Dying for Decent Care - Bad Medicine in Immigration Custody, FIAC, 2009

• July 26, 2016 • Locations: United States of America • Topics: Medical, Systemic Medical Neglect, Failure to Treat, International, Immigration, Medical Neglect/Malpractice, Failure to Treat (Mental Illness)

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DYING FOR DECENT CARE:

BAD MEDICINE IN IMMIGRATION CUSTODY

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FLORIDA IMMIGRANT ADVOCACY CENTER

Dying for Decent Care:
Bad Medicine in
Immigration Custody
february 2009

3000 Biscayne Boulevard, Suite 400
Miami, Florida 33137
Tel (305) 573-1106
Fax (305) 576-6273
www.fiacfla.org

To protect and promote the basic rights of immigrants

dying for decent care: bad medicine in immigration custody

Dedication
Rev. Joseph Dantica, an 81-year-old Baptist minister, fled Haiti after he was targeted for
persecution. Gangs had burned and ransacked his home and church. Although Rev. Dantica had
a valid visa to enter the United States, where he had traveled many times, he was detained at the
Miami airport when he told officials he sought political asylum. At the Krome immigration
detention center, he was accused of “faking” his illness and later transferred to the prison ward of
Miami’s public hospital in leg restraints. Rev. Dantica died there alone five days after his arrival
in October 2004. His family was allowed to see him only after his death.
Since March 2003 more than 80 people have died in or soon after leaving immigration custody,
and poor medical care could have contributed to at least 30 of those deaths, according to an
investigative report by the Washington Post. No one knows how many others have died
unreported or after being deported. Immigration authorities are not required to report the
deaths of detainees in their custody. There also is no telling how many detainees have received
inadequate or no medical care and will have to cope with pain, paralysis, loss of limbs and other
health consequences for the rest of their lives.
This report was written in memory of Rev. Dantica and all other detainees who have lost their
lives and health in immigration detention. The true measure of our society is how it treats those
who cannot take care of themselves. If we are ever to become the society that he dreamed of
when he came to the United States, the Department of Homeland Security and its Immigration
and Customs Enforcement (ICE) arm must protect the health and human rights of people like
Rev. Dantica. This means providing them humane, life-saving medical treatment in their time
of need.
Florida Immigrant Advocacy Center’s report documents the urgent crisis in medical care for ICE
detainees. Our aim is to inspire real changes and prevent more needless deaths and suffering.

dying for decent care: bad medicine in immigration custody

Acknowledgements
FIAC is extremely grateful to The Ford Foundation, The Florida Bar Foundation, Lutheran Immigration and
Refugee Services, Equal Justice Works, and Herb Block Foundation. This report would not have been possible
without their support.
Dying for Decent Care: Bad Medicine in Immigration Custody was inspired by the thousands of immigration
detainees who have complained about medical care to FIAC staff during 13 years of visits to immigration
detention facilities. It began as the written testimony of Cheryl Little, FIAC executive director, for the U.S. House
Immigration Subcommittee’s hearing, Detention and Removal: Immigration Detainee Medical Care, on October
4, 2007. The information in this report was obtained through interviews, phone conversations and correspondence
with detainees, as well as jail and immigration officials. It also includes information from U.S. government
materials, newspaper articles and other data.
FIAC thanks Steptoe & Johnson, Carlton Fields and Shook, Hardy & Bacon who have provided pro bono legal
representation to ill detainees. FIAC is most grateful for the assistance of physicians who have contributed
countless hours reviewing the medical records of detainees and providing their expertise in order to advocate for
better medical treatment. FIAC also wishes to recognize the remarkable dedication of its staff in providing legal
representation and advocacy on behalf of detainees.
Finally, FIAC extends its deepest thanks to the men, women and children in immigration detention who are the
subject of this report, for their remarkable courage and for the privilege of representing many of them.

Florida Immigrant Advocacy Center
Florida Immigrant Advocacy Center, Inc. (FIAC) was founded in January of 1996 in anticipation of the drastic
changes in the availability of legal services to immigrants due to federal funding restrictions on Legal Services
Corporation. It is a non-profit law firm whose mission is to protect and promote the basic rights of immigrants
through advocacy and legal services for low-income clients.

For further information contact:
Cheryl Little, Executive Director
Susana Barciela, Policy Director
Charu Newhouse al-Sahli, Statewide Director
Sharon Ginter, Administrative Assistant to the Executive Director
Florida Immigrant Advocacy Center
3000 Biscayne Boulevard, Suite 400
Miami, Florida 33137
Tel (305) 573-1106
Fax (305) 576-6273
www.fiacfla.org

dying for decent care: bad medicine in immigration custody

Acronyms and Abbreviations
ACLU:

American Civil Liberties Union

Annex:

Women’s Detention Center in Miami

BTC:

Broward Transitional Center, ICE-contracted detention facility north of Fort Lauderdale

DHS:

The U.S. Department of Homeland Security

DIHS:

Division of Immigration Health Services

FIAC:

Florida Immigrant Advocacy Center, which produced this report

Glades:

Glades County Detention Center, an ICE-contracted facility in central Florida

ICE:

Immigration and Customs Enforcement, an agency of the U.S. Department of Homeland
Security (DHS)

INS:

U.S. Immigration and Naturalization Service, the country’s immigration agency prior
to the creation of DHS and ICE in 2003

Krome:

Krome Service Processing Center, ICE detention facility in Miami

OIG:

The Department of Homeland Security Office of Inspector General

ORR:

The Office of Refugee Resettlement, an agency of U.S. Health and Human Services

Pinal:

Pinal County Jail, an ICE-contracted detention facility in Florence, Arizona

MCC:

Medical Care Coordinators, review, approve or deny “Treatment Authorization Requests” for DIHS

San Pedro: San Pedro Service Processing Center, ICE detention facility in California
TAR:

Treatment Authorization Request, must be submitted to DIHS for approval to provide detainees
diagnostic testing, specialty care, or surgery

TGK:

Turner Guilford Knight Correctional Center, a county jail in Miami

Wyatt:

Donald W. Wyatt Detention Facility in Central Falls, Rhode Island, contracted by ICE

dying for decent care: bad medicine in immigration custody

Table of Contents

Executive Summary

Introduction

Deaths in Detention

Abuses in Medical Care

Unacceptable Mental-Health Treatment

Physically Disabled Detainees

Mismanaged Medication

Forcible Drugging to Deport

Language Barriers

Unhealthy Living Conditions

Detainees Treated Like Criminals

Denied Medical Records

Conclusions and Recommendations

Background

Footnotes

executive summary

Executive Summary
Immigration and Customs Enforcement (ICE) detainees are
routinely subjected to poor, and sometimes appalling, medical
care. These detainees are entirely at the mercy of the
Department of Homeland Security. DHS officials determine
what medical treatment, if any, a detainee gets, when and
where they get it, and the quality of that care.

“I have to pee on myself putting a towel on my laps [sic] to prevent
the urine [from] running all over myself. When I have to do the
other necessity [it] is very uncomfortable [and] unsanitary….Don’t
you think I’m still a human being?”
Felipe Perez-Leon, a paraplegic detainee denied handicap
-accessible facilities while detained in an Atlanta jail.

Americans who cannot afford healthcare or insurance by law
will be treated at an emergency room, and some can get
financial help from families and friends. ICE patients do not
have those choices. ICE does not even allow detainees to use
private insurance to pay for medical care that ICE denies. And
the great majority of detainees have no lawyer to help them
obtain appropriate medical attention.

Government records, news reports, and FIAC’s experience in
detention centers plainly indicate that healthcare in ICE
custody is deteriorating, and many officials responsible for that
care are alarmed. Regardless of its public posturing, ICE
funding for detainee medical care is inadequate.

Meanwhile, attempts by the Florida Immigrant Advocacy
Center (FIAC) and other advocates to get ICE to correct serious
medical deficiencies repeatedly have been ignored. In detainees’
own words, here are some complaints:

“I am a 35-year-old man without a penis with my life on the line.
I have a young daughter, Vanessa, who is only 14…. The thought
that her pain – and mine – could have been avoided almost makes
this too much to bear.”
Francisco Castañeda, before dying of penile cancer that went
untreated while he was in ICE detention in California.
“At the clinic, I could no longer speak, only cry. A nurse told me
she was sorry, but that the doctor had resigned so there was no
doctor. I sat in a chair and clutched my stomach…. I thought I
was going to die.”
Miguel Bonilla Cardona, who suffered a ruptured appendix
at an ICE-contracted county jail in central Florida.
“My heart is broken. My body feels like its falling apart, and I am
here in the county jail slowly dying. I was transferred to Arizona
… so I could get treated, but I’m in worse condition than ever.”
Yong Sun Harvill, after a year in a jail contracted by ICE.
“Immediately my body started shaking. I felt so cold that I thought
I was freezing to death, but at the same time I was sweating….
Within minutes I had a seizure and my body began to shake so
violently that I fell off the bed onto the floor.”
Zena T. Asfaw, on her near-death experience after being
forced to take the wrong medication at a California
detention facility.

At the same time, ICE’s attempts to save money – by limiting
covered ailments and denying requests for needed treatment –
are counterproductive. Covered services are in essence limited
to emergency care, and a managed-care process requires every
referral, medical exam, or treatment of a detainee to be
approved by off-site nurses who conduct a paper review,
sometimes without the full medical records. Thus, a nonphysician can deny a treatment requested by a physician who
has seen the patient. Too often, denied or botched care then
leads to costly complications and lawsuits that cost taxpayers
more money.
Many government employees responsible for the care and
custody of ICE detainees are competent and dedicated.
Nonetheless, denying that problems exist places at risk the
very detainees in dire need of medical care. Though some
detainees may exaggerate the hurdles they face in getting
proper medical attention, FIAC’s experience, press reports,
detainee medical records and statements from detention
medical staff demonstrate that detainee complaints often are
legitimate. Among the most common problems are:
•
•
•
•
•
•
•
•
•
•

executive summary

Only independent, external
scrutiny of detainees’
medical care will ensure
that the Department of
Homeland Security and
ICE carry out their moral
and legal responsibility to
provide for the health and
safety of detainees entrusted
to their care.

The current detention policy
is overly broad and inhumane.
Immigrants who are neither
dangerous nor likely to flee
should not be detained. Those
currently detained – whether
severely ill, asylum seekers or
others challenging deportation
orders – should be fairly
considered for parole and
alternatives to detention. The
alternatives are cheaper, more
humane and can be structured
to ensure participants
regularly appear before
immigration authorities.

Unfortunately, oversight of ICE detention conditions, including
detainee medical care, is sorely lacking. In such an oversight
vacuum, ICE tolerates a culture of cruelty and indifference to
human suffering. Detainees routinely report being treated as
criminals, being accused of faking illnesses, and having painful
symptoms ignored. They also face retaliation for demanding
better medical treatment or complaining about the medical
abuse of fellow detainees. We do not know if this happens
because they are foreign, imprisoned, have no lawyer to defend
them or all of the above. We do know from years of direct
experience that cruel and inhumane treatment of sick detainees
is a systemic problem.
Only independent, external scrutiny of detainees’ medical care
will ensure that the Department of Homeland Security (DHS)
and ICE carry out their moral and legal responsibility to
provide for the health and safety of detainees entrusted to their
care. Given the dramatic increase in detainees, the need for
proper scrutiny of medical care is more critical now than ever.
In short, many immigration detainees are subjected to
substandard medical care, and the problem is growing. Death
rates in detention appear to be worsening. ICE needlessly
detains people with severe illnesses and those who pose no
harm to U.S. communities. Doing so drives up ICE costs even
as ICE provides increasingly inadequate medical and mental
healthcare to those in its custody.
Lives are at stake. The urgency to improve detainee medical
care cannot be overstated.

FIAC recommendations include:

To the Administration and Congress
• Establish an independent oversight commission composed of
healthcare and immigration experts to oversee medical care
in U.S. immigration custody. Its mission: to ensure that the
conditions, practices and quality of medical care for detainees
meet established legal, medical and human-rights standards.
• Strengthen and issue regulations that codify detention
standards for Immigration and Customs Enforcement (ICE),
including medical standards, so that all immigration
detention facilities provide competent, timely, and necessary
medical care by force of law. Require ICE detention facilities
and all contracted facilities to annually report their
compliance with the detention standards.
• Strengthen and issue regulations requiring DHS to
promptly report the death of any immigration detainee to
the U.S. Attorney General. Require an independent
investigation of each death. Require DHS to annually
submit a report to the Judiciary Committees of the U.S.
House and U.S. Senate with detailed information on all the
deaths, including the cause of death and the results of related
investigations.
• Promote alternatives to detention by shifting ICE funding
from detention beds to proven, community-based
alternatives. Prioritize the release of vulnerable detainees,
such as detainees with ongoing medical or mental-health
issues.
To the DHS and ICE
• Ensure that detainees are properly and consistently referred
to competent healthcare providers within the facility in
which they are detained and outside the facility as needed.
• Revamp or eliminate Division of Immigration Health
Services policies – which dictate the medical treatments that
may be approved or denied – to conform to broader ICE
detention standards and accepted legal, medical and humanrights standards on medical care.
• Require a mental-health screening that properly identifies
detainees with illnesses such as post-traumatic stress disorder
and other psychiatric conditions. Mentally ill detainees must
be placed in a facility that can properly care for their mentalhealth needs. Prohibit placing such detainees in isolation or
seclusion at a detention facility for punitive reasons.
• Launch training efforts to combat the culture of indifference
to human suffering that ICE tolerates within its ranks. This
culture views all detainees as criminals who are faking
illnesses, regardless of painful symptoms, and often prevents
timely and appropriate medical treatment.

introduction

Introduction
Florida Immigrant Advocacy Center (FIAC) provides free legal
services to immigrants of all nationalities, including many in
the custody of Immigration and Customs Enforcement (ICE), a
division of the Department of Homeland Security (DHS). Lack
of competent medical care is one of the chief complaints of the
men, women and children in immigration detention
throughout the country.
FIAC has written numerous reports documenting our concern
that medical care for those in immigration custody is woefully
inadequate and all too frequently leads to unnecessary suffering
and, in some cases, death.1 Dying for Decent Care: Bad
Medicine in Immigration Custody includes significant new
accounts along with information from FIAC reports that span
more than a decade of advocacy. The content is based on
hundreds of interviews with detainees, FIAC’s own
observations, medical records, and conversations with jail and
immigration officials. The report focuses on cases between
2003-2009.
This report draws from current news items such as the New
York Times reporting on deaths in detention and other medical
issues.2 It also refers to The Washington Post’s investigative
series, Careless Detention, published in May 2008. The Post’s
series, based on months of research and thousands of internal
government documents, found what FIAC sees in immigration
detention facilities every day: “a massive crisis in detainee
care.’’3
The U.S. now has the world’s highest rate of incarceration, and
ICE detainees are its fastest growing prison population. Since
2001, the number of immigration detainees tripled to some
311,000 in fiscal year 2007. The daily population now averages
more than 30,000 detainees in more than 300 detention
facilities nationwide.4 In fiscal year 2008, ICE had funding for
32,000 beds at an annual cost to U.S. taxpayers of more than
$1.65 billion.5
For 2009 the cost of detention is budgeted at $1.72 billion,
which will provide ICE with an additional 1,400 beds and $2
million for the ICE Office of Professional Responsibility to
conduct “a comprehensive review” of detainee medical care.6
Overall the total funding for detaining and deporting
immigrants is $2.4 billion – more money for immigration
enforcement than the administration requested, courtesy of
Congress.7

The surge in immigration detention has greatly benefited
private prison operating companies, like Corrections
Corporation of America (CCA) and the Geo Group (formerly
Wackenhut), whose stocks sharply increased following
President Bush’s proposal in February 2006 to increase
spending on immigration detention.8
The federal government has
increasingly turned to these
prison companies and local jails
as a cheaper alternative to ICErun facilities. According to ICE,
it cost $87.99 per day for each
detainee in a contracted jail or
prison versus $119.28 a day at
its own detention facilities
during fiscal year 2007.9

Meanwhile, as funding
for contract detention
facilities continues to
grow, medical care for the
fast-growing population
of ICE detainees has not
kept pace.

Alternatives to detention, which cost as little as $12 a day, are
even cheaper and more humane.10 One tested alternative
required people to periodically report by phone and in person.
Another released asylum seekers to community shelters and
found them pro bono attorneys. Both succeeded in keeping
participants on a legal track: Appearance rates before
immigration authorities ranged from 93 percent to 96
percent.11
Such alternatives are particularly suited for severely ill
detainees and the majority of detainees who pose no danger to
U.S. communities. Yet ICE’s 2009 funding provides only $63
million for alternatives to detention – 3.7 percent of the $1.72
billion detention budget.12
Meanwhile, as funding for contract detention facilities
continues to grow, medical care for the fast-growing population
of ICE detainees has not kept pace.
ICE spent nearly $100 million on detainee healthcare in the
2007 fiscal year. That is double the amount spent in 2001,
even though the detainee population tripled during the same
period. The funding squeeze is exacerbated by the growing
number of detainees with chronic health conditions. Now more
than a third of ICE’s 300,000 plus yearly population suffers
chronic illnesses such as hypertension and diabetes.13 Another
measure of inadequate funding: By comparison, Rikers Island
Jail in New York City has spent the same amount on

introduction

While the number of
detainees has tripled since
2001, medical spending has
lagged and detainee
healthcare has suffered. And
fewer deaths in ICE custody
are a misleading measure of
detainee health.

healthcare annually for more
than a decade while
imprisoning about half the
people detained by ICE.14

A Secret World
ICE detainees include
pregnant women, families,
the sick and elderly, legal
permanent residents, asylum
seekers, torture survivors,
and victims of human
trafficking, among others
targeted for deportation. Most of the detainees have no criminal
record and pose no threat to U.S. communities. Those who
have records, many of which are minor infractions, already have
completed their sentences and paid for their crimes. ICE
warehouses most immigration detainees in local and county
jails or in large, privately run facilities in remote areas.
This is an oftentimes secret detention world outside of the
public eye and subject to little scrutiny. Though immigrants in
ICE custody have a number of rights, including the
constitutional protection against cruel and unusual
punishment, they often don’t know those rights or find it
impossible to assert them in such an environment. Detainees
who complain often face retaliation. The difficulty is
compounded by the lack of legal representation. Unlike U.S.
criminal convicts, ICE detainees are not entitled to a courtappointed lawyer, and 84% face deportation without
attorneys.15
Many immigrants are detained for months or even years.
However, ICE detention facilities are not designed for longterm prisoners. Neither county jails nor large, ICE owned and
managed detention sites have the programs, services, or
medical care offered in federal prisons and other facilities that
keep prisoners for more than six months.
ICE touts that one of its highest priorities is the quality care of
detainees in its custody. At a congressional hearing in June
2008, then-ICE chief Julie L. Myers noted that ICE has
increased annual spending on detainee healthcare to $100
million. She also pointed to fewer deaths in custody as a sign of
improved medical care. She said, “Though the ICE population
has increased by more than 30 percent since 2004, the actual
number of deaths in ICE detention has declined from 29 in
2004 to seven last year.”16

Those figures do not tell the full story. In fact, ICE’s medical
spending has not kept up with the explosive growth of people
in immigration custody. While the number of detainees has
tripled since 2001, medical spending has lagged and detainee
healthcare has suffered. And fewer deaths in ICE custody are a
misleading measure of detainee health.
Fuzzy Math
Dr. Homer D. Venters testified as much at the June 2008
congressional hearing.17 A physician at the Bellevue/NYU
program for torture survivors, Dr. Venters noted that ICE’s
mortality rates must be adjusted by ICE’s average length of
detention to be comparable over time and to other prison
facilities. Adjusting the figures, Dr. Venters found that
mortality rates for ICE detainees actually increased by 29
percent from 2006 to 2007. His observations raise important
questions:
“The reliance by ICE on unsound statistical methods that
consistently present a more positive picture of detainee
health should generate concerns about the ability of ICE to
adequately assess and improve its own healthcare system.
Our review of the ICE health plan, including recent changes,
suggests that ICE detainees are receiving medical care that is
increasingly limited and inconsistent with current standards
of medical practice.”18
FIAC’s experience, The Washington Post investigation, other
news accounts and congressional testimony corroborate the
same conclusion: ICE’s de facto medical mission is to keep
detainees healthy enough to deport.19 Or, in the words of
ICE’s top official: “I believe that [the Division of Immigration
Health Services] has a responsibility to provide the medically
necessary healthcare while at the same time ensuring proper
obligation of federal funds, to ensure that we don’t overpay for
anything.”20
This may sound like a reasonable managed-care approach. In
practice, however, it means that ICE’s medical “Covered
Services Package” provides for emergency care at the expense of
treating chronic and other costly illnesses. It also means
persistent medical-staff shortages at immigration detention
facilities, practices that lead to medical abuses and the denial of
expensive medical tests and treatment. This ICE approach
encourages denying care and saving money instead of
preventing disease and death.21

introduction

The approach takes a toll in human suffering. It also may cost
ICE more money than it saves. U.S. Rep. Zoe Lofgren,
chairwoman of the U.S. House Immigration Subcommittee,
made this point at a congressional hearing last year. Speaking
of the ICE documents obtained by The Washington Post,
Chairwoman Lofgren noted:
“One document, which I can’t even begin to reconcile with
humane treatments, lists the amount of money ICE saved by
denying requests for treatment. Such requests, which were
all submitted by on-site medical personnel, were for such
things as tuberculosis, pneumonia, bone fractures, head
trauma, chest pain and other serious complaints. How an offsite bureaucrat can deny a request to treat tuberculosis or a
bone fracture, I just don’t know, but the document makes it
seem as if ICE is proud of that fact.
“Putting aside the inhumanity of denying necessary
healthcare, the $1.3 million savings that ICE brags about in
this document is going to pale in comparison to the money
that DHS will have to pay when courts begin to rule against
it, as they already have.’’22

The document referred to by U.S. Representative Zoe Lofgren.

Loose Standards
Beyond ICE’s funding and medical care policy, issues of
detention culture also negatively impact the healthcare of
people in immigration custody. Nationwide, as numerous
accounts attest, immigration detainees quite often are treated as
criminals and accused of faking illness – whether in ICE-owned
detention centers or contracted facilities such as local jails. Such
accounts are included in this report.

Correctional Association (ACA) provide useful information for
those running ICE detention facilities. However, ACA
standards were designed for a criminal population and do not
take into account that ICE detainees are there on the basis of
civil violations only and are not serving criminal sentences or
awaiting trial. ICE detainees have special needs that are not
applicable to those accused or serving criminal penalties.
ICE inherited the current medical standards from its precursor
agency, the Immigration and Naturalization Service, which had
adopted those standards in 2000.23 In September 2008, ICE
published updated and expanded standards called the
Performance-Based National Detention Standards, which are
being implemented slowly over several years. More important,
neither set of medical standards is consistently adhered to by
detention facilities or enforced by ICE. These standards have
not been codified and are not legally binding. Clear violations
of the standards exist, despite repeated complaints by
detainees, medical employees, and advocates.
For example, for some time at the San Pedro detention facility
near Los Angeles, the clinical director prohibited any lab work
for any detainee who had been detained for less than 30 days,
regardless of their medical condition. This policy was roundly
criticized by the agency’s top specialist on infectious diseases as
a violation of ICE medical guidelines as well as medical
ethics.24 The policy also contributed to the 2007 death of
Victoria Arellano, a detainee with AIDS who didn’t get lab
work for 22 days and was denied medication during her first
month at San Pedro.25
Regardless of where an immigration detainee is held, approval
from the Division of Immigration Health Services (DIHS) is
required for diagnostic testing, specialty care, or surgery. Even
when detention or outside medical personnel have
recommended treatment, on-site medical staff is required to
submit a Treatment Authorization Request (TAR) to off-site
DIHS Medical Care Coordinators (MCC) – who are nurses and
may not have all the detainee’s medical records – for each and
every exam, referral, or treatment.26
Thus, someone who is not a doctor and who has never seen the
patient has the authority to override the request of a doctor and
deny care for a detainee.

Standards regarding the medical care of immigration detainees
are also problematic. The standards promoted by the American

introduction

Problems in medical care for immigration detainees include:
•
•
•
•
•
•
•
•
•
•

Delayed and denied healthcare
Shortages of qualified staff
Improper care of mentally ill patients
Inadequate care of physically disabled patients
Denied, mistaken and insufficient prescription medication
Difficulty getting access to medical records
A lack of competent, professional interpreters
Cruel and abusive behavior by some clinic and detention staff
Unsanitary and overcrowded facilities
Detainees transferred or segregated in retaliation for
complaints
• A lack of independent oversight to ensure the quality and
effectiveness of care
Recent reports of deaths in immigration detention have shed
new light on a system in crisis.27 Nationwide, since 2003
some 83 detainees have died in, or soon after leaving, custody.
Medical care, or its lack thereof, may have contributed to 30 of
those deaths, according to The Washington Post’s investigative
series.28 At least another four deaths, including that of a young
man whose family FIAC represents, have occurred since that
series was published in May. FIAC is working to prevent
further deaths and medical abuses in custody, although at times
it seems an uphill battle.

deaths in detention

Deaths in Detention
“I am a 35-year-old man without a penis with my life on the line.
I have a young daughter, Vanessa, who is only 14…. The thought
that her pain – and mine – could have been avoided almost makes
this too much to bear.
I had to be here today because I am not the only one who didn’t get
the medical care I needed. It was routine for detainees to have to
wait weeks or months to get even basic care. Who knows how many
tragic endings can be avoided if ICE will only remember that,
regardless of where they will end up, they are still human and
deserve basic, humane medical care.”29
- Francisco Castañeda, testifying before
dying of penile cancer

The grave consequences of inadequate medical care are clear. In
May 2008, The Washington Post documented 83 deaths in
immigration custody and shortly after leaving custody since
ICE came into being in 2003. The medical care provided, or
denied, may have been a factor in 30 of those deaths, according
to government documents and medical experts who reviewed
some cases for The Washington Post’s investigative series.30
Among those deaths are those of:
• Rev. Joseph Dantica, an elderly minister accused of faking
his illness
• Francisco Castañeda, who died after being denied treatment
for cancer
At least another four questionable deaths have occurred since
The Washington Post series was published in May 2008,
including those of:31
• Valery Joseph, a Haitian whose family is represented
by FIAC
• Hiu Lui Ng, a New Yorker who died of untreated cancer
• Guido Newbrough, who died of an untreated cardiac
infection
These cases are among those chronicled more fully below.
Along with the deaths have come an increasing number of
lawsuits by bereaved relatives accusing ICE of medical
misconduct and inhumane treatment. The cost of these lawsuits
could outstrip whatever ICE has saved by skimping on detainee
healthcare. U.S. Rep Lofgren, Chairwoman of the House
Immigration Subcommittee, suggested as much at a
congressional hearing in June 2008. She said:

“Last October, Francisco
Castañeda testified before
our committee concerning
the medical care he received,
or I should say failed to
receive, during his
detention. He is now dead.
A quick review of his
medical records shows that
several on-site physicians
recommended biopsy to rule
out cancer, but it also shows
that these requests were
repeatedly denied over a 10month period by managedcare coordinators here in D.C.

“When several doctors say
that someone needs a simple
biopsy, but this is denied not
once, not twice, but repeatedly
over 10 months by off-site
bureaucrats, something is
fundamentally wrong. No
matter how it happened, there
is no question that the system
failed Mr. Castañeda over
and over again. He paid with
his life...”

“Some might say this is just one case and does not signify
anything. I disagree. When several doctors say that
someone needs a simple biopsy, but this is denied not once,
not twice, but repeatedly over 10 months by off-site
bureaucrats, something is fundamentally wrong. No matter
how it happened, there is no question that the system failed
Mr. Castañeda over and over again. He paid with his life,
and now the Government is on the verge of paying millions
in a lawsuit pursued by his family.’’32
The cases that follow trouble the conscience. A common thread
is cruel, indifferent, and negligent medical care in custody.
This is no way to treat human beings.
‘Brother, I’m Dying’
Joseph Dantica, an elderly Baptist minister, was running for
his life. Violent gangs had ransacked his church and home in
Haiti. Arriving at Miami’s airport on October 29, 2004, he
showed his valid U.S. visa and said he wanted to seek asylum.
Border officials detained him for 12 hours and would not let
him leave the airport with his family. Instead, he was
imprisoned at the Krome detention facility. He died five days
later in the prison ward of a public hospital.
When he first arrived at Krome, Rev. Dantica was placed in
the medical unit because a medical screening determined he
had uncontrolled hypertension, prostate enlargement and a
history of larynx cancer. Thus, Krome medical staff had some
knowledge that he had health issues that needed to be
monitored.
13

deaths in detention

In fact, Rev. Dantica, 81, had been treated for the cancer 20
years earlier. He had a hole in his throat and spoke with the
help of an electronic voice box, which made it difficult for him
to communicate. He also had been visiting the United States
for 30 years without any hint that he wanted to stay or break
the law. None of this made a difference. Immigration officials
denied him a humanitarian release on Nov. 1, 2004,33 though
they had the authority and discretion to do so.

to limp, thus not allowing his head to fall back. PHS
representative stated that was another way he determined
Applicant was faking symptoms.

