[Extensions of Remarks]
[Pages E877-E879]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

TREATMENT OF DETAINEES AT ICE DETENTION FACILITIES

______

HON. JASON CROW

of colorado

in the house of representatives

Tuesday, July 9, 2019

Mr. CROW. Madam Speaker, today, I include in the Record two agency
letters my office received in response to two inquiries I sent in
February.
The first is a June 25, 2019 letter in response to a February 28,
2019 letter I wrote with 19 of my colleagues to the U.S. Immigration
and Customs Enforcement (``ICE'') regarding public health risks and
treatment of detainees at ICE detention facilities and contract
facilities.
The second is a June 28, 2019 letter in response to a February 20,
2019 letter I wrote to the Department of Homeland Security regarding
medical concerns at the ICE contract facility in Aurora, Colorado.

U.S. Immigration and Customs

Enforcement,

June 18, 2019.
Hon. Jason Crow,
U.S. House of Representatives,
Washington, DC.
Dear Representative Crow: Thank you for your February 28,
2019 letter regarding public health risks and treatment of
detainees at U.S. Immigration and Customs Enforcement
detention facilities and contract facilities. Enclosed,
please find answers to the questions posed in your letter.
The co-signers of your letter will receive a separate,
identical response.
Thank you again for your letter and interest in this
important matter. Should you wish to discuss this matter
further, please do not hesitate to contact me.
Sincerely,

Raymond Kovacic,

Assistant Director, Office of
Congressional Relations.
____

U.S. Immigration and Customs Enforcement (ICE) Response to the February
28, 2019 Letter regarding Public Health Risks and Treatment of
Detainees at Detention Facilities

