Testimony of Tom Jawetz, staff attorney for the ACLU National Prison Project, before the US House Committee on the Judiciary, Subcommittee on Immigration, Citizenship, Refugees, Border Security, and International Law
I would like to thank Senator Menendez and Representative Lofgren for inviting me here today to speak about an immigration detention health care system in crisis. This issue lies at the center of one of our country's most basic principles: that everyone is entitled to fair and humane treatment.
The recent news coverage about horribly inadequate detainee health care confirms what the ACLU has long known. That all across the country, in hundreds of county jails and the handful of facilities run by ICE or private prison companies, immigration detainees are suffering unnecessarily—and sometimes dying—because of gross medical neglect.
Last year, the ACLU filed a class action lawsuit against the Otay Mesa Facility near San Diego for failing to uphold its constitutional obligation to care for detainees. At the Otay Mesa Facility, featured heavily in the Washington Post’s coverage, detainees have been routinely subjected to long treatment delays, denied necessary medications, and refused essential referrals. One woman, detained since July 2006, lives with a genetic disorder that causes painful tumors to develop on her body. She was scheduled for surgery to remove one such tumor in August 2006, but missed the appointment due to her detention. It has taken nearly two years for the immigration health service to finally approve her surgery.
Through my office's investigations, along with reports from the ACLU's local affiliates—we have identified serious systemic problems with ICE’s medical care policies and procedures. First, detainees may not receive specialty services such as a biopsy unless on-site medical personnel obtain authorization from off-site Managed Care Coordinators with the Division of Immigration Health Services (DIHS) in Washington, D.C. This results in unreasonable delays in medical care, and unjustifiable refusals to provide authorization. In some cases, DIHS' refusal to authorize necessary care has placed individual doctors, and entire counties, at risk of liability.
Second, the treatment authorization decisions are made by nurses, not doctors, acting in accordance with deeply flawed policies. Those policies emphasize that detainees primarily receive emergency care only—literally when life or limb is at stake. This policy blatantly contravenes constitutional requirements and basic notions of decency.
The terrible consequence of poor medical care for ICE detainees is that it can result in death. Recently, the Washington Post revealed that at least 83 people have died in ICE custody or shortly after leaving ICE custody since 2003. Yet ICE is not required to report deaths that take place in their custody and concedes that not every in-custody death is investigated.
This grossly deficient care is inexcusable and immoral, but it is also common and often unchecked. I applaud the efforts by the Senator Menendez and Representative Lofgren for introducing the Detainee Basic Medical Care Act of 2008. This legislation is a strong first step towards ensuring those held in immigration detention are treated humanely and receive the basic medical care they need. On behalf of the ACLU, I would like to thank Senator Menendez and Representative Lofgren for their leadership on this most important issue.