Conditions at Detention Centers Questioned

Reports of substandard health care and unnecessary deaths at U.S. immigration detention centers have heightened concerns among immigrant families and advocates. Reporter Elizabeth Llorente, who writes for New Jersey's The Record, has been reporting on the issue for more than a decade; she talks about the recent reports and the changes some advocates are demanding.

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MICHEL MARTIN, host:

I'm Michel Martin, and this is Tell Me More from NPR News. Just ahead, would you let your nine-year-old ride the New York subway alone? One mom did, but when she wrote about it some other parents felt she wasn't playing with a full deck of Metro cards. So we asked the Mocha Moms to weigh in on balancing independence and safety with kids. That's a little later.

But first we want to talk about an issue that's engaged the attention of the nation's leading lawmakers, the kind of medical care immigrants receive while in detention. Earlier this month the New York Times wrote about the case of Boubacar Bah, the tailor from Guinea who was detained by the Immigration and Customs Enforcement Agency last year for overstaying his visa. He suffered a skull fracture while in detention and was in a coma by the time he was taken to the hospital. Bah died four months later. Family members say they weren't told he was ill until it was too late, and they question whether he received adequate medical care.

Advocates and lawmakers are increasingly concerned about the number of immigrants like Bah who are becoming sick and dying while in custody. According to Immigration and Customs Enforcement figures obtained by the Times under the Freedom of Information Act, more than 60 immigrants have died in administrative custody since 2004. And some estimates put the number higher. We invited Immigration and Customs Enforcement officials to send a representative to speak with us today, and they declined. They sent over a lengthy statement which we'll post on our website.

Elizabeth Llorente, though, has reported on immigration and detention issues for the Bergen Record in New Jersey for a number of years, and she joins us now by phone. Welcome, Elizabeth. Thanks so much for talking to us.

Ms. ELIZABETH LLORENTE (Reporter, Bergen Record): Thank you.

MARTIN: Elizabeth, as an immigration reporter, how long have you been watching these types of cases? How long have they been on your radar?

Ms. LLORENTE: Well, I've been writing about the detention system since 1995, and so, many of these concerns are familiar to me because they've been expressed by - especially by human rights organizations for at least that long.

MARTIN: Why do you think these cases are coming to light now? This particular concern about the medical care detainees receive?

Ms. LLORENTE: Well, I think because there have been some high-profile deaths. There was the death of a man from El Salvador after he left detention now - and that's under litigation now. But as the story goes, he was brought - when he was brought to detention he had a lesion that he was very concerned about and that some people feared, you know, might indicate some kind of cancer. And his family had wanted a biopsy to be done. It wasn't. And then he started to become progressively more ill.

He was released from detention, his relatives say, inexplicably. And then not long after that he died. And as it turns out, after he was released from detention he was seen by a doctor who did diagnose cancer. And then he died. And a judge had very harsh words, you know, for the government as far as their negligence, as he saw it, of this case. And that made headlines. And so I think that sort of exposed, you know, these problems which, you know, have been known to immigration advocates and immigration officials for quite a while.

MARTIN: Are there any enforceable standards that require a certain level of care for immigrant detainees?

Ms. LLORENTE: Well, you know, I know that there are standards for detention, but as I understand it, I mean, they're not really, you know, enforceable. They're more along the lines of guidelines. Now, you know, there are just some basics, I would think - and I'm saying that because I can't cite chapter and verse anything that's governs medical care in general - but I would think that there has to be, you know, some basic enforceable guidelines just governing people who are imprisoned or jailed or detained under the custody of the U.S. government.

MARTIN: Now, as I mentioned, we asked ICE to join us for this conversation and they declined. They sent us a lengthy statement which is rebutting - mainly rebutting the New York Times peace point-by-point. But it's too long to read, we'll post it on our website. But they - one point stood out to me. They said that the detainee population has increased by more than 30 percent since 2004, but that the mortality rate has actually decreased and that the number of deaths per 100,000 is actually lower for ICE detainees than for the population in U.S. prisons and jails around the country. What do you say to that?

