[Congressional Bills 118th Congress]
[From the U.S. Government Publishing Office]
[H.R. 5605 Introduced in House (IH)]
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118th CONGRESS
1st Session
H. R. 5605
To require U.S. Customs and Border Protection to perform an initial
health screening on detainees, and for other purposes.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
September 20, 2023
Mr. Ruiz introduced the following bill; which was referred to the
Committee on the Judiciary, and in addition to the Committee on
Homeland Security, for a period to be subsequently determined by the
Speaker, in each case for consideration of such provisions as fall
within the jurisdiction of the committee concerned
_______________________________________________________________________
A BILL
To require U.S. Customs and Border Protection to perform an initial
health screening on detainees, and for other purposes.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
SECTION 1. SHORT TITLE; TABLE OF CONTENTS.
(a) Short Title.--This Act may be cited as the ``Humanitarian
Standards for Individuals in Customs and Border Protection Custody
Act''.
(b) Table of Contents.--The table of contents of this Act is as
follows:
Sec. 1. Short title; table of contents.
Sec. 2. Initial health screening protocol.
Sec. 3. Water, sanitation, and hygiene.
Sec. 4. Food and nutrition.
Sec. 5. Shelter.
Sec. 6. Coordination and surge capacity.
Sec. 7. Training.
Sec. 8. Interfacility transfer of care.
Sec. 9. Planning and initial implementation.
Sec. 10. Contractor compliance.
Sec. 11. Inspections.
Sec. 12. GAO report.
Sec. 13. Rules of construction.
Sec. 14. Definitions.
SEC. 2. INITIAL HEALTH SCREENING PROTOCOL.
(a) In General.--The Commissioner of U.S. Customs and Border
Protection (referred to in this Act as the ``Commissioner''), in
consultation with the Secretary of Health and Human Services, the
Administrator of the Health Resources and Services Administration, and
nongovernmental experts in the delivery of health care in humanitarian
crises and in the delivery of health care to children, shall develop
guidelines and protocols for the provision of health screenings and
appropriate medical care for individuals in the custody of U.S. Customs
and Border Protection (referred to in this Act as ``CBP''), as required
under this section.
(b) Initial Screening and Medical Assessment.--The Commissioner
shall ensure that any individual who is detained in the custody of CBP
(referred to in this Act as a ``detainee'') receives an initial in-
person screening by a licensed medical professional in accordance with
the standards described in subsection (c)--
(1) to assess and identify any illness, condition, or age-
appropriate mental or physical symptoms that may have resulted
from distressing or traumatic experiences;
(2) to identify acute conditions and high-risk
vulnerabilities; and
(3) to ensure that appropriate healthcare is provided to
individuals as needed, including pediatric, obstetric, and
geriatric care.
(c) Standardization of Initial Screening and Medical Assessment.--
(1) In general.--The initial screening and medical
assessment shall include--
(A) an interview and the use of a standardized
medical intake questionnaire or the equivalent;
(B) screening of vital signs, including pulse rate,
body temperature, blood pressure, oxygen saturation,
and respiration rate;
(C) screening for blood glucose for known or
suspected diabetics;
(D) weight assessment of detainees under 12 years
of age;
(E) a physical examination; and
(F) a risk-assessment and the development of a plan
for monitoring and care, when appropriate.
(2) Prescription medication.--The medical professional
shall review any prescribed medication that is in the
detainee's possession or that was confiscated by CBP upon
arrival and determine if the medication may be kept by the
detainee for use during detention, properly stored by CBP with
appropriate access for use during detention, or maintained with
the detained individual's personal property. A detainee may not
be denied the use of necessary and appropriate medication for
the management of the detainee's illness.
(3) Rule of construction.--Nothing in this subsection shall
be construed as requiring detainees to disclose their medical
status or history.
(d) Timing.--
(1) In general.--Except as provided in paragraph (2), the
initial screening and medical assessment described in
subsections (b) and (c) shall take place as soon as
practicable, but not later than 12 hours after a detainee's
arrival at a CBP facility.
(2) High priority individuals.--The initial screening and
medical assessment described in subsections (b) and (c) shall
take place as soon as practicable, but not later than 6 hours
after a detainee's arrival at a CBP facility if the individual
reasonably self-identifies as having a medical condition that
requires prompt medical attention or is--
(A) exhibiting signs of acute or potentially severe
physical or mental illness, or otherwise has an acute
or chronic physical or mental disability or illness;
(B) pregnant;
(C) a child (with priority given, as appropriate,
to the youngest children); or
(D) elderly.