1. How many and what kind of outbreaks have occurred at ICE
and contract detention facilities nationwide in the past 12
months and how many of those did the ICE Health Service Corps
oversee?
Response: In the past 12 months, the U.S. Immigration and
Customs Enforcement (ICE) Health Service Corps (IHSC) was
notified of an estimated 308 public health investigations in
51 detention facilities housing ICE detainees; those
investigations affected 308 housing units. IHSC oversaw 112
of these investigations in 15 facilities where IHSC is the
facility medical authority that operates the medical clinic.
2. What is the ICE Health Service Corps protocol for
treating these diseases, including the protocol to quarantine
detainees?
Response: IHSC protocols and official guidance for treating
infectious diseases apply in 22 detention and staging
facilities where IHSC is the facility medical authority and
operates the medical clinic. ICE staff in these 22 facilities
conduct intake medical screening for detainees inclusive of
infectious diseases and coordinate with local ICE Enforcement
and Removal Operations (ERO) personnel to implement a medical
hold for detainees diagnosed with infectious diseases that
pose a public health threat to detainees, staff, visitors,
and the community until the detainee is rendered non-
contagious. ICE policies for these 22 facilities are designed
to control or limit the spread of infectious diseases and
minimize the impact on ICE operations. This action allows ICE
staff sufficient time to facilitate the necessary
arrangements for continuity of care prior to the alien's
transfer, release, or removal.
Additionally, in these 22 facilities, an IHSC medical
provider or designee orders medical isolation of detainees
diagnosed with infectious diseases in accordance with
guidelines on transmission-based precautions for the duration
of the infectious period to prevent transmission. ICE staff
are responsible for providing a recommendation on cohorting
with restricted movement in adult detention facilities and/or
social distancing in family residential facilities to help
reduce the spread of significant infectious diseases, if
appropriate.
IHSC does not have medical authority in facilities where it
does not operate the medical clinic--each medical authority
is responsible for developing its own facility policies and
protocols for managing infectious and communicable diseases
in compliance with governing detention standards. IHSC's
assigned Field Medical Coordinators (FMCs) in each area of
responsibility conduct site visits at locations housing
detainees for over 72 hours to ensure that appropriate
medical services are being provided according to national
detention standards and contractual requirements.
3. How is the ICE Health Services Corps ensuring that
detainees are treated properly, humanely and with dignity
while in quarantine?
Response: ICE ERO oversees the civil immigration detention
of one of the most highly transient and diverse populations
of any detention or correctional system in the world. ICE
takes very seriously the health, safety, and welfare of those
in our custody, and comprehensive medical care is provided
from the moment detainees arrive and throughout the entirety
of their stay.
As stated in Question 2, while IHSC does not have direct
operational oversight over medical care in facilities where
it does not provide that care, its FMCs in each area of
responsibility work to ensure proper medical services are
being provided and that national detention standards and
contractual requirements are met.
In those facilities that are staffed by IHSC, daily
assessments are provided of those individuals that are
cohorted due to exposure to an infectious disease. IHSC
monitors for signs and symptoms associated with the condition
and also provides open access to sick call and urgent care
services that are usually provided within the cohorted unit.
During these interventions, detainees have the opportunity to
report any complaints related to their medical and housing
conditions.
4. Please provide a list of ICE-owned and operated and
contracted detention facilities that ICE Health Services
Corps has treated for a disease outbreak and/or quarantine.
Response: The following indicates where public health
investigations occurred in the past twelve months. Each
facility's medical authority is responsible for overseeing
public health investigations in collaboration with their
local health department.
Facilities where IHSC is the medical authority: Alexandria
Staging Facility, Buffalo (Batavia) Service Processing
Center, Caroline Detention Facility, El Paso Service
Processing Center, Elizabeth Detention Center, Eloy Federal
Contract Facility, Florence Service Processing Center,
Houston Contract Detention Facility.
LaSalle ICE Processing Center (Jena), Montgomery Processing
Center (Houston), Otay Mesa Detention Center (San Diego CDF),
Port Isabel, South Texas Family Residential Center (Dilley),
South Texas ICE Processing Center (Pearsall), T. Don Hutto
Residential Center.
Facilities where IHSC is not the medical authority:
Adelanto ICE Processing Center, Albany County Jail, Broward
Transitional Center, Central Arizona Florence Correctional
Complex East, Cibola County Correctional Center, Coastal Bend
Detention Facility, Denver Contract Detention Facility, East
Hidalgo Detention Center, El Valle Detention Facility,
Folkston ICE Processing Center (D. Ray James), Geauga County
Jail (OH).
IAH Polk Adult Detention Facility, Imperial Regional
Detention Facility, James A. Musick Facility, Jerome Combs
Detention Center, Joe Corley Detention Center, Johnson County
Law Enforcement, La Palma Correctional Center, Laredo
Processing Center, LaSalle County Regional Detention Center
(TX), McHenry County Jail (IL).
Mesa Verde ICE Processing Center, Northeast Ohio
Correctional Ctr (Youngstown CDF), Otay Mesa Detention Center
(San Diego CDF), Otero County Processing Center, Pine Prairie
ICE Processing Center, Prairieland Detention Facility,
Pulaski County Detention Center, Rio Grande Detention Center,
San Luis Detention Facility, Stewart Detention Center.
Tallahatchie County Correctional Center, Theo Lacey, Webb
County Detention Center (CCA), West Texas Detention Center,
York County Prison.
5. How many inter-facility detainee transfers have occurred
in the last 12 months nationwide and how many of the
detainees has ICE Health Services Corps determined to have
had a viral disease?
Response: ICE cannot statistically report this information
in the manner in which it was requested.
6. What is the ICE Health Service Corps protocol for
ensuring that newly-transferred detainees do not pose a
health risk to themselves or other detainees?
Response: At IHSC-staffed facilities, all detainees are
screened upon arriving at a facility and a prescreen is
conducted to identify those detainees who have acute or
urgent medical concerns so that further evaluation can be
prioritized. All facilities, including those at which ICE
houses its detainees pursuant to Intergovernmental Service
Agreements, conduct intake screenings to identify individuals
with time-sensitive health concerns.
7. What is the ICE Health Service Corps guidance in place
to prevent communicable diseases from spreading among
detainee populations?

[[Page E878]]

Response: Please see response to Question 2.
8. Which agency is responsible for oversight of the ICE
Health Service Corps protocols?
Response: IHSC is responsible for oversight of IHSC
protocols, which are only applicable in the 22 facilities for
which IHSC is the medical authority and where IHSC operates
the medical clinic. These protocols comply with state and
local requirements, as well as applicable detention
standards.
9. What role does the Centers for Disease Control and
Prevention (CDC) play in responding to public health risks at
ICE and contract detention facilities?
Response: ICE defers questions on CDC authorities and
responsibilities to the CDC. However, ICE notes that in
general, public health interventions fall under the authority
of local and state health departments, although state health
departments do occasionally request assistance from the CDC.
In ICE's case, IHSC routinely collaborates with the CDC on
public health interventions involving multiple jurisdictions.
____

U.S. Immigration and

Customs Enforcement,

June 28, 2019.
Hon. Jason Crow,
House of Representatives,
Washington, DC.
Dear Representative Crow: Thank you for your February 20,
2019 letter to the Department of Homeland Security.
I appreciate your concerns regarding the recent expansion
of the Denver Contract Detention Facility and welcome the
opportunity to address them more fully. Please see the
attached enclosure with responses to the specific questions
posed in your letter.
Thank you again for your letter and interest in this
important matter. Please contact the ICE Office of
Congressional Relations for additional assistance.
Sincerely,
Mark A. Morgan,
Acting Director.
____