The next day, only minutes into an asylum interview, Rev.
Dantica began vomiting violently. Vomit covered his clothes
and face. Mr. Pratt, the reverend’s lawyer and Ms. Castro, the
asylum officer,34 twice had to ask a Krome officer to call for
medical help. Rev. Dantica’s son Maxo Osnac, who also had
been detained, was brought to help provide information about
his father’s medical condition.35

Only after he was moved to the medical unit did Krome staff
make any attempt to clean Rev. Dantica of the vomit.
According to Mr. Pratt:

“Attorney John Patrick Pratt vigorously contradicted PHS
representative, stated that he did not believe that vomit
could be faked, and stated that the Applicant was very ill
and that his medications should not have been removed.”37

“During the entire time the medic and other Krome officials
were in the Asylum Unit, when I was there, no medical
treatment at all was provided to Rev. Dantica. No one
checked his vital signs or did anything at all to determine
the state of his medical condition. No one ever wiped the
vomit off his face and clothes. Eventually, about 25-30
minutes after he suffered the attack, the medic, officer
and/or other detainees brought a stretcher and moved Rev.
Dantica from the asylum unit to the medical facility.”38
Later that day, Rev. Dantica was transferred to the prison ward
of Miami’s Jackson Memorial Hospital in leg restraints – as if a
gravely ill senior posed an escape threat. A Krome officer
informed Mr. Pratt that no one, not his family or lawyer, would
be allowed to visit Rev. Dantica at the hospital “for security
reasons.’’39 This was a violation of current detention standards,
which direct ICE to “provide as much opportunity for
visitation as possible’’ in a case of serious illness.40

Officer Castro’s report

Rev. Dantica’s electronic voice box had been rendered
inoperable by vomit. He was extremely sick and distressed, as
the following events proved. Yet one of the three medical staff
members who came to see Rev. Dantica suggested that he was
“faking” his illness, according to Officer Castro, Mr. Pratt and
Mr. Osnac. Three Krome staff members and Mr. Pratt
confirmed that Krome medical staff stated that Rev. Dantica
was not being cooperative.36
After the Reverend died, Officer Castro described the medical
staffer’s conduct:
“The PHS [Public Health Service] representative made
statements… that he believed the Applicant [Rev. Dantica]
was faking because the Applicant kept looking at him
randomly. The PHS representative then went on to
demonstrate that when he moved the Applicant’s head up
and down, Applicant maintained his head rigid as opposed
14

Abuses of discretion by ICE also are clear. When Rev. Dantica
was first detained, ICE officials at Krome told his lawyer that
he could not be released before his initial asylum screening.
After Rev. Dantica became violently ill at the interview and
was sent to the hospital, an ICE official told the lawyer that
Rev. Dantica would be released as soon as he was stabilized.
Yet the same official would not allow family members to visit
him in the hospital. What possible security threat could there
be if Rev. Dantica was going to be released?
At the hospital, he was not seen by a doctor for 24 hours. By
then it was too late. Rev. Dantica died on Nov. 3, 2004,
without seeing his son again.
Rev. Dantica’s niece Edwidge Danticat was not allowed to visit
him, either. A celebrated author, she has since written Brother,
I’m Dying, a prizewinning memoir chronicling his ordeal. In
her words:

deaths in detention

My uncle was treated like a criminal
when his only crime, like many asylum
seekers, was thinking he could find shelter
in the United States.
“My 81-year-old uncle, Joseph Dantica,
escaped gang warfare and threats to his life
in Haiti and fled to Miami. He had a valid
multiple-entry visa, but when immigration
officials at Miami International Airport
asked how long he’d be staying in the
United States, he explained that he would
be killed if he returned to Haiti and that
he wanted ‘temporary’ asylum. He was
immediately arrested and taken to Krome detention center,
where his medicine was taken away. He died a few days later.
My uncle was treated like a criminal when his only crime,
like many asylum seekers, was thinking he could find shelter
in the United States.”41
U.S. Rep. Kendick Meek, FIAC and others had to request an
investigation into Rev. Dantica’s death. FIAC believes that the
investigation conducted by the Department of Homeland
Security Office of Inspector General (OIG) was a whitewash
and wrote a detailed letter of complaint.42
Unfortunately, the inspector general squandered an opportunity
to hold DHS and ICE accountable and to insist on medical
policies and procedures to prevent needless deaths. U.S. Rep.
Meek has asked the DHS Inspector General to “review and
evaluate the claims raised by FIAC.”43
The sad truth is that ICE treated Rev. Dantica as if he were a
criminal when he broke no law, had a valid visa to enter the
United States and should never have been thrown into
immigration detention. He came to this country to save his life
and ended up losing it in ICE custody.
ICE’s detention and mistreatment of asylum seekers is not rare.
Among other examples featured in this report are the cases of
Amina Bookey Mudey and Zena Asfaw in the Mismanaged
Medication section.
At Risk of Seizures
Valery Joseph suffered from seizures and was mentally
challenged. He was 23 when he died at the Glades County
Detention Center on June 20, 2008. Only a month later the
same ICE-contracted jail failed to treat detainee Miguel
Bonilla, and he almost died from a ruptured appendix. (Mr.

Bonilla’s ordeal is detailed in the next
section: Abuses in Medical Care.)
Mr. Joseph came to this country from Haiti
as a boy but didn’t finish high school.
Public-school records show that he was
classified as “mentally handicapped.’’44 He
left school illiterate.
A U.S. resident, Mr. Joseph came to ICE’s
attention after he served a short sentence on
a robbery charge. Jail records note his
“psychiatric history” and two suicide
attempts while incarcerated.45 After he
completed the jail term, ICE detained him
at Krome and began deportation
proceedings.
At Krome, Mr. Joseph recognized the importance of medical
attention. In a letter to an immigration judge there, which he
dictated to a friend, Mr. Joseph said:
“I don’t, and really can’t imagine, how someone like me
would make it to Haiti…. I truly, verily thank God for
being in America able to get help from those expensive
meds. If, unfortunately you would send me back to Haiti,
my life would considerably being destroy. [Sic]”46
His medical and mental issues appeared to worsen significantly
after he was transferred to the Glades facility in February 2008.
Mr. Joseph’s medical records paint a portrait of his increasingly
anxious and desperate behavior. Shortly after his arrival, he had
a seizure and was taken to a hospital emergency room. Less
than three weeks later, he was found on the floor having
another seizure.47
After the first seizure, he asked to be housed in the medical
area because of his medical and mental-health issues. In a jail
incident report, a jail officer documents Mr. Joseph’s
complaint:
“Joseph stated to me that he felt as though he should be
housed in medical because he has seizures frequently and
does not feel safe in the pod because of his condition.
Joseph stated that he is on seizure medication and
mental-health medication and has always been housed in
medical due to his physical and mental condition.
“I advised Joseph that he had been cleared from medical
and I could place him in protective confinement if he felt
as though his safety was at risk. Joseph declined and

deaths in detention

stated that he wanted to be transferred back to Krome
where he could be better cared for.’’48
The transfer back to Krome never happened.
But at least one detainee who befriended Mr. Joseph at Krome
had worried that he would have problems after the transfer.
“Sam’’ described Mr. Joseph as being visibly abnormal. He told
FIAC that Mr. Joseph looked “cross-eyed” and visibly
“retarded,” and other detainees would poke fun and torment
him because of his appearance was not even be able to
articulate that he was not receiving proper medical care.
“Anyone could see that this was someone with severe mental
disabilities who should not have been housed with the general
detention population,” Sam said.49
After three months at Glades, it was clear Mr. Joseph was
deteriorating. A psychiatric note describes his state: “Reports
presently hearing voices…. Staff reports [patient] exhibiting
bizarre behavior: talking to self …. Poor sleep.” Four weeks
later, medical records state that Mr. Joseph attempted “suicide
by hanging.”
Medical staff was well aware of his history of seizures,
psychiatric issues and suicide attempts. Yet the staff repeatedly
cleared Mr. Joseph to be placed in “confinement,” a practice
typically used to discipline detainees, despite his having most
contraindications for confinement: taking psychotropic
medication, history of self-harm, diagnosed with major mental
illness, among others. His stays in confinement became more
frequent. The special accommodation: Mr. Joseph would be
placed in a low bunk while in confinement.50

A person who suffers seizures should not be left alone and
unmonitored for long periods of time. As his mother said, “If
he was on medication and had seizures they should have been
watching him.”53
Two Glades detainees told FIAC that Mr. Joseph had been in
the “hole,’’ the inmates’ term for confinement. One of them
said:
“I knew Joseph because, when I was in the hole, I was in
the cell next to his. I was in the hole for 30 days back in
May for instigating a small riot when I was beaten by a
guard. I got three 10 day charges in the hole as
punishment. Joseph was in there when I went in and he
was still in there when they let me out.… A couple of
weeks ago, one of the guards … said this guy, Joseph, had
died in the hole.”
“I didn’t talk much with him, but I don’t think Joseph
was normal. He wasn’t all there. He didn’t seem to
associate with many people. They mostly kept him in the
hole. If he was out in the pod more than a couple of days
that was a lot. I think the guards picked on him.”54
Ms. Fleury first learned of her son’s death in ICE custody from
his fiancé, who apparently was notified by a chaplain from the
Krome detention center. Ms. Fleury and other family members
went to the Glades jail in an attempt to get more information
about Mr. Joseph’s death. No one there would give them any
information. Instead, they were told to go to Krome, a 90 to
100 mile drive, which they did.

Dr. Kenneth Fischer, a neurologist who reviewed Mr.
Joseph’s medical records, noted that there were wild
swings in his levels of his anti-seizure medication.
Could the medical staff have better controlled the
medication levels? It was not clear what caused the
wide fluctuations in those levels. These fluctuations,
however, may have contributed to the seizure that
ultimately caused Mr. Joseph’s death. When he died, he
was in confinement.
Family members say that Mr. Joseph appeared to have
more severe and frequent seizures after being
transferred to Glades. Jacqueline Fleury, Mr. Joseph’s
mother and a FIAC client, said her son complained that ICE
officers stripped him naked at times and subjected him to long
periods of confinement in very cold conditions.52
Valery Joseph’s letter

deaths in detention

At Krome, they were not allowed past the guard station.
Eventually, the Krome chaplain walked out to inform them
that all he knew was what he heard on the news, that Mr.
Joseph had died. After getting no responses from ICE officials,
the family said they had to hire an attorney to locate Mr.
Joseph’s body.

abruptly releasing Mr. Castañeda from custody. By then, the
untreated cancer had spread.
Mr. Castañeda died on February 16, 2008, at age 36 – one year
after his penis was amputated in an attempt to stop the cancer
that spread while he was denied crucial medical care in ICE
detention.

Since then, FIAC has attempted
to obtain numerous public
records related to Mr. Joseph’s
detention, medical care and death
at Glades. Since Glades is a
county jail, it is clearly subject to
Florida’s public records laws. Yet
Armor Correctional Health
Services, the ICE contractor that
provides medical services to
detainees at Glades, has denied
FIAC records relating to the
facility’s medical and mentalhealth policies, confinement and
use-of-force policies, medical
staffing and job descriptions.
FIAC may have to file a lawsuit
to get these public records.

Recently, government
documents revealed how
some medical staff
members attempted to
falsify Mr. Castañeda’s
complaints and to
mischaracterize his
medical state while in
custody. Some staff
members not only
ignored doctor
recommendations to treat
him, but also may have
lied about those
recommendations. In an
Francisco Castañeda’s complaint
e-mail obtained by the
Washington Post, a physician assistant at the facility where Mr.
Castañeda was held tells a medical staffer to alter a complaint
that Mr. Castañeda had filed and had not been resolved.
ICE’s medical system too often fails inmates like Mr. Joseph,
who have serious medical and psychiatric conditions. The
“We need to write something different, or make some
autopsy report cites “seizure disorder” as his cause of death.55
While we do not know exactly all the factors that resulted in
amendment, on the Grievance for Francisco Castaneda,”
Mr. Joseph’s death, we suspect medical mistreatment played a
Physician Assistant David Lusche wrote. “…Your response
role and continue to investigate.
starts, ‘Grievance not resolved.’ Those words are going to
attract all kinds of attention during an ICE Jail Standards
Death by Denial
audit…. Could you somehow ‘patch up’ that Grievance with an
As an appeals court rightly noted, Francisco Castañeda was
amendment then put it in my box. I just want to avoid
subjected to a “Kafkaesque nightmare” while in ICE custody.56
problems when the Auditors show up.”58
He had come to this country at age 10 with his mother fleeing
civil war in El Salvador. A longtime U.S. resident, he was
A wrongful-death lawsuit, Castañeda v. Henneford, is pending.
being deported after a four-month term for drug possession.
ICE already admitted that its negligence caused Mr.
Castañeda’s death. Under California law, this admission makes
In March 2006, ICE placed him at a San Diego detention
the federal government subject to paying damages of up to
facility. As soon as he arrived, Mr. Castañeda complained of a
$250,000. More recently, an appellate court upheld the lower
lesion on his penis that was growing, oozing, and increasingly
court’s decision to allow Mr. Castañeda’s daughter to sue federal
painful. For 11 months, ICE’s Division of Immigration Health
doctors and employees individually on the grounds that they
Services (DIHS) in Washington, D.C., denied repeated requests
were “deliberately indifferent to his condition” and violated his
for a biopsy and other doctor-recommended procedures. The
constitutional protection against “cruel and unusual
reason: procedures to determine if he had cancer and to
punishment.’’59
alleviate his condition were deemed “elective.’’57
In the lower court ruling, U.S. District Court Judge Dean D.
After vigorous advocacy by the American Civil Liberties Union
Pregerson wrote a scathing critique of Mr. Castañeda’s medical
(ACLU), ICE finally scheduled a biopsy for February 2007. ICE
mistreatment by medical staff while in ICE custody:
then avoided paying for it, and any other cancer treatment, by
17

deaths in detention

“Plaintiff has submitted powerful evidence that
defendants knew Castañeda needed a biopsy to rule out
cancer, falsely stated that his doctors called the biopsy
‘elective,’ and let him suffer in extreme pain for almost
one year while telling him to be ‘patient’ and treating
him with Ibuprofen, antihistamines and extra pairs of
boxer shorts.”
“Everyone knows cancer is often deadly. Everyone knows
that early diagnosis and treatment often saves lives.
Everyone knows that if you deny someone the opportunity
for an early diagnosis and treatment, you may be –
literally – killing the person. Defendants’ own records
bespeak of conduct that, if true, should be taught to every
law student as conduct for which the moniker ‘cruel’ is
inadequate.’’60
An Agonizing Death
Hiu Lui Ng suffered agonizing abuse while in ICE lock-ups. As
in Mr. Castañeda’s case, medical staff failed to diagnose or treat
a cancer that spread while he was detained. Tragically, Mr. Ng’s
broken spine was not detected nor treated despite his repeated
complaints of excruciating pain for four months. He died in
ICE custody at age 34.
A scathing ICE investigative report describes his brutal
treatment, particularly one videotaped incident in which Mr.
Ng was forcibly dragged by detention officers while he cried
and screamed in pain. Detention officials cursed at him and
accused him of faking his illness. He was denied medication,
medical care and a wheelchair when he was too weak to walk
and a doctor had requested one for him. The report also points
out multiple violations of ICE National Detention Standards in
medical care and use of force, among others.61
According to family members and his lawyers, Mr. Ng began
complaining of back pain and itchy skin in April 2008. At the
time he was detained at the Franklin County Jail in Vermont,
which had no medical staff. He asked to be transferred to the
Donald W. Wyatt detention facility in Rhode Island, a large
ICE-contracted prison with in-house medical staff.62
There, detention staff subjected Mr. Ng to terrible abuse, in
apparent attempts to prove that he was faking his illness.
Arriving at Wyatt on July 3, 2008, he spent the first three
days in pain while in a dark isolation cell. Officials required
him to come down from his upper bunk at least three times a
day for head counts even though the climbing caused him
horrific pain, especially as his condition deteriorated.63

The ICE report notes instances when Mr. Ng was denied
appropriate medical care and subjected to unwarranted use of
force.
When he could not get out of his bunk and go to the cell door
to get his prescribed medication, a nurse wrote in medical
records that Mr. Ng “refused’’ to take his medication. Given
the severity of his condition, it was evident to ICE
investigators that Mr. Ng was “physically unable’’ to get out of
bed without assistance. The report concluded: “By failing to
take appropriate action bringing the prescribed medication
directly to Mr. Ng. the facility had effectively denied Mr. Ng
the medication.”64
On another occasion Mr. Ng
missed an appointment for a
A scathing ICE
doctor-prescribed CT scan
investigative report describes
because he could not move
his brutal treatment,
without a wheelchair and
Wyatt detention officials
particularly one videotaped
refused to provide him one.
incident in which Mr. Ng
Investigators saw this as an
was forcibly dragged by
unwarranted denial of
detention officers while he
medical care. They noted
another incident in which
cried and screamed in pain.
he was denied access to see
his attorney when detention
officials would not provide a wheelchair and Mr. Ng was
unable to stand, much less walk to see his attorney who had
come for a meeting.65
One particularly cruel instance was videotaped only a week
before his death. Wyatt officers pulled Mr. Ng out of his bed.
Despite his screams and pleas for a wheelchair – and a doctor’s
order to provide him a wheelchair – officers dragged him
forcibly down a hallway, bruising his arms and legs while his
feet trailed on the floor. When he told a nurse that he could
not walk to the van on his own, the nurse “stated he could go,
he was just refusing to go.’’ Officers placed him in shackles and
forcibly took him to a van.66
Mr. Ng was then driven two hours to an ICE Office in
Hartford, Connecticut, where an ICE officer pressured him to
withdraw all pending appeals of his case and accept
deportation.’’67
While overhead video monitors filmed the entire incident at
Wyatt, a camcorder used by Wyatt staff was turned on and off
13 times at captain’s orders. It was an apparent attempt to
show Mr. Ng’s refusal to cooperate and prove he was faking
illness. During the painful process, the captain in charge told
Mr. Ng to “stop whining’’ and called him a “f***king idiot.’’68

deaths in detention

ICE investigators found multiple violations of ICE’s use-offorce standard, which prohibits using force against a detainee
offering no resistance. That “Wyatt officials took Mr. Ng by his
upper extremities and dragged him from his cell to R&D unit
and into the awaiting van’’ also was a violation.69
Family members had to sue ICE to get Mr. Ng medical care
and relief from abusive treatment. By the time a federal judge
ordered ICE to take him to a hospital, the diagnosis was
terminal. Cancer riddled his liver, lungs and bones. He died
five days later.
Here was a young man who came to New York as a teenager
and overstayed his visa years ago. He married a U.S. citizen,
had two children and a career as a computer engineer. He
landed in custody for trying to do the right thing: ICE locked
him up when he went to his last interview for a green card
after his wife applied to legalize his status. Why did ICE detain
him when he had committed no crime and posed no danger the
community? He should not have been detained in the first
place.
In December 2008, ICE authorities investigating Mr. Ng’s
death removed all 153 detainees from the Wyatt detention
facility.70 Now Mr. Ng’s widow and children, aided by the
ACLU, are suing ICE, Wyatt detention center’s owner and
numerous individuals. Among other complaints, they are
charging brutality and constitutionally inadequate medical
care.71
Two Deaths in Two Years
ICE’s internal investigation of Mr. Ng’s death and subsequent
removal of detainees from the contract facility are
commendable. Had ICE taken similar action at the Piedmont
Regional Jail in Virginia after a death there in 2006, Guido
Newbrough might still be alive.
Instead, Mr. Newbrough died in November 2008 from
endocarditis, a heart-valve infection that often is successfully
treated with antibiotics. The infection ravaged his organs as jail
guards ignored his complaints of pain, put him in isolation,
and left him untreated, according to accounts from detainees
and his family.72
Mr. Newbrough was born in Germany, where his mother met
and married a U.S. Air Force sergeant. His parents brought
him to the United States when he was 6 years old. He died at
age 48 – after 42 years of believing that he was a U.S. citizen.
He found out that he wasn’t when ICE detained him at the
Piedmont jail in February 2008. The reason: Six years earlier,
Mr. Newbrough had taken a plea deal in which he denied his
guilt but admitted there was enough evidence to convince a

The Sunday before
Thanksgiving, he pounded
the door of the lunchroom,
yelling for help. He was
crying, trying to tell the
guards about his medical
requests. Guards threw
him on the floor, dragged
him, and put him in
isolation. He died the day
after Thanksgiving.

jury to convict him of
molesting his girlfriend’s
daughter. He served less than
a year for the offense.73
Once in detention, Mr.
Newbrough began fighting
his deportation in
immigration court. Nine
months after arriving at the
Piedmont jail, he started
complaining of terrible back
pain and stomach aches. He
told his family he had talked
to the medical staff but,
“They just don’t care.”74

Fellow detainees described Mr. Newbrough’s increasing
discomfort and pleas for medical attention. He was sobbing all
night because of the pain, and other detainees began making
him hot compresses. The Sunday before Thanksgiving, he
pounded the door of the lunchroom, yelling for help. He was
crying, trying to tell the guards about his medical requests.
Guards threw him on the floor, dragged him, and put him in
isolation. He died the day after Thanksgiving.
Dr. Homer Venters, a detention healthcare expert, reviewed the
autopsy report and information provided by Mr. Newbrough’s
family. He told the New York Times that endocarditis is lethal
when not treated. The death rate is 25 percent or less with
modern hospital care.75
Mr. Newbrough’s ordeal recalls other deaths in detention,
including that of Abdoulai Sall, another detainee who had died
at the Piedmont jail in 2006. Mr. Sall, 50, was a mechanic
from Guinea with no criminal record. He died after his kidneys
failed over the course of several weeks.76
In that case, an internal review by ICE’s Office of Detention and
Removal was an indictment of Piedmont’s medical care. The
review concluded that:
“The facility failed on multiple levels to perform basic
supervision and provide for the safety and welfare of ICE
detainees.…Staff did not follow established policy, procedure,
and practice….
“The medical unit does not meet minimum ICE standards….
Staff selectively follows procedure and readily admits they do not
follow established custodial medical policy and procedure. The
line of communications in the medical department at this facility
is poor, and detainee health care is in jeopardy.”77
19

deaths in detention

Despite this damning assessment, ICE did not remove
immigration detainees from Piedmont. ICE knew that medical
care was seriously deficient yet failed to ensure that those
deficiencies were corrected there. Nor did ICE make the report
public until the ACLU requested it. Instead, ICE officials
publicly defended the medical care provided to Mr. Sall and all
detainees as Congress and the media questioned the healthcare
provided in ICE custody.78
Mr. Newbrough paid the ultimate price for ICE’s failure to act
to protect the welfare of detainees who have no other recourse
for medical care. Now ICE is conducting another investigation
of medical care at Piedmont and has suspended placing more
detainees at the facility. As of February 15, 2009, however, 53
detainees remained at that jail.79
The Littlest Victim
Children are not exempt from dying in the custody of DHS
immigration authorities. The case of 14-day-old Michael Futi is
every parent’s horror. Born with a hole in his heart, Michael
had been flown to Honolulu from Samoa for emergency
surgery. He never left the airport. He died after being detained
by U.S. Customs and Border Protection (CPB) officers – even
though he and his nurse were U.S. citizens.
Doctors detected the boy’s heart defect soon after his birth in
American Samoa. But the surgery that he needed was not
available there. So a local hospital made arrangements for
Michael to travel to a hospital in Honolulu for urgent
evaluation and treatment. Michael was hooked up to an oxygen
tank during the five hour flight to Hawaii.80

Imagine the panic. The two women and the baby are locked in
a room. The baby goes into respiratory distress. Government
officials will not let anyone out. The nurse is doing all she can
to keep the baby alive, including putting her finger in the
child’s hand to reassure him. But the door stays locked for
more than 30 minutes.
Michael released his grip on the nurse’s finger at 6:12 a.m.,
February 8, 2008. By the time the paramedics arrived, he had
no vital signs.84 He died due to lack of oxygen, according to
the medical examiner.85
Now the family is suing the federal government. The lawsuit
accuses CBP staff of “carelessly and negligently” delaying
Michael’s U.S. entry, thus, causing his death.
There is no justification for CBP detaining two U.S. citizens
with valid passports, much less when they had flown in to
obtain emergency medical attention. Michael’s death was as
tragic as it was needless.
AIDS Meds Denied
Victoria Arellano, 23, had little chance of surviving ICE’s San
Pedro detention center in California. A transgender immigrant
from Mexico, she was detained for being in the country
illegally after a traffic stop in May 2007. Though she had
AIDS at the time she was detained, she was on medication that
controlled the illness. By all accounts, she exhibited no
symptoms before taken into ICE custody86.

His mother, Lauipou Futi, obtained a U.S. visa waiver that
allowed her to travel to the United States with her son and to
stay during his medical treatment. He, his mother and nurse
were the first people off the plane. They expected to be taken
straight to the hospital, a 10 to 15 minute ride.81
The nurse and baby were cleared through immigration without
a problem. But CPB officers questioned Ms. Futi’s visa. Then,
inexplicably, CPB put all three of them into a locked room,
despite the nurse’s pleas to let her and the sick baby continue
on to the hospital.82
At that point, Michael had been off of oxygen for 13 minutes,
according to a timeline from the medical examiner’s office
provided by the Futi family’s lawyer. Five minutes later,
Michael began to breathe erratically and his skin mottled. The
nurse began to scream “Call 911’’ and to bang on the locked
door. CBP voices outside the door told her to calm down. She
began resuscitation on the baby.83

DIHS’s critical review of Ms. Arellano’s medical care

deaths in detention

At San Pedro, she reported her
medical history and
medication needs. The
medical staff denied her the
medication even though it is
critical to preventing
opportunistic infections that
can quickly cause death in
people with AIDS. Not
surprisingly, Ms. Arellano’s health began to deteriorate. She
soon developed a cough and fever, for which she should have
been hospitalized but wasn’t. Instead, medical staff gave her an
antibiotic that did not treat her illness.87

The combination of cruel,
inept and negligent care
proved fatal. An attempt
to save money cost this
detainee her life.

By July, Ms. Arellano was vomiting blood and showed blood in
her urine, according to cellmate testimony and statements. She
became increasingly weak, but medical staff only told her to
take Tylenol and drink fluids.88
Horrified at her treatment and suffering, fellow detainees
cooled Ms. Arellano’s fever with damp towels. She complained
of severe pain, nausea and stomach cramps. Cellmates used a
cardboard box to collect her vomit. One night, an ICE captain
put his shoe on her pillow and rudely asked, “What’s wrong
with you?’’ After her cellmates protested, she was taken to a
hospital, but not before being placed in a holding cell and
taunted by security staff.89
A week later she died of meningitis, a disease commonly seen
in cases of advanced AIDS.
Government documents unearthed by The Washington Post
suggest how San Pedro medical staff botched care for Ms.
Arellano. A review of her death by DIHS’ top specialist on
infectious diseases, Dr. Carlos Duchesne, notes that San Pedro’s
clinical director had prohibited lab tests for any detainee who
had been in the facility for less than 30 days.90 This was a
violation of ICE medical guidelines as well as established
medical ethics.91
Dr. Duchesne’s review pointedly noted the lab tests should have
been run on Ms. Arellano immediately. Instead, those tests
were delayed by 22 days as a result of the policy. Such a delay
could be a death sentence for any detainee with AIDS, HIV or
any other condition that weakens the immune system. Dr.
Duchesne didn’t mince words about the lab-test ban in his
review:
“…That practice is particularly dangerous with chronic
care cases and [e]specially is particularly dangerous with
… HIV/ AIDS patients. Labs for AIDS patients … must

be performed ASAP to know their immune status and
where you are standing in reference to disease control and
meds….
“The clinical staff at all levels fails to recognize early signs
and symptoms of meningitis.… Pt was evaluated
multiple times and an effort to rule out those infections
was not even mentioned.”92
Without test results, ICE medical staff gave Ms. Arellano a
“completely useless” antibiotic.93 The combination of cruel,
inept and negligent care proved fatal. An attempt to save
money cost this detainee her life. The following year, ICE
touted the savings from denying “treatment authorization
requests’’ – including $129,713.62 saved by denying HIV
treatments.94
After Ms. Arellano’s death, more than 20 cellmates who had
witnessed her mistreatment were quickly shipped to detention
centers nationwide. Such transfers often separate detainees from
their family and lawyers. The tactic also often succeeds in
keeping detainees from speaking out for fear of further
retaliation.95
Though continuity of HIV drugs is critical, lapses in their
administration occur too often in immigration custody. In
2006, a transgender detainee from South America reported not
receiving his HIV medications on several occasions at the
Krome detention facility in Miami.
Once, ICE officers failed to escort him to get medications after
a shake-down in the dorms. About a week later, medical staff
failed to give him medication for three days. Later, the nurses
were dispensing less than half of the prescribed doses of one of
his two drugs. As noted above, such interruptions can seriously
endanger the health of people with HIV. FIAC complained on
his behalf.96 Ultimately the detainee was deported, and FIAC
is unaware of the state of his health.
Deaths Yet Unknown
Because there is no mandatory reporting of deaths in
immigration custody, and ICE contracts with hundreds of
detention facilities nationwide, the actual number of deaths in
detention remains uncertain. Over the years detainees have
alerted FIAC to suspected deaths in ICE custody.
In late July 2007, for example, a detainee wrote FIAC about a
Haitian woman at the Glades County Jail in Moore Haven,
Florida, who may have died following her collapse. The
detainee said she coughed blood and begged for medical
attention for hours and fell to the ground. She had no pulse

deaths in detention

when taken away. Detainees hadn’t seen her since and “think
she is dead.”97 FIAC was unable to confirm what happened to
this woman.
Other reports of detainee deaths pre-dating ICE’s creation in
2003 are noted in the Background section of this report.
Immigration authorities are not required to report detainee
deaths to any central authority. Thus, no master list publicly
existed until the New York Times requested one under the
Freedom of Information Act and published it in May 2008.98
ICE listed 66 names of detainees who, like Reverend Dantica,
had died between January 2004 and November 2007 – a
period in which ICE detained nearly a million people. The list
contained few details, and even those details were not reliable.
With increased scrutiny, other names and allegations of medical
mistreatment have surfaced. We cannot be sure of how many
people have died in ICE custody.
Requiring ICE to report all deaths by law, and the
circumstances of those deaths, would provide some measure of
accountability. Until such reporting is mandatory, we can only
wonder how many detainees have lost their lives behind closed
doors, far from loved ones and removed from the public eye.

Because there is no mandatory reporting of deaths in
immigration custody, and ICE contracts with
hundreds of detention facilities nationwide, the actual
number of deaths in detention remains uncertain.

abuses in medical care

Abuses in Medical Care
“At the clinic, I could no longer speak, only cry. A nurse told me
she was sorry, but that the doctor had resigned so there was no
doctor. I sat in a chair and clutched my stomach. The nurse asked
me if I had I had been given bad news by the court or if I had
heard bad news about my family – and that was why I was feeling
bad…. I thought I was going to die.”99
Miguel Bonilla, suffering a ruptured
appendix in ICE custody

Inadequate medical and mental healthcare are among the most
common complaints from immigration detainees
nationwide.100 Detainees report undue delays in obtaining
proper medical care or outright denial of such care. Even
emergency treatment is delayed or ignored. Another complaint
is that nonviolent, mentally ill detainees are placed in
segregation, which often worsens the illness.
When detainees are transferred to another facility, their medical
records and prescription drugs often are left behind. Even
detainees with serious and obvious symptoms are accused of
“faking’’ an illness. They are shackled and handcuffed during
transport and in the hospital, even when doing so causes them
serious pain, discomfort and humiliation. In FIAC’s experience,
detainees are always placed in criminal prison wards upon
hospitalization.
Fear of retaliation frequently prevents detainees from seeking
appropriate medical care. Sometimes, detainees who attempt to
get proper medical care are placed in lockdown. Detainees also
report they have been threatened with transfers, and in some
cases transferred, after complaining about their or other
detainees’ medical care.
Cruel, indifferent and negligent medical care can scar
immigration detainees for life. Sometimes the attempt to cut
medical costs ends up costing ICE more, particularly when a
detainee is denied care and develops severe complications or
ends up in the emergency room. ICE is paying more, too, to
fight and settle the increasing number of lawsuits by detainees
demanding redress for medical mistreatment.
The following cases illustrate numerous problems with the
healthcare provided in immigration custody.

Life-Threatening Emergency
Miguel Bonilla Cardona, a FIAC client, almost died from a
ruptured appendix at the Glades detention facility – the same
jail where Valery Joseph had died a month before. Mr. Bonilla
agonized for a week before a nurse saw him doubled over from
the pain and sent him to a hospital where he had emergency
surgery. Not once did a doctor see or examine him at the jail.
Nurses offered no relief for his acute pain. Except for the nurse
that finally sent him to a hospital, jail staff did not appreciate
the urgency of his medical needs. A treatable condition turned
into a life-threatening emergency that kept Mr. Bonilla in the
hospital for 11 days.
Mr. Bonilla arrived in the United States from Honduras in
1998 and has no criminal history. He was detained by ICE at
the Port of Miami although he had no order of deportation.
Until then, he worked and supported a family that includes
two U.S-citizen children.
He was the picture of health when he arrived at the Glades jail
in July 2008: no existing medical or mental-health problems.
He didn’t smoke, drink alcohol or take drugs, prescription or
otherwise.
As he began feeling sicker and sicker, Mr. Bonilla complained
repeatedly of increasing pain. Medical staff at the jail failed to
recognize the symptoms of acute appendicitis, a condition that
“a first year medical student should be able to recognize,’’
according to a gastroenterologist told about Mr. Bonilla’s
symptoms.101 Nor did staff order tests or treatment.
Mr. Bonilla, 30, described the harrowing week he tried to get
medical care.102 First came his abdominal pains. Every time he
swallowed food he would vomit. He filled out one or more
requests for medical help daily.
He repeatedly asked for a doctor, pills, anything to stop the
pain as it worsened. Nurses at the Glades jail gave him PeptoBismol, Maalox, salty soup and sent him back to his cell.
When he complained that he couldn’t eat, one officer told him
not to worry: He could live without eating for 30 days.
Cellmates recognized his agony, helped him to the bathroom,
and tried to make him feel better. Glades medical staff did not
recognize the severity of his condition.

abuses in medical care

...family members were
not allowed to visit or
speak to him by phone in
the hospital...No one at
the hospital would give
them any information
about his condition, not
even whether he was
critical or stable,
“because he’s detained.”

