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116th Congress     }                                    {       Report
                        HOUSE OF REPRESENTATIVES
 1st Session       }                                    {      116-211

======================================================================



 
           U.S. BORDER PATROL MEDICAL SCREENING STANDARDS ACT

                                _______
                                

 September 18, 2019.--Committed to the Committee of the Whole House on 
            the State of the Union and ordered to be printed

                                _______
                                

 Mr. Thompson of Mississippi, from the Committee on Homeland Security, 
                        submitted the following

                              R E P O R T

                             together with

                             MINORITY VIEWS

                        [To accompany H.R. 3525]

      [Including cost estimate of the Congressional Budget Office]

    The Committee on Homeland Security, to whom was referred 
the bill (H.R. 3525) to amend the Homeland Security Act of 2002 
to direct the Commissioner of U.S. Customs and Border 
Protection to establish uniform processes for medical screening 
of individuals interdicted between ports of entry, and for 
other purposes, having considered the same, report favorably 
thereon with an amendment and recommend that the bill as 
amended do pass.

                                CONTENTS

                                                                   Page
Purpose and Summary..............................................     3
Background and Need for Legislation..............................     4
Hearings.........................................................     4
Committee Consideration..........................................     5
Committee Votes..................................................     6
Committee Oversight Findings.....................................     7
New Budget Authority, Entitlement Authority, and Tax Expenditures     7
Congressional Budget Office Estimate.............................     7
Statement of General Performance Goals and Objectives............     8
Duplicative Federal Programs.....................................     8
Congressional Earmarks, Limited Tax Benefits, and Limited Tariff 
  Benefits.......................................................     8
Federal Mandates Statement.......................................
Preemption Clarification.........................................
Disclosure of Directed Rule Makings..............................
Advisory Committee Statement.....................................
Applicability to Legislative Branch..............................
Section-by-Section Analysis of the Legislation...................     8
Changes in Existing Law Made by the Bill, as Reported............     9
Minority Views...................................................    12

    The amendment is as follows:
  Strike all after the enacting clause and insert the 
following:

SECTION 1. SHORT TITLE.

  This Act may be cited as the ``U.S. Border Patrol Medical Screening 
Standards Act''.

SEC. 2. UNIFORM PROCESSES FOR MEDICAL SCREENING OF INDIVIDUALS 
                    INTERDICTED BETWEEN PORTS OF ENTRY.

  (a) In General.--Subtitle C of title IV of the Homeland Security Act 
of 2002 (6 U.S.C. 231) is amended by adding at the end the following 
new section:

``SEC. 437. MEDICAL SCREENING OF INDIVIDUALS INTERDICTED BETWEEN PORTS 
                    OF ENTRY.

