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Poor Care Played a Role in the Deaths of Immigrants in ICE Custody

A new report highlights troubling patterns in medical care in immigration detention facilities.
Immigrants wait for medical attention at the Adelanto Detention Facility in Adelanto, California.

Immigrants wait for medical attention at the Adelanto Detention Facility in Adelanto, California.

Jose Manuel Azurdia Hernandez died in the Adelanto Detention Facility in San Bernardino, California, at 54, after a nurse ignored clear symptoms of a heart attack because she "didn't want to get sick."

Wenceslau Esmerio Campos died of a heart attack in the South Texas Detention Complex in Pearsall, Texas, in 2016, after an officer at the immigration detention center refused to call in a medical emergency as the 49-year-old complained of chest pain and began vomiting.

Moises Tino Lopez, a 23-year-old Guatemalan man, died at the Hall County Department of Corrections in Grand Island, Nebraska, following multiple seizures. He had refused seizure medication from medical personnel who could only communicate with him through another Guatemalan detainee and Google Translate.

All three of these deaths were likely preventable, according to a new report out Wednesday from the American Civil Liberties Union, Detention Watch Network, Human Rights Watch, and the National Immigrant Justice Center. The groups analyzed 15 Detainee Death Reviews (made public by Immigration and Customs Enforcement) for immigrants who died in detention facilities between December of 2015 and April of 2017. Independent physicians with expertise in correctional health who reviewed the death records found signs of substandard medical care in almost every case, and agreed that poor care contributed to eight of the 15 deaths.

All three physicians who reviewed Jose Manuel Azurdia Hernandez's case agreed that delays in administering care—including the nurse's "egregious" decision to refuse to see him—contributed to his death. Azurdia arrived at the hospital a full two hours after his symptoms began. By then his heart was too damaged to recover. He died in the hospital four days later.

"During a heart attack, every minute counts," said Marc Stern, an affiliate professor of public health at the University of Washington, who had previously investigated health care in ICE detention facilities for the Department of Homeland Security. "A common phrase amongst cardiologists during medical emergencies involving heart complications is 'Time Is Muscle.' Every minute is vital to preventing the loss of life, and thus delays by medical and detention staff likely turned a survivable event into a fatal one."

Experts concluded that the language barrier in Moises Tino Lopez's case, along with multiple other medical errors, contributed to his death. Stern said that the use of Google Translate and another detainee to communicate sensitive medical issues to Tino was "in violation of ICE detention standards, HIPAA [the medical privacy law]" and "just wrong."

The report comes at a moment when the number of detainees—and detainee deaths—appears to be rising as the Trump administration cracks down on both illegal and legal immigration. Twelve people died in ICE custody in 2017, more than in any other year since 2009. The number of people in immigration detention facilities has spiked in recent years to a daily average of 40,500—up from roughly 6,800 people 25 years ago. Meanwhile, the Trump administration has asked for less money for DHS oversight of detention facilities, and, last year, the National Archives and Records Administration made public a request from ICE to destroy detainee records, including files related to sexual abuse, assault, solitary confinement, and death.

The report cautions that "the reviews do not constitute a representative sample of detainee health-care outcomes," but they do point to some troubling trends in health care across multiple immigration detention facilities.

Those recurrent failures in care include: avoidable delays; missed diagnoses; "botched" emergency responses, such as lacking emergency equipment or failure to transport patients by ambulance; and the use of isolation for people with mental illness.

JeanCarlo Jimenez-Joseph, for example, killed himself in Georgia's CoreCivic Stewart Detention Center, 19 days after he was placed in solitary confinement for a previous suicide attempt. Despite a documented attempt to harm himself, the 27-year-old Deferred Action for Childhood Arrivals recipient, who had spent most of his life in the United States, was not put on suicide watch or provided with the increased dosage of anti-psychotic medication that he requested.

Placing individuals with mental illness in solitary confinement is a violation of the United Nations Convention Against Torture, an international human rights treaty to which the U.S. is a party. The nation is also a party to the International Covenant on Civil and Political Rights, which mandates that governments provide detainees with "adequate medical care during detention."

"ICE, the agency with authority over the United States' sprawling system of immigration detention centers, has proven unable or unwilling to provide adequately for the health and safety of those it detains," the new report states. "Oversight and accountability mechanisms have too often failed, and the current administration's proposal to weaken existing standards will further endanger lives."

The groups provided over a dozen recommendations to Congress, ICE, and state and local governments to increase oversight of medical care in detention facilities and reduce preventable deaths, including a ban on isolation for vulnerable individuals.