Two days before he was sent to
the hospital, the pain was so
intense that Mr. Bonilla said,
“My stomach felt as if it was
exploding.’’103 Burning up with
fever, he curled up, hands and
knees on his stomach. He cried
continuously. He thought he
was going to die. Only the
thought of his two children
kept him going. The nurses told
him he could see a doctor the
following week.

Two days later, pain had
rendered Mr. Bonilla speechless. Two Glades nurses still denied
him care. He was in a chair clutching his stomach when
another nurse, one he had not seen before, quickly recognized
his condition. Her action likely saved his life.
Mr. Bonilla spent 11 days in the hospital. He was handcuffed
and shackled in transit. After the surgery, he had tubes inserted
in him to combat raging infections. Glades guards shackled his
feet as soon as he regained consciousness. In his room, he
overheard one nurse say that he would have died had he arrived
one hour later.
During this period, his family frantically was trying to find out
what had happened to him. FIAC learned of his plight from his
sister-in-law, who called after driving from South Carolina to
Mr. Bonilla’s immigration hearing in Miami. When Mr.
Bonilla did not show up in court, the judge asked a Glades jail
officer where he was. That is how his family found out he was
in a hospital. ICE did not contact the family to notify them.104
This was a violation of ICE’s current detention standard, which
requires ICE to notify next of kin when a detainee is “seriously
injured or ill.” ICE is supposed to inform the family member of
the detainee’s medical condition, location and visiting hours
and to “provide as much opportunity for visitation as
possible.’’105 Little of this information was provided to Mr.
Bonilla’s family. Nor were visits allowed.
When the family called the Glades jail, the person answering
the phone confirmed that Mr. Bonilla was in the hospital due
to a ruptured appendix. However, Glades personnel who
answered repeated calls would not say which hospital “for
security reasons.”

After several days, worried that Mr. Bonilla was dying, the
family frantically called and finally got the hospital’s phone
number. Nonetheless, family members were not allowed to
visit or speak to him by phone in the hospital.
No one at the hospital would give them any information about
his condition, not even whether he was critical or stable,
“because he’s detained.”106 Such isolation and inhumane
treatment not only was a violation of ICE’s own standard, but
also unnecessary for a man who had just survived a near-death
experience. Most likely, family contact would have sped his
recovery and healing.
Mr. Bonilla still wasn’t feeling well when he was released from
the hospital. “Everything hurt in my body,’’ he said.107 But
ICE transferred him that day to the Krome detention facility in
Miami, a grueling 115 mile trip in his condition. Getting on
the bus, which had high steps, was distressing:
“I couldn’t raise my foot high enough to climb up the
steps because it hurt so much,” Mr. Bonilla said. “I tried
and tried with Glades officers watching me. I finally had
to climb up the steps on my knees.”108
That wasn’t the end of the cruelty. At Krome, he was placed in
a cold room around 4 p.m. He ended up spending the night
there on a cement bench and in pain. He didn’t see the doctor
until the next morning. Mr. Bonilla asked for pain medication.
But the doctor told him he could not give it because his
medical records had not been sent when he was transferred
from the Glades detention facility.
Not sending records is another violation of medical standards
and particularly egregious in this case, given that Mr. Bonilla
had just left a hospital and had not fully recovered from a grave
illness. He wasn’t seen again by the doctor or by any other
medical staff at Krome. Nor was he given any medication
during his eight days of confinement there.
Even his release turned into an obstacle course. Though an
immigration judge granted him parole and his family had the
money to post bond, they had to wait two days for Mr. Bonilla
to walk out the door. At one point, a Krome staff member told
his family that Mr. Bonilla had to be given a medical check to
ensure he was healthy so that advocates would not complain
that he had been mistreated. That was an insult to family
members who knew that he had suffered the lack of proper
medical care while in ICE custody. Ultimately, Mr. Bonilla was
released without a medical review.

abuses in medical care

Suffering 2,000 Miles From Home

“My heart is broken. My body feels like its falling apart and I am
here in the county jail slowly dying. I was transferred to Arizona
… so I could get treated, but I’m in worse condition than ever. “109
- Yong Sun Harvill, after a year in a
county jail contracted by ICE
FIAC also represents Yong Sun Harvill, who spent 15 months
in ICE custody without receiving the intensive medical care her
condition required. She suffers from a rare and serious set of
illnesses, which ICE detention facilities consistently failed to
treat. ICE also denied requests for her release on humanitarian
grounds so that Ms. Harvill could obtain medical care herself.
Ironically, she had good health insurance and doctors who
could provide proper care at no cost to taxpayers.
Ultimately, she sued ICE with the pro bono help of FIAC and
attorneys from the firm Steptoe & Johnson in Phoenix,
Arizona, which led to her release in July 2008. Her case was
also featured in a front-page story in The Washington Post’s
Careless Detention series.110
Ms. Harvill came to this country from Korea in 1975 as the
teenage wife of a U.S. soldier. She has been a U.S. resident for
more than 30 years, is married to a U.S. citizen and was 50
years old when detained by ICE. She has a history of cancerous
tumors, hepatitis C, and liver disease. She also suffers from
chronic lymphedema, a painful swelling of fluid in her left leg
caused by past cancer treatments. Before ICE detained her and
attempted to deport her, she was under doctor supervision,
taking medication, and her illnesses were under control.
Medical negligence while in ICE detention caused a dramatic
deterioration in Ms. Harvill’s physical and mental health. She
was in constant pain while detained and now faces an increased
risk of complications that could shorten her life.
Ms. Harvill’s ordeal began at Florida’s Palm Beach County jail,
which provided little to no medical care during her seven-week
stay. FIAC asked ICE to release her due to her multiple and
serious medical illnesses. In May 2007, ICE acknowledged the
seriousness of her condition but claimed that no detention
facility in Florida could accommodate her medical needs.
Instead, she was transferred to the ICE-run Florence Service
Processing Center in Arizona, “in order to provide for Mrs.
Harvill’s medical needs.’’111

physician on staff for months. In August 2007, the jail’s
Health Services Administrator told FIAC that neither the jail
nor ICE’s Florence facility had a physician on staff. In February
2008, a third of the jail’s 29 medical positions were vacant,
according to government documents obtained by the
Washington Post.112 Moreover, the closest emergency room to
the jail was about 70 miles away in Phoenix.
In short, ICE moved Ms. Harvill more than 2,000 miles away
from the people who could help her – her family, doctors and
lawyers – only to isolate her in a jail that failed to provide the
medical and mental-health services she needed. Equally
troubling, ICE would not permit her to obtain medical care
using her own insurance or medical equipment.
During her detention, a suspicious lump grew below her left
knee and her leg swelled up to two to three times the size of
her right leg. The damage to her leg was so great that the skin
broke open in spots and secreted fluid. Nonetheless, during 15
months of detention, and despite the recommendation of jail
medical staff, she was not provided the medical pump she
needed to control the swelling. Nor was she allowed to use her
own pump, which her family offered to send. She was not
properly treated for the chronic pain caused by this and other
conditions, either. Consequently, Ms. Harvill suffered severe
and persistent pain for more than a year.113
Pinal medical staff also ignored Ms. Harvill’s liver problems.
Despite her hepatitis C diagnosis and history of cancer, ICE
never provided the liver biopsy ordered by an oncologist. In
August 2007, Pinal County Jail’s health administrator told a
FIAC attorney that it was jail policy not to treat inmates for
hepatitis C. The reason given was that most criminal inmates
were in jail for relatively short periods.114
Such a policy makes no sense for immigration detainees who
are locked up more than a year, like Ms. Harvill, and could
sustain life-threatening liver damage from hepatitis C.
Ms. Harvill also suffered numerous needless and agonizing
trips to the public hospital in Phoenix. She had to wait in a
freezing-cold holding cell while waiting to be picked up for
the ride. The hour - 20 minute drive each way was grueling.
“Every trip I take to the Maricopa County Clinic [MCC] is an
ordeal and causes me further pain,” she said. “I have to wait in
a holding cell for ICE to pick me up and when they return me.
I am unable to elevate my leg and sometimes have to sit on the
floor for hours at a time waiting to be transferred.”115

Within the month, however, ICE moved Ms. Harvill again.
This time she was sent to the Pinal County Jail, also in
Florence, Arizona, where there was no on-site, full-time
25

abuses in medical care

Once she got to the hospital, her records were not consistently
available. She was typically seen by different doctors who
ordered tests and treatments that were canceled by ICE or only
provided after months of delay. The pain and frustration are
evident in samples of Ms. Harvill’s statements and journals:
“On August 13 [2007], the officers at PCJ woke me up
around 6:00 a.m. to take me to the outside clinic, but
ICE couldn’t find my doctor’s order. My appointment was
for 8:30 a.m., but they didn’t find the order until 8:00
a.m. and it takes an hour to get to the hospital in
Phoenix. When we finally got to MCC [Maricopa County
Clinic], the radiologist I finally saw decided that I didn’t
need the liver biopsy.
“About August 16, 2007, they took me to the Maricopa
County Clinic and we waited four or five hours to see a
doctor for less than 10 minutes. Nothing was done
because the doctor just wanted to do a pap smear, which
he didn’t know I had already had done a month earlier.
He said I needed to see another doctor for anything else
and that they would have to schedule another
appointment.
“About August 21, 2007, an ICE officer said he was
going to take me to see the doctor. I told him that I had
an immigration hearing that day, but they took me to
Phoenix anyway. We were on the way to Phoenix when
someone called the officer about my court hearing. So
they asked me if I wanted to see the doctor or go to court.
I felt I couldn’t miss my court date so I didn’t get to see
the doctor. I’m still not sure which doctor I was going to
see, whether it was for my liver, my abdomen, or my leg.
No one told me….116
On September 20, 2007: “Woke up at 5:30 a.m. ICE
picked me up. Went to Maricopa Medical Center. ICE
officer thought I was going for a biopsy of my uterus.
Pinal County [Jail] nurse thought I was going to the GI
doctor. I didn’t see any of them. I went to the oncology
doctor. He asked if I had a liver biopsy. I told him no
because they told me it was just a cyst not a tumor. He
was upset. He already knew that but wanted a biopsy….
“We just waited there and that was it. Just like always.
Turn around and nothing gets done. I’ve been in Florence
5 months. They send me everywhere but nothing gets
done.’’117
On October 4, 2007, “I woke up at 5 a.m. I was taken to
Florence detention center. I was there until 7 a.m. ICE
officer picked me up. They said I was going to [get a]
26

Ms. Harvill’s journal

biopsy. ….We got to Maricopa to get registered. The
receptionist told us that my biopsy had been rescheduled
to Nov. 6. ICE officer told her it couldn’t be because they
had the order for today. She checked why it had been
cancelled and she said that it was not from their end. It
had to be from ICE medical. ICE officer was upset and
said somebody should let them know when that happens.
“The receptionist said that I did have a CT scan at 11
a.m. at radiology. We got to radiology early, and they
wanted to put me in a holding cell. The ICE officer told
them it was not necessary. But they said it was policy…
The scan only took 5 minutes. We got out of the hospital
and the ICE officer said he felt bad for me because he has
taken me to the hospital 4 or 5 times and they never do
anything for me.”118
Throughout Ms. Harvill’s detention, FIAC submitted letters to
ICE substantiating her fragile medical state and requesting
that she be provided the necessary treatment. ICE consistently
responded that DIHS “is currently able to meet Mrs. Harvill’s
medical needs”.119 Alternatively, FIAC repeatedly requested
that she be released on humanitarian parole so that she could
obtain that care using her own medical insurance.

abuses in medical care

Among the letters substantiating her condition was one from a
doctor at the H. Lee Moffitt Cancer Center and Research
Institute in Tampa, Florida, where Ms. Harvill had been a
patient:
“Ms. Harvill’s disease is extremely debilitating and
painful. She will need continued care at a facility familiar
with these types of tumors as they will continue to occur
and progress. If not treated properly they can become lifethreatening.”120
A Board-Certified Oncologist, Hematologist and Internist in
Miami, Florida, reviewed Ms. Harvill’s medical records. His
letter noted:
“The consequences of continued incomplete and
superficial care of Mrs. Harvill may include chronic
infections, disability, recurrence and progression of
tumors, deteriorating physical and mental health, and
other complications that could even lead to her death.”121
Despite ICE claims, the medical experts concluded that Ms.
Harvill was not getting the care demanded by her multiple
illnesses. Dr. Lee Cranmer, director of the Melanoma/Sarcoma
Program at the Arizona Cancer Center,
examined more than 700 pages of her
medical records. He stated:
“It is my professional opinion that Mrs.
Harvill is suffering from a rare, severe
and complex set of medical conditions for
which she is not receiving necessary
medical condition from ICE or the Pinal
County Jail.

“At present, she is not receiving the kind of cancer
screening and examination that is indicated for a person
of her medical history and physical condition.
“Second, Mrs. Harvill suffers from severe lymphedema in
her left leg, a complication of treatment that she received
for her cancers….I fear that her lymphedema has already
progressed to elephantiasis.
“In response to these compelling and serious medical
needs, however, I am informed and believe that Mrs.
Harvill has merely received an extra blanket, a pillow and
a stocking; that she has been denied the use of a
compression pump that physicians at the H. Lee Moffitt
Cancer Center in Tampa, Florida, have prescribed; and
that she is not in the care of a lymphedema sub-specialist.
In my professional opinion, Mrs. Harvill’s left leg requires
meticulous care by physicians who specialize in
lymphedema treatment.’’122
Ms. Harvill’s desperation deepened as the months passed in
Arizona and she became increasingly hopeless that she would
ever get the medical care she needed. After a year in the Pinal
County Jail she wrote:
“Sometimes I have so much
pain, I feel I am close to death.
My heart aches because of the
uncertainty of my health. My
worst fear is that one morning,
while being held in this county
jail, I won’t wake up. I have
heard on the news that this has
happened to other detainees.
Please don’t let me die in this
place. Every day I pray for God
to help me because that is
about all I can do.”123

“First, Mrs. Harvill has a highly unusual
and rare condition (aggressive
After her release, Yong Sun Harvill, right, thanks
fibromatosis, … a rare genetic syndrome) FIAC’s Cheryl Little
that requires close periodic monitoring,
Ms. Harvill was finally released on July 3, 2008 after 15
including physical examinations and appropriate followhorrific months in ICE detention. Her release followed the
up tests, to detect recurrence of this aggressive cancer,
settlement of the federal lawsuit filed on her behalf by FIAC
which can be life-threatening.
and Steptoe & Johnson and coverage of her case in the
Washington Post. Detainees shouldn’t have to suffer this much
“Specifically, because of her history of aggressive
or need this much legal assistance to get ICE to provide proper
fibromatosis, she needs to be seen regularly by an
medical attention or for ICE to release them so they can get
oncologist with expertise in desmoid tumors who can
medical care themselves.
establish an ongoing relationship with her and detailed
familiarity with her medical history, examine her
Eight months later, Ms. Harvill is back home, still battling
periodically for recurrence of cancer, and coordinate other
medical issues. One doctor has recommended she have colon
aspects of the management of this complicated condition
surgery, which may require her to use a colostomy bag for the
and the collateral damage she has suffered from its
rest of her life. Fortunately, her cancer is in remission.
treatment.
27

abuses in medical care

A Host of Deadly Illnesses
“Rose Marie,” a Haitian with at least four life-threatening
conditions, spent more than two months in ICE detention
before being released in December 2008. ICE should not have
detained her in the first place, given her mental and physical
state at the time. Fortunately FIAC did not have to file a
lawsuit, as it did in Ms. Harvill’s case, for ICE to release Rose
Marie on humanitarian grounds.
Even so, FIAC attorneys worked hundreds of hours to achieve
this positive outcome. Countless other ill detainees without
legal representation continue to suffer in silence.
Rose Maries’s medical condition is complicated and a treatment
challenge. Her life-threatening illnesses include:
• Schizophrenia
• HIV
• Sickle-cell anemia
• Congestive heart failure, and
• Cervical cancer, most recently diagnosed124
She also has had a double-joint hip replacement, which was
“related to the degenerative processes caused by sickle-cell
anemia.” Altogether she takes at least 11 different prescription
drugs to control her numerous and severe illnesses. Those
illnesses landed her in a hospital intensive care unit at least
three times in 2008, including as recently as in August. She
was hospitalized on six other occasions that year for medical
and psychiatric reasons.125
ICE detained Rose Marie on October 14, 2008, as a result of a
non-violent psychotic episode. ICE also placed her in
deportation proceedings. At the time, she told ICE about her
medications, multiple serious illnesses, and her assisted-living
facility.
Prior to being detained, her illnesses were being cared for and
managed by a group of medical-service providers. Rose Marie
lived in an assisted-living facility, Merriment Manor, where she
obeyed the rules and “did not have behavior problems.’’126 For
more than five years she had been treated for her medical and
mental-health issues by the Henderson Mental Health Center’s
FACT Team, which provides a broad range of services.127
Clearly ICE is not equipped, nor does it have the funding, to
provide the round-the-clock medical care that Rose Marie’s
severe illnesses require. Further, she would have faced nearcertain death had she been deported to Haiti, where finding
adequate medication and medical care would be next to
impossible for a person with her chronic conditions. Even so,

ICE did not consider releasing her until FIAC took her case
and intervened.
On November 12, 2008, FIAC wrote a letter to ICE urgently
requesting her release on humanitarian grounds. Rose Marie
was not a flight risk, national-security threat or danger to the
community. She was a severely ill individual who needed
treatment. The FIAC request also included letters of support
from her assisted-living facility and her medical-services
provider, both of which were happy to resume her care.128
Afterward, ICE officials verbally told FIAC that the release was
being denied. Only after FIAC appealed to higher-level ICE
officials was she released on Dec. 17, 2008, more than a month
after FIAC submitted the request.129
Too often in complicated cases such as those of Rose Marie and
Ms. Harvill, ICE’s default position is to attempt to deport the
severely sick person or to indefinitely detain them, regardless of
ICE’s ability to provide them the intensive medical care they
need. For those who have no attorney – more than 80 percent
of detainees – there are dim prospects of getting released or
getting decent medical care in custody. In those cases, being
detained by ICE could amount to a death sentence.
A Cancer Time Bomb
Hanna Boutros, another FIAC client, had been diagnosed with
prostate cancer before he was transferred to immigration
detention in July 2006 and told he needed radical
prostatectomy surgery. In Mr. Boutros’ medical file, the doctor
noted in June 2006 that he sent information to ICE about the
necessary treatment, and told Mr. Boutros that he needed
immediate surgery.
When Mr. Boutros was transferred to Krome detention facility
in July, he was told it was the best facility for an ICE detainee
needing medical treatment. After his transfer, he asked for
treatment for months but did not receive it. In October 2006
an independent oncologist reviewed Mr. Boutros’ medical
records and wrote a letter affirming that Mr. Boutros needed to
be urgently tested to see if he was still a candidate for surgery;
if so, Mr. Boutros had to be sent for prostate surgery without
delay. FIAC presented the letter to Krome officials, asking
them to comply with the medical expert’s recommendations.130
Mr. Boutros had to wait nearly two more months before
getting the operation.
Beyond his physical misery, Mr. Boutros described his mental
anguish due to the undue delay in his treatment. He told
FIAC:

abuses in medical care

“As bad as the physical pain and discomfort is, the mental
part is worse. The doctor told me that the cancer was
advanced. I feel sometimes like a time bomb is inside me.
Every day, I wake up and wonder if today is the last day
of living. When I go to sleep, I wonder if I am going to
wake up tomorrow. I fear death. I feel helpless. I feel like
there is no hope for me and I will just die. I am so
afraid.”131
Mr. Boutros’ doctor ordered the tests necessary for prostate
surgery in August 2006. Those tests were not completed until
late October. It was not until late December 2006, and after
FIAC threatened to sue, that Mr. Boutros actually had
surgery.132
Women Losing Babies
Many women detainees have reported not receiving regular
gynecological and obstetric care. There have been problems
with pregnancies as well. Officers’ personal beliefs can also
interfere with their ability to provide an effective and safe
environment for female detainees.
For example, FIAC documented the case of an African-born
asylum seeker who learned that she was pregnant while in
custody at the Broward Transitional Center (BTC) in 2003.
The pregnancy was the result of a politically motivated gang
rape in her home country, which compelled her flight to the
United States to seek asylum.
When detention staff learned that the pregnancy was
unwanted, they pressured her to carry the baby to term.133
Only after FIAC took her case was she informed that she could
get an abortion at her own expense while in custody. Later, this
woman was released and miscarried.
Another BTC detainee first brought her symptoms to the
attention of the medical staff on December 18, 2003. Although
she had the classic symptoms of an ectopic pregnancy, a painful
and potentially fatal condition, her concerns were ignored.
On several occasions, she was simply given Tylenol and told her
pain was normal. When she began to bleed profusely, the
medical staff still did not take her complaints seriously. On
January 4, 2004, when she was finally seen by a doctor, she was
immediately taken to the hospital for surgery, resulting in both
the loss of her child and the removal of one of her fallopian
tubes.134
Afterward she told FIAC:

The pregnancy was the
result of a politically
motivated gang rape in
her home country, which
compelled her flight to
the United States to seek
asylum...When detention
staff learned that the
pregnancy was
unwanted, they pressured
her to carry the baby
to term.

“I was taken to the
Broward Medical Center
and was told by the Doctor
there that it was too late
and they needed to operate
because I had an infection.
He said it was an ectopic
pregnancy. I had surgery on
January 5, 2004. I was told
afterwards that one of my
tubes had to be removed. I
was devastated by the news
because, not only had I lost
the baby, but also because
now it would be much
more difficult for me to
have a baby….

“I spent three days at the hospital and all the time that I
was there, even though there was a phone in my room,
the guard that stayed with me did not allow me to use
the phone to contact my relatives and let them know
what had happened…. I was not able to get any special
visit with my family either…. I will never be able to
forget all that I went through since I’ve been here.”135
Another detainee miscarried while in immigration custody at
the Turner Guilford Knight Correctional Center (TGK) in
Miami in 2004. Her requests for medical attention went
unheeded. She was six weeks pregnant when she arrived at the
facility and observed that the jail was filthy. The first two
holding rooms she was locked up in were smeared with feces.
Years later the presence of such filth was confirmed by ICE’s
own internal report on TGK’s compliance, or non-compliance,
with ICE National Detention Standards.136
On July 12, 2004, she submitted a request to see a psychiatrist
because she felt the conditions were detrimental to her
pregnancy. She was stressed and distraught by the lack of
cleanliness. Three days later she lost the baby. Later that month
she wrote:
“My written request went ignored and on July, 15, 2004,
I miscarried. I was taken to Jackson Memorial Hospital
in shackles and handcuffs. I sat in the waiting room
amongst other pregnant women who wore looks of
concern sitting next to what looked like a criminal. I was
wearing a bright orange jail uniform and in shackles and
handcuffs with two guards at all times. I waited for three

abuses in medical care

hours at which point I started to visibly hemorrhage and
only at this point did the medical staff attend to me.
“I was supposed to go back to the hospital for a follow-up,
however, I was not going back through that humiliation
and violation of my human rights unless my life depended
on it. To date my request to see the facility psychiatrist
has still gone ignored and I have been unable to tell
anyone of the upset and emotional stress I have gone
through losing my child in a place like this. This jail is
not set up to handle real medical emergencies.”137
All the women in ICE custody at the TGK jail were moved to
a Monroe County jail in September 2004. The reason given by
ICE was that the jail could not meet the agency’s detention
standards,138 something immigration officials had previously
and repeatedly denied.139 In response to a Freedom of
Information Act request, FIAC learned in 2006 that an ICE
annual detention review of TGK in March 2004 assigned a
final rating of “At-Risk” regarding detainees’ access to medical
care and multiple other categories. The review concluded that
“the overwhelming lack for [sic] health and safety found at
TGK is disturbing.”140

Of further concern, male medical staff has conducted
gynecological and breast exams on female detainees without
anyone else present. Yong Sun Harvill – the severely ill FIAC
client transferred to an Arizona jail in 2007 – formally
complained, along with six other detainees, about such a
situation. FIAC raised the concern with ICE and the Division
of Immigration Health Services (DIHS). While there has been
no direct ICE response to the detainees or FIAC about this
troubling and inappropriate treatment, the nurse in question
apparently no longer works at that jail.141
Women detainees face other medical issues while in ICE
custody. In late August 2006 FIAC contacted ICE and the
captain of the Monroe County jail regarding a detainee who
had spent weeks in pain, trying to get medical attention for a
leaking breast implant.142 Receiving no response, FIAC
contacted the DIHS directly. Officials there quickly informed
FIAC that Monroe County jail staff had requested a plasticsurgeon consultation, which DIHS had approved on August
24, 2006.143 DIHS also acknowledged that jail staff admitted
the appointment for this detainee had not been made and they
promised to follow-up.
Children at Risk
Even children have been deprived of decent medical care in
immigration custody. One example is the case of Ernso Joseph,
who was 15 when he arrived on a boat that ran aground on
Key Biscayne, Florida, in October 2002. Shortly after he was
placed in immigration custody, Ernso was taken for dental and
wrist x-rays. Based on these suspect tests, immigration officials
labeled him an adult and placed him in an adult detention
center.144 Though an immigration judge granted him asylum
in 2003, DHS appealed the judge’s decision and kept him
detained.
A FIAC client, Ernso was kept detained for more than a year
while waging a legal battle against deportation. At one point,
he was released to an uncle after being diagnosed with PostTraumatic Stress Disorder (PSTD), clinical anxiety and extreme
depression by both government and independent trauma
specialists. Detained several months later, he was kept prisoner
in a hotel room. Receiving no psychological counseling, his
mental health rapidly deteriorated. FIAC spent weeks getting
permission for an independent trauma specialist to meet with
Ernso. Following the specialists’ report that Ernso was suffering
from PTSD and extreme depression, a government official came
to the same conclusion.145
U.S. House Rep. Kendrick Meek denounced Ernso’s treatment
and asked for his release. “It is not an exaggeration to say that

abuses in medical care

Eye care is not even
mentioned in the
standards.

dogs in kennels receive more
humane treatment and have
more attentive and kinder
human contact than this
Haitian teenager has received at
the hands of the federal
government.”146

blind. He said that he was scheduled for eye surgery before he
was transferred to ICE custody in November 2007.149
Although he was initially told by a physician at Krome that he
would receive the surgery, it was not until FIAC brought his
case to the attention of officials at Krome that he finally had
surgery at the end of January 2008.

It was not until January 2004 that immigration officials
granted Ernso permission to take his case to state juvenile
court, and the judge ruled in his favor.147 Eventually, Ernso
was granted deportation relief. He was finally able to attempt
to recover from the trauma he had suffered in Haiti and in U.S.
immigration custody.
More information on children in ICE custody follows in the
section on Unacceptable Mental-Health Treatment.
Scant Dental and Eye Care
ICE’s new performance-based standards require a dental
screening to be completed, along with the initial medical and
mental screening, within 12 hours of a detainee’s arrival at a
detention site. The revamped standards maintain the current
requirement that a dental screening exam should be performed
within 14 days of the detainee’s arrival.
Only time will tell if the standard will change the current
practice, which currently provides only rudimentary or
emergency dental treatment during the first six months of
detention. Even after six months, dental care generally has been
limited to extractions. Treatment of painful dental and gum
conditions is typically delayed or denied altogether.148 Dentures
are not provided, and broken dentures are rarely fixed.
A petition from more than 250 Krome detainees in September
2006 summed up their frustration: “It’s either pull the tooth
out or nothing. Fal[se] teeth service is not provided, although
it is indicated in the detainees’ handbook.” Detainees may not
even use their own money to secure dental care.
Eye care is not even mentioned in the standards. Eyeglasses are
not a covered benefit except when detainees are taken into ICE
custody with eyeglasses and the glasses break while they are in
custody. Eyeglasses are not replaced if they were left behind or
lost at a previous detention facility.
Sometimes detention personnel do not take eye conditions
seriously. A diabetic detainee at Krome told FIAC that his eyes
had blood in them. He was terrified he would go completely

unacceptable mental-health treatment

Unacceptable Mental-Health Treatment
“The detention center … decided to take Isaias off his medication
for schizophrenia and depression. Isaias became very sick and was
put on suicide watch. He smeared feces and spit in his cell. He
became very disorientated and refused his other medication for
diabetes and high blood pressure. He was punished by the detention
staff – they put him in solitary confinement and gassed him.”150
- Testimony on Isaias Vasquez’s
experience in ICE custody

Immigration detainees with mental-health issues often receive
little, if any, treatment in ICE custody. In many cases, their
conditions worsen or they destabilize while in detention. They
are misdiagnosed, improperly medicated, cruelly treated or
denied psychiatric care altogether. Worse, many of those
immigrants should not have been detained in the first place.
The Washington Post investigative series concluded that,
“People with mental illness are relegated to the darkest and
most neglected corners of the system.’’ It found “multiple
failures’’ in mental healthcare, including:
“Suicidal detainees can go undetected or unmonitored.
Psychological problems are mistaken for physical maladies
or a lack of coping skills. In some cases, detainees’
conditions severely deteriorate behind bars. Some get help
only when cellmates force guards and medical staff to pay
attention. And some are labeled psychotic when they are
not; all they need are interpreters so they can explain
themselves.’’151
Suicide is the primary cause of death among detained
immigrants, accounting for 15 of 83 deaths since 2003,
according to the Washington Post count. Internal documents
also revealed that ICE medical officials estimate that 15 percent
of detainees, about 4,500 on an average day, suffer from mental
illness. Publicly, ICE’s official estimate is 2 percent to 5
percent of the detainees.153
ICE is not staffed adequately to care for the increasing numbers
of mentally ill detainees, either. One e-mail from Dennis Slate,
the detention system’s top mental-health official, noted that,
while the ratio of mentally ill inmates to staff was 1 to 10 in
prisons for the mentally ill and 1 to 400 in the federal Bureau
of Prisons, the ratio was 1 to 1,142 in immigration
detention154 – a mind-boggling disparity.