  ``(a) In General.--To improve border security and the processing of 
individuals and families interdicted by the U.S. Border Patrol between 
ports of entry, the Commissioner of U.S. Customs and Border Protection, 
in coordination with the Chief Medical Officer of the Department, 
shall, not later than 30 days after the date of the enactment of this 
section, establish uniform processes and training to ensure consistent 
and efficient medical screening of all individuals, with priority given 
to children who have not yet attained the age of 18, so interdicted 
before transfer from U.S. Customs and Border Protection custody, but in 
no case longer than 12 hours after such interdiction, or 6 hours in the 
case of a high priority individual. Such screening should be conducted 
by a medical professional and should be developed in collaboration with 
non-governmental experts in the delivery of health care in humanitarian 
crises and in the delivery of health care to children.
  ``(b) Screening Process Components.--At a minimum, the uniform 
processes and training established under subsection (a) shall include 
the following:
          ``(1) Requirements for initial in-person screening that 
        includes documentation of the following:
                  ``(A) Visual assessment of overall physical and 
                behavioral state, including any possible disability.
                  ``(B) A brief medical history, including demographic 
                information, current medications (including a list of 
                confiscated medications and whether such have been 
                replaced), and any chronic or past illnesses.
                  ``(C) Any current medical complaints.
                  ``(D) A physical examination that includes the 
                screening of vital signs such as body temperature, 
                pulse rate, and blood pressure.
          ``(2) Criteria for determining when to make a referral to 
        higher medical care and a process to execute such referral.
          ``(3) Recordkeeping requirements regarding how information is 
        to be recorded for each initial screening under paragraph (1), 
        including information on the use of interpretation services.
          ``(4) Review by a medical professional of any prescribed 
        medication that is in the detainee's possession or that was 
        confiscated upon arrival to determine if such medication may be 
        kept by such detainee for use during detention, properly stored 
        with appropriate access for use during detention, or maintained 
        with a detainee's personal property.
          ``(5) Chaperones for the physical examination of minors, 
        including, as appropriate, the parent, legal guardian, or the 
        such minors' closest present adult relative, or a U.S. Border 
        Patrol agent of the same gender.
  ``(c) Pediatric Expertise.--A pediatric medical expert shall be on 
site in every U.S. Border Patrol sector, including at U.S. Border 
Patrol processing centers and at U.S. Border Patrol facilities at which 
20 percent or more of detained individuals over the immediately 
preceding six month period are minors. The Chief of the U.S. Border 
Patrol shall prepare a plan to deploy in-person or technology-
facilitated medical consultation with a licensed medical professional 
to U.S. Border Patrol facilities that experience an increase in 
apprehensions of children greater than 10 percent over the preceding 60 
days.
  ``(d) Definition.--In this section, the term `high priority 
individual' means an individual who self-identifies as having a medical 
condition needing prompt attention, exhibits signs of acute illness, is 
pregnant, is a child, or is elderly.
  ``(e) Training.--Not later than 60 days after the issuance of the 
uniform processes and training established under subsection (a), the 
Commissioner of U.S. Customs and Border Protection shall ensure that 
any individual carrying out medical screening under this section at a 
U.S. Customs and Border Protection facility of individuals interdicted 
by the U.S. Border Patrol between ports of entry shall complete 
training on such uniform processes.''.
  (b) Rule of Construction.--Nothing in this section or the amendment 
made by this section may be construed as authorizing U.S. Customs and 
Border Protection to detain individuals for longer than 72 hours.
  (c) Clerical Amendment.--The table of contents in section 1(b) of the 
Homeland Security Act of 2002 is amended by inserting after the item 
relating to section 436 the following new item:

``Sec. 437. Medical screening of individuals interdicted between ports 
of entry.''.

SEC. 3. RESEARCH REGARDING PROVISION OF MEDICAL SCREENING OF 
                    INDIVIDUALS INTERDICTED BY U.S. CUSTOMS AND BORDER 
                    PROTECTION BETWEEN PORTS OF ENTRY.

  (a) In General.--Not later than one year after the date of the 
enactment of this Act, the Secretary of Homeland Security, acting 
through the Under Secretary for Science and Technology of the 
Department of Homeland Security, in coordination with the Commissioner 
of U.S. Customs and Border Protection and the Chief Medical Officer of 
the Department, shall research innovative approaches to address 
capability gaps regarding the provision of comprehensive medical 
screening of individuals, particularly children, pregnant women, the 
elderly, and other vulnerable populations, interdicted by U.S. Customs 
and Border Protection between ports of entry and issue to the Secretary 
recommendations for any necessary corrective actions.
  (b) Consultation.--In carrying out the research required under 
subsection (a), the Under Secretary for Science and Technology of the 
Department of Homeland Security shall consult with appropriate national 
professional associations with expertise and non-governmental experts 
in emergency, nursing, and other medical care, including pediatric 
care.
  (c) Report.--The Secretary of Homeland Security shall submit to the 
Committee on Homeland Security of the House of Representatives and the 
Committee on Homeland Security and Governmental Affairs of the Senate a 
report containing the recommendations referred to in subsection (a), 
together with information relating to what actions, if any, the 
Secretary plans to take in response to such recommendations.