(e) Further Care.--
(1) In general.--If, as a result of the initial health
screening and medical assessment, the licensed medical
professional conducting the screening or assessment determines
that one or more of the detainee's vital sign measurements are
significantly outside normal ranges in accordance with the
National Emergency Services Education Standards, or if the
detainee is identified as high-risk or in need of medical
intervention, the detainee shall be provided, as expeditiously
as possible, with an in-person or technology-facilitated
medical consultation with a licensed emergency care
professional.
(2) Re-evaluation.--
(A) In general.--Detainees described in paragraph
(1) shall be re-evaluated within 24 hours and monitored
thereafter as determined by an emergency care
professional (and in the care of a consultation
provided to a child, with a licensed emergency care
professional with a background in pediatric care).
(B) Reevaluation prior to transportation.--In
addition to the re-evaluations under subparagraph (A),
detainees shall have all vital signs re-evaluated and
be cleared as safe to travel by a medical professional
prior to transportation.
(3) Pyschological and mental care.--The Commissioner shall
ensure that detainees who have experienced physical or sexual
violence or who have experienced events that may cause severe
trauma or toxic stress, are provided access to basic, humane,
and supportive psychological assistance.
(f) Interpreters.--To ensure that health screenings and medical
care required under this section are carried out in the best interests
of the detainee, the Commissioner shall ensure that language-
appropriate interpretation services, including indigenous languages,
are provided to each detainee and that each detainee is informed of the
availability of interpretation services.
(g) Chaperones.--To ensure that health screenings and medical care
required under this section are carried out in the best interests of
the detainee--
(1) the Commissioner shall establish guidelines for and
ensure the presence of chaperones for all detainees during
medical screenings and examinations consistent with relevant
guidelines in the American Medical Association Code of Medical
Ethics, and recommendations of the American Academy of
Pediatrics; and
(2) to the extent practicable, the physical examination of
a child shall always be performed in the presence of a parent
or legal guardian or in the presence of the detainee's closest
present adult relative if a parent or legal guardian is
unavailable.
(h) Documentation.--The Commissioner shall ensure that the health
screenings and medical care required under this section, along with any
other medical evaluations and interventions for detainees, are
documented in accordance with commonly accepted standards in the United
States for medical record documentation. Such documentation shall be
provided to any individual who received a health screening and
subsequent medical treatment upon release from CBP custody.
(i) Infrastructure and Equipment.--The Commissioner or the
Administrator of General Services shall ensure that each location to
which detainees are first transported after an initial encounter with
an agent or officer of CBP has the following:
(1) A private space that provides a comfortable and
considerate atmosphere for the patient and that ensures the
patient's dignity and right to privacy during the health
screening and medical assessment and any necessary follow-up
care.
(2) All necessary and appropriate medical equipment and
facilities to conduct the health screenings and follow-up care
required under this section, to treat trauma, to provide
emergency care, including resuscitation of individuals of all
ages, and to prevent the spread of communicable diseases.
(3) Basic over-the-counter medications appropriate for all
age groups.
(4) Appropriate transportation to medical facilities in the
case of a medical emergency, or an on-call service with the
ability to arrive at the CBP facility within 30 minutes.
(j) Personnel.--The Commissioner or the Administrator of General
Services shall ensure that each location to which detainees are first
transported after an initial encounter has onsite at least one licensed
medical professional to conduct health screenings. Other personnel that
are or may be necessary for carrying out the functions described in
subsection (e), such as licensed emergency care professionals,
specialty physicians (including physicians specializing in pediatrics,
family medicine, obstetrics and gynecology, geriatric medicine,
internal medicine, and infectious diseases), nurse practitioners, other
nurses, physician assistants. licensed social workers, mental health
professionals, public health professionals, dieticians, interpreters,
and chaperones, shall be located on site to the extent practicable, or
if not practicable, shall be available on call.
(k) Ethical Guidelines.--The Commissioner shall ensure that all
medical assessments and procedures conducted pursuant to this section
are conducted in accordance with ethical guidelines in the applicable
medical field, and respect human dignity.
SEC. 3. WATER, SANITATION, AND HYGIENE.
The Commissioner shall ensure that detainees have access to--
(1) not less than 1 gallon of drinking water per person per
day, and age-appropriate fluids as needed;
(2) a private, safe, clean, and reliable permanent or
portable toilet with proper waste disposal and a hand washing
station, with not less than 1 toilet available for every 12
male detainees, and 1 toilet for every 8 female detainees;
(3) a clean diaper changing facility, which includes proper
waste disposal, a hand washing station, and unrestricted access
to diapers;
(4) the opportunity to bathe daily in a permanent or
portable shower that is private and secure; and
(5) products for individuals of all age groups and with
disabilities to maintain basic personal hygiene, including
soap, a toothbrush, toothpaste, adult diapers, and feminine
hygiene products, as well as receptacles for the proper storage
and disposal of such products.