Documents revealed cost-cutting measures and angst among
some of the detention system’s medical staff over the lack of
resources and the trade-offs they had to manage. An ICE chart,
for example, shows the Division of Immigration Health
Services saving $45,158.57 with nine denials of “depressive
disorder not elsewhere classified” during a one year period
ending in August 2006; four denials of treatment for manicdepressive psychosis yielded $18,145.36 in savings.155
Such cost-cutting in healthcare may ultimately be selfdefeating. In yet another document, Mr. Slate wrote, “The
little money managed care may save in the short run is going
to be dwarfed by the millions that will be paid out by ICE
when the lawsuits roll in.’’156
In some cases, a detainee’s mental illness may complicate
treatment for other medical issues, which may lead to death. In
other cases, negligence or mistreatment of mental illness leads
to a needless death, as in that of Algerian asylum seeker,
Hassiba Belbachir, which is detailed below. Her suicide, the
overall number of suicides in detention, and other disturbing
cases raise serious questions about ICE’s ability to properly
oversee and care for mentally ill detainees.
‘Death is Dripping’
Ms. Belbachir, 27, was detained by ICE in March 2008 after
arriving at O’Hare International Airport and asking for
political asylum. Sent to the McHenry County jail in the
suburbs of Chicago, she was dead within nine days. The asylum
seeker with a history of depression and panic attacks landed in
a jail with a history of inadequate mental healthcare.
ICE knew that this jail consistently failed to provide detainees
the mental-health and suicide screenings required by ICE
standards, having completed a recent review of the facility.157
The jail did not have an adequate written suicide-prevention
policy and had not fully trained staff to prevent suicides.158 It
was a fatal place for Ms. Belbachir.
During her interview upon arrival, Ms. Belbachir revealed that
she had once tried to kill herself by drinking soap, according to
jail records. Her interviewer noted she had “a major depressive
disorder” and needed to see a psychiatrist for medication. She
was given a routine appointment for 10 days later. She died
March 17, one day before her appointment.159

unacceptable mental-health treatment

DIHS concerns about the McHenry County Jail

Five days before she committed suicide, Ms. Belbachir was
moved to a medical ward after having a panic attack in her cell.
The following day she told a social worker that she was hearing
“parasites’’ and wanted to die. She said. “Death is dripping,
drop by drop.’’ Nonetheless, medical staff did not place her on
suicide watch.

both say they fled persecution in Brazil. The two
arrived on a boat that ran aground in South
Florida on October 31, 2008. A private doctor
hired by their families diagnosed both of them
with PSTD. Their symptoms included insomnia,
depression, anxiety and psychotic episodes. On
March 5, 2009, the men sued ICE in federal court
for failing to treat them for at BTC. That lawsuit
charges that, despite repeated requests, the men
have not been given medication or mental-health
treatment for their disorder at BTC. ICE also
rejected their requests to be released so they can get
proper treatment themselves. According to their lawyer, a BTC
officer said that the men would have to be moved to another
detention facility to be treated.162 The charges raise significant
concern because the vast majority of detained asylum seekers in
Florida are at BTC.

The day she died, a guard saw her lying motionless, face down
on the floor, but did not enter the cell. When the guard
returned to bring her food 3o minutes later, her face was
purple. By the time emergency service arrived, it was too late.
She had strangled herself by knotting jail-issued socks together
and wrapping them around her neck.160

Many of the asylum seekers FIAC has represented are Haitians
who legitimately fear for their lives if deported and for the
lives of deported family and friends who have disappeared. Yet
Haitian asylum seekers and others generally are not offered
meaningful mental-health services or orientation before being
deported. Adding to the trauma, such deportations often are
carried out without notice in the middle of the night.

Other Asylum Seekers
Many immigrants, like Ms. Belbachir, come to the United
States to seek asylum. Many have suffered grievous harm in
their own country, including rape, torture, sexual slavery,
forced marriages, trafficking, and female genital mutilation.
Despite such traumatic experiences, many asylum seekers are
detained by ICE for prolonged periods in harsh conditions that
cause them further trauma and hardship.

Double the Abuse
Like many others in immigration custody, “Ana’’ should not
have been placed in detention. A FIAC client, Ana suffered
horrific physical, emotional and sexual abuse by her husband.
As a consequence, she has serious mental-health and medical
conditions that have been exacerbated by detention. Yet she is
receiving no counseling or therapeutic mental healthcare in
custody other than anti-depressant medication.

It’s no wonder then that depression and anxiety are among the
most prevalent chronic diseases among asylum seekers. One
2003 study of asylum seekers in detention found that their
mental health was “extremely poor and worsened the longer’’
they were detained. Researchers from Physicians for Human
Rights reported symptoms of depression in 87 percent of the
detained asylum seekers, anxiety in 77 percent and posttraumatic stress disorder (PSTD) in 50 percent.161 Detainees
sometimes become so depressed by their long detention that
they are unable to properly articulate their story to a judge or
asylum officer.

Her abusive husband, a U.S. citizen, reported her to ICE in an
attempt to have her deported. ICE officers went to her home
and arrested her. In doing so they likely violated federal law
that prohibits DHS, ICE, and other government agencies from
relying on an abuser’s information to act against a victim.163

Two asylum seekers detained at Broward Transitional Center
(BTC) could identify with the study’s findings. Jaime Miranda,
whose father was murdered, and Daniel Padilha, who is gay,

FIAC has made repeated requests for Ana’s humanitarian
release.164 To date, however, she has been detained by ICE
more than six months.
In September 2008, FIAC requested that an independent
psychologist and professor be permitted to see Ana at the
detention facility in order to conduct an evaluation. ICE has
yet to respond to the request though denying such a visit is
contrary to ICE National Detention Standards. Those standards
direct ICE to “generally approve’’ examinations by independent
medical experts and service providers.165

unacceptable mental-health treatment

ICE’s yet to be implemented Performance-Based National
Detention Standards go further by stating: “Ordinarily the
Field Office Director shall approve the request for independent
examination, as long as it would not present a security risk.
Requests for independent examinations shall be answered as
quickly as practicable.’’166
Ana, meanwhile, has been further traumatized by her
experiences in detention. She was invasively searched – “all over
my body and especially my intimate parts’’ – when evacuated
from the facility in September 2008. Male inmates also exposed
themselves to her and other women detainees at the jail where
they were transferred.
Worse, an ICE officer threatened Ana when she was brought
back to the detention facility. He first asked her a question
related to her husband, and she responded by asking why he
needed to know. Ana said the officer “became angry and told
me it was none of my f***ing business and called me a bitch.
Then he advanced toward me with his hand raised as if to hit
me.’’

Gloria Armendariz, Mr. Vasquez’s common-law wife of more
than 30 years, testified in Congress about his mistreatment in
immigration custody. First, at the Central Texas Detention
Facility in San Antonio, he complained that he was fainting
and suffering side effects from medication; on two occasions he
had fallen and hit his head. He also told Ms. Armendariz that
the officers didn’t believe he was mentally ill. Though she
complained about his treatment, the detention staff told her
that Mr. Vasquez was “fine and did not need additional medical
attention.’’171
Then, in August 2005, Mr. Vasquez was granted relief from
deportation under the Convention Against Torture when an
immigration judge ruled that he would likely suffer torture in
Mexico due to his mental illness. A letter from a VA hospital
staff psychiatrist noted that that Mr. Vasquez “suffers from
chronic paranoid schizophrenia’’ and that deportation to
Mexico could “cause him to relapse into frank psychosis and
possibly even dangerous behavior.’’172
Since he was not deportable, ICE could have released him then.

Only the intervention by the facility chief stopped the officer
from striking Ana.167 Such treatment of any detainee is
highly inappropriate, much less when the detainee is
already shell-shocked by domestic abuse and in need of
mental-health treatment.
Punishment, Not Treatment
Isaias Vasquez’s family brought him to United States
legally from Mexico when he was 2 years old. A Vietnam
veteran, he was discharged from the Army after two years
due to psychiatric problems.168 In 1990 he was diagnosed
with schizophrenia after many years of struggling with
mental illness. Altogether he had been hospitalized more
than 18 times at the VA hospital in San Antonio before
being detained by ICE.169
Mr. Vasquez was treated for schizophrenia at the North
Texas State Hospital while he served an 18-month term
for drug possession and then was detained by ICE in
November 2004. ICE also began trying to deport him.
Despite his long record of mental illness, medical staff did
not believe Mr. Vasquez was schizophrenic and doubted
his symptoms. During his 15 months in ICE custody, he
was accused of faking his illness and was punished for
protesting a lack of medication and for behaviors related
to his illness.170 Medical staff not only was cruel to him,
but also vindictive.

unacceptable mental-health treatment

Instead, ICE transferred him to the South Texas Detention
Complex at Pearsall, much farther away from Ms. Armendariz.
When she visited Mr. Vasquez at the new location, he seemed
“frail and undernourished” as well as “unstable and
disoriented.’’173 He told her he was not getting medication or
enough to eat and complained that officers were punishing him
and putting him in segregation.

“Crisis in mental healthcare at
Pearsall.’’ The e-mail was
prompted by an alarming
statistic in June 2007: Nearly
140 mentally ill detainees were
going untreated at the
facility.179

In November 2005, unknown to Ms. Armendariz at the time,
Pearsall’s medical staff diagnosed Mr. Vasquez with an
“unspecified personality disorder.’’ They did so despite his
continued insistence that he was “paranoid schizophrenic and
needed medication.’’ The staff thought he was faking to prevent
losing his Social Security disability payments. Staff took him
off medication for schizophrenia and depression. A week later,
he was put on suicide watch.174

Dennis Slate, the immigration detention system’s top mentalhealth official, recommended that Dr. Johnson be ordered to
treat mentally ill detainees; if Dr. Johnson did not, “then this
behavior needs to be interpreted as insolence and
insubordination and documented as such.’’ His
recommendation was circulated to top ICE and immigrationhealth officials.180

Mr. Vasquez continued to deteriorate. He began to smear feces
and spit in his cell. Staff responded by eliminating all his
psychotropic medication.175 He began to refuse medication for
diabetes and high blood pressure. He acted irrationally and
defied the staff. His punishment: “They put him in solitary
confinement and gassed him.”176
Finally, in May 2006, he was released. But there was one last
torment. When Ms. Armendariz arrived to bring him home:
“I was stunned at his condition when I got there. Isaias
was very thin, his feet were swollen, he was covered with
sores and he was ranting. I was afraid of him because he
was so sick, and I asked the doctor, Dr. Johnson, to
transfer Isaias to the VA hospital. He refused and said that
Isaias was not sick. So, I drove him straight to the VA
hospital in San Antonio.’’177
Adding insult to injury, when she arrived at the hospital, Ms.
Armendariz discovered that Dr. Erik Johnson had called the
VA to tell the staff that nothing was wrong with Mr. Vasquez.
So at first, the hospital would not admit him. She refused to
take him home, and Mr. Vasquez became violent. The hospital
admitted him to its psychiatric ward, put him back on his
medication, and he stayed there for several weeks.
In September 2007, Mr. Vasquez became a U.S. citizen based
on his military service. “Now, he has his good and bad days,”
Ms. Armendariz said, “but he still suffers from the memories of
his treatment at Pearsall.”178
The Pearsall facility, apparently, did not improve after Mr.
Vasquez’s release. Pearsall continues to be known for its terrible
record on mental-health services. Dr. Johnson, the facility’s
clinical director, became the subject of an internal e-mail titled
36

...the detainee was
simply sitting on his
bunk when sprayed with
the noxious chemical.

Dr. Johnson was still at Pearsall as of May 2008 when he
declined to speak to Washington Post reporters. Officially, ICE
told the Washington Post that Pearsall’s mental health-care
program “meets the current ICE National Detention
Standards.’’181
Mace and Restraints
FIAC repeatedly has complained about the use of force on
detainees who may have mental-health issues at the Glades
County Detention Center in Central Florida.182 Several
incidents reflect the problem, which include the inappropriate
use of mace and forcible restraint. When used on detainees
with mental illness, such practices can threaten their mental
stability as well as their physical health.
In one incident, a gay detainee from Jamaica told FIAC that he
had thrown feces under the door of other detainees who had
taunted him with homosexual slurs and threatened to kill him.
In response, a Glades sergeant told the Jamaican detainee to
clean up the feces or he would be “maced.” When the detainee
didn’t comply, the guard followed through with his threat.
This occurred in December 2007.
The jail’s own incident report confirms that the detainee was
simply sitting on his bunk when sprayed with the noxious
chemical. He said he felt a burning sensation all over his body
and in his eyes. His eyes and face swelled up, and his skin
peeled after a shower.
In another troubling incident in November 2007, a woman
diagnosed with depression and on suicide watch was sprayed
with mace in the face. Her offense: She had spread feces on the
walls of her holding cell and refused to clean it. In her case as
in that of the Jamaican, there was no indication in the jail’s
incident report that either detainee posed a threat to their own
safety, to other people or to any property.

unacceptable mental-health treatment

Rather, it appears that jail staff used a chemical spray on
detainees for punitive reasons, a clear violation of ICE National
Detention Standards. Under these standards, immediate force
may be used only if necessary to prevent a detainee from
harming himself, others, and/or property “when a detainee acts
violently or appears on the verge of violent action(s).” These
standards also expressly forbid using force on detainees as a
punitive measure.183
Nonetheless, when Glades investigated the spraying of the
Jamaican detainee, it inexplicably concluded that the sergeant’s
actions complied with ICE rules and state statutes on the use of
force. Yet at the same time it found that the officer used force
only to compel the detainee to obey an order – not to prevent
violence, property damage or a major disturbance.
Another disturbing case: A detainee, after slitting her wrists,
was placed in isolation – a move that is more likely to
exacerbate suicidal tendencies and mental illness than to
stabilize or improve mental health. Worse, Glades officers
ordered the woman to strip naked so they could place her in a
restraint smock. She refused and threatened to bang her head
against the wall. Eventually, she took off all her clothes except
her underpants.
Two officers then restrained her arms while another forcibly
removed her undergarment. Officers wrapped her in the
restraint smock and placed her in a restraint chair. All this was
documented in a jail incident report. The report also said that
the detainee was seen and cleared by medical. It was unclear
what, if any, follow-up care was given to her.
In a joint newsletter, The National Center on Institutions and
Alternatives and the U.S. Department of Justice’s National
Institute of Corrections describe a model suicide-prevention
policy based on standards established by the American
Psychiatric Association and the National Commission on
Correctional Health Care. It notes that “removal of an inmate’s
clothing … and the use of physical restraints should be avoided
whenever possible and used only as a last resort when the
inmate is physically engaging in self-destructive behavior.”184
It is not clear that the restraint smock and chair were used as a
last resort in the Glades detainee case. Further, new ICE
National Detention Standards state that, “[w]hen standardissue clothing presents a security or medical risk, the detainee
is to be provided an alternative garment that promotes detainee
and staff safety, while preventing the humiliation and
degradation of the detainee.”185

This detainee’s treatment by Glades staff was extremely
degrading and humiliating and counter to psychiatric
recommendations for suicide prevention. Such treatment of
mentally ill detainees is what contributes to making suicide
the number one cause of death in detention.
Let Them ‘Break Down’
Failure to properly care for detainees with mental-health issues
can pose a danger both to detainees and to others housed with
them. During a visit to Florida’s Wakulla County Jail in
January 2007, a number of male detainees expressed concern
about a Mexican detainee whom they believe had severe
mental-health issues.
Detainees said that the Mexican detainee would sometimes
rant, scream, and fight with someone who was not there,
causing detainees to fear for their own safety. They said his
behavior was unpredictable and frightening. When the
detainee would have a severe episode, guards would simply
lock down everyone in the pod except for the detainee in
question, who would then “break down” in the main pod area.
When FIAC spoke with nurses at the jail, their response was
that the detainee was schizophrenic, on medication, and was
going to be deported the following day.186
Other recent examples include:
• A Jamaican woman in ICE custody reported to FIAC in
January 2007 that she was hearing voices, feeling anxious
and depressed. She said she put in at least three medical
requests since her arrival at the Wakulla jail in Florida a few
weeks earlier. She told FIAC:
“The nurse told me it will take too long to get the records
[for me to] get treatment. About a week and a half ago the
nurse told me I’m leaving soon. They say I won’t get to see a
doctor in time and, if I start medication, I’ll be deported so
it won’t work. But I can’t take it anymore…. I hear voices.
It’s getting worse and I can’t sleep. I’m up all night. Please
help me.”187
• A woman who suffered a miscarriage in ICE detention was
diagnosed with major depressive disorder and hospitalized
for treatment of depression. She also alleged that she was
assaulted by an ICE officer. She was released from the
mental-health facility in Florida to ICE custody in June
2007 under physician’s orders for follow-up care. The
detained woman was transferred to Texas where she made
numerous requests for mental health treatment but did not
see a counselor until late 2007.188

unacceptable mental-health treatment

Mentally Ill Youths
Among the most vulnerable immigration detainees are children
who have no apparent family members in the United States,
among them those who have been abused, abandoned or
neglected by parents. Some of these “unaccompanied minors”
have been placed in adult detention facilities and jails after
being subjected to unreliable forensic tests to determine their
age. Such adult facilities often have a devastating impact on
minors’ mental and physical health. These youths are far less
likely than other unaccompanied minors to obtain legal counsel
or to be released.

Now 17, he suffered
extreme abuse and neglect
by his parents in
Guatemala. He was
transferred 11 times in
three years, crisscrossing
the nation before landing
at the Bay Point Schools
in summer 2008.

The prospects for medical and
mental-health treatment of
unaccompanied immigrant
youths have improved since
Congress transferred the legal
custody of such children from
the legacy Immigration and
Naturalization Service to the
Office of Refugee Resettlement
(ORR, an agency of the
Department of Health and
Human Services) in 2003.

The progress has been particularly evident in the last few years.
Although ICE continues to use forensic tests – such as dental
and bone examinations – to gauge age, we see fewer cases of
unaccompanied minors placed in adult facilities.
What hasn’t changed is that, as in the cases of adult detainees,
detention adversely affects children’s mental health. Generally,
the longer children are detained and the more transfers and
instability in their living arrangements, the more likely it is for
them to suffer mental trauma and behavioral issues and not get
the treatment they need. That’s particularly true for children
who already have been traumatized by sexual and other abuse
and life on the streets in their home countries.
Further, the levels of medical and mental-health services vary
widely by location depending on the availability of resources
and professional providers.
The case of “Jose,’’ another FIAC client, is illustrative. Now 17,
he suffered extreme abuse and neglect by his parents in
Guatemala. He was transferred by ORR 11 times in three
years, crisscrossing the nation before landing at the Bay Point
Schools in summer 2008. Bay Point is a Miami shelter
contracted by ORR to care for unaccompanied minors who
have serious behavioral problems.

In Jose’s case, those behavioral and mental-health problems had
been aggravated by the instability and lack of adequate mentalhealth treatment during his long three years in ORR custody.
During that time, he had been diagnosed with major
depressive disorder and hospitalized twice in mental-health
units for harming himself.
His pattern: He would do well in a facility during the first
couple of months. But without intensive treatment, his mental
state would deteriorate. Bad behavior would prompt yet
another transfer to another facility designed for short-term
stays of minors. Meanwhile, his mental-health issues were not
truly addressed. And all the transfers delayed his legal case.
Once he arrived in Miami, however, FIAC was able to work
with ORR to speed Jose’s legal case and find a more
appropriate placement for him. A local dependency court
declared that it was in Jose’s best interest to become a ward of
the state of Florida and ordered him into state foster care. He
was released from immigration custody on Christmas Eve 2008
and is entitled to receive state benefits until he turns 22. FIAC
is now working to get Jose into a therapeutic foster home.

physically disabled detainees

Physically Disabled Detainees
“Then ICE officers attempted to pull me out of my wheelchair and
get me on my feet. One of them said to me, ‘we don’t give a f***
about you, now get on your f***ing feet and get on the bus.”189
- A disabled asylum seeker in ICE custody

The neglect of disabled detainees is not an isolated concern.
Complaints come from detention facilities nationwide. The
following examples are centered in Georgia and Florida.
No cleanliness, no dignity
Felipe Perez-Leon, a paraplegic Cuban, was denied handicapaccessible facilities while at the Atlanta City Detention Center
in Georgia. He was forced to urinate and defecate on himself
for nearly six months. His relief and medical care came only
after he was released from immigration custody in November
2007.
Mr. Perez-Leon noted that he did receive adequate medical
treatment in the detention centers where he was held prior to
his transfer to Atlanta. Yet from May 2007 until his release in
November, he was denied supplies needed to maintain his wellbeing. He also did not have access to a handicap-accessible
toilet or bathing facility during most of his detention in the
Atlanta jail.190
As a result, he was constantly urinating and defecating on
himself. Nor could he clean himself without an accessible
shower.
During that period, he wrote to ICE complaining about the
situation. At the time Mr. Perez-Leon was a 58-year-old man

paralyzed from the waist down and dependent on a wheelchair.
He also needs a special catheter to urinate and suppositories to
relieve himself. Despite his condition, the medical staff
knowingly gave him supplies for only a couple of weeks.
Further, he complained that the “disability shower” was
broken. He was embarrassed and humiliated by the odor in his
cell. He wrote:
“Suddenly they stop giving me the supplies. One day I
asked the nurse and she tell me that I have to filed a
complaint or grievance. After that they tell that the
facility was not have more funds. Is been more than 5
months and the situation is getting worse [sic].…191
“I have to pee on myself putting a towel on my laps to
prevent the urine run all over myself. When I have to do
the other necessity is very uncomfortable [and] unsanitary.
This is a pitiful and inhumane situation but it is the
truth. I’ve been mistreated; this is a violation of my
rights. I think that animals got more rights that a person.
I made my mistakes in the past but believe me sir, I
learned a valuable lesson. Don’t you think I’m still a
human being?[sic]”
Mr. Perez-Leon says he wrote countless grievances and spoke to
the doctors about his problems every two weeks. He told
FIAC:
“It was a terrible problem, and no matter what I did, the
authorities would not do anything to help me…. The
nurse told me it was not in the prison budget to provide
me with these supplies.
“The situation could not have been more embarrassing. I
began to smell and people were avoiding me…. The
toilet did not have a [handicapped-accessible] commode
so it was difficult for me to sit on. It was just impossible
for me to take care of myself because of the conditions at
that detention center.
“Since no one was helping me, I stopped drinking water
so that I would not urinate as much. I believe this has had
an adverse impact on my health…. Finally in October
they fixed the shower but not the toilet. And I still was
not given a catheter or suppositories…

Excerpt of Felipe Perez Leon’s complaint

physically disabled detainees

“My treatment in immigration detention was inhumane,
animals are treated better. I am still feeling the effects of
how I was treated…. My urine is thick, and I think I have
a permanent kidney problem.”192
FIAC has requested Mr. Perez-Leon’s medical records from the
Atlanta jail three times since December 7, 2007. FIAC
followed up by fax and voicemails to the jail’s medical
department. In February 2008, we also wrote a letter to the
ICE Field Office Director asking for an investigation into how
his condition was managed and to ensure that detainees with
disabilities not be mistreated as he was at the Atlanta
facility.193 FIAC has not received a response and is considering
a lawsuit.
Make Them Walk
A detainee who was confined to a wheelchair had to confront
immigration agents who attempted to force him to walk,
claiming that he was “faking” his disability. This happened at
the Krome detention facility in Miami in December 2007.
This disabled asylum seeker suffered from an improperly
treated wound that resulted after a soldier shot him in the leg
in his home country. The wound had seriously deteriorated
since his detention at Krome, where a doctor had ordered him
to stay in a wheelchair and not put any weight on his injured
leg. The detainee described the incident, which occurred on
December 5, 2007. He said that a supervising security officer
told him:
“‘Listen, you are going to Glades [County Detention
Center] today and I don’t want any trouble out of you. I
know that you are faking your injury so don’t try to use it
as an excuse.’
“I told him that I was not faking and that he should talk
to my doctor. He then said to me, ‘I talked to your doctor
and he said that you can walk.’ I told him that I knew
that he was lying because my doctor had specifically
instructed me only days earlier not to walk on my leg.
The ICE officer then cursed at me and told me to keep
my mouth shut….”194
According to the detainee, another officer brought him
crutches and told him to use them to get on the bus. After the
detainee refused, saying he could not get out of his wheelchair,
the supervising officer again told him, “Don’t give us any
trouble. You are going to get up and walk now. You are going
to Glades today.”195

The supervisor called another
ICE officer and ordered him
to put the disabled detainee
on the bus. The two officers
attempted to pull the man
out of his wheelchair and get
him to stand. The disabled
man said that he started
shouting:

...another officer brought
him crutches and told him
to use them to get on the bus.
After the detainee refused,
saying he could not get out
of his wheelchair, the
supervising officer again
told him, “Don’t give us
any trouble. You are going
to get up and walk now.”

“‘I can’t walk! You are
going to hurt my leg! If
anything happens to me
you are responsible!’ One
of them said to me, ‘we
don’t give a f*** about you, now get on your f***ing feet
and get on the bus.’ I then said, ‘I know you don’t care
about me, which is why I have to care about myself. And
I am not going to walk.’
“I felt so helpless and scared. I was praying to God that
they would not injure me. At that point, all of the
detainees who were already on the bus started protesting
and shouting out to the officers, ‘You can’t do that! You
can’t make a man in a wheelchair walk….’ Finally, the
officers stopped struggling with me and dropped me
down in my chair. One of the officers said to me, ‘You’re
lucky you’re in a wheelchair.’ ”196

Ultimately, this detainee was not transferred. However, he felt
humiliated, helpless, and scared by the way the officers treated
him.
Complaints have also included inadequate help for disabled
detainees in showering, going to the bathroom or washing
their underwear. Additionally, outside medical appointments
are too often postponed because adequate transportation is not
available for detainees who need a wheelchair.

mismanaged medication

Mismanaged Medication
“The next day I was still feeling sick. I was vomiting continuously.
I lost control of myself and fainted. …. Emergency was called and
two nurses came. I was taken to the medical unit at the facility by
wheelchair and examined. They gave me an I.V., and I started
bleeding from my mouth and my private parts.”197
- Zena Asfaw, an asylum seeker forced
to take the wrong medication

During the course of presentations to detainees at county jails,
FIAC often learns about problems they have with their medical
care and medications in ICE custody. The complaints are
common nationwide.
Detainees report serious problems in obtaining proper
medication, including getting medication at improper times or
in the wrong dosages. Some detainees have been given the
wrong medication by mistake or due to a misdiagnosis. Others
have received no drugs even after ordered. Disruptions in
getting prescribed medication are common when immigrants
are first detained or transferred. This practice is particularly
problematic for people with HIV or AIDS, who are vulnerable
to opportunistic infections without the medication.
Detainees often complain that they don’t know what drugs
they are taking or why. Some wonder if the drugs are
appropriate. Sometimes medications are so bungled in
detention facilities that they threaten the health and wellbeing, if not the lives, of the unfortunate detainees affected.
The following two cases are such examples.
Fleeing Torture to Find Abuse
Amina Bookey Mudey, 29, fled torture in her home country
Somalia. Her first five months in the United States were spent
in an immigration detention facility. There she suffered
medical abuses largely because she was misdiagnosed and given
the wrong medication.

When she arrived at JFK Airport in New York City in April
2007, she was exhausted and malnourished. She asked for
political asylum, but there was no Somali interpreter to help
interview her. So immigration officers put her in shackles and
took her to the Elizabeth Detention Center in New Jersey.
Soon after arriving, she had a panic attack.
That’s when the miscommunication turned into a medical
problem. There was no Somali translator at Elizabeth. The
doctor who examined her correctly diagnosed that she had
post-traumatic stress disorder and depression, but erred by
diagnosing her as psychotic and prescribing Risperdal, a
powerful drug with potentially fatal side effects.
Soon Ms. Mudey began exhibiting “devastating and lifethreatening’’ side effects of the anti-psychotic drug. She began
to shake uncontrollably and could not close her mouth. Her
tongue thrashed in her mouth. She stopped menstruating and
started lactating. She drooled and vomited frequently.
“She became dizzy, disoriented and confused,’’ her lawyer later
testified. “The drug made Ms. Mudey seem developmentally
disabled, when in reality she is highly intelligent.’’199 The
symptoms were well-documented side effects of Risperdal. But
when Ms. Mudey complained, the detention center’s doctor
increased the dosage despite its risk of causing permanent
damage, if not death.
It’s not as if Risperdal’s side effects were difficult to figure out.
Her symptoms were clearly apparent to two doctors later asked
by the lawyer to independently examine Ms. Mudey at the
detention center and to doctors consulted by the Washington
Post. The symptoms were such that she was unresponsive and

Born into an “outcast’’ clan, Ms. Mudey long had suffered
atrocities at the hands of majority clan members. Her genitals
had been cut off with a razor blade when she was 10. As a teen,
she heard the gunshots when men stormed her home and
murdered her father and brothers. In her twenties, she
witnessed five men brutally rape and kill her sister. These men
then beat her, bashed her head with the butt of a gun, and left
her for dead.198
Excerpt from a doctor’s statement on Ms. Mudey’s condition

mismanaged medication

disoriented at her first immigration court appearance, which
didn’t bode well for her asylum case.200
Fortunately, two months after being detained, Ann Schofield
Baker began to represent Ms. Mudey as her pro bono attorney.
Two noted doctors recruited by Ms. Schofield Baker, a
gynecologist and psychiatrist, found Ms. Mudey’s medical
records riddled with errors largely due to miscommunication.
After examining Ms. Mudey with a Somali interpreter, both
doctors determined that Ms. Mudey was not psychotic and
should be taken off the medication that was causing her severe
side effects.201
The doctors told Ms. Mudey to refuse the Risperdal, and she
did. “The first day I stopped taking it, I noticed I stopped
drooling,’’ Ms. Mudey said in court documents. “In two or
three days I could close my mouth. I was not as dizzy and
confused. My appetite came back. I started feeling almost
normal.”202
Ms. Mudey’s prospects improved. Then a few weeks later she
began feeling pain in her stomach and back while urinating.
She went to see a detention-center doctor, again without an
interpreter. The doctor dismissed her without conducting tests
or a physical exam and without any treatment. As her
condition worsened, she submitted repeated medical requests.
Without seeing or examining her, the doctor prescribed a drug
for yeast infections.
Again, it was the wrong diagnosis and medication. Ms. Mudey
continued to deteriorate and suffer intense pain. The crisis
came to a head when Elizabeth medical staff assured her lawyer
that Ms. Mudey would receive immediate medical attention.
Two days later, no one had attended Ms. Mudey, and her lawyer
prepared an emergency federal injunction to force the Elizabeth
facility to take her to a hospital.
Just before the injunction was filed, Ms. Mudey was taken to a
hospital and recovered there. After her release, she did not
know what illness she had or how it was treated because ICE
would not tell her or release her medical records to her. She
went on to win her asylum case, however.203
No questions allowed
Zena Asfaw also fled persecution to seek asylum in the United
States. In Ethiopia she had been jailed, beaten and sexually
assaulted in a government crackdown on suspected opposition
members. She travelled through 17 countries and took 14
months to get to the United States.
Once she arrived in Los Angeles in November 2006,
immigration officers jailed her again. She was detained at ICE’s
42

San Pedro detention center in California – where the clinical
director prohibited lab work for detainees held at the center
less than 30 days and where Victoria Arellano died after being
deprived of AIDS drugs for a month.
Ms. Asfaw was having
trouble sleeping, sought
medical help and was given
pills that provided her relief
for about a month. Then a
San Pedro nurse forced her to
take the wrong pills, and she
had a “near death
experience.’’204

It took two trips to the
hospital to stabilize her.
Her stomach was pumped.
She vomited continuously
and bled from her “mouth
and private parts.’’ An
examining doctor told her
that tests showed damage to
her liver. For a month she
was on pain medication
and needed help to do “just
about everything.”