SEC. 4. ELECTRONIC HEALTH RECORDS IMPLEMENTATION.

  (a) In General.--Not later than 30 days after the date of the 
enactment of this Act, the Chief Information Officer of the Department 
of Homeland Security, in coordination with the Chief Medical Officer of 
the Department, shall establish within the Department an electronic 
health record system that can be accessed by all departmental 
components operating along the borders of the United States for 
individuals in the custody of such components.
  (b) Assessment.--Not later than 120 days after the implementation of 
the electronic health records system, the Chief Information Officer, in 
coordination with the Chief Medical Officer, shall conduct an 
assessment of such system to determine system capacity for improvement 
and interoperability.

                          Purpose and Summary

    H.R. 3525, the ``U.S. Border Patrol Medical Screening 
Standards Act,'' improves on existing medical screenings 
performed by U.S. Border Patrol. The bill requires U.S. Customs 
and Border Protection (CBP), in conjunction with the Chief 
Medical Officer (CMO) of the Department of Homeland Security 
(DHS or Department), to establish uniform standards and 
training for an initial medical screening of all individuals 
apprehended by U.S. Border Patrol, with priority given to 
children under the age of 18. The bill provides deadlines for 
screenings to be completed and specifies elements that must be 
a part of the screening. These efforts would establish a 
consistent medical screening process to be carried out by 
trained personnel at all U.S. borders. To further improve 
medical screenings by U.S. Border Patrol, H.R. 3525 requires 
the Department to establish a pediatric medical presence along 
the border, research innovative solutions to address any 
capability gaps, and mandates the use of electronic health 
records for individuals in DHS custody. These are critical 
steps to safeguard against further deaths at our borders.

                  Background and Need for Legislation

    In December of 2018, the public learned about the deaths of 
Jakelin Caal Maquin and Felipe Alonzo-Gomez, two migrant 
children who passed away while in the custody of the U.S. 
Border Patrol. Following their deaths, CBP announced new 
medical screening procedures for children in its custody. 
Despite this added measure, there have been additional deaths 
in CBP custody, with a total of six children have passed away 
since 2018. In the decade proceeding 2018, not one child died 
while in CBP custody.\1\
---------------------------------------------------------------------------
    \1\Commissioner Kevin McAleenan, CBS This Morning, December 26, 
2018, ```We need a different approach,' says border protection chief 
after 2nd migrant child dies in U.S. custody.'' Available at: https://
www.cbsnews.com/news/customs-and-border-protection-chief-kevin-
mcaleenan-on-migrant-child-death/.
---------------------------------------------------------------------------
    The Committee received testimony in March 2019 from the 
American Academy of Pediatrics that detailed the challenges of 
providing medical care for children. Children's vital signs 
have different normal parameters than adults and they vary by 
age. When children become ill, the symptoms are subtler, can be 
easily overlooked, and escalate quickly. A child can be happily 
playing even as their physical systems are shutting down. 
Conditions like the flu and sepsis can be particularly serious 
for children because symptoms are not easily recognizable to 
the untrained eye and with sepsis, each hour of delayed 
treatment dramatically increases morbidity. Significantly, the 
flu or sepsis played a role in the deaths of at least four of 
the six children who passed away in CBP custody.\2\
---------------------------------------------------------------------------
    \2\Robert Moore, ``Autopsy Offers Jarring New Details About the 
Death of a 16-year-old Guatemalan Boy,'' Texas Monthly, July 24, 2019. 
See also, Molly Hennessy-Fiske, ``Six migrant children have died in 
U.S. custody. Here's what we know about them,'' Los Angeles Times, May 
24, 2019.
---------------------------------------------------------------------------
    Medical professionals continue to find that the CBP medical 
screening process at the border is inadequate for children.\3\ 
Directing DHS to explore new approaches or solutions for the 
medical screening process will help ensure that medical 
screenings conducted at the border improve. Additionally, the 
implementation of electronic health records for screened 
individuals is critical. Such a system should be able to be 
accessed by any DHS component at the border to reduce reliance 
on hard copy records, lessen the risk of lost health records, 
and ensure DHS personnel or contractors are not needlessly 
duplicating medical checks or procedures. This will not only 
ensure continuity of care but better facilitate custody 
transfers between DHS components.
---------------------------------------------------------------------------
    \3\Bob Ortega, ``Doctor says Border Patrol often misses early signs 
of illness in migrant children,'' CNN, July 1, 2019.
---------------------------------------------------------------------------