SEC. 4. FOOD AND NUTRITION.
The Commissioner shall ensure that detainees have access to--
(1) three meals per day including--
(A) in the case of an individual age 12 or older, a
diet that contains not less than 2,000 calories per
day; and
(B) in the case of a child who is under the age of
12, a diet that contains an appropriate number of
calories per day based on the child's age and weight;
(2) accommodations for any dietary needs or restrictions;
and
(3) access to food in a manner that follows applicable food
safety standards.
SEC. 5. SHELTER.
The Commissioner shall ensure that each facility at which a
detainee is detained meets the following requirements:
(1) Except as provided in paragraph (2), males and females
shall be detained separately.
(2) In the case of a minor child arriving in the United
States with an adult relative or legal guardian, such child
shall be detained with such relative or legal guardian unless
such an arrangement poses safety or security concerns. In no
case shall a minor who is detained apart from an adult relative
or legal guardian as a result of such safety or security
concerns be detained with other adults.
(3) In the case of an unaccompanied minor arriving in the
United States without an adult relative or legal guardian, such
child shall be detained in an age-appropriate facility and
shall not be detained with adults.
(4) A detainee with a temporary or permanent disability
shall be held in an accessible location and in a manner that
provides for his or her safety, comfort, and security, with
accommodations provided as needed.
(5) No detainee shall be placed in a room for any period of
time if the detainee's placement would exceed the maximum
occupancy level as determined by the appropriate building code,
fire marshal, or other authority.
(6) Each detainee shall be provided with temperature
appropriate clothing and bedding.
(7) The facility shall be well lit and well ventilated,
with the humidity and temperature kept at comfortable levels
(between 68 and 74 degrees Fahrenheit).
(8) Detainees who are in custody for more than 48 hours
shall have access to the outdoors for not less than 1 hour
during the daylight hours during each 24-hour period.
(9) Detainees shall have the ability to practice their
religion or not to practice a religion, as applicable.
(10) Detainees shall have access to lighting and noise
levels that are safe and conducive for sleeping throughout the
night between the hours of 10 p.m. and 6 a.m.
(11) Officers, employees, and contracted personnel of CBP
shall--
(A) follow medical standards for the isolation and
prevention of communicable diseases; and
(B) ensure the physical and mental safety of
detainees who identify as lesbian, gay, bisexual,
transgender, and intersex.
(12) The facility shall have video-monitoring to provide
for the safety of the detained population and to prevent sexual
abuse and physical harm of vulnerable detainees.
(13) The Commissioner shall ensure that language-
appropriate ``Detainee Bill of Rights'', including indigenous
languages, are posted or otherwise made available in all areas
where detainees are located. The ``Detainee Bill of Rights''
shall include all rights afforded to the detainee under this
Act.
(14) Video from video-monitoring must be preserved for 90
days and the detention facility must maintain certified records
that the video-monitoring is properly working at all times.
SEC. 6. COORDINATION AND SURGE CAPACITY.
The Secretary of Homeland Security shall enter into memoranda of
understanding with appropriate Federal agencies, such as the Department
of Health and Human Services, and applicable emergency government
relief services, as well as contracts with health care, public health,
social work, and transportation professionals, for purposes of
addressing surge capacity and ensuring compliance with this Act.
SEC. 7. TRAINING.
The Commissioner shall ensure that CBP personnel assigned to each
short-term custodial facility are professionally trained, including
continuing education as the Commissioner deems appropriate, in all
subjects necessary to ensure compliance with this Act, including--
(1) humanitarian response protocols and standards;
(2) indicators of physical and mental illness, and medical
distress in children and adults;
(3) indicators of child sexual exploitation and effective
responses to missing migrant children; and
(4) procedures to report incidents of suspected child
sexual abuse and exploitation directly to the National Center
for Missing and Exploited Children.
SEC. 8. INTERFACILITY TRANSFER OF CARE.
(a) Transfer.--When a detainee is discharged from a medical
facility or emergency department, the Commissioner shall ensure that
responsibility of care is transferred from the medical facility or
emergency department to an accepting licensed health care provider of
CBP.
(b) Responsibilities of Accepting Providers.--Such accepting
licensed health care provider shall review the medical facility or
emergency department's evaluation, diagnosis, treatment, management,
and discharge care instructions to assess the safety of the discharge
and transfer and to provide necessary follow-up care.
SEC. 9. PLANNING AND INITIAL IMPLEMENTATION.