That night, the nurse
brought Ms. Asfaw seven
pills to take, instead of the
routine two pills. Ms. Asfaw
asked the nurse whether that
was the correct medication,
noting the difference in the
quantity, color, and shape of the pills. Angered, the nurse
ordered Ms. Asfaw to swallow the pills and told a guard to
check her mouth to ensure she had.205

The consequences were devastating. Ms. Asfaw recounted that
night:
“Immediately my body started shaking. I felt so cold that
I thought I was freezing to death, but at the same time I
was sweating. I went to my bed and lay down. Within
minutes I had a seizure, and my body began to shake so
violently that I fell off the bed onto the floor.’’206
She ended up in the medical unit where, unfortunately, the
same nurse gave her four more pills.
It took two trips to the hospital to stabilize her. Her stomach
was pumped. She vomited continuously and bled from her
“mouth and private parts.’’ An examining doctor told her that
tests showed damage to her liver. For a month she was on pain
medication and needed help to do “just about everything.”207
As of June 2008, when she testified in Congress about her
ordeal in ICE custody, she had not received her medical records
from ICE despite repeated requests. A year and a half after a
forced overdose of mystery pills, she still did not know to what
extent her health had been compromised by an ICE nurse’s
mistake.

mismanaged medication

Killing Her Slowly
FIAC client “Lourdes” suffered three months in detention
getting insufficient medication for her rheumatoid arthritis, a
painful and debilitating disease. Prior to arriving at the Monroe
County Detention Center in Key West, Florida, nine separate
medications and supplements kept her arthritis symptoms
under control.208 She was able to walk, had minimal joint
complaints and was relatively comfortable.
By the time Lourdes was released in August 2008, she had
deteriorated significantly. Six months later, she is still unable to
walk and must use a wheelchair. According to her doctor, “Her
current condition is potentially irreversible.”209
Lourdes, 49, described the pain as feeling like “someone
sticking knives” into her arms and legs.210
While in detention, Lourdes submitted numerous requests to
medical staff for medication and injections. She received no
treatment until FIAC intervened.211

Her doctor plans to start
Lourdes on a new treatment
Lourdes, 49, described the
involving infusions of a
pain as feeling like
different prescription drug
“someone sticking knives”
every few weeks at the
rheumatology clinic. If that
into her arms and legs.
treatment does not work,
other, riskier treatments may be an option.215 Ultimately the
lack of medication in ICE detention has caused Lourdes
tremendous pain and may confine her to a wheelchair for the
rest of her life.
Good and Bad Care
In one respect, ICE provided excellent medical care for Syed
Ateequllah, a FIAC client: To its credit, ICE approved critical
eye surgery for him at Bascom Palmer Eye Institute, an
internationally renowned medical facility in Miami. After the
eye surgery in July 2008, Mr. Ateequllah returned to the
Krome detention facility with instructions for special eye
drops. His doctor prescribed that he get drops four times a day
to control post-operative inflammation.

By then, her condition had worsened alarmingly. She said:
“After 15 or 20 days, they could see that I could no
longer walk well. To walk or bathe, I had to hold on to
someone…. I made the requests to see a doctor. It took 10
days to see him. Then they would tell me they could not
give me the treatment because it hadn’t been approved –
until they saw that that I was in crisis. I couldn’t walk,
and they gave me a wheelchair…. They were killing me
little by little.’’212
Lourdes’ doctor is an arthritis specialist at the rheumatology
clinic of Miami’s public hospital. She had treated Lourdes prior
to her detention. Her doctor was extremely concerned that
Lourdes had to use a wheelchair to get around and was in
significant pain. The doctor noted, “Rheumatoid arthritis is a
chronic inflammatory arthritis that, if left untreated or poorly
controlled, can lead to joint destruction with permanent
deformity and disability.”213
Lourdes was released shortly after FIAC wrote a letter
requesting that the Monroe detention facility provide her
medical care. Subsequently, her doctor reinstated the same
medication regime that Lourdes had prior to being detained.
But Lourdes’ condition did not improve. As her doctor noted:
“Unfortunately she has not been responding to these
medications. Although we do not understand why, some
[rheumatoid arthritis] patients may become resistant to the
medication when they do not take it for a period of time, and
this may be occurring with [Lourdes].’’214

By August, Krome medical staff was not regularly providing
him the four drops a day. When he went to see his Bascom
Palmer ophthalmologist, Dr. Usha Reddy, Mr. Ateequllah
complained of eye pain, redness and inflammation. Dr. Reddy
was extremely concerned. By September, Krome medical staff
had cut the dosage to two drops a day. Dr. Reddy wrote a letter
that FIAC sent to the chief medical officer at Krome. It noted:
“If Mr. Ateequllah does not use his eye drops as prescribed, the
inflammation of his eye could lead to permanent damage
including loss of vision.’’216
Two weeks later, medical staff began giving him only one drop
a day. Such indifference to post-operative care begs the
question: Why does ICE send a detainee for expensive surgery
only to risk ruining it by denying him crucial post-operative
medication?
Ultimately, with FIAC’s persistent requests, Mr. Ateequllah
was given a bottle of eye drops that he could administer
himself and subsequently was released on parole.
Other Medication Mishaps
Disruptions in medications often occur whenever a detainee is
moved or transferred, as well as when detainees are first
apprehended. Other examples of mismanaged drugs abound.
The consequences can be severe and immediate:

mismanaged medication

• In January 2009, a Cuban detainee with a history of heart
disease was transferred to the Wakulla County Jail in North
Florida. He arrived on a Monday and was not given his
prescribed medication. The following day he had a heart
attack. He returned to the jail from the hospital on Thursday
evening. When FIAC spoke to him mid-morning on Friday,
jail medical staff had not given him his medication.
• In late July 2007, FIAC wrote to the captain at the Monroe
County jail in Key West, Florida, on behalf of a detainee
who suffered from seizures. She had been on daily medication
for years but had not been given her medications for at least
two weeks since her transfer to ICE custody.217 This is a
common violation of ICE medical standards, which require
at least 7 days of prescription medications, (14 days in the
case of TB medications) to ensure continuity of care.218
• After a visit to the Clay County Jail near Jacksonville,
Florida, FIAC found seven detainees in need of care. One
man with asthma was not getting his inhaler. He was told
the jail “ran out.” Additionally, the detainee was illiterate
and had to depend on other detainees to submit medical
written requests for him. This is a common problem because
ICE does not have a process for illiterate detainees to submit
oral requests for medical care.
• Another Clay detainee, who was being treated with
prescriptions for an upper abdominal hernia, had his
medications taken away upon his transfer to immigration
custody and was not receiving any treatment.219
• A Krome detainee who was HIV positive went three days
without his medication following a dorm shakedown in July
2006. Medical staff told him they had forgotten to refill his
prescription and consequently were giving him less than half
his prescribed dosage.220

forcible drugging to deport

Forcible Drugging to Deport
“They injected me with Haldol. The nurse that accompanied me
was a Cuban man from Krome. Then it’s all a haze. I remember
eating Chinese food in the New York airport. I just passed out.”221
- Emmanuel Dimitris Kyriakakis,
deported to Greece in 2007

While DHS officials denied for decades that drugs were used to
carry out difficult deportations, immigration employees
privately conceded the opposite.222 On the few occasions that
federal authorities publicly admitted sedating people to deport
them, they characterized the practice as rare and a “last resort.”
That wasn’t true, according to numerous records and interviews
obtained by The Washington Post. The Post’s investigative
report found more than 250 cases in which psychiatric drugs
were forcibly given to people to deport them, even though the
drugs were not medically indicated. That is the count since
2003, when ICE was created to handle immigrant detention
and deportation.223
The U.S. push to increase deportation considerably stepped up
in the aftermath of the Sept. 11, 2001, attacks and the Bush
administration’s tougher positions on immigration and against
terrorism. ICE had just been formed as a part of the
Department of Homeland Security when immigration
authorities set a new and extreme policy: an “ICE detainee with
or without a diagnosed psychiatric condition who displays
overt or threatening aggressive behavior … may be considered
a combative detainee and can be sedated if appropriate under
the circumstances .’’224
But ICE went beyond even the tough new rules, forcibly
drugging people without medical justification, people without
a record of mental illness and those who were not an apparent
danger to themselves, officers or others.
Forcibly drugging detainees without medical justification
violates some international human-rights conventions, is
widely considered unethical and is banned by some countries.
In one notable incident in April 2006, a sedated detainee being
deported to Guinea was turned back to the United States from
a Paris airport. French police informed the ICE escort nurse
that any involuntary injection was forbidden in France, and the
connecting plane’s captain refused to let the deportee aboard.225

It was not until the ACLU filed a lawsuit on behalf of two men
drugged against their will that ICE modified its policy.226
Federal immigration agents at a Los Angeles detention center
had forcibly drugged the two men while attempting to deport
them on different occasions. The Los Angeles Daily Journal
obtained medical records confirming that both men, who
reportedly had no history of mental illness or violence, were
sedated against their will. Airline officials refused to let the
sedated men board the plane.227
The sedation policy was changed in June 2007, around the
time the lawsuit was filed, to “no longer provide medical
treatment to a detainee solely for the purposes of restraint,
unless a medical professional determines that they present a
danger to themselves or to others.’’228 In effect, ICE began
requiring its staff to obtain a federal court order to forcibly
drug a deportee for aggressive behavior, when no psychiatric
condition existed. When the lawsuit was settled in January
2008, ICE tightened its policy to no longer forcibly sedate any
deportee without a court order.229
The drugs and dosages used by ICE to forcibly deport detainees
also raised alarm. Typically an ICE escort nurse would inject
deportees with a cocktail with two or three drugs. Most
cocktails included Haldol, Ativan and/or Cogentin, according
to The Washington Post’s analysis of 53 deportees sedated
without psychiatric reason in fiscal year 2007.
In official comments to the Washington Post, ICE explained its
use of Haldol and other psychiatric drugs on people with no
indication of mental illness: The medications “are widely used
in psychiatry” and medical escorts use “the lowest dose
possible” on deportees.230
ICE’s actual records tell a different story. Escort nurse logs
reveal alarmingly high levels of antipsychotic drugs used on
forcibly deported detainees who had no mental illness.
Haldol, the most powerful drug in ICE’s cocktail, is an
antipsychotic medication used to treat schizophrenia and other
severe psychotic states. Its side effects include dizziness,
sleepiness, muscle spasms, and stiffness, among others.
Recommended doses of Haldol for aggressiveness range from 1
milligram to 15 milligrams a day.

forcible drugging to deport

By comparison, ICE used much higher levels, injecting from
10 to 29 milligrams into 8 detainees in fiscal year 2007.
Another six deportees got from 30 to 40 milligrams. One
example was the deportee who was turned back from the Paris
airport in April 2006. Five weeks later, ICE managed to
successfully deport him to Guinea. The escort nurse gave him
nine injections of Haldol in transit, an astounding total of 55
milligrams.231

ICE did not show him a court order, he said, although ICE
policy at the time would have required such an order to
forcibly sedate a deportee who had no psychiatric indication
and was no danger to himself or others.

Gone in a Haze
FIAC was contacted by a deportee who detailed how he was
forcibly drugged and deported to Greece after living in the
United States for 39 years. Emmanuel Dimitris Kyriakakis says
he was injected with Haldol and deported by ICE on October
28, 2007.

“They called me out, then seven or 10 of them
surrounded me. They injected me with Haldol. The
nurse that accompanied me was a Cuban man from
Krome. Then it’s all a haze. I remember eating Chinese
food in the New York airport. I just passed out.”233

He landed in ICE custody after serving a prison term on a drug
charge. Greece, he said, would not issue travel documents. So
he was detained at the Manatee County Jail for 16 months.
After challenging his detention in court, he was released under
supervision in late 2006.
The following year, ICE came back to detain him. “I also filed
an appeal on my [criminal] case,’’ he said. “But one week before
I was supposed to go to the appeals court, ICE came to my
house and picked me up.’’232

Mr. Kyriakakis was taken to the Krome detention center in
Miami. Several days later he was placed alone in a cell and
forcibly sedated. He recalled:

Now Mr. Kyriakakis is living on a small Greek island with
an elderly aunt.234

language barriers

Language Barriers
ICE detainees who do not speak English face unique obstacles
in obtaining medical and mental healthcare. Their health issues
are more likely to be ignored, misdiagnosed and/or incorrectly
treated if they do not speak English and are not provided a
competent interpreter.235 Medical screenings are often
conducted in English. Non-English-speaking detainees often
are extremely frustrated with their inability to communicate
with medical staff and even have had to resort to sign language
to try to get a concern understood.
The consequences of poor or no translation can be devastating
to a detainee’s mental and physical health. Miscommunication
may cause serious delays and mistakes in medical treatment.
Some examples come from cases previously mentioned in this
report.
Amina Bookey Mudey, the asylum seeker from Somalia
mentioned in the Mismanaged Medication section, was
misdiagnosed when she was detained because there was no
Somali translator at the Elizabeth Detention Center, where she
was held. The doctor who first examined her correctly
diagnosed that she had post-traumatic stress disorder and
depression, but erred by diagnosing her as psychotic and
prescribing Risperdal, a powerful drug with potentially fatal
side effects.
Soon she began exhibiting “devastating and life-threatening’’
side effects of the anti-psychotic drug. She began to shake
uncontrollably and could not close her mouth. Her tongue
thrashed in her mouth. She stopped menstruating and started
lactating. She drooled and vomited frequently.
“She became dizzy, disoriented and confused,’’ her lawyer
later testified. “The drug made Ms. Mudey seem
developmentally disabled, when in reality she is highly
intelligent.’’236
Fortunately, Ms. Mudey was seen by two outside doctors who
used a Somali interpreter. The doctors found Ms. Mudey’s
medical records riddled with errors largely due to
miscommunication. After examining Ms. Mudey with the
interpreter, both determined that she was not psychotic and
should be taken off the medication that was causing her severe
side effects.237 The doctors advised her to stop taking the
Risperdal, and most side-effects dissipated within several
days.238

Routine detention practices
A nurse at the jail said that
also create language barriers.
Jails and detention centers
the ICE office is next door to
most often require detainees
the medical unit; if someone
to submit a written request
at the jail speaks Spanish,
for medical care, which may
she asks a male ICE officer
stop detainees who are
illiterate and/or do not speak
to interpret – even if the
or write English from
patient is a woman who
requesting care. Jails
might have sensitive
typically rely on other
detainees, and in some cases
gynecological issues.
ICE or jail officers, to
translate even the most
private and confidential details of health matters. Even in
facilities housing only ICE detainees, such as the Broward
Transitional Center (BTC) in South Florida, the medical staff
typically resorts to translation by telephone, another source of
frustration and miscommunication for detainees.
During a visit to the Wakulla County Jail in Florida, a
detainee who spoke only Chinese told FIAC that he could not
write a medical request in English, though he needed care for
back, hip and ankle pain. A nurse at the jail said that the ICE
office is next door to the medical unit; if someone at the jail
speaks Spanish, she asks a male ICE officer to interpret – even
if the patient is a woman who might have sensitive
gynecological issues.239
This practice may be handy and cheap, but does not encourage
open and frank dialogue about sensitive medical issues. FIAC
was particularly concerned about the women (about a halfdozen of them there in February 2008) who only spoke Spanish
and would only be able to explain medical conditions and
obtain medical treatment through a male ICE officer.
Detainees who speak Creole, Mandarin or other less commonly
spoken languages have an especially difficult time. Those who
are illiterate have no way to get medical care under the
written-request system at the Wakulla jail and elsewhere.
Recently, FIAC brought a translator to speak to Chinese
detainees at the Glades County detention facility. The detainees
reported that Glades medical personnel never use translators.
One Chinese detainee said:

language barriers

“They never use an interpreter in the medical clinic. Not
by phone or in person. We [Chinese detainees and others]
all have a lot of respiratory problems at this jail. I try to
speak English, but it’s really difficult for me. They just
give me a bunch of pills, and the doctor says things I
don’t understand. I don’t know what the pills are called or
exactly what they’re for or if they have side effects or
anything.”240
The inability to communicate with medical staff affects not
only the extent and quality of the medical care detainees
receive, but it may also violate confidentiality between
detainees and the medical staff.
Detainees also are inhibited from getting medical attention by
medical staff that is rude and intolerant with non-English
speakers. A Mexican woman detained at BTC in South Florida
suffered serious swelling and pain in her legs. Her condition
developed after she was improperly shackled and handcuffed for
more than 12 hours in September 2008.
Late in October, she told FIAC she could no longer walk on
one leg or feel her foot and she had boils on her ankle. She was
afraid to go to the medical office, however, because staff “yells”
at her to fill out the request form. The nurse always “yells’’ at
her to “speak English.’’
Though she can speak rudimentary English, she is not skilled
enough to properly communicate her symptoms and medical
concerns. She went to the office nonetheless, and was told to
fill out another medical request, her ninth about her leg
problem.241 With such poor communication and medical
treatment in detention, it is not surprising that her condition
has worsened.
Detainees and their children also have suffered due to lack of
interpreters. In April 2003, Jordan, the 2-year-old son of a
detained Haitian asylum-seeker, was rushed to the emergency
room of a local hospital. Though his health had been
deteriorating for some time, medical attention was inexcusably
delayed.242
At the time, detainee children were being warehoused with a
parent in a hotel. A week before the boy was rushed to the
hospital, his mother told FIAC:

“My son has been sick for weeks. A doctor finally did
come and see us here at the hotel and prescribed him
some medicine, but the medicine has not worked and it's
been well over a week since he saw the doctor. The
problem was that I don't speak English and the doctor
didn't speak Creole. He did not use an interpreter, so I
couldn't tell the doctor about all of my son's
symptoms…. I’m very worried about his health…. I
never imagined the United States would treat us like
this.”243

unhealthy living conditions

Unhealthy Living Conditions
“The immigration department picks up so many people that it has
no resources left to minister to them. Rarely will you have soap, you
are forced to wash your whole body with tiny sachets of hair
shampoo, go without toothpaste and other personal products. I can
only imagine the anguish of the female detainees in their
facilities.”244
- A Kenyan describing overcrowding and filth at Krome

Detainees complain about unhealthy, unsafe conditions,
including filthy jails and crowding. Chronic crowding can lead
to serious health consequences for those detained. Such
conditions increase the risk of infectious diseases spreading and
of even minor injuries or illnesses developing complications
due to poor hygiene. Medical services also are stretched to the
brink.
The medical clinic at the Krome detention facility in Miami
has been greatly improved over the years and in many ways is
now state-of-the art. Yet detainees continue to report that their
complaints aren’t taken seriously and that the facility continues
to suffer periods of severe crowding.
Detainees also frequently tell FIAC about transfers of detainees
out of facilities in advance of scheduled inspections. Just such a
report came as recently as January 2009 from a detainee at
Krome. He said that many detainees were being transferred and
moved around at the facility because there was going to be an
inspection that afternoon.245 Such a practice allows detention
facilities to present a cleaner appearance with less crowding
than what is routine.

On September 20, 2006,
1,054 persons were
detained at Krome –
nearly double the stated
capacity of 572. A
detainee aptly described
their frustrations: “We’re
living like boil spaghetti.”

Krome detainees had
complained of crowding just a
month before. One letter
described 83 people in a
pod/dorm designed for no
more than 52 people. The pod
had only 26 bunk beds and six
toilets. The letter said
detainees with mental illnesses
were being held with those
who had physically disabilities
– two groups with differing
medical needs.246

In 2006, Krome’s population skyrocketed. Reports described
detainees sleeping in the halls and medical area, sometimes
near toilets, while waiting to be processed. Detainees wrote to
FIAC:
“The campus is overcrowded like Sardines with full bunkbeds plus 58+ average (army cots & boat beds), average
1,300, plus 250+ non-processed detainees, which is
causing lots of tension that leads to confrontations,
unsanitary dorm, showers, and clogged toilets (5 toilets
per 120+ detainees) with low water pressure, flies,
shortage of hygiene items….
“The A.C. read 79-80 degree and the exhaust fan [is]
never on for circulation of the air; dirty air is making
detainees sick especially breathing on one another while
sleeping with 1 foot distance to each other.”247
On September 20, 2006, 1,054 persons were detained at
Krome – nearly double the stated capacity of 572.248 A
detainee aptly described their frustrations: “We’re living like
boil spaghetti. Me, myself, I end up have a detainee so close to
my bunk it seems like we’re sleeping together.”249
Another detainee from Nairobi, Kenya, was so troubled about
overcrowded conditions at Krome in 2006 that he wrote a
column posted on the East Africa Standard website on April 5,
2007. His op-ed noted:
“In the months of October, November and December,
many times this limit was grossly overlooked with detainees
reaching numbers of up to 1,100 at one time. There are no
open windows and everyone is consistently sick with one
strain of something or another. The clinic is ill equipped to
deal with the situation, and going to it only guarantees that
you are going to sit in a cell for five or more hours only to
get aspirins to deal with whichever ailment you have.
“Rooms built to house 50 people often hold up to 120
people. The filth, congestion and mucky air, with people
literally walking over each other’s toes, make sure that there
were fights almost every day….
“On January 8, 2007, my building – Building 11 – had

unhealthy living conditions

164 detainees instead of the required 100. On that day, the
excess 64 detainees [were] sleeping on the floor in
contraptions called boat bunks were taken and distributed
evenly among the other buildings so that the overcrowding
wouldn’t be as pronounced. This was possible because on the
same day, tens of detainees were picked up and transferred to
other facilities, some in Florida and some outside.
“We didn’t know what was going on until the next day
when we saw people, who we could only assume to be
auditors, walking around the facility. This is a game that
ICE plays all the time. Every time there is too much public
outcry, they move some people around to reduce the
congestion. After a week or so, everything is right back to
normal.”250
When Krome was terribly overcrowded in 2006 and early
2007, ICE refused to provide actual population numbers or
acknowledge the serious problem overcrowding was creating.
Nor did ICE approve a Miami Herald request for a tour of
Krome until months afterward, when the population had
significantly decreased.251
The Government Accountability Office found Krome to be
well over capacity during a visit to Krome in late 2006: “At
the time of our visit, the Krome Service Processing Center in
Florida had a population of 750 detainees with a rated capacity
of 572 detainees. Officials told us that the facility’s population
had been as high as 1,000 detainees just one week prior to our
visit. An official at that facility expressed concern about the
limited amount of unencumbered space at the facility.”252

detainees treated like criminals

Detainees Treated Like Criminals
“Some three detainees vomited on themselves, and our cries for help
were met with indifference by the ICE officers. We were kept five
hours inside the van, without food, water or medication for insulin
dependent women. It was a horrible situation. Some women
fainting, others crying, and there we were, helpless, shackled, and
impotent to help them.”253
- A Nicaraguan detainee during an
evacuation in September 2008

Whether in ICE-run detention facilities or ICE-contracted local
jails, detainees describe an anti-immigrant bias by some
detention officials. Beyond its discriminatory and pernicious
effects, this bias also can hurt detainees’ access to medical care.
Add to this mix a detention culture in which guards may
become hardened and abusive toward immigrants in custody.
Such officers and medical staff frequently view ICE detainees as
criminals – though detainees are in administrative custody and
most have no criminal history. Some staff too readily assume
that detainees are faking their illness and have ulterior motives
for doing so.
Needlessly Cruel
During the evacuation of detainees in advance of a hurricane in
September 2008, hundreds of detainees from South Florida
were subjected to cruel, unhealthy and inhumane treatment
throughout journeys that lasted 12 hours and longer in some
cases. The conditions not only caused injuries and illness but
exacerbated health issues that some detainees already had.254
Further, relatives and lawyers had no information about where
the detainees were taken or what their conditions were.
All of the detainees, women and men, consistently reported
being shackled and handcuffed during long trips to Texas and
Maine on buses, vans and planes. They remained in restraints
the entire time, including while going up and down stairs and
to the bathroom. Not surprisingly, injuries occurred.
A detainee from Nicaragua tripped on his shackles and
tumbled down the stairs while exiting an airplane. He thus
injured his left shoulder and arm and his right hip. The
detainee told FIAC that an ICE officer ordered him to stand
after the fall. When he said that he needed medical help, the
officer pulled him up and forced him to walk to the bus and
climb up the steps. The following week a FIAC staff person

visiting BTC saw the detainee’s swollen hip and a brace on his
shoulder.
Numerous women reported that the metal handcuffs and
shackles used on them were much too tight, a violation of ICE
standards.255 FIAC observed bruising and obvious swelling on
one detainee where she had been shackled. The detention
standards state, “To ensure safe and humane treatment, the
officers will check the fit of restraining devices immediately
after application, at every relay point, and any time the
detainee complains. Properly fitting restraints do not restrict
breathing or blood circulation.”256
Women uniformly reported that they were denied access to a
bathroom until they were on the plane, and even then
remained handcuffed and shackled while attempting to use the
bathroom. Some detainees said they were not allowed to use
the bathroom at all while on buses or vans. One woman
reportedly urinated in a vomit bag. One detainee said:
“We only stopped one time at a rest area so the officers
could get food. We had no bathroom for over six hours,
no food, no water, and no air.”257
Not drinking water and not going to the bathroom can
damage a person’s health, particularly for those who already
have kidney, prostate or other medical problems.
Detainees told FIAC that diabetics did not have access to
medications during the evacuation, and several became faint
because they did not have food or water while being bused,
another violation of ICE standards.258 Other detainees became
ill.
One woman who is on anti-anxiety medication at BTC
reported she did not have her medication during the journey
and had a panic attack because of the extremely confined
conditions in which they traveled:
“I was put inside of a completely enclosed cage in the van.
I am claustrophobic with anxiety problems. I was
suffocating and hyperventilating. I told the officer I
needed air. He opened the door for 5 seconds and
slammed it. After driving for over three hours or so, we
stopped at a rest area. One of the officers came to check
on me and saw I was pale.

detainees treated like criminals

Then he was looking for a cup to give me water and
couldn’t find one when he had his own bottle inside. He
just said, ‘hang on, we’re almost there.’ On the day we
were leaving Maine, Sept. 11, 2008, I told the officer
before he loaded me in the van I was claustrophobic, he
said he’ll let me sit by the caged window. I was still sick
and the only thing he gave me was a vomit bag.”259
South Florida’s detainees were evacuated when it was clear that
Hurricane Ike no longer posed a threat to the area. So the
illness, mistreatment and expense all were unnecessary. Local
ICE detention chief, Michael Rozos, told FIAC that the
complaints would be forwarded for investigation.260 To date,
FIAC has yet to see the findings of such an investigation.
Routine Abuses
Even during trips to local hospitals for medical care, ICE
detainees who are not serving criminal sentences are routinely
handcuffed and/or shackled when transported. The same is true
when they are seriously ill and hospitalized. That was the case
with Miguel Bonilla, the man who suffered a ruptured
appendix in detention. He was shackled on the way to the
emergency room, as soon as he regained consciousness after
emergency surgery, and on the way back to the Glades
detention facility in Central Florida after he was released and
while still in pain.
Mr. Bonilla described his harrowing ride from the hospital back
to the Glades detention center:
“I still wasn’t feeling well. Glades officers brought me
from the hospital in a small bus. I left with my hands
handcuffed and feet shackled. They didn’t fasten my seat
belt. Every time the bus turned, I felt as if I was about to
fall. Everything hurt in my body, but I had to push down
with my feet hard to stop myself from falling.”261
Mr. Bonilla’s experience with Glade’s mode of transportation is
not unique. FIAC has fielded numerous complaints from
detainees about the bus ride from Glades to Krome, a common
destination for immigration court dates. One Glades detainee
summed it up:
“They take 40 or 50 people shackled together when we
have to go to Krome for court. Forget about seatbelts.
There aren’t any on the buses. Sometimes they’ll take
people in those little ice cream wagons (vans). There are
seatbelts in there, but they never put them on us. And
we’re shackled and cuffed so we can’t put them on. We
just bounce all around inside that thing the whole way to
Krome. And they drive like crazy. Once they forgot I had

court and another officer had
to take me. There was a big
pile up out here so they
drove down the grass
median. I don’t want to be
the one to get to sue them
for getting hurt during
transportation. That’s an
accident waiting to
happen.”262

He was shackled on the
way to the emergency
room, as soon as he
regained consciousness
after emergency surgery,
and on the way back to
the Glades detention
facility in Central
Florida after he was
released and while
still in pain.

In the case of medical patients
like Bonilla, such bus rides are
no way to promote healing.
But even routine trips to court
can be dangerous for the health
of any detainee in rides such as the ones described above.
Equally disturbing is that ICE routinely shackles and handcuffs
seriously ill detainees on the way to hospital emergency rooms.
For example, in the summer of 2004 a very ill, pregnant ICE
detainee held at a local Miami jail was taken to Jackson
Memorial Hospital in shackles and handcuffs and not seen by
doctors until she began to hemorrhage. Later that year, Rev.
Dantica, an 81-year-old Baptist minister with no criminal
history, was transported to Jackson Memorial Hospital with leg
restraints, and relatives who requested to see him were turned
away. He died without seeing any of his loved ones.
Here are other examples of cruel, abusive and unhealthy
treatment:

• FIAC assisted a 54-year-old Swiss woman with a history of
blood clots in the veins of her legs. Her condition had been
treated for years with blood thinners. She also had suffered a
triple fracture to her left ankle, which had not completely
healed when she was detained at Bay County Jail in North
Florida in January 2007. Though she told the jail officer
about her ankle problem, she was nonetheless forced to board
a bus wearing shackles. She tripped and fell trying to board
the bus, suffering further injury. She reported that a jail
officer who observed her said, “I think I’m looking at a
broken ankle.”263
She was transferred on that bus to the Wakulla County Jail,
an ICE-contracted detention facility. There, she was given
ACE bandages and ibuprofen for pain, but did not receive
any further medical attention for her ankle for several
weeks.264 More serious, she repeatedly told DHS and jail
personnel about her history of blood clots and the
excruciating pain she felt in her legs. It was not until FIAC

detainees treated like criminals

submitted an independent physician’s review of her medical
file that confirmed the severity of her condition and
recommended tests that she was started on medication to
prevent blood clots in June 2007.265
• Another example of undue harshness involved a Haitian
detainee at Wakulla County Jail who had a swollen abscess
on his neck. During a June 2006 interview he told FIAC
that the jail’s medical staff did not explain anything about
his condition to him when he was taken to the jails’ medical
clinic. He was simply told to lie down and was then held
down by a physician, nurse and jail sergeant. Then the
doctor, without his consent and without anesthesia, “came at
[me] with a knife” and sliced open the abscess. He was
escorted back to his jail pod and administered pain
medication only after the incident.266
• A 65-year-old Haitian detainee who had been in ICE custody
for about two years had renal failure while in jail in
Bradenton, Florida, and had to be hospitalized. While there,
the Haitian was released on his own recognizance by an
immigration judge after winning his appeal to the Board of
Immigration Appeals. ICE appealed the decision, staying
this gentleman’s release. Subsequently ICE dropped the
appeal and decided to release him in 2006. But ICE did not
contact his FIAC attorney about the release, which FIAC had
requested due to his serious medical condition.

tips,” which told detainees not to spit or blow their nose on the
floor, walls or in the sink.
The manual also instructed them to stand arms-length away
and speak in a low, even tone, rather than a loud rapid manner,
when speaking to Americans. It added that Americans are very
conscious of personal hygiene and, therefore, detainees should
shower, brush their teeth and change their undergarments
every day. Underlying these “tips’ is the assumption that
foreign-born women engage in socially unacceptable behavior.
BTC finally revised the manual after FIAC complained.