                                Hearings

    For the purposes of section 103(i) of H. Res. 6 of the 
116th Congress, the following hearings were used to develop 
H.R. 3525:
           On March 6, 2019, the Committee held a 
        hearing entitled ``The Way Forward on Border 
        Security.'' The Committee received testimony from 
        Kirstjen Nielsen, Secretary of Homeland Security.
           On March 26, 2019 the Subcommittee on Border 
        Security, Facilitation, and Operations held a hearing 
        entitled ``The Department of Homeland Security's Family 
        Separation Policy: Perspectives from the Border.'' The 
        Subcommittee received testimony from Jennifer Podkul, 
        Director of Policy, Kids in Need of Defense; Michelle 
        Brane, Director for Migrant Rights and Justice, Women's 
        Refugee Commission; Dr. Julie M. Linton, Co-Chair, 
        Immigrant Health Special Interest Group, American 
        Academy of Pediatrics; Tim Ballard, Founder and CEO, 
        Operation Underground Railroad.
           On May 9, 2019, the Subcommittee on Border 
        Security, Facilitation, and Operations held a hearing 
        entitled ``A Review of the FY 2020 Budget Request for 
        U.S. Customs and Border Protection, U.S. Immigration 
        and Customs Enforcement, and U.S. Citizenship and 
        Immigration Services.'' The Subcommittee received 
        testimony from Robert E. Perez, Deputy Commissioner, 
        U.S. Customs and Border Protection; Matthew T. Albence, 
        Acting Director, U.S. Immigration and Customs 
        Enforcement; Tracy Renaud, Acting Deputy Director, U.S. 
        Citizenship and Immigration Services.
           On May 22, 2019, the Committee held a 
        hearing entitled ``A Review of the Fiscal Year 2020 
        Budget Request for the Department of Homeland 
        Security.'' The Committee received testimony from Kevin 
        K. McAleenan, Acting Secretary of Homeland Security.

                        Committee Consideration

    The Committee met on July 17, 2019, to consider H.R. 3525 
and ordered the measure to be reported to the House with a 
favorable recommendation, with amendment, by voice vote.
    The following Amendments were offered and accepted by voice 
vote:
    An amendment in the Nature of a Substitute offered by Ms. 
Underwood (#1);
    An amendment offered by Ms. Underwood:
    Page 2, line 1, insert ``, with priority given to children 
who have not yet attained the age of 18,'' after 
``individuals''.
    Page 2, line 3, strike ``of such interdiction'' and insert 
``after such interdiction, or six hours in the case of a high 
priority individual. Such screening should be conducted by a 
medical professional and should be developed in collaboration 
with non-governmental experts in the delivery of health care in 
humanitarian crises and in the delivery of health care to 
children.''.
    Page 2, line 7, insert ``in-person'' after ``initial''.
    Page 2, line 13, insert ``(including a list of confiscated 
medications and whether such have been replaced)'' after 
``current medications''.
    Page 2, line 16, insert the following: (D) A physical 
examination that includes the screening of vital signs such as 
body temperature, pulse rate, and blood pressure.''.
    Page 2, line 23, insert the following:

                  ``(4) Review by a medical professional of any 
                prescribed medication that is in the detainee's 
                possession or that was confiscated upon arrival 
                to determine if such medication may be kept by 
                such detainee for use during detention, 
                properly stored with appropriate access for use 
                during detention, or maintained with a 
                detainee's personal property.
                  (5) Chaperones for the physical examination 
                of minors, including, as appropriate, the 
                parent, legal guardian, or the such minors' 
                closest present adult relative, or a U.S. 
                Border Patrol agent of the same gender.
    (c) Pediatric Expertise.--A pediatric medical expert shall 
be on site in every U.S. Border Patrol sector, including at 
U.S. Border Patrol processing centers and at U.S. Border Patrol 
facilities at which 20 percent or more of detained individuals 
over the immediately preceding six month period are minors. The 
Chief of the U.S. Border Patrol shall prepare a plan to deploy 
in-person or technology-facilitated medical consultation with a 
licensed medical professional to U.S. Border Patrol facilities 
that experience an increase in apprehensions of children 
greater than 10 percent over the preceding 60 days.
    (d) Definition. In this section, the term `high priority 
individual' means an individual who self-identifies as having a 
medical condition needing prompt attention, exhibits signs of 
acute illness, is pregnant, is a child, or is elderly.''.

    Page 3, line 6, insert the following: ``(b) Rule of 
Construction.--Nothing in this section or the amendment made by 
this section may be construed as authorizing U.S. Customs and 
Border Protection to detain individuals for longer than 72 
hours.''
    Page 4, line 7, insert ``and non-governmental experts'' 
after ``expertise''.
    Page 4, line 8, strike ``expertise in''.
    Page 4, strike line 18 to end, and insert new section 4,

``SEC. 4. ELECTRONIC HEALTH RECORDS IMPLEMENTATION.

    (a) In General.--Not later than 30 days after the date of 
the enactment of this Act, the Chief Information Officer of the 
Department of Homeland Security, in coordination with the Chief 
Medical Officer of the Department, shall establish within the 
Department an electronic health record system that can be 
accessed by all departmental components operating along the 
borders of the United States for individuals in the custody of 
such components.
    (b) Assessment.--Not later than 120 days after the 
implementation of the electronic health records system, the 
Chief Information Officer, in coordination with the Chief 
Medical Officer, shall conduct an assessment of such system to 
determine system capacity for improvement and interoperability.

                            Committee Votes

    Clause 3(b) of rule XIII of the Rules of the House of 
Representatives requires the Committee to list the recorded 
votes on the motion to report legislation and amendments 
thereto.
    No recorded votes were requested during consideration of 
H.R. 3525.

                      Committee Oversight Findings

    In compliance with clause 3(c)(1) of rule XIII of the Rules 
of the House of Representatives, the Committee advises that the 
findings and recommendations of the Committee, based on 
oversight activities under clause 2(b)(1) of rule X of the 
Rules of the House of Representatives, are incorporated in the 
descriptive portions of this report.

Congressional Budget Office Estimate New Budget Authority, Entitlement 
                    Authority, and Tax Expenditures

    With respect to the requirements of clause 3(c)(2) of rule 
XIII of the Rules of the House of Representatives and section 
308(a) of the Congressional Budget Act of 1974 and with respect 
to requirements of clause (3)(c)(3) of rule XIII of the Rules 
of the House of Representatives and section 402 of the 
Congressional Budget Act of 1974, the Committee adopts as its 
own the estimate of the estimate of new budget authority, 
entitlement authority, or tax expenditures or revenues 
contained in the cost estimate prepared by the Director of the 
Congressional Budget Office.

