The well-known group Human Rights Watch says that the unsolved problem of "subpar" medical care in federal immigrant detention centers is about to get a whole lot worse under President Donald Trump.
The group followed up on its findings from last summer of inadequate or callous medical care in existing facilities with a new report that says suffering and death by immigrants will likely increase.
The 104-page report released on Monday, "Systemic Indifference," repackages and expands on HRW's 2016 findings, which were based on data from 18 death investigations released last June by the U.S. Immigration and Customs Enforcement Bureau.
Two independent doctors who examined the ICE documents for HRW and another group, Community Initiatives for Visiting Immigrants in Confinement, found that 16 of the 18 cases involved "substandard medical practices."
Seven of the 18 deceased detainees had "subpar" treatment that contributed to their deaths, the experts say.
Now that Trump's been elected and is carrying out his vision for tougher immigration policies, HRW sees a crisis on the horizon.
Following his immigrant-bashing campaign, Trump signed a series of executive orders after taking office. They included more enforcement and a corresponding expansion of federal detention centers for immigrants.
"The data reveals that people in immigration detention died needlessly under the Obama administration, even with its attempts at reforms," Grace Meng, HRW senior researcher, said in a written statement.
"The Trump administration has already announced its intent to roll back key reforms while detaining even more immigrants, which would likely mean more people will die needless and preventable deaths," she added in the statement.
The group claims the problem is acute at the federal immigration detention facility in Eloy, Arizona, which is run by the private-prison company Corrections Corporation of America/CoreCivic. The facility has experienced 15 detainee deaths since 2003, more than any other facility.
ICE's own death reports show that emergency medical care for three of four detainees who died at the Eloy facility between 2012 and 2015 had been delayed, the group says.
The new HRW report, and the group's July report, give detailed information about the deaths. The findings also include comments from the medical experts, Dr. Allen Keller, an associate professor of medicine and rights activist from New York City, and Dr. Marc Stern, a correctional health expert who's worked for the Department of Homeland Security's Office of Civil Rights and Civil Liberties.
The July report itself followed numerous reports in the news media and by activist groups about conditions at immigrant detention centers.
The tragic stories include instances of mentally ill people committing suicide successfully after previous attempts, and inmates afflicted by cancer, heart attack, or stroke who allegedly could have survived with better health care.
Three of the deaths were suicides that occurred after repeated previous attempts by the detainee. Two of those cases involved mentally ill people who were held for long periods of solitary confinement.
For instance, Tiombe Carlos, a native of the Caribbean nation of Antigua-Barbuda who was diagnosed with chronic schizophrenia in New York when she was 14, had her permanent legal residency revoked after being arrested for a bar fight, according to the Philadelphia Inquirer.
In the months before she hanged herself in 2013 at age 34, the HRW reports states, she had been in solitary confinement twice, including once for about two and a half months.
One death considered "very likely preventable" was that of Manuel Cota-Domingo, 34. The man entered the Eloy detention facility with a plastic bag full of diabetes drugs, but it was put in a locker.
He told the facility's staff that he didn't need insulin or was diabetic because he was worried about having to pay for expensive treatment, his cousin later told officials. Treatment at the facilities actually don't cost immigrants anything.
One night in December 2012, Cota-Domingo began to have trouble breathing.
"His cellmate began to bang his cell door and call for help at about 11 p.m.," the HRW report says. Correctional officers finally responded at 2 a.m. But a policy dictated who could call 911 — and apparently, it was none of the staff members there at the time.
The staff decided to send him to a hospital in a van. He arrived at the hospital eight hours after his breathing problem began, and was pronounced dead a few days later.
About half the deaths were at county jails, which are frequently used by the feds to temporarily house immigrants.
Stern, the correctional health expert, tells Phoenix New Times somewhat tongue-in-cheek that "on the positive side, I never found the jails discriminate in their medical care."
That is, he explained, county jail medical care across the country is usually substandard. If anything, immigrants get treated slightly better in county jails because they're subject to federal oversight, he said.
Stern said the worst part of examining the reports for HRW was realizing how many deaths could have been avoided.
Yet Stern added that the medical staff at ICE facilities don't employ "bad people." Rather, they follow "bad systems."
In the case of Cota-Domingo, he said, confusion reigned. Some staff members thought the nurses should call 911, and vice-versa.
"I'm sure none of those people wanted someone to die," he said.
Eloy, located between Phoenix and Tucson, probably has more difficulties recruiting top-quality doctors and nurses because it's not located near a city center, he said.
ICE detention facilities nationwide hold about 41,000 detainees on any given day.
Trump's enforcement priorities call for increased detention of immigrants, HRW notes, both through tougher policies regarding detention and the planned construction of more facilities. His administration is rolling back oversight that President Obama had put in place — oversight that already had been deemed inadequate by the group.
Trump has also decided to reverse a Department of Justice decision to stop using private companies to run detention centers.
All of this "raises serious concerns that the problems fueling the unnecessary suffering could grow even worse," the group says.
HRW's report makes a number of suggested changes to improve ICE's record, including releasing more immigrants who are awaiting court dates. The group also wants to see improvement in data collection, investigations of grievances by detainees, and facility staff trained on better policies and practices.
Jennifer Elzea, ICE deputy press secretary, said the agency will review the report and decide if any changes should be made.
"ICE is committed to ensuring the welfare of all those in the agency’s custody, including providing access to necessary and appropriate medical care," she said in a statement released to New Times. "Comprehensive medical care is provided to all individuals in ICE custody."
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The agency utilizes licensed health care workers including doctors, dentists, nurses, physician's assistants, and many others, she said, all providing 24/7 care that costs U.S. taxpayers more than $180 million each year.
A "multi-layered inspections program" keeps the facilities at a proper standard, she said.
That oversight is provided in part by ICE officials, and also by the DHS Office of Civil Rights and Civil Liberties, Elzea said.
Click here for Human Rights Watch's report, "Systemic Indifference."