Ms. LLORENTE: Well, they do say - I know that they say that they have many more people that are in their custody right now, and that's because of stricter immigration laws. And they do say that last year, for example, they put in about 100 million dollars into detainee health care, which they say is double what they put towards that five years ago. But I think the issue here is - and of course, people are going to get sick and they're going to, you know, they're going to die no matter where they are - but the issue here, and I think what's most troubling to many people is people who seem to have died needlessly. In other words, it wasn't really an act of God or something inevitable.

I think the cases that are causing outrage are cases where people were clearly in distress - were complaining, were exhibiting what I think anyone, even without a medical degree, would consider serious symptoms and were maybe just given Tylenol in some cases - and it appears were ignored. And so I think that's what's troubling. Not that people, you know, not that people died or even got sick - I mean, which happens - but just the way that these warning signs were handled, or better yet, you know, not handled.

MARTIN: What do advocates believe the core of the problem here - you know, recognizing that there's going to be a dispute about whether ICE has any standards or followed any standards or whether they even have an appropriate medical infrastructure - but what do advocates believe the problem is? Is it they believe that the people who are working in these facilities aren't adequately trained to recognize serious medical conditions?

Is it that they don't believe the infrastructure exists to offer care? Or do they believe that the facilities think that people are going to be there for not very long? I mean, the average stay in detention as I understand it is about 37 days, so that they don't really feel they have a duty to care or to provide any care for people who may have serious health conditions.

Ms. LLORENTE: Right. I mean, first of all, you know, what immigration says - has said, is that many people come to them with already chronic conditions. That about a quarter of the people who enter the detention system already had conditions and that sometimes they just don't - they're not in their detention centers long enough to actually get cured or, you know, to get treatment that's really going to make them a lot better. And they can't always control what happens in terms of that medical condition.

They point out, you know, that they're getting people from other countries, maybe who got inadequate care, who maybe never even got any care at all. Maybe who weren't even aware of the conditions that they had. That said, advocates have just been concerned about, you know, the world of immigration detention in general. And their concern has been that the standards for treatment, you know, both humane treatment, medical treatment - and that includes psychological treatment because many of these people come with some form of post-traumatic stress disorder because of what some of them had experienced, you know, back in their countries, persecution and so forth. Seeing their family members killed.

And so the concern has been that these folks who end up in detention, many of them don't know anybody here in this country. They're cut off and really, you know, have no one to really share any kind of problems that they may encounter. And yes, there are groups that do monitor these places. But it's really largely at the discretion of the people who are in charge of the detention center. You know, they don't have a, quote, unquote, right to go in there.

MARTIN: If you would talk for one minute about the whole psychological care issue. Because, as you point out, some of the people that are detained are seeking asylum, so it's not a matter of having been adjudicated as a law-breaker. Some people are in detention - people are in detention for various reasons. So can you talk a little bit if you would, about the psychological care issue? Is there any system for psychological care for people?

Ms. LLORENTE: Well, it's been a problem. That's been another concern. Actually, I've heard more concern about that than about the actual physical health conditions of people. And that is the mental health. And I mean, you know, the people who are seeking asylum - and I have to say, I mean, not everybody necessarily has a valid claim, because, to be fair, there's a whole system, a global system of people who basically coach and take their money and exploit them. You know, people who want to come to this country and coach them to make claims about persecution that really aren't true.

And so, you know, there is that. So not all asylum seekers did go through trauma, but many did. You know, those with valid claims. And they come here needing psychological care. And oftentimes, according to psychologists and psychiatrists who have seen them in detention, they say that the whole experience of detention exacerbates any underlying psychological problems that they already had. And these are seldom treated appropriately in the detention center.

When people do, say, make an attempt to commit suicide - which happens often in these places - sometimes they are sent to a hospital, or outside the detention facility to get some kind of care. But sometimes this is just being taken to the emergency room and being put under observation.

MARTIN: As I mentioned, we asked Immigration and Customs Enforcement to join our conversation. They declined. They did send us a lengthy statement which we will post on our Web site, npr.org/tellmemore. In the meantime, we talked to Elizabeth Llorente, she reports on immigration issues for the Bergen Record in New Jersey. She joined us by phone from Newark. Elizabeth, thanks so much for speaking with us.

Ms. LLORENTE: Well, thank you, Michel.

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