H.R. 3525--Enhanced Border Security and Visa Entry Reform Act of 2002

    CBO estimates that H.R. 3525 (enacted as Public Law 107-
173) will result in no significant net cost to the federal 
government. The act will affect direct spending, but we 
estimate that any net effects will not be significant.
    H.R. 3525 sets the amount of the machine-readable visa 
(MRV) fee at $65 and establishes a surcharge of $10 for issuing 
an MRV in a nonmachine-readable passport. Under prior law, the 
Secretary of State had the authority to raise MRV fees at his 
discretion, and on June 1, 2002, the department implemented a 
new schedule of consular fees, including an increase in the MRV 
fee from $45 to $65. According to the State Department, it 
would be nearly impossible to collect the $10 surcharge under 
the existing application procedures because banks that collect 
various application fees would be unable to distinguish 
machine-readable passports from nonmachine-readable ones. 
Because the State Department currently does not have a specific 
plan for collecting the new surcharge, CBO cannot estimate the 
additional amounts that will be collected and spent, but the 
net effects will not be significant in any year.
    H.R. 3525 also will increase the penalty from $300 to 
$1,000 for improper submission of passenger manifests by 
carriers entering United States ports. This provision will 
increase both collections and spending of such penalties by the 
Immigration and Naturalization Service (INS), but CBO estimates 
that the net effect will be less than $500,000 annually.
    The CBO staff contacts for this estimate are Mark Grabowicz 
(for INS costs) and Sunita D'Monte (for State Department 
costs). This estimate was approved by Peter H. Fontaine, Deputy 
Assistant Director for Budget Analysis.

                      Duplicative Federal Programs

    The Committee adopts as its own the estimate of Federal 
mandates prepared by the Director of the Congressional Budget 
Office pursuant to section 423 of the Unfunded Mandates Reform 
Act.

                    Performance Goals and Objectives

    The Committee states that pursuant to clause 3(c)(4) of 
rule XIII of the Rules of the House of Representatives, H.R. 
3525 would require the Department of Homeland Security to make 
certain improvements to medical screening of individuals 
apprehended at the border.

                          Advisory on Earmarks

    In compliance with rule XXI of the Rules of the House of 
Representatives, this bill, as reported, contains no 
congressional earmarks, limited tax benefits, or limited tariff 
benefits as defined in clause 9(d), 9(c), or 9(f) of the rule 
XXI.

             Section-by-Section Analysis of the Legislation


Section 1. Short title

    This section provides that this bill may be cited as the 
``U.S. Border Patrol Medical Screening Standards Act''.

Sec. 2. Uniform medical screening process for apprehensions

    This section amends the Homeland Security Act to require 
the Commissioner of U.S. Customs and Border Protection (CBP), 
in coordination with the Department's Chief Medical Officer 
(CMO), to establish uniform medical screening processes and 
training not later than 30 days after enactment. The U.S. 
Border Patrol, in turn, will be required to use these processes 
to conduct consistent and efficient medical screening of all 
apprehended individuals with priority given to children under 
the age of 18. Such screening is to occur before the individual 
is transferred from CBP custody or within 12 hours of 
apprehension, whichever is shortest. An individual who self-
identifies as having a medical condition needing prompt 
attention, exhibits signs of acute illness, is pregnant, is a 
child, or is elderly, is to be considered a high-priority 
individual and should be screened within six hours of 
apprehension. This section lists the minimum requirements that 
must be a part of the screening process and requires pediatric 
medical expert presence on site in every U.S. Border Patrol 
sector, processing center, and facility with a significant 
presence of children.
    This section also requires that not later than 60 days 
after the establishment of uniform processes and training, the 
CBP Commissioner ensure that the individuals conducting such 
screening shall be trained on the process to ensure consistent 
assessments and operations along the borders of the United 
States.

Sec. 3. Research improvements to medical screening

    Not later than one year after enactment, the Secretary of 
Homeland Security, acting through the Under Secretary for 
Science and Technology, in coordination with the CBP 
Commissioner and CMO, are required to research innovative 
solutions to address any capability gaps in the screening of 
individuals apprehended by U.S. Border Patrol. In carrying out 
this research, national professional associations and non-
governmental experts in relevant medical fields are to be 
consulted. Any recommendations resulting from such research are 
to be submitted by the Secretary to the House Committee on 
Homeland Security and the Senate Committee on Homeland Security 
and Governmental Affairs along with information on what actions 
the Secretary plans in response to the recommendations.

