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Advocates: Medical negligence caused deaths in immigration detention

A review of eight cases shows serious problems in the medical care of detainees at immigration holding facilities across the United States and a lack of transparency and oversight when it comes to medical care, according to a report released Thursday by advocates.

In June 2011, 54-year old Pablo Garcida-Conte was detained by U.S. Immigration and Customs Enforcement after his arrest in Fairfield, Calif., for selling alcohol to a minor. As his case worked through the nation's immigration courts, Garcida-Conte was transferred to the Eloy Detention Center, about 50 miles north of Tucson. 

In mid-July, Garcida-Conte visited the medical clinic complaining of vomiting and profuse sweating, but waited 22 days before a registered nurse examined him for decreased appetite. 

His symptoms continued to worsen and over the next three months, he complained of excruciating abdominal pain, headaches, shortness of breath, and daily vomiting. Finally, on Oct. 28, he was taken to University Medical Center in Tucson, where he died two days later. An autopsy report noted that Garcida-Conte suffered from cardiomyopathy, a treatable disease of the heart muscle. 

A review of his death by the Office of Detention Oversight, an internal watchdog agency with ICE, said that Garcida-Conte's death might have been prevented if "the providers, including the physicians at EDC had provided the appropriate medical treatment in a timely manner." 

A doctor interviewed by ODO officials was more pointed: "Garcida did not receive appropriate or medically acceptable medical care while confined at EDC." 

The death of Garcida-Conte was one of eight cases advocates say highlight pervasive medical negligence at ICE facilities in a report issued Thursday by the ACLU, the National Immigrant Justice Center, and the Detention Watch Network. 

In the 28-page report, titled "Fatal Negligence: How ICE ignores deaths in detention," advocates compiled documents obtained through multiple freedom of information requests to review 24 deaths in U.S. immigration detention from January 2010 to May 2012. 

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In 2009, following widespread criticism of detainees treatment, the Obama administration mandated death reviews, created a new facility inspection process, and introduced tighter standards for detention centers. However, advocates say that the reforms have failed to prevent unnecessary deaths. 

Reviews conducted by ODO identified serious violations of medical protocol, and yet inspections conducted by another internal watchdog before and after deaths appeared to ignore medical mistakes, and ICE inspectors gave passing grades to all but one of the eight facilities, the report said. 

Since 2003, 155 people have died in custody at ICE facilities nationwide, including 14 who died at the Eloy Detention Center. The most recent death in Arizona was the Sept. 2015 death of Juan Garcia-Hernandez, 39, who collapsed outside the medical unit at the Florence Processing Center and died of a heart attack at a nearby hospital. 

Garcia's death came just months after the May 2015 suicide of Jose de Jesus Denis-Sahugun, 31, who died of asphyxia after swallowing one of his own socks. 

Denis-Sahugun's death set off day of protests by detainees at the Eloy facility, and Rep. Raúl Grijalva sent a letter to the Department of Justice and asked for an investigation. 

ICE defended itself against accusations that detainees are not given appropriate medical care, noting that the agency has spent $195 million in 2015 on medical, dental and mental healthcare for more than 300,000 detainees held at ICE facilities.

"ICE takes the death of any individual that occurs in the agency's custody very seriously," said Yasmeen Pitts O'Keefe, an ICE spokeswoman. "In fact, the findings cited in this report are the result of exhaustive case reviews conducted by ICE’s own Office of Detention Oversight, which was established in 2009 as part of the agency’s comprehensive detention reforms. Under ICE’s protocols, a detainee death triggers an immediate internal inquiry into the circumstances."

Pitts O'Keefe said that agency has since simplified the process for health care treatment, and has made significant changes to the ensure "that those in ICE custody receive timely access to medical services and treatment." 

She said that six of the eight facilities referenced in the report, including the Eloy Detention Center, have shifted to a revised standard created in 2011 that are the "most rigorous operating requirements imposed by the agency." A seventh site in Utah has not been used by ICE to house immigration detainees since 2011, she said. 

"These developments reflect ICE’s continuing resolve to improve the conditions of confinement for all those in the agency’s custody. ICE has made substantial progress on implementing reforms across its detention system and that important work is ongoing," Pitts O'Keefe said. 

Carl Takei, a staff attorney with the ACLU said that the revelations from the documented were disturbing when compared to the ICE's own inspection reports. The agency's own internal watchdog had found that failure to meet health care needs in a  timely manner, failure to refer detainees to hospitals, and a failure to provide adequate medical staff had all contributed to deaths. ICE did not seem to identify these mistakes, Takei said and that the inspection system appear to "sweep deaths under the rug." 

He noted the death of Evelin-Ali Mandza, an immigrant from Gabon, who died at an ICE facility in Aurora, Colo., in April 2012 "after egregious delays in calling 911 and referring Mr. Mandza to a higher level provider."

A guard called a code blue emergency after seeing Mandza, 46, holding his chest and complaining of severe chest pain. However, a nurse at the facility attempted to evaluate him using an EKG machine, but did not know how to use it leading to a hour-long delay before a doctor agreed to transfer Mandza to a hospital. He died a few hours later of a heart attack. 

"Despite these damning findings, ICE's routine annual inspections before and after Mr. Mandza's death gave the facility passing ratings," Takei said. "In other health care providers, the post-mortem analysis isn't just filed away, but is used to provide health care for the next patient who goes through the door," he said. 

This isn't happening at ICE facilities, Takei said. 

Dora Schriro, a former Department of Homeland Security advisor to Janet Napolitano who previously headed the Arizona Department of Corrections, said she had presented her concerns to agency officials in 2009. Health care systems at ICE facilities were poorly equipped, lacked infrastructure, and medical personnel were not trained well, she said. 

"There was no medical or mental health classification system. At the time, they just characterized incoming detainees as either 'healthy' or 'unhealthy'," Schriro said. She also said that officials lacked universal protocols for infectious and contagious disease and medical records did not follow along with a detainee when they were transferred from one facility to another. 

"Each time an individual came in, a new file was started," Schriro said. 

Schriro said that the agency's reliance on private contractors for many of its facilities also contributed.

"This gets to the heart of the issue," she said. ICE excels in enforcement, however, "the operation of facilities and decision about releasing [detainees] is a different speciality," Schriro said. 

Mary Small, a policy director with Detention Watch Network, said that the facilities with the highest deaths, occurred with facilities run by local governments and subcontracted to private prisons. "I don't think that's a coincidence," Small said. This arrangement includes the facility in Eloy and nine others. 

Each day more than 34,000 people are held in 250 immigration detention centers across the United States, at a cost of more than $2 billion, according to the National Immigration Justice Center. Often referred to as a "bed quota" the 2006 Congressional mandate requires officials to hold immigrants in detention centers, rather than releasing them as their cases are completed and seek outside medical care. 

Despite the quota, advocates have asked the agency to release people with serious medical conditions to be released and terminate contracts with facilities that have had "repeated preventable deaths" including the Eloy Detention Center. They also asked the agency to shift funding for detention to "community-based alternatives" that allow people to seek medical attention and support from family, legal counsel and the wider community. 

Takei said that the families of three people covered in the report were currently pursuing wrongful death lawsuits, but said that that failed to protect people. 

Wrongful death lawsuits don’t solve systemic issues, so we don’t see them as a full response to the problem," said Small. 

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The logo of the Corrections Corporation of America hangs over the Eloy Detention Center, which the private prison company runs under contract with immigration authorities.