(a) Planning.--Not later than 60 days after the date of enactment
of this Act, the Secretary of Homeland Security shall submit to
Congress a detailed plan delineating the timeline, process, and
challenges of carrying out the requirements of this Act.
(b) Implementation.--The Secretary of Homeland Security shall
ensure that the requirements of this Act are implemented not later than
6 months after the date of enactment.
SEC. 10. CONTRACTOR COMPLIANCE.
The Secretary of Homeland Security shall ensure that all personnel
contracted to carry out this Act do so in accordance with the
requirements of this Act.
SEC. 11. INSPECTIONS.
(a) In General.--The Inspector General of the Department of
Homeland Security shall--
(1) conduct unannounced inspections of ports of entry,
border patrol stations, and detention facilities administered
by CBP or contractors of CBP; and
(2) submit to Congress, reports on the results of such
inspections as well as other reports of the Inspector General
related to custody operations.
(b) Particular Attention.--In carrying out subsection (a), the
Inspector General of the Department of Homeland Security shall pay
particular attention to--
(1) the degree of compliance by CBP with the requirements
of this Act;
(2) remedial actions taken by CBP;
(3) the health needs of detainees; and
(4) the degree of compliance with part 115 of title 6, Code
of Federal Regulations (commonly known as the ``Standards To
Prevent, Detect, and Respond to Sexual Abuse and Assault in
Confinement Facilities'').
(c) Access to Facilities.--The Commissioner may not deny a Member
of Congress entrance to any facility or building used, owned, or
operated by CBP.
SEC. 12. GAO REPORT.
(a) In General.--The Comptroller General of the United States
shall--
(1) not later than 6 months after the date of enactment of
this Act, commence a study on implementation of, and compliance
with, this Act; and
(2) not later than 1 year after the date of enactment of
this Act, submit a report to Congress on the results of such
study.
(b) Issues To Be Studied.--The study required by subsection (a)
shall examine the management and oversight by CBP of ports of entry,
border patrol stations, and other detention facilities, including the
extent to which CBP and the Department of Homeland Security have
effective processes in place to comply with this Act. The study shall
also examine the extent to which CBP personnel, in carrying out this
Act, make abusive, derisive, profane, or harassing statements or
gestures, or engage in any other conduct evidencing hatred or invidious
prejudice to or about one person or group on account of race, color,
religion, national origin, sex, sexual orientation, age, or disability,
including on social media.
SEC. 13. RULES OF CONSTRUCTION.
Nothing in this Act may be construed--
(1) as authorizing CBP to detain individuals for longer
than 72 hours;
(2) as contradicting the March 7, 2014, Department of
Homeland Security rule adopting Standards to Prevent, Detect,
and Respond to Sexual Abuse and Assault in Confinement
Facilities, which includes a zero tolerance policy prohibiting
all forms of sexual abuse and assault of individuals in U.S.
Customs and Border Protection custody, including in holding
facilities, during transport, and during processing;
(3) as contradicting current protocols related to
Department background checks in the hiring process;
(4) as restricting the Department from denying employment
to or terminating the employment of any individual who would be
or is involved with the handling or processing at holding
facilities, during transport, or during processing, or care of
detainees, including the care of children, and has been
convicted of a sex crime or other offense involving a child
victim; or
(5) as affecting the obligation to fully comply with all
applicable immigration laws, including being subject to any
penalties, fines, or other sanctions.
SEC. 14. DEFINITIONS.
In this Act:
(1) Interpretation services.--The term ``interpretation
services'' includes translation services that are performed
either in-person or through a telephone or video service.
(2) Child.--The term ``child'' has the meaning given the
term in section 101(b)(1) of the Immigration and Nationality
Act (8 U.S.C. 1101(b)(1)).
(3) U.S. customs and border protection facility.--The term
``U.S. Customs and Border Protection Facility'' includes--
(A) U.S. Border Patrol stations;
(B) ports of entry;
(C) checkpoints;
(D) forward operating bases;
(E) secondary inspection areas; and
(F) short-term custody facilities.
(4) Forward operating base.--The term ``forward operating
base'' means a permanent facility established by CBP in forward
or remote locations, and designated as such by CBP.
(5) Publication of data on complaints of sexual abuse at
cbp facilities.--Not later than 90 days after the date of
enactment of this Act, the Secretary of Homeland Security,
acting in coordination with the Office of Inspector General and
Office for Civil Rights and Civil Liberties, shall publicly
release aggregate data on complaints of sexual abuse at CBP
facilities on its website on a quarterly basis, excluding any
personally identifiable information that may compromise the
confidentiality of individuals who reported abuse.
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