Sec. 4. Electronic health records implementation

    This section requires the Department's Chief Information 
Officer (CIO) and CMO to establish an electronic health record 
system for individuals in DHS custody along the borders of the 
United States not later than 30 days after enactment. All the 
DHS components who operate along the borders should be able to 
access the records in the system. Not later than 120 days after 
implementation of the system, the CIO and CMO will assess the 
system to determine its interoperability and identify needed 
improvements. Presently, DHS does not have a fully-integrated 
electronic records system to ensure that each component 
involved in the care of an apprehended individual has access to 
any records from an initial health screening and information on 
any health conditions warranting certain care.

         Changes in Existing Law Made by the Bill, as Reported

  In compliance with clause 3(e) of rule XIII of the Rules of 
the House of Representatives, changes in existing law made by 
the bill, as reported, are shown as follows (new matter is 
printed in italic and existing law in which no change is 
proposed is shown in roman):

                     HOMELAND SECURITY ACT OF 2002

SECTION 1. SHORT TITLE; TABLE OF CONTENTS.

  (a) Short Title.--This Act may be cited as the ``Homeland 
Security Act of 2002''.
  (b) Table of Contents.--The table of contents for this Act is 
as follows:

Sec. 1. Short title; table of contents.
     * * * * * * *

                  Subtitle C--Miscellaneous Provisions

Sec. 437. Medical screening of individuals interdicted between ports of 
          entry.

           *       *       *       *       *       *       *


TITLE IV--BORDER, MARITIME, AND TRANSPORTATION SECURITY

           *       *       *       *       *       *       *


Subtitle C--Miscellaneous Provisions

           *       *       *       *       *       *       *


SEC. 437. MEDICAL SCREENING OF INDIVIDUALS INTERDICTED BETWEEN PORTS OF 
                    ENTRY.

  (a) In General.--To improve border security and the 
processing of individuals and families interdicted by the U.S. 
Border Patrol between ports of entry, the Commissioner of U.S. 
Customs and Border Protection, in coordination with the Chief 
Medical Officer of the Department, shall, not later than 30 
days after the date of the enactment of this section, establish 
uniform processes and training to ensure consistent and 
efficient medical screening of all individuals, with priority 
given to children who have not yet attained the age of 18, so 
interdicted before transfer from U.S. Customs and Border 
Protection custody, but in no case longer than 12 hours after 
such interdiction, or 6 hours in the case of a high priority 
individual. Such screening should be conducted by a medical 
professional and should be developed in collaboration with non-
governmental experts in the delivery of health care in 
humanitarian crises and in the delivery of health care to 
children.
  (b) Screening Process Components.--At a minimum, the uniform 
processes and training established under subsection (a) shall 
include the following:
          (1) Requirements for initial in-person screening that 
        includes documentation of the following:
                  (A) Visual assessment of overall physical and 
                behavioral state, including any possible 
                disability.
                  (B) A brief medical history, including 
                demographic information, current medications 
                (including a list of confiscated medications 
                and whether such have been replaced), and any 
                chronic or past illnesses.
                  (C) Any current medical complaints.
                  (D) A physical examination that includes the 
                screening of vital signs such as body 
                temperature, pulse rate, and blood pressure.
          (2) Criteria for determining when to make a referral 
        to higher medical care and a process to execute such 
        referral.
          (3) Recordkeeping requirements regarding how 
        information is to be recorded for each initial 
        screening under paragraph (1), including information on 
        the use of interpretation services.
          (4) Review by a medical professional of any 
        prescribed medication that is in the detainee's 
        possession or that was confiscated upon arrival to 
        determine if such medication may be kept by such 
        detainee for use during detention, properly stored with 
        appropriate access for use during detention, or 
        maintained with a detainee's personal property.
          (5) Chaperones for the physical examination of 
        minors, including, as appropriate, the parent, legal 
        guardian, or the such minors' closest present adult 
        relative, or a U.S. Border Patrol agent of the same 
        gender.
  (c) Pediatric Expertise.--A pediatric medical expert shall be 
on site in every U.S. Border Patrol sector, including at U.S. 
Border Patrol processing centers and at U.S. Border Patrol 
facilities at which 20 percent or more of detained individuals 
over the immediately preceding six month period are minors. The 
Chief of the U.S. Border Patrol shall prepare a plan to deploy 
in-person or technology-facilitated medical consultation with a 
licensed medical professional to U.S. Border Patrol facilities 
that experience an increase in apprehensions of children 
greater than 10 percent over the preceding 60 days.
  (d) Definition.--In this section, the term ``high priority 
individual'' means an individual who self-identifies as having 
a medical condition needing prompt attention, exhibits signs of 
acute illness, is pregnant, is a child, or is elderly.
  (e) Training.--Not later than 60 days after the issuance of 
the uniform processes and training established under subsection 
(a), the Commissioner of U.S. Customs and Border Protection 
shall ensure that any individual carrying out medical screening 
under this section at a U.S. Customs and Border Protection 
facility of individuals interdicted by the U.S. Border Patrol 
between ports of entry shall complete training on such uniform 
processes.