This manual included a section
on “social tips,” which told
detainees not to spit or blow their
nose on the floor, walls or in the
sink. The manual also instructed
them to stand arms-length away
and speak in a low, even tone,
rather than a loud rapid manner,
when speaking to Americans.

Following his discharge from the hospital and release that
night from ICE custody, this seriously ill man ended up
sitting on a bench outside the jail all night, without any
money or belongings. The next morning when the
immigration court judge was going to work, she saw him
and contacted FIAC. After his FIAC attorney picked him
up, he became extremely ill and was taken to the local
hospital from which he had just been released the day before.
He spent another week there before he was stabilized. Later
he was put on dialysis and died a year following his release.
• In June 2006 a detainee from Trinidad was taken to the
Wakulla County jail’s medical unit after being Tasered in his
neck and abdomen, falling to the floor and hitting his head.
This detainee was Tasered though he had done nothing
wrong. On the contrary, he was a victim of abuse by another
detainee.267
The condescending nature of the treatment at times received
by female asylum seekers is apparent in staff culture and
training. In 2004, for example, FIAC reviewed BTC Detention
Manual given to detainees to help them navigate the
correctional institute. This manual included a section on “social

denied medical records

Denied Medical Records
“Although Ms. Mudey was ultimately granted asylum, and has
been free for over eight months, ICE officials have refused to release
Ms. Mudey’s medical records to her, or to me, and to this day, have
refused to identify which hospital they took her to and what
treatment was rendered to her, despite numerous requests.”268
- Amina Mudey’s attorney

It can be extremely difficult for detainees to obtain their own
medical records and can take months for FIAC or other lawyers
to obtain records on clients’ behalf.
In 2006, FIAC spent months trying to get the medical records
and test results for one client who was detained at Broward
Transitional Center in South Florida. The woman had first
found a lump in her breast in May 2006. The lump was
documented as growing and increasingly painful. Nonetheless,
she was denied access to her own medical records for months.
Eventually she received a biopsy in November 2006. Neither
she nor her FIAC attorney was informed of the results for
weeks. Fortunately, the test revealed the lump was benign. Had
the medical staff informed her of the results promptly, she
would have been spared weeks of needless worry.

Similarly, ICE denied Zena Asfaw crucial records. As of June
2008, when she testified to Congress about her ordeal in ICE
custody, she had not received her medical records from ICE
despite repeated requests. A year and a half after a forced
overdose of mystery pills, she still did not know to what extent
her health had been compromised by an ICE nurse’s mistake.271
FIAC also has requested the medical records of Felipe PerezLeon, the paraplegic Cuban who was denied handicapaccessible facilities while at the Atlanta City Detention Center
in Georgia from May to November in 2007. Three times since
December 7, 2007, FIAC has asked for those records from the
Atlanta jail to no avail. FIAC followed up by fax and
voicemails to the jail’s medical department. FIAC still has not
received a response and will likely have to sue.
The process for requesting records is different at each facility
where immigrants are detained, but is consistently riddled

When there is a death, such as in Rev. Joseph Dantica’s case, it
is even more difficult to obtain medical records. After he died
in custody in November 2004, FIAC was forced to sue to
obtain medical records on behalf of his family. It took about a
year before we got all the records – at least all the records that
ICE says exist.
Even so, 31 pages of Rev. Dantica’s records were redacted by
ICE, which claimed a privacy issue. Whose privacy, or
misconduct, is being protected when the subject is dead? Not
that of the family members who asked for, and have a legal
right to, the information.269
In the more recent case of Amina Mudey, mentioned earlier in
this report, ICE refused to release all of her medical records.
Eight months after being released from ICE custody in
September 2007, she still had not seen medical records related
to a hospital stay for an untreated illness that worsened while
she was in detention. She still did not know what illness she
had, how it was treated, what its aftereffects might be or even
the hospital that cared for her – despite numerous requests for
medical records that should be hers.270

Excerpt from one of Ms. Mudey’s requests

denied medical records

with bureaucratic red tape. Medical files are often imperative
not only to help ensure that a detainee is receiving proper
treatment but also for political-asylum and torture-convention
immigration cases.
Sometimes requests for medical records can be made directly to
the jail, but records may be held off-site. At the Broward
Transitional Center, officials claim that all requests must first
be approved by the detainee’s deportation officer. ICE approval
is not legally required and should not be imposed by ICE or
detention staff as a requirement for a detainee to obtain their
medical records. FIAC has complained about this practice, but
the requirement persists.
With transfers of detainees steadily increasing, it can take
months to gather a detainee’s medical records. Such transfers
routinely interrupt medical care. One cause: Detainee medical
records are not always transferred promptly, in complete form,
or in some cases, at all. Medications provided a detainee in one
facility are frequently not provided for weeks following a
transfer to another facility.
At the Glades County Detention Center, a detainee was hit
over the head with a chair by another detainee in August 2007.
The injury damaged the detainee’s hearing and caused a skull
fracture that required temporary staples in his head. The
detainee was transferred to Krome in order to receive better
medical care. However, his medical records indicate that
Krome medical staff had to rely on the detainees’ description of
what happened. His complete medical records apparently were
not transferred with him. Though he was transferred to Krome
with staples in his head and a recent, serious injury that
occurred in immigration custody, medical records critical to his
treatment did not follow promptly.272

The process for requesting records is different at
each facility where immigrants are detained, but is
consistently riddled with bureaucratic red tape.

conclusions and recommendations

Conclusions and Recommendations
ICE detainees are routinely subjected to poor, and sometimes
appalling, medical care. They are particularly vulnerable and at
the mercy of DHS officials. Because they are detained, they are
not permitted to get treatment from their own outside doctors
– even at their own expense. The great majority have no lawyer
to help them. Meanwhile, attempts by FIAC and other
advocates to obtain adequate medical treatment for detainees
and to call attention to serious medical issues repeatedly have
been ignored.
Government records, news reports and FIAC’s experience in
detention centers indicate that healthcare in immigration
custody is deteriorating, and many officials responsible for that
care are alarmed. Regardless of its public posturing, ICE
funding for detainee medical care is inadequate.
At the same time, ICE’s attempts to save money – by limiting
covered ailments and denying requests for needed treatment –
are counterproductive. Covered services are in essence limited
to emergency care, and a managed-care process requires every
referral, medical exam, or treatment of a detainee to be
approved by off-site nurses who conduct a paper review,
sometimes without the full medical records.
Thus, a non-physician can deny a treatment requested by a
physician who has seen the patient. Too often, denied or
botched care then leads to costly complications and lawsuits
that cost taxpayers more money.
Many government employees responsible for the care and
custody of ICE detainees are competent and dedicated.
Understandably, some overwhelmed health-care employees may
be suffering from compassion fatigue. Nonetheless, denying
that problems exist place at risk the very detainees in dire need
of medical care. Though some detainees may exaggerate the
problems they face in getting proper medical attention, FIAC’s
experience, detainee medical records and statements from
detention medical staff provide ample proof that detainees’
complaints often are legitimate.
The current detention policy is overly broad and inhumane.
Notwithstanding the best efforts of ICE officials, they must
work within the system, and the system is fundamentally
flawed. Immigrants who are neither dangerous nor likely to
abscond should not be detained. Those detained – whether
severely ill, asylum seekers or others challenging deportation
orders – should be fairly considered for parole and other
alternatives.

Alternatives to detention are cheaper and more humane. At the
daily average of more than 31,500 ICE detainees per day, ICE
spent more than $1.65 billion in the 2008 fiscal year on
detention alone – with taxpayers paying the tab.273 On
average, it costs $95 per day to hold someone in immigration
custody. The alternatives cost as little as $12 a day.274
One tested alternative required people to periodically report by
phone and in person. Another released asylum seekers to
community shelters and found them pro bono attorneys. Both
succeeded in keeping participants on a legal track: appearance
rates before immigration authorities ranged from 93 percent to
96 percent.275 Such alternatives allow ICE to save money by
detaining fewer people without threatening national security.
In fact, national security could improve if the Department of
Homeland Security were to focus resources on terrorist and
criminal threats instead of immigrants who contribute to their
communities.
The immigration detention standards adopted in 2000 were
designed to ensure safe and secure treatment of immigration
detainees. But these standards have never been fully
implemented or enforced, despite assurances to the contrary.
The standards still are not binding and are routinely ignored,
as many examples in this report attest.
Now ICE is transitioning to updated “Performance-Based
National Detention Standards’’ released in September 2008.276
These standards could easily be ignored like the old standards
unless compliance is mandated and rigorously enforced.
Nor is ICE compelled by law or other authority to report
deaths in custody to the Department of Justice, Congress or
any other government body that could exert oversight over the
agency’s conduct.
This is only one example of the lack of oversight regarding the
medical care provided to ICE detainees. DHS’s Office of
Inspector General has investigated conditions in immigration
detention, including one report on two deaths in ICE custody.
So has the Government Accountability Office.277 Yet, overall,
the efforts failed to scrutinize critical deficiencies in the
medical care provided to detainees.

conclusions and recommendations

Within this oversight
vacuum, ICE tolerates a
culture of cruelty and
indifference to human
suffering. This is not to say
that all ICE staff is
inhumane. In fact,
government documents
obtained by The
Washington Post and
FIAC’s own experience reveal the concerns of medical personnel
who agonized over treatment denials, staffing shortages and
other situations that threatened detainee healthcare.

Ensure that the conditions,
practices and quality of
medical care for detainees
meet established legal,
medical and human-rights
standards.

However, the ICE culture tolerates treating detainees as
criminals, shackling them when they are desperately sick,
ignoring painful symptoms, retaliating against those who
demand better medical attention, and denying life-sustaining
medication and treatment. ICE tolerates cruel treatment of the
most vulnerable people in its custody– the physically and
mentally ill.
We do not know if such cruel treatment happens because
detainees are foreign, imprisoned, have no lawyer to defend
them or all of the above. We do know from years of direct
experience that cruel and inhumane treatment of sick detainees
is a systemic problem.
ICE is responsible for providing basic and required medical
care to its detainees, regardless of where they are housed or who
the medical providers are, because it is ICE that holds them
prisoner. Yet ICE has abdicated this responsibility by failing to
oversee the provision of such care.
Only outside, independent scrutiny of detainees’ medical care
will ensure that the DHS and ICE carry out their moral and
legal responsibility to provide for the health and safety of
detainees entrusted to their care. Given the dramatic increase in
detainees in recent years, the need for proper scrutiny of
medical care is more critical now than ever.
In short, many immigration detainees are subjected to
substandard medical care, and the problem is growing. Death
rates in detention appear to be worsening. There are signs that
infectious diseases, among them chicken pox, are spreading in
the detention system.278 Overcrowding exacerbates the
unhealthy conditions that breed such diseases. ICE needlessly
detains people with severe and complicated illnesses and those
who pose no harm to U.S. communities. Doing so drives up
ICE costs even as ICE provides inadequate medical and mental
healthcare to those in its custody.

Lives are at stake. The urgency to improve detainee medical
care cannot be overstated. FIAC recommends that the
following steps be taken immediately:
To the Administration and Congress
• Establish an independent oversight commission, composed of
healthcare and immigration experts, to oversee medical care
in U.S. immigration custody. Its mission: to ensure that the
conditions, practices and quality of medical care for detainees
meet established legal, medical and human-rights standards.
Charge the commission to: issue regulations on medical
standards and practices; conduct independent inspections of
detention facilities; investigate allegations of inadequate
medical care; and refer complaints to appropriate
government agencies, among other oversight activities.
• Strengthen and issue regulations that codify detention
standards for ICE, including medical standards, so that all
immigration detention facilities provide competent, timely,
and necessary medical care by force of law. Require ICE
detention facilities and its contracted facilities to annually
report their compliance with the detention standards.
• Strengthen and issue regulations requiring DHS to
promptly report the death of any immigration detainee to
the U.S. Attorney General. Require an independent
investigation of each death. Also require DHS to annually
submit a report to the Judiciary Committees of the U.S.
House and U.S. Senate with detailed information on all the
deaths, including the cause of death and the results of related
investigations. Make the information available to the public
through the Deaths in Custody Reporting Program of the
Bureau of Justice Statistics.
• Direct oversight agencies to conduct unannounced
inspections of ICE medical facilities and investigations of
medical incidents. These investigations should include
reviews of medical records, procedures, and staff levels.
Investigations should also include interviews of detainees
with medical issues and reviews of detainee medical requests
and complaints. Encourage accountability and transparency
by directing investigation reports and findings be released to
the public.
• Promote alternatives to detention by shifting ICE funding
from detention beds to proven, community-based
alternatives. Prioritize the release of vulnerable detainees,
such as detainees with ongoing medical or mental-health
issues.

conclusions and recommendations

• Direct ICE and the Division of Immigration Health Services
(DIHS) to clarify its mission, policies, and “Covered Services
Package” to comport with the established legal, medical, and
human-rights standards for providing healthcare to
detainees. Covered services should include eye care and
ensure a continuum of healthcare services.

• Strengthen and enforce ICE standards to ensure that the
conditions and quality of medical care for all detainees in
ICE-run and ICE-contracted facilities meet established legal,
medical and human-rights standards. Establish clear policies
to ensure that detention staff members who abuse detainees
are disciplined.

• Limiting care to “keeping detainees healthy enough to
deport” invites abuses and is unacceptable.

• Launch training efforts to combat the culture of indifference
to human suffering that ICE tolerates within its ranks. This
culture views all detainees as criminals who are faking
illnesses, regardless of painful symptoms, and often prevents
timely and appropriate medical treatment.

• Direct and fund ICE and the Office of Refugee Resettlement
to provide adequate resources for the medical treatment of
unaccompanied children in custody. In particular, the
agencies need to improve mental-health treatment for
children who remain in custody for more than a month.
• Direct ICE and DIHS to revamp or eliminate the “Treatment
Authorization Request” process so that physicians evaluating
detainees on-site have the ultimate say on whether to provide
detainees medical treatment based on medical criteria.
• Require DHS and ICE to ensure continuity of care by: 1)
requiring detainees to be medically cleared by medical staff
for transfer, and 2) stopping or delaying any transfer when
the continuity of medication, medical records, treatment or
other medical need is not assured.
• Require ICE to promptly provide medical records to
detainees requesting those records. Encourage accountability
and transparency by directing ICE not to abuse publicrecords privacy exemptions by excess redaction of documents,
particularly those requested by family members.

• Revamp or eliminate DIHS policies and practices – which
dictate what medical treatment is offered, approved or
denied – to conform to broader ICE National Detention
Standards and accepted legal, medical and human-rights
standards on medical care. Physicians should have the
ultimate say on whether to provide a detainee treatment
based on medical criteria.
• Require a mental-health screening that properly identifies
detainees with illnesses such as post-traumatic stress disorder
and other psychiatric conditions. Mentally ill detainees must
be placed in a facility that can properly care for their mentalhealth needs. Prohibit placing such detainees in isolation or
seclusion at a detention facility for punitive reasons.
• Require ICE and ORR to provide adequate medical
treatment for unaccompanied children in custody. In
particular, the agencies need to improve mental-health
treatment for children who remain in custody for more than
a month.

• Require all medical and other staff, including interpreters,
working with ICE detainees in a health-care capacity to
complete a standard patient-confidentiality training program
that satisfies the requirement of Title II of the Health
Insurance Portability and Accountability Act of 1996.

• Ensure that detainees are properly and consistently referred
to competent health-care providers within their detention
facility and outside the facility as needed.

• Prohibit ICE or any ICE contract facility from asking any
detainee to pay for medical care or medication provided in
detention facilities or during outside medical visits.

• Require any ICE detainee to be medically cleared for transfer.
Stop or delay any transfer where the continuity of care is not
clearly ensured. Medications and complete medical records
must accompany detainees upon transfer so that medical
treatment is not interrupted.

To DHS and ICE
• Ensure that detainees are properly and consistently referred
to competent healthcare providers within the facility in
which they are detained and outside the facility as needed.

• Heavily weight a detainee’s medical condition and the
availability of competent medical care in custody in
determining whether he or she should be released or
transferred.

conclusions and recommendations

• Prohibit the use of restraints on detainees in hospitals and
during medical transfers absent exigent circumstances. Stop
placing detainees in hospital criminal wards absent exigent
circumstances.
• Require all ICE medical staff and detention facilities,
whether ICE run or contracted, to promptly provide
complete medical records to detainees requesting them.
Standardize the policy for all immigration detention
facilities.
• Ensure that detainees may seek medical care without threat
that they will be transferred or punished if they do so.
• Provide women detainees with regular gynecological care,
mammograms and prenatal care if appropriate. Require a
female staff person to be present when any male medical
personnel provide gynecological care to a woman.
• Ensure that adequate translation services exist at every
facility where detainees need to communicate medical needs.
Translators not only must be competent but must know and
abide by the confidentiality provisions of Title II of the
Health Insurance Portability and Accountability Act.
• Prohibit any ICE facility or ICE contract facility from asking
detainees to pay for medical care or medication provided in
detention facilities or during outside medical visits.
• Discontinue arbitrary rules such as the refusal to provide
dental care until the detainee has been in custody for at least
six months.
• Ensure that medical facilities for immigration detainees are
clean and properly staffed, maintained and equipped.

background

Background

Inadequate, negligent and abusive medical care in immigration
custody is not new. Long before ICE was created in 2003, the
Immigration and Naturalization Service that preceded it had an
equally questionable record in treating ill detainees. Following
are examples FIAC’s experience with such cases.
Deaths in Detention
• In November 2001, 28-year-old Jean Jude Andre, a Haitian
national, died after collapsing in a bathroom at the Krome
detention facility in Miami. A preliminary autopsy report
indicated that an abnormal heart probably caused his death.
According to his family and other Krome detainees, however,
Andre’s death might have been prevented had he received
proper medical care while in immigration custody.279
• In 1999, 46-year-old Ashley Anderson died after being
transferred from Krome to Larkin Community Hospital in
South Miami. Before his death, Anderson had repeatedly
complained to The Miami Herald about neglect and
inadequate medical treatment at Krome.280
• Following the death of a Nigerian man at Krome in 1996, a
fellow detainee wrote:
“I… watched the Nigerian who died on the soccer field
on January 1st. We were playing soccer and… he fell
down. When that happened, a detainee from Israel and
some of us tried to resuscitate him because he was not
breathing…. About three INS officers were there [on the
soccer field] but…for about thirty minutes no one [from
INS or PHS] help[ed].
“When the doctor finally came, he came with empty
hands, nothing to help the detainee. So I think he died
because he didn’t have medical help in time…. They
don’t care here…. So we got scared for ourselves. With
that, we Nigerians here, we feel very troubled.”281
• Detainees have alerted FIAC to other suspected deaths in
ICE custody. At the Bay County Jail in Panama City,
Florida, detainees suggested that questionable medical care
led to the death of one man:

Abusive Medical Care
Lack of medical care was the number one complaint from
women, many of them asylum seekers, detained at the Turner
Guilford Knight Correctional Center (TGK). TGK is a
maximum security county jail in Miami. ICE began detaining
women there in December 2000, following allegations of
sexual abuse by officers at Krome.283
Ultimately, all the women in ICE custody at the TGK jail were
moved to a Monroe County jail in September 2004. The move
was prompted by an ICE annual detention review of TGK in
March 2004 assigned a final rating of “At-Risk” regarding
detainees’ access to medical care. The review concluded that
“the overwhelming lack for [sic] health and safety found at
TGK is disturbing.”284
During the period that women detainees were placed at TGK,
it is FIAC’s understanding that the already overwhelmed TGK
medical staff, providing medical to more than 1,000 jail
inmates, were simply asked to work overtime upon the
detainees’ arrival from Krome.
The women detainees complained that sick-call requests
routinely were ignored. They reported that some TGK officers
and medical staff were upset at how the detainees were being
treated, told them that some nurses “were taking detainees’
pink slips and throwing them in the garbage.”285 The women
also claimed they were charged each time they went to the
clinic, even though officials claimed not to charge detainees for
medical care.
Not surprisingly there were numerous medical complaints,
among them:
• On June 2, 2001, a FIAC attorney learned about a Haitian
woman who was so ill that she could barely walk or talk. She
said her vision was badly blurred and couldn’t eat but was
thirsty all the time. She also had made several unsuccessful
requests to see a doctor. Attorneys from FIAC had to insist
that she see a doctor. The same day, she was rushed to the
hospital and diagnosed with chronic diabetes. An officer at
TGK told FIAC that she had been trying to get this
detainee medical attention for days.286

“[O]ver here in Panama City there was an old man by the
name of_______. He told the medical department that he
was feeling sick, all they gave him was aspirin, and they
waited until he got really sick to take him to the hospital
where he died. He was here in my dorm.”282
61

background

Detainees who were diabetic often suffered needlessly at TGK:
• “I’m a diabetic and they didn’t have a special diet for me
there [at TGK]. I could only eat the starches. I never got
physical therapy and I couldn’t move around at all. They
changed my meds there. So I gained 80 pounds in that time
because I could only eat those starches and couldn’t exercise
because of my handicap and not getting proper
treatment.”287
Detainees suffering from epilepsy also face serious delays in
getting medical attention.288 One detainee described her
experience at TGK:
• After she fell down “the officers wouldn’t let [another
detainee] help me that day. Instead, they made me lie in my
own urine and defecation for three hours. I was completely
humiliated, the experience was terribly painful.”
“Also, at least 10 officers watched me beat my head
against the wall when I had a seizure and only one officer
tried to help me, the others just stood around watching.
It took three days to get me to the hospital… I can’t
forget the other detainees who have done everything for
me. I don’t know what I would have done without their
help; they’re the ones that took care of me.”289
• FIAC and the Women’s Commission for Refugee Women
and Children (Women’s Commission) were at TGK when a
detainee was having a seizure in February 2001. During the
seizures, other women housed in the same pod were locked
in their cells for more than an hour.
There were many other medical issues:
• On March 8, 2002, one of FIAC’s clients detained at TGK
was spitting up blood in the presence of an officer. Despite
attempts by both the officer and FIAC staff to get this
detainee appropriate medical care, such care was not
provided until Congressman John Conyers visited the jail
and insisted she be seen by a doctor. That same day, she was
taken to the hospital:
“FIAC came when I was sick and spitting up blood. They
called the clinic. The officer also called the clinic, and the
clinic said there was nothing wrong with me. The nurse
said I would have to spit up blood in a special pail to
show them. The next day this delegation [from
Washington, D.C.] came and I showed them the pail with
the blood.

“They took me to the clinic after that, and while I was
waiting I spit up blood on the floor at the clinic. Then
they sent me to Jackson Hospital. I had to spend the
night at the hospital and they put me on an IV. They
brought me back to TGK. Three days later I went back to
Jackson for a test…. They brought me back to TGK the
same day and then three days after that I went to Jackson
again. That time I spit up blood at the hospital so they
had to put a tube through my nose to get the blood out
of my stomach. After that they started giving me
medicine….
“So it took one month and two days of me spitting up
blood before they gave me real medicine.”290
• Another woman who had not had her period since arriving
at TGK and was having lower abdominal pain said she made
numerous requests to see a physician, beginning in March
2001. In late June she was informed that a referral had been
made for her to be seen at Jackson Memorial Hospital, but
not until August.
• A detainee suffering from a gynecological condition was
scheduled for surgery on her uterus. The surgery was
canceled on the evening before it was to take place. She was
never notified of the reason.291
Obtaining mammograms also could be difficult:
• FIAC attorneys represented a female detainee who was
transferred to several detention facilities. Despite her
repeated requests, she was unable to obtain a mammogram
at any of the jails even though she had suffered recurrent
bouts with breast cancer, underwent a mastectomy, and had
been instructed to undergo regular mammograms.
Fort Lauderdale City Jail medical personnel requested
that the detainee be transferred to a facility where she
could obtain counseling. Immigration officials transferred
her to the Monroe County jail, where she still could not
obtain a mammogram. In a December 8, 1996, written
response to one of her repeated requests for a
mammogram, she was told “reg. mammograms –
supposed to have one ever 6 mths – last one was 9/95 –
explained WE DON’T DO mammograms.”
This detainee did not receive a mammogram until
months after the Krome administrator claimed he had
ordered one be provided at the Monroe County jail,
months after the mammogram should have been done.292

background

Infections among detainee also were a problem:
• “Since I been detained, I never got to have a nail clipper. So
my big toe nail started growing in the skin. I finally got
help for my infected toe. They did surgery on it, which was
butchering procedure with a sharp knife going under the
nail to cut it out. This was done without any local
anesthesia. I almost broke my teeth grinding them from the
pain.”293
• A detainee who slit her wrist couldn’t get proper medical
attention to clean it for several days and had to soak a sock
in bleach to make a makeshift bandage for her wound.
Following this incident the detainee was locked down and
reprimanded by an officer:
“When I returned from the hospital I needed something
to cover my wrist because it was bleeding and I need[ed]
butterfly stitches. I asked [a TGK Corporal], and she
asked me to let her see. That’s when she stated that I
really didn’t want to kill myself. Because, if I did, I would
have cut my arm the long way across. I told her thank
you, I had never known how [to go] about going to kill
myself but now I know how to the next time the right
way.”294

Unacceptable Mental-Health Treatment
One asylum seeker who seemed perfectly healthy upon arrival
in the United States apparently suffered a psychotic break
shortly after her asylum interview at TGK. In July 2001, she
was stripped naked and sent to the Women’s Detention Center
(“Annex”) in Miami, where her condition worsened. Her
cousin, a psychiatric nurse, was given permission to visit her
after contacting a local Congresswoman. The cousin described
detention at the Annex:
• “The condition in which I saw [her] was extremely
disturbing. She was completely naked, lying on a bare,
narrow cot secured in a cell next to a security guard. Her lips
were dried, chapped and cracked. She appeared to be
extremely dehydrated. She expressed a desire for some water.
“I requested a cup of water from the security guard on duty.
The guard directed me to a dirty, empty milk carton which I
used to secure water from the tap in the cell. She drank four
cartons of water. I revisited. I saw her lying naked on the cot
in a worse condition than the day before. When an attempt
was made to get her up, she collapsed. At that point, I was
asked to leave.”295

This detainee was transferred to the Palmetto Mental Health
Center, in Florida, where her relatives were not allowed to
see her for several days. She was heavily medicated with such
drugs as Haldol, Ativan, Syroquil and Cogentin. The family,
concerned about the amount and kind of drugs being
prescribed for her, only consented to the medication after
being told that a court order would be obtained if they did
not sign and agree.
The family claims the medications were changed without
their knowledge and/or permission. FIAC accompanied the
young woman’s relatives to the Palmetto Mental Health
Center where they initially encountered her incoherent and
lying on the floor. Although this asylum seeker was
eventually released, her relatives had much difficulty in
obtaining her medical records. Several months after her
release, she was still unable to discuss what had caused her
psychotic break.297
Following the transfer of female detainees from Krome to
TGK, FIAC understands that TGK officials determined that
many of the women were over-medicated and given too many
psychotropic drugs at Krome. Abrupt changes in their
medication were made, and TGK officials claimed the
detainees were suicidal. As a result, eight or nine of the women
were temporarily transferred to the psychiatric ward of
Palmetto Hospital in Miami.
• At the Palmetto Hospital, detainees reported that they had
tried to help another detainee with AIDS who was having
multiple seizures. The women claim they were depressed but
not suicidal and that the depression resulted from drastic
changes in their medication:
“When I was transferred from Krome to TGK on 12-13-00,
I did not receive any of my psych meds for almost a week….
Many officers and supervisors tried to see if there was any
way they could help me get my meds. But, because of the
transfers there was a lot of confusion and miscommunication
between INS and TGK staff.
“On two occasions Cpl. – – and Cpl. – – took me down to
the clinic to see if anything could be done about my meds.
Once I was down in the clinic one of the nurses asked me if
I wanted to go to the mental hospital to get my meds
straightened out because there was nothing they could do in
the clinic. I told her I knew these things took time and I
was going to try to give them a couple of days.

background

“When I was brought back to the unit, as I was entering my
room, I passed out…. Once Nurse seen it was me, he made a
smart remark stating I was faking to go to the (Psych ward)
at Palmetto hospital. He was not there when 15 minutes
prior I was offered to go to the Palmetto hospital and had
refused. He also stated, if I wanted to go suicidal, I would be
going to the Annex.”298

girls here are too scared to tell anybody now because they
might ship us to the Annex and say we’re crazy… There are
women here that need to see a psychiatrist but if they admit
what they’re going through, they’re afraid the doctor will
prescribe something for them that’s off the wall.”301
Other mentally ill detainees were not properly treated or
managed:

• TGK officials acknowledged that when a detainee appeared
to be suffering from depression, she was stripped naked and
sent to the Annex. As one detainee said: “They take
detainees to the Annex saying that they are crazy – no they
are just depress and hate this place. I wonder if INS knows
this.”299

• An April 4, 1999 Miami Herald article described a number
of incidents at Krome’s health clinic in which mentally ill
detainees “terrorized or assaulted other patients, officers and
medical staff.”302

An openly gay female detainee at the Ft. Lauderdale jail said
she was mistakenly labeled “crazy”:

• FIAC also observed a young Ethiopian detainee in the Port
Manatee jail who had been eating soap, putting Bengay on
his genitals, and babbling incoherently. Jail personnel stood
by and did nothing when FIAC was there.303

• “I was kept in a cell by myself. I started my menstruation
and kept asking the officers for maxi pads, but they wouldn’t
give me any. They would laugh at me and ignore me. I
begged them to please give me one because I was bleeding
on myself….
“I was put in the single cell but I still didn’t get any pads.
They kept saying bad things about immigrants, that
immigrants should stay out of America….
“I didn’t know what to do. I felt desperate. All I wanted was
a maxi pad. So I took some of my own blood and I wrote the
word HELP on the wall using my blood. The officers took
pictures of me and took pictures of the wall. They started
making fun of me, telling me I was crazy….
“I finally got two pads. But two were not enough for me. I
needed more, so I asked for more when those ran out. Instead
of getting more pads, they put me in the black chair: The
black restraining chair. I was strapped down in the chair and
handcuffed for sixteen hours. I was put there during one
shift and stayed there for an entire shift after that. I wasn’t
allowed to use the bathroom or get a pad. I was kept dirty. I
went to the bathroom on myself and was bleeding on my
clothes.”300
Many detainees were afraid to seek treatment for depression or
other medical problems due to threats of transfer or lockdowns
if they do:
• “I was on psych medication but I’m afraid to say it because
they’ve made so many other mistakes with my medication. I
need some therapy; I’m just trying to hang in there. The

Some detainees have even been brought to court heavily
drugged:
• In late 1992, the INS mistakenly advised a Chinese detainee
that he was going to be deported the next day, which was
the day his asylum hearing was scheduled. As a result, he
tried to commit suicide. Public Health Service (PHS)
personnel injected him with Thorazine and Benadryl, put
him on suicide watch, and tied him to his bed. They woke
him up after he had been sleeping for 24 hours and sent him
off to his asylum hearing.304
Neither PHS nor immigration officials told the detainee’s
lawyer nor the immigration judge about the previous day’s
events. The immigration judge denied the detainee’s asylum
application, ruling that he had not presented a coherent
claim for asylum. In April 1993, a federal judge set aside the
deportation order, finding that the detainee had been denied
the opportunity for a full and fair hearing. The judge found
discrepancies between the treating physician’s report of the
detainee’s treatment and INS and PHS records.305