The Department of Homeland Security's Response to Representative Jason
Crow's February 20, 2019 Letter

Please explain the number and types of disease outbreaks
(i.e., chicken pox) in the past year at the Denver Contract
Detention Facility in Aurora, including the number of
outbreaks requiring quarantines. What are the reporting
criteria and requirements for outbreaks and which entities
receive the reports?
The Denver Contract Detention Center (CDF) has had seven
cases of varicella and 15 probable or confirmed cases of
mumps over the past year.
In such cases, U.S. Immigration and Customs Enforcement's
(ICE) Health Service Corps (IHSC) Public Health, Safety, and
Preparedness Unit (PHSP) and the Colorado State Health
Department are notified. Per the ICE Performance-Based
National Detention Standards 2011 (PBNDS 2011), facilities
shall comply with current and future plans implemented by
federal, state, or local authorities addressing specific
public health issues including communicable disease reporting
requirements (specific requirements are codified in state
regulations). Designated medical staff shall notify the IHSC
PHSP of any ICE detainee with a significant communicable
disease and of any contact or outbreak investigations
involving ICE detainees exposed to a significant communicable
disease without known immunity.
Significant communicable diseases include, but are not
limited to, varicella (chicken pox), measles, mumps,
pertussis (whooping cough), and typhoid. Additionally, IHSC
provides a weekly cohort report to ICE Enforcement and
Removal Operations (ERO) leadership in those situations where
cohorting of exposed detainees is required.
2. What active have ICE and GEO taken to respond to the
recent varicella outbreaks and what measures are being put in
place to prevent future outbreaks?
When active varicella is suspected or confirmed, the
patient is isolated, placed under airborne precautions, and
the dorm in which the patient was housed is placed under
cohort status. In addition, dorm members and susceptible
contacts are then tested for their immune status if
documentation of immunity is not available. Contacts with a
positive titer, which is suggestive of immunity, can be
released from cohort status. Health care staff monitor the
dorms placed under cohort status daily to identify any new
patients with signs and symptoms of varicella. The GEO Group
Inc. (GEO) followed these precautions in the seven cases
identified.
Because medical staff from ICE and our vendor, GEO, often
do not know which detainees have been in contact with or
exposed to disease prior to being detained, observation of
early symptoms and prompt isolation are used to prevent the
spread of varicella. IHSC and GEO have also consulted with
the state and local health departments regarding their
recommendations.
Additionally, ICE notes that six of the seven varicella
cases were at the facility for less than three weeks prior to
diagnosis. The incubation period for varicella is 10 to 21
days, so it is not known whether they were exposed to
varicella before or after entering the facility. All seven
individuals came from a facility in California where they
were housed for only a few days after crossing the border.
3. Will ICE direct GEO to hire more properly-trained
medical staff to accommodate the increase in detainee
admissions? Please also describe what contract requirements
and oversight are in place to ensure that detainees receive
proper medical attention.
ICE continually evaluates medical services nationwide to
ensure the highest level of care for its detained population.
In accordance with the terms and conditions related to the
number of full-time equivalent (FTE) medical staff positions
in ICE's Federal Acquisition Regulation (FAR)-based contract
with GEO, the service provider conducted a staffing analysis
and created a staffing plan for the delivery of health care
services. FAR-based medical staffing plans, which typically
include additional FTEs for overtime, shift rotations, and
facility-specific circumstances, are reviewed by IHSC as part
of the initial acquisition process and, thereafter, as deemed
necessary by ICE. IHSC also has a Field Medical Coordinator
(FMC) assigned to the Denver Area of Responsibility who is
responsible for monitoring medical concerns at the Denver
CDF. The FMC works with local GEO medical staff to ensure
detainee healthcare services are being provided appropriately
and timely to detainees irrespective of the day-to-day
changes in the Denver CDF's admissions and releases. In
addition, the FMC receives reports regarding medical cases on
a routine basis.
All ICE-owned service processing centers, contract
detention facilities, and dedicated inter-governmental
service agreement facilities are inspected annually by an ICE
inspections contractor. ICE inspectors typically spend three
days auditing each facility. In addition to environmental
health, safety, and corrections experts, each inspection team
includes a Detainee Rights subject matter expert (SME) and a
health professional (e.g., physician, physician's assistant,
registered nurse, nurse practitioner, or a medical
professional SME). The health professional conducts a Quality
of Medical Care (QMC) review as part of the inspection, which
measures the quality of detainee health care across more than
20 areas of health care, including such measures as
medication, grievances, suicide watch, hunger strikes,
screening and health assessment, acute disease and chronic
conditions, sick call, urgent care, treatment of disability,
continuity of care, laboratory and diagnostics, staffing,
credentialing, and medical recordkeeping practices. The
results of the QMC are reviewed by the IHSC division.
In addition to the annual inspection, detention facilities
are also subject to a number of special assessments conducted
by ICE ERO, as well as audits, reviews, and site visits
conducted by the Office of Detention Oversight (ODO) within
the ICE Office of Professional Responsibility and by the OHS
Office for Civil Rights and Civil Liberties (CRCL). When
deficiencies are found during any type of inspection or
review, ICE works with the field offices and facilities and
collaborates with ICE ODO and CRCL to ensure timely and
appropriate corrective actions are implemented to address
issues and concerns.
4. What requirements are in the GEO contract or other ICE
guidance to ensure detainees are provided proper medical
care?
ICE takes the health, safety, and welfare of those in our
care very seriously. Comprehensive medical care is provided
from the moment detainees arrive in ICE custody and continues
throughout the entirety of their stay. This care includes an
initial health screening, as well as subsequent medical
visits, referrals to specialists, and 24-hour access to
emergency care as necessary.
Section IV.A.1.5-Management Plan of ICE's contract with GEO
states that GEO ``[u]understands the importance of a fully
qualified and trained professional staff in appropriate
number to operate a safe, secure, and efficient medical
department at the Aurora ICE Processing Center (the Center).
Our proposed staffing plan reflects a well thought out and
efficient strategy for staffing the Center in order to
provide detainees with access to medical care 24 hours a day
seven (7) days a week.''
Also, at Section IV.A.I.I-Quality Control and Assurance.
GEO is required to establish a Quality Control Plan governing
health services at the Center to ensure that healthcare
services are in compliance with the Performance Bases
National Detention Standards, court orders, American
Correctional Association (ACA) standards, standards
established by the National Commission of Correctional Health
Care (NCCHC), and specific client policies.
In addition, ICE's PBNDS 2011 clearly lay out the expected
outcomes and expected practices for detainee health care at
dedicated facilities like the Denver CDF in detention
standards 4.3-Medical Care and 4.4-Medical Care (Women).
These two standards cover topics such as designation of
authority, communicable disease and infection control,
notifying detainees about health care services, translation
and language access for detainees with limited English
proficiency, pharmaceutical management, medications, medical
personnel, medical and mental health screening of new
arrivals, substance dependence and detoxification,
comprehensive health assessment, mental health program,
medical/psychiatric alerts and holds, annual health
examinations, dental treatment, sick call, emergency medical
services and first aid, delivery of medication, health
education and wellness information, restraints, continuity of
care, informed consent and involuntary treatment, medical
records, and documentation.