           *       *       *       *       *       *       *


                             MINORITY VIEWS

    H.R. 3525 directs the Border Patrol to conduct 
comprehensive medical screenings of the thousands of people 
they encounter every day within 12 hours of interdiction. 
Border Patrol simply does not have the resources, medical 
contract support, or physical space to meet the requirements of 
H.R. 3525, especially with the record numbers of migrants it is 
encountering on a daily basis. No funding is provided in this 
bill to enable Customs and Border Protection (CBP) to achieve 
this mandate.
    The Border Patrol is responsible for short-term detention 
and for expeditiously processing and coordinating the transfer 
of illegal immigrants into the custody of agencies with the 
capacity to hold them for longer terms of stay. The majority's 
policy decision to deny funding for Immigration and Customs 
Enforcement (ICE) bed space has severely degraded the U.S. 
government's ability to safely hold illegal immigrants in long-
term facilities. As a result, illegal immigrants are being held 
in Border Patrol custody much longer than was ever envisioned. 
ICE provides comprehenive medical screenings for illegal 
immigrants when they are transferred into their care, which 
prior to the crisis took on average no more than 72 hours. 
Instead of conflating which government agencies are responsible 
for the comprehensive medical screening of illegal immigrants, 
Congress should provide ICE the resources it needs to provide 
proper care to the record number of illegal immigrants in 
government custody.
    H.R. 3525 also forces huge unfunded and unachievable 
mandates on the Department of Homeland Security (DHS). The bill 
requires DHS research innovative ways to conduct medical 
screenings at the border. This new research and development 
mandate would force the DHS to redirect its limited funding 
away from homeland security research priorities that are 
focused on preventing drugs, criminals, and terrorists from 
entering the country, to instead research technology that is 
not directly related to the mission of the Department.
    This bill also forces DHS to establish within 30 days of 
passage, an electronic health record system to track illegal 
immigrant health records that is fully interoperable with all 
components that operate along the border. That is a completely 
unrealistic timeframe designed to result in failure. No funding 
is provided in the bill to cover such major acquisition, 
forcing the DHS to reprogram funding used for combating 
terrorists and criminal organizations, and for responding to 
man-made and natural disasters, to an IT system to track 
illegal immigrant health records.
    Health screenings for migrants are necessary to protect 
public health. Congress should work with DHS and the Department 
of Health and Human Services on ways to improve the delivery of 
these screenings. Unfortunately, the unrealistic mandates 
included H.R. 3525 are simply unachievable. As a result, H.R. 
3525 will not improve the health screening process or protect 
the health of migrants, Border Patrol, or the general public.
                                                       Mike Rogers.

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