.S. Immigration and Customs Enforcement operations to handle an anticipated daily detainee population of 41,500, up from an average of 34,000 in recent years.

Yet recent studies have exposed cracks that call into question
the agency’s ability to medically care for the detainees it is entrusted
with, including inhumane conditions, high suicide rates, structural problems such as the use of prisons to hold detainees, delayed or interrupted medical care and overcrowded conditions. Research also shows that the pandemic years further exacerbated these inequalities.

One recent report by a trio of nonprofit advocacy groups blames
preventable deaths of people detained by ICE on inadequate
investigations and flawed systems at the agency. The report, Deadly Failures,
released on June 25, 2024, by the American Civil Liberties Union,
American Oversight, and Physicians for Human Rights, documents
inadequacies in diagnosis, treatment and emergency response. It points
to suicides that might have been prevented with appropriate mental
health care and properly managed medication. And it details underlying
issues – understaffing and a lack of interpretation and translation
services.

The Conversation asked Cara Buchanan, an emergency physician and
clinical fellow in health policy and social emergency medicine at the
Harvard Kennedy School, whose research
the report cites, about research in this area by her team and others,
ICE’s track record on detainee medical care and what needs to be done to
improve medical care for people in ICE custody.

What have you and your colleagues found in studying medical
care for detainees in U.S. Immigration and Customs Enforcement custody?

Our research
shows that preventable deaths of people in ICE detention are often
preceded by lapses in a standardized, consistent and competent approach
to medical triage, including identification and escalation of the need
for emergency care.

What has other recent research uncovered in this area?

Research across many disciplines, including medicine, law, policy,
criminal justice, health economics, human rights and public health,
correlate structural design features of immigration detention facilities to adverse health outcomes for detainees. This includes the use of solitary confinement, which is linked to an increased risk of self-harm for detainees in ICE custody.

The COVID-19 pandemic highlighted significant health disparities in immigration detention facilities. Many facilities failed to provide adequate basic, preventive and emergency medical care.

Studies also demonstrate a persistent lack of transparent information about conditions in ICE facilities that continues to prompt ongoing calls for increased oversight and accountability to address the systemic sources of poor health outcomes.

The ultimate failure of the immigration detention system to protect
the health and safety of detainees is the outcome of preventable death.
Publicly available ICE detainee death reports provide basic details about timelines preceding death. However, independent investigations and analyses into the circumstances surrounding these deaths have demonstrated pervasive and systemic negligence.

Billions of dollars of congressional appropriations continue to pour
into the expansion of ICE detention facilities, and private prisons
contracted to provide services for immigrants in detention report profit margins in the billions of dollars.

How did your work fit with the recently released report?

Deadly Failures expounds on our prior research with a depth and breadth of context.

The report provides clear policy recommendations for major
stakeholders – the Department of Homeland Security, the Department of
Justice, Congress and local and state governments.

These recommendations range from feasible to ambitious in detailing
actions that would eliminate preventable death for those in ICE custody.
Proposed interventions include prompt disposition of detainees who have
medical and mental health vulnerabilities, limiting the physical and
fiscal expansion of detention facilities, investing in community-based
services, banning solitary confinement, passing legislation to ensure
accountability to standards of care in facility contracts and
establishing mechanisms for regular public data reporting. The report
also calls for ICE to dismantle the mass immigration detention system at
large.

I was particularly heartened to read the second line of the Deadly Failures executive summary,
which highlights the most striking finding of our research – the
troubling trend of ICE releasing people from custody immediately prior
to their deaths.

Why does this happen?

ICE regulations specify that when a detained noncitizen dies in
custody, the agency will conduct timely notification, review and
publication of the death. But the regulatory language about people who
die immediately after release from ICE custody is vague and doesn’t
include a reporting timeline or proposed mechanism of accountability for
such deaths.

When we investigated
the total number of deaths in ICE custody from fiscal years 2021 to
2023, our research team cross-referenced published ICE death reports
with news releases issued by investigative journalists and immigration
advocacy groups. Our review of public records and available legal
documents confirmed four deaths that were not accounted for in the 11
death reports ICE published from those years.

Through this investigation we found a pattern
of detainees who, while hospitalized, were released from ICE custody
after being deemed critically ill, with death clinically imminent. When
we reviewed these detainees’ medical records we found deaths that could
have been prevented. In one such case, a detainee contracted COVID-19
while in custody and suffered a series of complications, including
multiple hospitalizations for recurrent infections. Concerns raised by
the facility medical director about the patient’s persistently critical
condition went unaddressed, and after ultimately suffering a stroke the
patient was placed on life support. ICE released the unconscious patient
from custody just prior to his death. This technical release from
custody allowed ICE to avoid mandatory public reporting of this case and
its details.

Officially, ICE has said that it is continuing to evaluate its enforcement of health standards and is looking for ways to improve medical care delivery.

Our research team’s key recommendation, also highlighted by the
authors of Deadly Failures, is that all deaths of individuals that occur
within 30 days of release from ICE custody be included in mandatory
public reporting of ICE statistics and death reports. This is a critical
measure of transparency and accountability.

What should Immigration and Customs Enforcement be doing to prevent unnecessary deaths on its watch?

Time in ICE custody is related to preventable death.
People detained in ICE facilities should be released as quickly as
possible so their medical needs can be transitioned to more consistent
and long-term care.

Triage should also be standardized. Detainees who show signs and
symptoms of serious medical conditions should be rapidly assessed and
quickly transferred to local emergency rooms for further evaluation and
treatment. Rigorous oversight and accountability should be established
for all workers at ICE facilities and for clinical outcomes of detained
patients.

Are you still seeking answers to questions you have about detainees? If so, what are you looking for?

ICE’s collection, recording and sharing of high-quality data
regarding the capacity of ICE facilities, the scope of health services
available and metrics of health outcomes for people detained in ICE
custody is markedly limited. The dearth of data leaves a barrage of
unanswered questions regarding the conditions that contribute to poor
health outcomes. In my view, ICE detention facilities should be held to
standards of transparency and accountability to federal and public
reporting, as are other large systems of medical care.

Is there anything that has surprised you in what you’ve found over the past few years?

The instances of deficient professional language services,
including interpretation and translation, for people detained in ICE
custody is surprising. It is at odds with a federal mandate that
stipulates a patient’s right to receive health information in their
preferred language at no cost. This right is exercised daily in U.S.
hospitals and clinics across the country for the nondetained with
in-person interpreters or readily accessible technology.

Ultimately, it is disheartening but not surprising that extensive
research continues to demonstrate a diminished standard of care
experienced by people detained in ICE custody.