Physically Disabled Detainees
A detainee who suffered from illnesses which prevented her
from fully using her legs was not given a wheelchair or the
daily care she required at TGK. Instead, officers relied on other
detainees to assist her with her daily activities, including
showering, eating, combing her hair, and using the bathroom:

background

• “Lise [another immigration detainee] did everything for me
except eat, go to the bathroom and sleep…. She helped me
get from one place to another. She did my housekeeping and
my clothes. She washed my hair and bathed me. She got a
plastic chair so I could bathe. She combed my hair, cut my
nails, put cream on me. She had to help me get off the toilet
because it wasn’t handicapped accessible for me.
“Everything you do to yourself every day, she did for me. I
use diaper pads, but they didn’t have those there. They put
me in regular diapers. I had continuous seizures…. So
afterwards I’d need to be cleaned-up…. The guards would
yell across the pod, ‘Hey Lise, your baby needs her diaper
changed.’
“After the end of a bad night it still went back to Lise
getting up to clean me up, clean my room (get the urine up,
change my sheets) washing me all of that. The nurses flat
out said Lise was needed to take care of me. [Although there
were] times when they didn’t want to give Lise plastic gloves
to help when she cleaned me up, but she’d clean me
anyway.”306
While this detainee had a wheelchair at Krome, it was taken
from her upon her transfer to TGK. Only after she suffered a
bad fall and injured herself at TGK was she provided with
another wheelchair:
• “The first few days of April 2001 is when they put in a
handicap shower. That was in the week before I left. I
slipped coming out and messed my knee up real bad. They
didn’t take me to the hospital until the next day. Next day I
ended up in a stretcher in an ambulance. At the hospital
they said I had to have a wheelchair.”307
Another disabled detainee suffered the lack of a wheelchair and
treatment:
• J. had three heart by-pass surgeries and other serious medical
problems, including ulcers on his legs. J. complained that
three days after he got to Krome, the doctor took his
wheelchair away claiming he didn’t need it:
“From the time I was without the [chair] and have been
force[d] to walk. My legs and feet have [swollen] extremely
and I am in severe pain. And have not receive[d] any other
medical treatm[ent] in this institution.”308

Mismanaged Medication
Detainees often complain that they don’t know what drugs
they are taking or why. Some wonder if the drugs are
appropriate.
• A female detainee who suffered from epilepsy said she was
given the wrong medication: “When I started convulsing
due to the new medication, I was transferred to Palmetto
[hospital] as suicidal. I wasn’t suicidal. I was on the wrong
medication. [Then they] kept messing up my levels of
medication at TGK and I [had] seizures coming and going
all the time.”309
• Another detainee reported that her yeast infection went
untreated for two and a half months. She was prescribed
medication by an ob-gyn at TGK three times over the course
of two months. The nurses at TGK, however, failed to
dispense her medication despite multiple calls to the clinic
by on-duty TGK unit officers and multiple detainee sick-call
requests.
• Improperly dispensed medications can have serious
consequences. As one TGK detainee reported: “I only have
one functioning kidney and now they are giving me high
dosages of Motrin which can cause kidney problems. I take
the Motrin, but by fixing one problem, they’re creating
another.”310
• In one Florida detention facility near Sarasota, detainees
called the doctor “Dr. No-touch” because he prescribed
medication without seeing them.311
• Another detainee told FIAC: “I begged them for my
medicine practically in tears but they never listened to me.
My mouth was full of herpes … but they gave me pills that
weren’t for the herpes because they insisted it was a
fungus.”312
• Detainees have also complained that they were given expired
medication or medication that is different from their
prescription. One detainee reported, “[T]he nurses often get
the medications mixed up. If they don’t have what they
need, they’ll sometimes get pills from another detainee.”313
• In some facilities, detainees had to buy their own over-thecounter medications from the commissary, including aspirin,
at inflated prices. Detainees at the Bay County Jail Annex in
Florida told FIAC that, if detainees need over-the-counter
medications, such as Tylenol, Sudafed, or Zantac, they had to
buy them from the jail commissary or obtain a prescription
from the medical department. However, commissary orders

background

could only be placed twice a week. Indigent detainees, who
could not buy medication from the commissary, would have
to wait several days to establish eligibility for free
medication and to get their meds.314

Detained children sent to the hospital have been denied
permission to see their relatives. The sister of an
unaccompanied minor in immigration custody was denied
permission to visit her brother at the hospital shortly after he
arrived in October 2002, and burst into tears when forced to
leave the hospital. She said:

Unhealthy Living Conditions
Overcrowding at Krome has been a long-time concern. In June
1995, Dr. Ada Rivera, then chief of the Public Health Service
Clinic at Krome, sent a memorandum to Miami INS District
management warning of the “serious health consequences” of
overcrowded conditions at Krome. She warned that she
intended to suspend the medical clinic’s normal functions to
“prevent any potential epidemics.”315

• “I called Haiti and found out that Jimmy, my 16-year-old
brother, came to Miami on the October 29, 2002 boat. I
found out that he was taken to Jackson Hospital. When I
went to the hospital and into his room, there was an
immigration officer there. I was about to go in to hug my
brother and see how he was doing, but the officer would not
let me in.

Valerie Blake, then Deputy District Director, found Krome
“out of control.” Despite the clear warning, INS took no action
except to advise Dr. Rivera to improve the quality of her
paperwork.316

“I tried to plead with the officer and begged him to let me
see my brother, but he started screaming at me and did not
let me in the room. It had been six years since I had seen my
brother. I had to leave the hospital in tears without being
able to talk to him and see how he was doing.”319

Patients Treated Like Criminals
Until July 1998, immigration officials used the Jackson
County Correctional Facility in North Florida to house
detainees. Following complaints that officers sometimes used
an electric-shock shield to punish detainees, including
detainees who needed medical treatment, immigration officials
quickly removed the detainees.

Because the sister spoke to the press about her concerns, her
brother was advised that he could be deported because his
sister was “making problems.”320 Jimmy was finally released on
Christmas Eve, 2002.321

Detainees described the shield as a curved, four-foot high piece
of Plexiglas-like material with two handles in the middle. A
detainee’s hands and legs were handcuffed to a concrete bed,
and the shield was placed over the detainee’s body.317
Numerous detainees told FIAC and Miami Herald staff about
the electric shield. One detainee reported:
• “The first time I saw this [use of electronic shock shield], an
inmate had epileptic seizures: He kept begging for some
medication, banging on the glass window. Then four or five
officers came in with the electric shield, handcuffed him
after they threw him to the floor and handcuffed his hands
behind his back, and then they put the shield on him and
they hit him....
“He had plenty of seizures at Jackson. Many times his head
would be banging against the wall with the seizures, and the
officers would say, ‘Don’t touch him.’ And [the officer and
the nurses] would always tell the guy, ‘There is nothing
wrong with you, stop faking it.’ And the poor man was
having seizures back to back. He really needed help.”318

Other examples include:
• A Colombian woman at TGK said that, during her first
meeting with a doctor, he advised her to wait until she was
deported to Colombia to get medical care. During her third
visit, the doctor told her: “You should be happy. I
understand that you are about to be deported.”322
• An unnamed medical worker told The Miami Herald in the
fall of 1998 that “The majority of the staff there [at Krome]
right now is insensitive. They view the people in there as
criminals, and they are not treated with simple human
dignity. They just totally ignore them. Staff gets the attitude
that no one is really sick. They treat people like everyone is
faking it.”323
Unfortunately, this view remains all too pervasive even today in
detention facilities across Florida and elsewhere.

background

Forcible Drugging to Deport
In June 2001, FIAC received a call from a former detainee
following her deportation, who said:
• “A nurse woke me up to give me a shot…. I was taken to
the airport and boarded a plane. I fell asleep again. I don’t
remember anything about that morning after I got the shot.
When I got to St. Kitts… I started feeling really sick. I felt
weak and dizzy. I could barely walk or talk. I had to call a
cab to take me to the hospital… My speech was slurred… I
never felt like that before and I haven’t felt like that
again.” 324
• In October 1991, Krome’s medical staff injected a detainee
with extremely large doses of powerful anti-psychotic drugs
to carry out his deportation, although he was not diagnosed
as mentally ill. Tony Ebibillo Eplcen had applied for asylum
but was denied. He believed that his return to Nigeria was
tantamount to a death sentence and resisted deportation on
three occasions. An attempt to deport him in December
2001 failed.
Mr. Eplcen’s medical records indicated that he had been
given heavy doses of Thorazine and was placed in four-point
restraints.325 When he briefly regained consciousness in the
INS van, he was handcuffed, shackled, and straitjacketed.
His mouth was taped shut.
American Airlines officials refused to transport him. A flight
superintendent said that since the authorities refused to
remove Mr. Eplcen’s gag or straps, she and the plane’s
captain were worried that during the course of the nine hour
trip he wouldn’t be able to go to the bathroom or even drink
water.326

Retaliation
After the mysterious death in 2001 of Jean Jude Audre, the 28year-old Haitian mentioned earlier in this report, many of the
Krome detainees who vocally expressed concerns and wanted
answers about his death were transferred. Fifteen of the
detainees wrote a petition that described the events leading up
to their transfer as follows:

[On] “Monday, November 5th, 2001, the detainees of Pod 1
anxiously awaited the promised answers as to why Mr. Jude
died. All of the deportation officers at Krome came to Pod 1,
supposedly to explain the situation… [but they] had no
answers as to why Mr. Jude died. The head nurse was
supposed to go to Pod 1 to explain the situation; however,
she was not there.
[A detainee] “smashed the TV, and the deportation officers
ran out of the pod. There was chaos in Pod 1. Many INS
Officers then stormed the pod and sprayed pepper spray on
everyone. The detainees were then herded outside to the
yard. The INS agents said, ‘Those that want answers stay
outside, the rest go inside.’ More than half of the pod
remained outside. The INS agents then formed a riot line
and “bum rushed” everyone, tackled and handcuffed them,
and placed them in isolation, 2 to a cell designed for 1….
On “Tuesday, November 6th, 2001, a large INS bus shipped
everyone from pod 1 that wanted answers, and other
detainees randomly chosen (all Haitian) from [those] pods to
Pennsylvania. The camp remained ‘locked down.’ …
“On Thursday, beginning at approximately 4:30 a.m., 9 or
10 INS agents stormed the pods… The general attitude of
the INS agents was aggressive and menacing. We were
pushed around and treated like serial killers. When asked
why we were being shipped practically to Alabama, we were
told that, ‘They needed bed space.’
“The ironic thing is that most of the 22, in one way or
another, had stood up for their civil rights and complained
about the abusive behavior on the part of officers... About
six detainees with prescribed medication that was to be kept
in their lockers or on their persons at all times, were denied
their medication and it was thrown in the trash. Legal
documents of some of the detainees were also thrown
out.”327

• “On Sunday, November 4th, 2001, a memorial service was
held for Mr. Jude in which about 40 detainees attended…
Prior to attending the memorial service, everyone was
required to give their Alien number. Coincidently, everyone
at the funeral was transferred. The mood of the funeral was
tense. People wanted answers…

footnotes

1 FIAC Reports: Securing our Borders: Post 9/11 Scapegoating of
Immigrants, April 2005; Haitian Refugees: A People in Search of
Hope, May 2004; I Running Out of Hopely - Profiles of Children in
INS Detention in Florida, October 2002; Supplement to A Double
Standard of Treatment: INS Detainees In Florida, April 2002; INS
Detainees in Florida: A Double Standard of Treatment, December
2001; Cries for Help: Medical Care at Krome Service Processing
Center and in Florida’s County Jails, December 1999; Florida
County Jails: INS’s Secret Detention World, November 1997;
Krome’s Invisible Prisoners: Cycles of Abuse and Neglect, July 1996.
http://www.fiacfla.org/fiacpublications.php
2 Nina Bernstein, New Scrutiny as Immigrants Die in Custody,
The New York Times, June 26, 2007.
http://query.nytimes.com/gst/fullpage.html?res=9E0DE6DD1F
3FF935A15755C0A9619C8B63&scp=2&sq=Nina%20Bernste
in%20New%20Scrutiny%20as%20Immigrants%20Die%20in
%20Custody&st=cse; Bernstein, Few Details on Immigrants Who
Died in Custody, The New York Times, May 5, 2008.
http://www.nytimes.com/2008/05/05/nyregion/05detain.html?
_r=1&scp=1&sq=Few%20Details%20on%20Immigrants%20
Who%20Died%20in%20Custody&st=cse; Bernstein, Ill and in
Pain, Detainee dies in U.S. Hands, The New York Times, August
13, 2008.
http://www.nytimes.com/2008/08/13/nyregion/13detain.html;
Bernstein, City of Immigrants Fills Jail Cells With Its Own, The
New York Times. December 28, 2008.
http://www.nytimes.com/2008/12/27/us/27detain.html?scp=3
&sq=2009%20budget%20congress%20immigration%20Octob
er&st=cse; Bernstein, Another Detention Death, and Mounting
Questions, The New York Times, January 28, 2009.
www.nytimes.com/2009/01/28/us/28detain.html?_r=1&scp=1
&sq=Guido%20Newbrough&st=cse
3 Dana Priest and Amy Goldstein, Careless Detention. The
Washington Post, May 11-14, 2008.
http://www.washingtonpost.com/wpsrv/nation/specials/immigration/cwc_d1p1.html.
4 Alien Detention Standards: Observations on the Adherence to ICE’s
Medical Standards in Detention Facilities, June 4, 2008. GAO-08869T.
5 ICE Fact Sheet: Fiscal Year 2008, December 28, 2007.
http://www.ice.gov/doclib/pi/news/factsheets/2008budgetfactsh
eet.pdf.
6 ICE Fact Sheet, Fiscal Year 2009, October 23, 2008.
http://www.ice.gov/doclib/pi/news/factsheets/2009budgetfactsh
eet.doc.
7 Bernstein, City of Immigrants Fills Jail Cells With Its Own,
The New York Times. December 28, 2008.
http://www.nytimes.com/2008/12/27/us/27detain.html?scp=3
&sq=2009%20budget%20congress%20immigration%20Octob
er&st=cse.
8 Meredith Kolondner, Immigration Enforcement Benefits Prison
Firms, The New York Times. July 19, 2006.
68

http://www.nytimes.com/2006/07/19/business/19detain.html?_
r=1&scp=1&sq=Immigration%20
Enforcement%20Benefits%20Prison%20&st=cse.
9 Leslie Berestein, Lawsuits raise questions about private prisons;
Immigration agency, contractors are accused of mistreating detainees,
The San Diego Union-Tribune, May 4, 2008.
10 About the U.S. Detention and Deportation System, Detention
Watch Network.
http://www.detentionwatchnetwork.org/aboutdetention.
11 In Liberty’s Shadow, Human Rights First, 2004.
http://www.humanrightsfirst.org/about_us/events/Chasing_Free
dom/asylum_report.htm.
12 ICE Fact Sheet, Fiscal Year 2009, October 23, 2008.
http://www.ice.gov/doclib/pi/news/factsheets/2009budget
factsheet.doc.
13 Immigration and Customs Enforcement Fact Sheets, DRO
Detainee Health Care, May 7, 2008.
http://www.ice.gov/pi/news/factsheets/detaineehealthcare.htm.
14 Homer D. Venters, M.D., “Statement on Immigration
Detainee Health Care,’’ page 8, for U.S. House Judiciary
Subcommittee on Immigration hearing on Problems with
Immigration Detainee Medical Care, June 4, 2008.
http://judiciary.house.gov/hearings/pdf/Venters080604.pdf.
15 Scott Lewis and Paromita Shah, Detaining America’s
Immigrants: Is this the Best Solution? Detention Watch Network,
National Immigration Project, and Rights Working Group.
http://65.36.162.162/files/RealDealDetention.pdf.
16 Julie L. Myers, Assistant Secretary, U.S. Immigration and
Customs Enforcement, Department of Homeland Security,
written statement, page 4, for U.S. House Judiciary
Subcommittee on Immigration hearing, Problems with
Immigration Detainee Medical Care, June 4, 2008.
http://judiciary.house.gov/hearings/pdf/Myers080604.pdf.
17 Homer D. Venters, M.D., “Statement on Immigration
Detainee Health Care,’’ page 2, written statement for U.S.
House Judiciary Subcommittee on Immigration hearing,
Problems with Immigration Detainee Medical Care, June 4,
2008.
http://judiciary.house.gov/hearings/pdf/Venters080604.pdf.
18 Ibid, page 3; pages 5-7.
19 Mary Meg McCarthy, Executive Director, National
Immigrant Justice Center, pages 5-6, written statement for
House Judiciary Subcommittee on Immigration hearing,
Problems with Immigration Detainee Medical Care, June 4,
2008.
http://judiciary.house.gov/hearings/pdf/McCarthy080604.pdf;
Priest and Goldstein, System of Neglect, Careless Detention series.
The Washington Post, May 11, 2008;
http://www.washingtonpost.com/wpsrv/nation/specials/immigration/cwc_d1p1.html; Nina
Bernstein, Ill and in Pain, Detainee dies in U.S. Hands, The New
York Times. August 13, 2008.

footnotes

http://www.nytimes.com/2008/08/13/nyregion/13detain.html.
20 Julie L. Myers, Assistant Secretary, U.S. Immigration and
Customs Enforcement, Department of Homeland Security, page
56, transcript of U.S. House Judiciary Subcommittee on
Immigration hearing, Problems with Immigration Detainee
Medical Care, June 4, 2008.
21 U.S. Rep. Zoe Lofgren, chairwoman of U.S. House
Subcommittee on Immigration, Page 2, transcript of the
subcommittee’s hearing, Problems with Immigration Detainee
Medical Care, June 4, 2008.
22 Ibid.
23 ICE National Detention Standards.
24 Priest and Goldstein, System of Neglect, Careless Detention
series. The Washington Post, May 11, 2008;
http://www.washingtonpost.com/wpsrv/nation/specials/immigration/cwc_d1p1.html.
25 Priest and Goldstein, System of Neglect, Careless Detention
series. The Washington Post, May 11, 2008,
http://www.washingtonpost.com/wpsrv/nation/specials/immigration/cwc_d1p1.html; U.S. Rep. Zoe
Lofgren, chairwoman, U.S. House Subcommittee on
Immigration, page 2, transcript of the subcommittee’s hearing,
Problems with Immigration Detainee Medical Care, June 4,
2008.
26 Tom Jawetz, ACLU National Prison Project, written
statement, Presentation on Medical Care and Deaths in ICE
Custody, for U.S. House Immigration Subcommittee hearing on
Detention and Removal, Immigration Detainee Medical Care,
October 4, 2007.
http://judiciary.house.gov/media/pdfs/Jawetz071004.pdf.
27 Priest and Goldstein, Careless Detention series. The
Washington Post. May 11-14, 2008.
http://www.washingtonpost.com/wpsrv/nation/specials/immigration/cwc_d1p1.html; Scott Pelley,
Detention in America, CBS News 60 Minutes. May 11, 2008;
Nina Bernstein, New Scrutiny as Immigrants Die in Custody, The
New York Times. June 26, 2007.
http://query.nytimes.com/gst/fullpage.html?res=9E0DE6DD1F
3FF935A15755C0A9619C8B63&scp=2&sq=Nina%20Bernste
in%20New%20Scrutiny%20as%20Immigrants%20Die%20in
%20Custody&st=cse; and, Darryl Fears, 3 Jailed Immigrants Die
in a Month, Medical Mistreatment Alleged; Federal Agency Denies
Claims, The Washington Post, August 15, 2007, Page A02.
28 Priest and Goldstein, System of Neglect, Careless Detention
series, The Washington Post. May 11, 2008,
http://www.washingtonpost.com/wpsrv/nation/specials/immigration/cwc_d1p1.html.
29 Francisco Castañeda, Presentation on Medical Care in ICE
Custody, page 2, statement for U.S. House Judiciary
Subcommittee on Immigration hearing, Detention and
Removal: Immigration Detainee Medical Care. October 4,

2007.
30 Priest and Goldstein, System of Neglect, Careless Detention
series, The Washington Post. May 11, 2008.
http://www.washingtonpost.com/wpsrv/nation/specials/immigration/cwc_d1p1.html.
31 The other ICE detainee death is that of Ana Romero, an
apparent suicide by hanging in August 2008 according to a
preliminary autopsy report cited in a Lexington Herald-Leader
news report by Valarie Honeycutt Spears and Jillian Ogawa,
September 14, 2008. Ms. Romero was held at the Franklin
County jail in Kentucky at the time of her death. Her family
and advocates continue to call for an investigation.
32 U.S. Rep. Zoe Lofgren, chairwoman of U.S. House
Subcommittee on Immigration, page 2, transcript of the
subcommittee’s hearing, Problems with Immigration Detainee
Medical Care. June 4, 2008.
33 Declaration of John P. Pratt, Esq., Rev. Dantica’s
immigration attorney, January, 14, 2005.
34 Edwidge Danticat, Brother, I am Dying, New York, Alfred
A. Knopf publisher, 2007, pp 231-232.
35 Declaration of John Pratt, Esq., January 14, 2005;
corroborated by statements of Krome personnel included in the
Department of Homeland Security Office of Inspector General
Report on Investigation on Joseph Nozius Dantica, March 31,
2005.
36 Department of Homeland Security Office of Inspector
General Reports of Investigation on Joseph Nozius Dantica,
March 31, 2005.
37 Dana Priest and Amy Goldstein, Careless Detention Series,
Document Archive. Portions of a review of circumstances
surrounding the death in detention of Joseph Dantica, May 11,
2008. http://www.washingtonpost.com/wpsrv/nation/specials/immigration/documents.html. The U.S.
Citizenship and Immigration Services (CIS) memo shown is
dated November 12, 2004. Though the name of the officer is
redacted, Officer Castro was the only CIS official in the room at
Krome when the Rev. Dantica began to vomit.
38 Declaration of John Pratt, Esq., January 14, 2005.
39 Ibid
40 ICE National Detention Standard on Terminal Illness,
Advance Directives, and Death, Section III, A, 4.
41 Edwidge Danticat, Endorsements, Securing our Borders: Post
9/11 Scapegoating of Immigrants, April 2005.
42 FIAC wrote the DHS Inspector General with its concerns
that in far too many instances the findings in these reports
were either based upon alarmingly insufficient evidence or
clearly erroneous. See letter to Honorable Richard L. Skinner,
DHS Inspector General, from FIAC Executive Director Cheryl
Little, November 23, 2005.
43 Press Release, “Meek Asks DHS Inspector General to
Consider New and Conflicting Information in Investigating of

footnotes

Detainee Treatment,” December 9, 2005.
44 The School District of Palm Beach County, School Records
re Valery Joseph, 1995-2002.
45 Palm Beach Police Department, Case No. 2007CF007567,
May 24, 2007.
46 Valery Joseph, letter to Immigration Judge Denise Slavin,
January 25, 2008.
47 Armor Correctional Health Services, Inc., Joseph Valery
Medical Records, February 28, 2008 to June 20, 2008.
48 Glade’s County Detention Center, Jail Incident Report
regarding Valery Joseph, March 3, 2008.
49 FIAC interview with Krome detainee “Sam,” July 11,
2008.
50 Armor Correctional Health Services, Inc., Joseph Valery
Medical Records, February 28, 2008 to June 20, 2008.
51 Dr. Kenneth Fischer, neurologist, phone conversation with
FIAC, November 7, 2008.
52 Jacqueline Fleury, statements to FIAC, July 2008.
53 Statement of Jacqueline Fleury, June 23, 2008.
54 Affidavit of James White, July 11,2008.
55 Autopsy Report of Valery Joseph, Wendolyn Sneed, M.D.,
Associate Medical Examiner, Florida District 21 (Lee-HendryGlades Counties); Case Number 00455-2008.
56 9th U.S. Circuit Court of Appeals ruling in Castañeda v.
United States, October 2, 2008.
57 District Court Finds Refusal to Provide Medical Treatment to
Immigration Detainee Cruel and Unusual, Interpreter Releases,
pages 930-934, March 24, 2008.
58 Priest and Goldstein, E-Mails Show Attempt to ‘Patch Up’ a
Case of Medical Negligence. The Washington Post, May 11,
2008, http://www.washingtonpost.com/wpsrv/nation/specials/immigration/cwc_d1sidebar.html; District
Court Finds Refusal to Provide Medical Treatment to Immigration
Detainee Cruel and Unusual, Interpreter Releases, page 934.
March 24, 2008.
59 Ninth U.S. Circuit Court of Appeals ruling in Castañeda v.
United States, October 2, 2008.
60 District Court Finds Refusal to Provide Medical Treatment to
Immigration Detainee Cruel and Unusual, Interpreter Releases,
pages 930-934, March 24, 2008.
61 ICE Office of Professional Responsibility, Report of
Investigation Hui Lui Ng, January 12, 2009.
http://www.aila.org/content/default.aspx?docid=27666.
62 Bernstein, Ill and in Pain, Detainee dies in U.S. Hands, The
New York Times, August 13, 2008.
http://www.nytimes.com/2008/08/13/nyregion/13detain.html.
63 Nina Bernstein, Cellmate Describes Pain of Detainee Who
Died, The New York Times. August 20, 2008.
http://www.nytimes.com/2008/08/20/nyregion/20detain.html?s
cp=1&sq=,%20Cellmate%20Describes%20Pain%20of%20Det
ainee%20Who%20Died&st=cse.
64 ICE Office of Professional Responsibility, Report of
70

Investigation Hui Lui Ng, page 22-24, January 12, 2009.
http://www.aila.org/content/default.aspx?docid=27666.
65 Ibid
66 Ibid, pages 13 to 18.
67 Bernstein, Ill and in Pain, Detainee dies in U.S. Hands, The
New York Times, August 13, 2008.
http://www.nytimes.com/2008/08/13/nyregion/13detain.html.
68 ICE Office of Professional Responsibility, Report of
Investigation Hui Lui Ng, pages 28-33, January 12, 2009.
http://www.aila.org/content/default.aspx?docid=27666
69 Ibid
70 Zachary Malinowsky, Immigration detainees pulled from Wyatt
detention center, Providence Journal-Bulletin (Rhode Island),
December 9, 2008.
71 Lin Li Qu (a/k/a Michelle Ng) v. Central Falls Detention
Facility Corporation. February 9, 2009.
www.riaclu.org/20090209pf.htm
72 Nina Bernstein, Another Detention Death, and Mounting
Questions, The New York Times, January 28,
2009.www.nytimes.com/2009/01/28/us/28detain.html?_r=1&s
cp=1&sq=Guido%20Newbrough&st=cse; Nick Miroff and
Josh White, ICE Stops Using Jail in Pr. William After Fatality,
The Washington Post, February 20, 2009.
www.washingtonpost.com/wpdyn/content/story/2009/02/19/ST2009021902318.html.
73 Bernstein, Another Detention Death, and Mounting Questions,
The New York Times, January 28, 2009.
nytimes.com/2009/01/28/us/28detain.html?_r=1&scp=1&sq=
Guido%20Newbrough&st=cse.
74 Ibid
75 Ibid
76 Ibid
77 After Action Review Death of Abdeulaye Sall A# 70 306
018, Office of Detention and Removal, Washington Field
Office, December 4, 2006.
http://www.aclu.org/pdfs/prison/2006_1204_ice_sallreport.pdf.
78 Bernstein, Another Detention Death, and Mounting Questions,
The New York Times, January 28, 2009.
nytimes.com/2009/01/28/us/28detain.html?_r=1&scp=1&sq=
Guido%20Newbrough&st=cse.
79 Miroff and White, ICE Stops Using Jail in Pr. William After
Fatality, The Washington Post, February 20, 2009.
www.washingtonpost.com/wpdyn/content/story/2009/02/19/ST2009021902318.html.
80 Nelson Daranciang, U.S. government sued in baby’s death,
Honolulu Star-Bulletin. September 9, 2008.
81 Daranciang, U.S. government sued in baby’s death, Honolulu
Star-Bulletin, September 9, 2008; Greg Small, American Samoa
baby dies in Honolulu airport, Associated Press, February 13,
2008; Dan Nakaso, Mother pleaded for help for baby, The
Honolulu Advertiser, February 13, 2008.
82 Dave Dondoneau, Customs accused of faking records. Honolulu

footnotes

Advertiser. September 10, 2008.
83 Ibid
84 Ibid
85 Daranciang, U.S. government sued in baby’s death, Honolulu
Star-Bulletin, September 9, 2008
86 Tom Jawetz, ACLU National Prison Project, Presentation
on Medical Care and Deaths in ICE Custody, written statement
for U.S. House Immigration Subcommittee hearing on
“Detention and Removal, Immigration Detainee Medical Care,"
October 4, 2007.
http://judiciary.house.gov/media/pdfs/Jawetz071004.pdf.
87 Priest and Goldstein, System of Neglect, Careless Detention
series. The Washington Post, May 11, 2008;
http://www.washingtonpost.com/wpsrv/nation/specials/immigration/cwc_d1p1.html.
88 Human Rights Watch Report, Chronic Indifference:
HIV/AIDS Services for Immigrants Detained by the United States.
December 2007; pages 25-26.
89 Ibid
90 Priest and Goldstein, System of Neglect, Careless Detention
series. The Washington Post, May 11, 2008;
http://www.washingtonpost.com/wpsrv/nation/specials/immigration/cwc_d1p1.html.
91 ICE National Detention Standard on Medical Care, Section
III, D, Medical Screening, states, “Health appraisals will be
performed according to National Commission on Correctional
Health Care and Joint Commission on the Accreditation of
Healthcare Organizations standards.”
92 Dana Priest and Amy Goldstein, Careless Detention Series,
Document Archive, Selections from the last page of the case
summary of detainee Victor Alfonso Arellano's death, May 11,
2008; http://www.washingtonpost.com/wpsrv/nation/specials/immigration/documents.html.
93 Priest and Goldstein, System of Neglect, Careless Detention
series. The Washington Post, May 11, 2008;
http://www.washingtonpost.com/wpsrv/nation/specials/immigration/cwc_d1p1.html.
94 Priest and Goldstein, Careless Detention Series, Document
Archive, Internal document from Division of Immigration
Health Services documenting how much money the agency has
saved by turning down Treatment Authorization Requests
(TARs) for detainees with specific medical problems, May 12,
2008; http://www.washingtonpost.com/wpsrv/nation/specials/immigration/documents.html.
95 Human Rights Watch Report, Chronic Indifference:
HIV/AIDS Services for Immigrants Detained by the United States.
December 2007; pages 25-26;
96 FIAC letter to Officer in Charge Marion Dillis, Krome
Processing Center, July 19, 2006.
97 Letter from ICE detainee, July 24, 2007.
98 Nina Bernstein, Few Details on Immigrants Who Died in