[[Page E879]]

The Denver CDF is accredited by the ACA and the NCCHC, and
the facility is obligated to comply with the requirements of
both the ICE PBNDS 2011 and the DHS Prison Rape Elimination
Act regulations. On October 4, 2018, ICE's inspection
contractor, The Nakamoto Group, completed an annual detention
inspection. The Lead Compliance inspector recommended a final
rating of ``Meets Standards'' and reported zero deficiencies
in medical care.
5. Please describe the contract relationship between ICE
and GEO and attach copies of the relevant contract documents
(e.g. agreements, MOUs, guidance, etc.)
GEO was awarded an indefinite-delivery/indefinite-quantity
contract to provide detention services at the Denver CDF on
September 15, 2011. The contract period of performance
included a 2-year base period and four 2-year option periods.
The contract Period of Performance expires on September 16,
2021.
GEO provides full-time detention and transportation
services at the Denver CDF in Aurora, Colorado, for ICE
detainees. Services are provided in compliance with the ICE
PBNDS 2011, ACA standards for adult local detention
facilities, standards for health services in jails, NCCHC,
and other applicable state and local requirements.
6. Since 2015, how many 911 calls were placed from the
Facility to local and state emergency professionals?
ICE is unable to provide a response, as it does not track
this data. However, as previously noted, detainees have
access to 24-hour emergency care as necessary.
7. When privately contracted facilities fail to comply with
their contractual obligations, ICE has the opportunity to
issue compliance waivers forgiving contractors for the
breach. Has ICE issued any compliance waivers for the
Facility? If so, how many, and what were the justifications
for those waivers?
ICE has issued no compliance waiver to or on behalf of the
Denver CDF.
8. Since 2015, has ICE submitted a Contract Discrepancy
Report for the Facility following the granting of any
compliance waivers? If so, please attach and all such reports
in your response.
ICE has not submitted a Contract Discrepancy Report for the
facility.

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