Custody, The New York Times, May 5, 2008.
http://www.nytimes.com/2008/05/05/nyregion/05detain.html?
_r=1&scp=1&sq=Few%20Details%20on%20Immigrants%20
Who%20Died%20in%20Custody&st=cse; Bernstein, New
Scrutiny as Immigrants Die in Custody, The New York Times,
June 26, 2007.
http://query.nytimes.com/gst/fullpage.html?res=9E0DE6DD1F
3FF935A15755C0A9619C8B63&scp=2&sq=Nina%20Bernste
in%20New%20Scrutiny%20as%20Immigrants%20Die%20in
%20Custody&st=cse; and, Darryl Fears, 3 Jailed Immigrants
Die in a Month, Medical Mistreatment Alleged; Federal
Agency Denies Claims, The Washington Post. August 15,
2007. Page A02.
99 Statement of Miguel Alonso Bonilla Cardona, September 4,
2008.
100 Detention Watch Network, Common Detainee Complaints,
June 27, 2008.
101 FIAC conversation with Jose “Joe” Greer Jr., MD, August
2008.
102 Statement of Miguel Alonso Bonilla Cardona, September
4, 2008.
103 Ibid
104 Statement of Maria Leatherwood, October 16, 2008.
105 ICE National Detention Standard on Terminal Illness,
Advance Directives, and Death, Section III, A 4.
106 Ibid
107 Statement of Miguel Alonso Bonilla Cardona, September
4, 2008.
108 Ibid
109 Declaration of Yong Sun Harvill, May 2008, page 5.
110 Priest and Goldstein, In Custody, In Pain, Careless Detention
series. The Washington Post, May 12, 2008.
http://www.washingtonpost.com/wpsrv/nation/specials/immigration/cwc_d2p1.html.
111 Letter to FIAC from Michael Rozos, Director for
Detention and Removal, Miami Field Office, ICE, May 11,
2007.
112 Priest and Goldstein, In Custody, In Pain, Careless Detention
series. The Washington Post, May 12, 2008;
http://www.washingtonpost.com/wpsrv/nation/specials/immigration/cwc_d2p1.html.
113 Verified Complaint for Injunctive and Declaratory Relief,
Yong Sun Harvill vs. Julie L. Myers et al, June 12, 2008.
114 Declaration of Kelleen Corrigan, June 9, 2008, pages 4-5.
115 Declaration of Yong Sun Harvill, May 2008, page 2.
116 Ibid
117 Journal, Yong Sun Harvill, September 20, 2007.
118 Ibid, October 4, 2007.
119 Letter to FIAC from Michael Rozos, Director for
Detention and Removal, Miami Field Office, ICE, June 11,
2007; letter to FIAC from Katrina Kane, Director for

footnotes

Detention and Removal, Phoenix Field Office, ICE, February
25, 2008.
120 Letter to FIAC from G. Douglas Dotson, M.D., Program
Leader, H. Lee Moffitt Cancer Center & Research Institute,
June 26, 2007.
121 Letter from Gotardo A. Rodrigues, M.D., September 27,
2007.
122 Declaration of Lee Cranmer, MD, PhD, May 7, 2008.
123 Declaration of Yong Sun Harvill, May 2008, page 5.
124 Michael N. Cox, Master of Social Work, Henderson
Mental Health Center’s Florida Assertive Community
Treatment (FACT) Team, Letter to FIAC. November 4, 2008.
125 Ibid
126 Dorit Itzchaki, Merriment Manor Administrator, Letter.
November 5, 2008.
127 Cox, MSW, Henderson Mental Health Center’s FACT
Team, Letter to FIAC. November 4, 2008.
128 FIAC letter to Deportation Officer Hicks, ICE Office of
Detention and Removal, “Urgent Request for Immediate
Humanitarian Release of Detainee with Severe Medical and
Mental-Health Conditions.” November 12, 2008.
129 FIAC conversation with ICE, December 2008.
130 FIAC letter to Krome Service Processing Center, Prison
Health Services and Officer in Charge, October 17, 2006.
Includes letter by Gotardo A. Rodrigues, MD, Hematology and
Medical Oncology, October 16, 2006;
131 Declaration of Hanna Boutros, November 20, 2006.
132 In November 2007, Mr. Boutros was deported to Lebanon
where he was jailed for several days.
133 Letter to ICE/BTC from Cheryl Little, FIAC, November
6, 2003.
134 Letter from FIAC and the Women’s Commission for
Refugee Women and Children to the Department of Homeland
Security, Office of the Undersecretary, Officer Daniel W.
Sutherland, Civil Rights and Civil Liberties, June 18, 2004.
FIAC and the Women’s Commission wrote DHS to request an
investigation into this case and the previous case involving the
asylum seeker at BTC who learned that she was pregnant due
to a politically motivated gang rape in her home country. In a
letter of response, the DHS Office of Civil Rights and Civil
Liberties said it conducted an investigation but the results were
“protected communication” and were not provided.
135 Statement of Haitian woman at the Broward Transitional
Center, February 4, 2004.
136 DHS, US ICE TGK Correctional Center Annual
Detention Review, April 5, 2004.
137 Letter from detainee to FIAC, July 28, 2004.
138 Alfonso Chardy, Immigration agency moves 45 female detainees
to Keys, The Miami Herald. September 18, 2004.
139 In a letter to TGK officials, thanking them for their
efforts to comply with the Detention Standards, an
immigration official asked the jail staff not to meet with FIAC,
72

“in particular Ms. Little, without approval from ICE. (Letter to
Lois Spears, Miami-Dade County of Corrections, from Kim
Boulia, Immigration and Naturalization Service, Office of the
District Director, March 27, 2001). Meetings with TGK staff
that had resulted in some improvement in medical care for
detainees came to an abrupt end.
140 DHS, US ICE TGK Correctional Center Annual
Detention Review, April 5, 2004.
141 Supplemental Request for Immediate Humanitarian
Parole of Yong Harvill, November 26, 2007.
142 Letter to Marion Dillis, Krome Detention Center OfficerIn-Charge to Captain Penny Phelps, Monroe County Detention
Center, from FIAC Executive Director Cheryl Little, August
23, 2006.
143 Letter to Cheryl Little (FIAC) from Gene Migliaccio, Dr.,
PH., CAPT, US PHS, Director, September 25, 2006.
144 As an orphan in Haiti, Ernso has never been sure of his
true date of birth. However, DHS officials decided he was 18
shortly after he arrived, relying primarily on a dental test, and
locked him up with adults at the Krome detention center. In
October 2003, his attorneys submitted authenticated official
Haitian documents showing Ernso to be 16 years old, and
establishing his eligibility for a Special Immigrant Juvenile
Status (SIJS) visa as an abused, abandoned or neglected child in
whose best interest it is not to be returned to Haiti.
145 Letter to Cheryl Little, FIAC, from Teresa Descilo,
Executive Director, Victim Services Center, October 22, 2003.
146 Letter to Thomas Ridge, Secretary Department of
Homeland Security, from Congressman Kendrick Meek,
November 12, 2003.
147 Congress passed Special Immigrant Juvenile (SIJ) status
into law in 1990 in order to protect abused, abandoned and
neglected immigrant children. Eligible immigrant children are
granted SIJ status and ultimately permanent residence. To be
eligible, an immigrant child must be (1) found dependent on a
juvenile court; (2) a victim of abuse, neglect and abandonment;
(3) found eligible for long-term foster care because family
reunification is not a viable option, and (4) determined it is not
in the child’s best interests to be returned to her native country
but rather in her best interest to remain in the U.S.
148 Petition from detainees at Krome, signed by 254
detainees, September 20, 2006.
149 Detainee interview, January 8, 2008.
150 Gloria Armendariz, testimony on behalf of Isaias Vasquez,
House Immigration Subcommittee hearing on Problems with
Immigration Detainee Medical Care, June 4, 2008, page 1;
http://judiciary.house.gov/hearings/pdf/armendariz060408.pdf
151 Dana Priest and Amy Goldstein, Suicide Points to Gaps in
Treatment, Careless Detention Series. The Washington Post. May
13, 2008 http://www.washingtonpost.com/wpsrv/nation/specials/immigration/cwc_d3p1.html
152 Ibid

footnotes

153 Priest and Amy Goldstein, Careless Detention Series,
Document Archive, Selected responses from ICE to questions
posed by The Washington Post regarding the provision of
mental healthcare to immigration detainees;
http://www.washingtonpost.com/wpsrv/nation/specials/immigration/documents.html
154 Ibid
155 Priest and Amy Goldstein, Careless Detention Series,
Document Archive, Internal document from Division of
Immigration Health Services documenting how much money
the agency has saved by turning down Treatment
Authorization Requests (TARs) for detainees with specific
medical problems; http://www.washingtonpost.com/wpsrv/nation/specials/immigration/documents.html
156 Priest and Goldstein, Suicide Points to Gaps in Treatment,
Careless Detention Series. The Washington Post. May 13, 2008;
http://www.washingtonpost.com/wpsrv/nation/specials/immigration/cwc_d3p1.html
157 Ibid
158 Mary Meg McCarthy, Executive Director , National
Immigrant Justice Center, pages 89-900, transcript of U.S.
House Judiciary Subcommittee on Immigration hearing,
Problems with Immigration Detainee Medical Care. June 4,
2008.
http://judiciary.house.gov/hearings/pdf/McCarthy080604.pdf
159 Priest and Goldstein, Suicide Points to Gaps in Treatment,
Careless Detention Series. The Washington Post. May 13, 2008;
http://www.washingtonpost.com/wpsrv/nation/specials/immigration/cwc_d3p1.html
160 Ibid
161 From Persecution to Prison: The health consequences of Detention
for Asylum Seekers, Physicians for Human Rights/Bellevue/NYU
Program for Survivors of Torture, 2003, pages 56-57;
http://physiciansforhumanrights.org/library/documents/reports/
report-perstoprison-2003.pdf
162 Jennifer Kay, Brazilian migrants sue ICE over mental health
care, Associated Press, March 5. 2009.
163 Penalties for Disclosure of Information, at 8 U.S.C. 1367,
prohibits government agencies from relying on information
from an abuser to act against his or her victim.
164 FIAC letter to Michael Rozos, Field Office Director, ICE
Miami, Urgent Request for Humanitarian Release, October 16,
2008; FIAC letter to Michael Rozos, Field Office Director, ICE
Miami, Urgent Request to Stay Removal and Release. July 20,
2008.
165 ICE National Detention Standard on Visitation; Section,
III. O. 5.
166 ICE Performance Based National Detention Standards, on
Medical Care, III. Y; at
http://www.ice.gov/doclib/PBNDS/rtf/medical_care.rtf
167 FIAC letter to Michael Rozos, Field Office Director, ICE

Miami, Urgent Request for Humanitarian Release, October 16,
2008.
168 Priest and Goldstein, Suicide Points to Gaps in Treatment,
Careless Detention Series. The Washington Post. May 13, 2008;
http://www.washingtonpost.com/wpsrv/nation/specials/immigration/cwc_d3p1.html
169 Gloria Armendariz, testimony on behalf of Isaias Vasquez,
House Immigration Subcommittee hearing on Problems with
Immigration Detainee Medical Care, June 4, 2008, page 1;
http://judiciary.house.gov/hearings/pdf/armendariz060408.pdf
170 Ibid
171 Ibid
172 Priest and Amy Goldstein, Careless Detention Series,
Document Archive, Letter from a Department of Veterans
Affairs staff psychiatrist concerning the diagnoses, past
treatment and military service of Isaias Vasquez-Cisneros;
http://www.washingtonpost.com/wpsrv/nation/specials/immigration/documents.html
173 Armendariz, testimony on behalf of Isaias Vasquez, June
4, 2008; page 1;
http://judiciary.house.gov/hearings/pdf/armendariz060408.pdf
174 Priest and Goldstein, Suicide Points to Gaps in Treatment,
Careless Detention Series. The Washington Post. May 13, 2008;
http://www.washingtonpost.com/wpsrv/nation/specials/immigration/cwc_d3p1.html.
175 Ibid
176 Armendariz, testimony on behalf of Isaias Vasquez, June
4, 2008; page 1;
http://judiciary.house.gov/hearings/pdf/armendariz060408.pdf.
177 Armendariz, testimony on behalf of Isaias Vasquez, June
4, 2008; page 2;
http://judiciary.house.gov/hearings/pdf/armendariz060408.pdf.
178 Ibid
179 Priest and Goldstein, Suicide Points to Gaps in Treatment,
Careless Detention Series. The Washington Post. May 13, 2008;
http://www.washingtonpost.com/wpsrv/nation/specials/immigration/cwc_d3p1.html.
180 Ibid
181 Priest and Amy Goldstein, Careless Detention Series,
Document Archive, Selected responses from ICE to questions
posed by The Washington Post regarding the provision of
mental healthcare to immigration detainees;
http://www.washingtonpost.com/wpsrv/nation/specials/immigration/documents.html.
182 FIAC Letter to Joseph Greene, Chief of Policy and
Communications, ICE Office of Detention and Removal, U.S.
Department of Homeland Security, Conditions of detention for
ICE detainees at Glades County Detention Center, November 17,
2008; FIAC Letter to Major Richard Jones, Glades County
Sheriff’s Office, Use of Force Against ICE detainees at Glades
County Detention Center, July 29, 2008; FIAC Letter to Major

footnotes

Richard Jones and Paul Candemeres, Assistant Field Office
Director, ICE, Krome Service Processing Center, Use of Force
Against ICE detainees at Glades County Detention Center, April 30,
2008.
183 FIAC Letter to Joseph Greene, November 17, 2008.
Under ICE Detention Standards, Use of Force, III A, immediate
force may be used only if necessary to prevent a detainee from
harming himself, others, and/or property “when a detainee acts
violently or appears on the verge of violent action(s).” Under
ICE Detention Standards, Use of Force, III H. non-lethal weapons,
including chemical agents, may only be used if the detainee is
“1) armed and/or barricaded; or 2) cannot be approached
without danger to self or others; and 3) a delay in controlling
the situation would seriously endanger the detainee or others,
or would result in a major disturbance or serious property
damage.” ICE Detention Standards, Use of Force, III B 1 expressly
prohibits using force as a punitive measure.
184 Jail Suicide/Mental Health Update, Vol. 13, No. 4, p. 10,
Spring 2005.
185 ICE National Detention Standards (September 12, 2008
version), Suicide Prevention and Intervention, V F.
186 FIAC letter to ICE Office of Detention and Removal,
February 6, 2007.
187 FIAC interview with Jamaican detainee, January 23,
2007. See also FIAC letter to ICE Office of Detention and
Removal, February 6, 2007.
188 FIAC letter, Request for Investigation, to Michael D. Rozos,
Miami Field Office Director, ICE, December 21, 2007.
189 Disabled detainee letter, March 4, 2008.
190 Mr. Perez-Leon told FIAC that he received adequate
medical treatment at the detention facilities that preceded his
transfer to Atlanta.
191 Detainee letter to ICE Field Office Director, October
2007.
192 Detainee statement, December 4, 2007.
193 Letter to ICE/DRO Field Office Director from FIAC,
February 6, 2008.
194 Disabled detainee statement, January 9, 2008.
195 Ibid
196 Ibid
197 Zena T. Asfaw, page 2, written statement for the U.S.
House Immigration Subcommittee hearing on Problems with
Immigration Detainee Medical Care, June 4, 2008.
http://www.judiciary.house.gov/hearings/pdf/asfaw060408.pdf
198 Ann Schofield Baker, Written Testimony Regarding Abuses in
the Medical Care Provided to Immigration Detainees, House
Immigration Subcommittee hearing on Problems with
Immigration Detainee Medical Care, June 4, 2008;
http://judiciary.house.gov/hearings/pdf/Baker080604.pdf.
199 Ibid
200 Priest and Goldstein, Suicide Points to Gaps in Treatment,
Careless Detention Series. The Washington Post. May 13, 2008;
74

http://www.washingtonpost.com/wpsrv/nation/specials/immigration/cwc_d3p1.html.
201 Schofield Baker, Written Testimony Regarding Abuses in the
Medical Care Provided to Immigration Detainees, June 4, 2008;
http://judiciary.house.gov/hearings/pdf/Baker080604.pdf.
202 Priest and Goldstein, Suicide Points to Gaps in Treatment,
Careless Detention Series. The Washington Post. May 13, 2008;
http://www.washingtonpost.com/wpsrv/nation/specials/immigration/cwc_d3p1.html.
203 Schofield Baker, Written Testimony Regarding Abuses in the
Medical Care Provided to Immigration Detainees, June 4, 2008;
http://judiciary.house.gov/hearings/pdf/Baker080604.pdf.
204 Zena T. Asfaw, Testimony before the House Immigration
Subcommittee hearing on Problems with Immigration
Detainee Medical Care, June 4, 2008.
http://www.judiciary.house.gov/hearings/pdf/asfaw060408.pdf.
205 Ibid
206 Ibid
207 Ibid
208 Letter from patient’s doctor, Jackson Memorial Hospital
Rheumatology Clinic. August 7, 2008.
209 Letter from patient’s doctor, Jackson Memorial Hospital
Rheumatology Clinic. February 24, 2009.
210 “Lourdes” conversation with FIAC attorney Romy Lerner,
February 24, 2009.
211 FIAC letter, Urgent Request for Immediate Medical Care, to
Captain Penny Phelps, Monroe County Detention Center, Key
West, Florida. August 8, 2008.
212 Lourdes conversation with FIAC Policy Director Susana
Barciela, August 19, 2008.
213 Letter from patient’s doctor, Jackson Memorial Hospital
Rheumatology Clinic, August 7, 2008.
214 Letter from patient’s doctor, Jackson Memorial Hospital
Rheumatology Clinic. February 24, 2009.
215 Ibid
216 Letter from Usha Reddy, MD, ophthalmology resident at
Bascom Palmer Eye Institute , sent to Commander Eunice
Jones-Smith and ICE Assistant Field Office Director Paul
Candemeres. September 4, 2008.
217 Letter to Captain Penny Phelps, Monroe County
Detention Center, from Charu al-Sahli (FIAC). July 23, 2007.
218 ICE National Detention Standard on Transportation (By
Land), V, D, 1, c, (2),
www.ice.gov/doclib/PBNDS/rtf/transfer_of_detainees.rtf and
ICE Medical Care Standard, V.S.,
http://www.ice.gov/doclib/PBNDS/pdf/medical_care.pdf.
September 12, 2008.
219 Letter to Clay County Jail Captain and Medical Staff from
FIAC, August 9, 2006.
220 Letter to Krome Officer in Charge from FIAC, July 19,
2006.
221 Emmanuel Dimitris Kyriakakis, statements to FIAC by

footnotes

phone from Greece on November 24 and October 15, 2008.
222 William Booth, U.S. Accused of Sedating Deportees, The
Washington Post, October 7, 1993.
223 Dana Priest and Amy Goldstein, Some Detainees Are
Drugged For Deportation, The Washington Post. May 14, 2008.
http://www.washingtonpost.com/wpsrv/nation/specials/immigration/cwc_d4p1.html
224 Ibid
225 Ibid
226 Ibid
227 Sandra Hernandez, U.S. Agents Forcibly Drug Immigrants to
Deport, Los Angeles Daily Journal. May 8, 2007.
228 Priest and Goldstein, Careless Detention Series, Document
Archive, Change in sedation policy in June 2007, around the
time that the American Civil Liberties Union filed a lawsuit
over sedation of two detainees in California. May 14, 2008.
http://www.washingtonpost.com/wpsrv/nation/specials/immigration/documents.html.
229 Anna Corman, Immigration officials need court orders to
forcibly drug deportees, Los Angeles Times, January 12, 2008
Wayne Drash, U.S. settles immigrant drugging suit, CNN.
February 1, 2008.
230 Ibid
231 Dana Priest and Amy Goldstein, Some Detainees Are
Drugged For Deportation, The Washington Post. May 14, 2008.
http://www.washingtonpost.com/wpsrv/nation/specials/immigra
tion/cwc_d4p1.html.
232 Emmanuel Dimitris Kyriakakis, statements to FIAC by
phone from Greece. October 15, 2008 and November 24.
233 Ibid
234 Ibid
235 Multiple medical studies among the general U.S.
population show that the quality of care for limited-Englishproficient individuals is inferior and that more interpreter
errors occur with untrained, ad hoc interpreters – the kind of
interpreters often used in detention facilities. Inadequate
interpretation can have serious health repercussions. For
example, people with language barriers are at increased risk of
not properly taking their medication. Patients with psychiatric
problems with language difficulties are more likely than others
to be diagnosed with a severe psychopathology. See Flores,
Glen, Language Barriers to Health Care in the United States, The
New England Journal of Medicine, July 20, 2006;
http://content.nejm.org/cgi/content/full/355/3/229.
236 Schofield Baker, Written Testimony Regarding Abuses in the
Medical Care Provided to Immigration Detainees, U.S. House
Immigration Subcommittee hearing on Problems with
Immigration Detainee Medical Care, June 4, 2008.
http://judiciary.house.gov/hearings/pdf/Baker080604.pdf.
237 Ibid
238 Priest and Goldstein, Suicide Points to Gaps in Treatment,

Careless Detention Series. The Washington Post. May 13, 2008.
http://www.washingtonpost.com/wpsrv/nation/specials/immigration/cwc_d3p1.html.
239 FIAC letter to ICE Office of Detention and Removal,
Conditions of detention for ICR detainees at Wakulla County Jail,
page 10. February 6, 2007.
240 Detainee interview with FIAC. October 1, 2008.
241 Mexican Detainee phone conversation with FIAC lawyer
Kelleen Corrigan, October 30, 2008.
242 See e.g., Letter to Deportation Officer Morales from
Charu Newhouse al-Sahli, FIAC (April 11, 2003); Letter to
Deportation Officer Morales from Jack Wallace, FIAC (April 9,
2003); Letter to Marion Dillis from Jack Wallace, FIAC
(March 31, 2003); and Letter to Marion Dillis from Charu
Newhouse al-Sahli, FIAC (March 7, 2003).
243 Statement of Lormise Guillaume, April 3, 2003.
244 “Horror of Being Held in Immigrants’ Deportation Cell,”
Opinion, East African Standard (Nairobi), August 5, 2007,
available at http://allafrica.com/stories/200708060947.html.
245 FIAC staff conversation with Krome detainee, January 27,
2009.
246 Letter to FIAC, Re: Overcrowding at Krome Detention
Center, December, 11, 2008.
247 Petition from detainees at Krome, signed by 254
detainees. September 20, 2006.
248 FIAC Letter to John Stevenson, ICE Acting Officer-InCharge. September 28, 2006.
249 Letter from ICE detainee. June 21, 2006.
250 “Horror of Being Held in Immigrant’s Deportation Cell,”
Opinion, East African Standard (Nairobi). August 5, 2007.
http://allafrica.com/stories/200708060947.html.
251 An overcrowded Krome, again, Editorial, The Miami Herald.
July 7, 2006.
252 Government Accountability Office (GAO), Alien Detention
Standards: Telephone Access Problems Were Pervasive at Detention
Facilities; Other Deficiencies Did Not Show a Pattern of
Noncompliance, GAO-07-875. July 6, 2007.
http://www.gao.gov/new.items/d07875.pdf.
253 FIAC letter, Evacuation and Transportation of ICE Detainees,
to Michael Rozos, Field Office Director, ICE Miami, September
22, 2008.
254 Ibid
255 ICE National Detention Standards, Transportation (Land
Transportation), III.AA.
256 Ibid
257 FIAC letter, Evacuation and Transportation of ICE Detainees,
to Michael Rozos, Field Office Director, ICE Miami. September
22, 2008.
258 ICE National Detention Standards, Transportation (Land
Transportation), III.AA.
259 Ibid

footnotes

260 Letter from Michael Rozos, Field Office Director, ICE
Miami, Evacuation and Transportation of ICE Detainees, to Cheryl
Little, FIAC Executive Director. September 25, 2008.
261 Statement of Miguel Alonso Bonilla Cardona. September
4, 2008.
262 Declaration of James White. July 11, 2008.
263 Letter to BTC and ICE from FIAC, June 7, 2007; E-mail
to ICE official from FIAC. June 21, 2007.
264 Letter to ICE Office of Detention and Removal from
FIAC, February 6, 2007.
265 Letter to BTC and ICE from FIAC, June 7, 2007; E-mail
to ICE official from FIAC, June 21, 2007.
266 Letter to Sheriff David Harvey from FIAC, September 13,
2006.
267 Statement of Keston Phillip. June 15, 2006. Also FIAC
letter to Wakulla County Sheriff David Harvey. September 13,
2006.
268 Ann Schofield Baker, Written Testimony Regarding Abuses in
the Medical Care Provided to Immigration Detainees. U.S. House
Immigration Subcommittee hearing on Problems with
Immigration Detainee Medical Care. June 4, 2008.
http://judiciary.house.gov/hearings/pdf/Baker080604.pdf.
269 FIAC filed its first request for Rev. Dantica’s medical
records on December 3, 2004, asking for all of his records and
any investigative reports on his illness and death. The request
was filed with the DHS’s Miami office because the records
being sought were held at Krome. After more than month
passed, FIAC inquired about the status of its request on
January 10, 2005. A Krome staff person said that she had not
seen the request and that the request had not been sent to
Krome from DHS’s Miami office. A staff person at DHS’s
Miami office told FIAC that it had not even begun to process
the request because the entire office was behind on Freedom of
Information Act requests since some of its staff had been
reassigned to another unit. FIAC faxed the request to the
Miami office again on January 11, 2005. In a letter to FIAC on
January 11, 2005, U.S. Citizenship and Immigration Services
District Director John M. Bulger said that the Dantica request
had been placed on the “complex track” and would not be
processed as quickly as simple requests. Bulger’s letter
suggested that FIAC “simplify” its request to get faster service.
FIAC noted that its expedited request was very short and very
specific, requesting only the medical records of one person who
was in DHS custody for five days. When FIAC followed up
with a call to Krome on January 26, 2005, a detention center
staff person said that they had still not received orders to
process the request from DHS’s central office. In response to
FIAC’s January 20, 2005, letter, DHS sent a letter, dated
January 26, 2005, suggesting that the records request be
redirected to the ICE Office of Investigations in Washington,
D.C. FIAC contended that DHS’s Miami office was the
correct venue for making the request, citing the department’s
76

own policy.
270 Ann Schofield Baker, Written Testimony Regarding Abuses in
the Medical Care Provided to Immigration Detainees, U.S. House
Immigration Subcommittee hearing on Problems with
Immigration Detainee Medical Care. June 4, 2008;
http://judiciary.house.gov/hearings/pdf/Baker080604.pdf.
271 Zena T. Asfaw, Testimony before the House Immigration
Subcommittee hearing on Problems with Immigration
Detainee Medical Care. June 4, 2008.
http://www.judiciary.house.gov/hearings/pdf/asfaw060408.pdf.
272 Detainee medical records and statement. October 8, 2007.
273 ICE Fact Sheet: Fiscal Year 2008. December 28, 2007.
http://www.ice.gov/doclib/pi/news/factsheets/2008budgetfactsh
eet.pdf.
274 About The U.S. Detention and Deportation System, Detention
Watch Network;
http://www.detentionwatchnetwork.org/aboutdetention
275 In Liberty’s Shadow, Human Rights First. 2004.
http://www.humanrightsfirst.org/about_us/events/Chasing_Free
dom/asylum_report.htm.
276 Operations Manual ICE Performance Based National
Standards. September 12, 2008.
http://www.ice.gov/partners/dro/PBNDS/index.htm.
277 ICE Policies Related to Detainee Deaths and the Oversight of
Immigration Detention Facilities, Department of Homeland
Security Office of Inspector General. June 2008.
http://www.dhs.gov/xoig/assets/mgmtrpts/OIG_0852_Jun08.pdf . This report only looked at two cases where ICE
detainees died, neither of which involved gross medical abuses
such as those seen in the cases of Victoria Arellano or Francisco
Castañeda. Testimony by Richard Stana of the Government
Accountability Office – “Observations of the Adherence to ICE’s
Medical Standards in Detention Facilities” at U.S. House Judiciary
Subcommittee on Immigration hearing Problems with
Immigration Detainee Medical Care. June 4,
2008–http://www.gao.gov/new.items/d08869t.pdf– was based
on a July 2007 GAO report that looked at eight of ICE’s
national standards. This report did not address quality-of-care
issues.
278 Priest and Goldstein, System of Neglect, Careless Detention
series. The Washington Post. May 11, 2008.
http://www.washingtonpost.com/wpsrv/nation/specials/immigration/cwc_d1p1.html.
279 FIAC and Human Rights Watch wrote immigration
officials to express concern over Andre’s death. See e.g. letter
to John Bulger, Acting INS District Director, November 14,
2001; letter to Wesley Lee, Krome Officer-in-Charge, from
FIAC, November 14, 2001.
280 In September 1998, a Krome Public Health Service
worker described to The Herald clinic deficiencies so extensive
that “the whole system needs to be closed down and the
patients evacuated.” Although many improvements have since

footnotes

been made, and Krome’s medical center now has state-of theart equipment, other problems described to The Herald by
clinic workers clearly have not been addressed. Among these
are accusations that “the majority of the staff” at Krome is
insensitive: “They view the people in there as criminals, and
they are not treated with simple human dignity,” another
Krome worker told The Herald. “Staff gets the attitude that no
one is really sick. They treat people like everyone is faking it.”
281 Detainee statement, February 15, 1996.
282 Answer to questionnaire by Cuban Detainee in Bay
County Jail Annex. 1996-1997.
283 Women’s Commission for Refugee Women and Children,
Innocents in Jail: INS Moves Refugee women from Krome To Turner
Guilford Knight Correctional Center, Miami, June 2001 (follow-up
Report to Behind Locked Doors: Abuse of Refugee Women at the
Krome Detention Center, October 2000).
284 DHS, US ICE TGK Correctional Center Annual
Detention Review. April 5, 2004.
285 Detainee statement. January 4, 2001.
286 Women’s Commission for Refugee Women and Children,
Innocents in Jail: INS Moves Refugee women from Krome To Turner
Guilford Knight Correctional Center, Miami, June 2001 (followup Report to Behind Locked Doors: Abuse of Refugee Women at the
Krome Detention Center, October 2000).
287 Detainee statement. October 5, 2001.
288 Detainee statement. February 5, 2001.
289 FIAC interview, April 6, 2001.
290 FIAC interview, April 6, 2001.
291 FIAC interview. March 28, 2001.
292 A number of women have reported that sanitary napkins
were sometimes not available, at times when clean underwear
was also unavailable. One asylum seeker reported that a
woman who was menstruating was forced to go without any
protection at all. When the women were moved from Krome
to TGK, TGK officers reported that it was the responsibility of
the Immigration and Naturalization Service (INS) to provide
toiletries. Women reported that when they asked the INS
officer on site about this, she responded: “It’s in the contract.
TGK is supposed to provide these things. You should tell the
TGK officer.” Women’s Commission interview, June 2001.
293 Letter from Saudi detainee, May 7, 2001.
294 Detainee affidavit, March 14, 2001.
295 Letter from cousin of Guyanan asylum seeker, August 6,
2001.
296 FIAC telephone conversation with relatives of Guyanan
asylum seeker, August 16, 2001.
297 FIAC telephone conversation with relatives of Guyanan
asylum seeker, October 24, 2001.
298 Detainee statement, January 19, 2001.
299 Detainee letter, February 15, 2001.
300 Detainee statement, June 13, 2001. This detainee was

subsequently forcibly drugged and deported to St. Kitts.
301 Detainee statement, June 2, 2001.
302 Andres Viglucci, Krome clinic under fire, The Miami
Herald. April 4, 1999.
303 FIAC letter to Robert Wallis, District Director,
Immigration and Naturalization Service, August 4, 1999.
304 Ho Guo Xiang v. Cadman, U.S.D.C., S.D. Fl., Docket
No. 93-0640-CIV-DAVIS (1993).
305 Ibid
306 Detainee statement, October 5, 2001.
307 Ibid
308 Detainee statement, undated. FIAC, Cries for Help:
Medical Care at Krome Service Processing Center and in Florida’s
County Jails, pp. 10-11, December 1999.
309 Detainee statements, January 4 and 9, 2001.
310 FIAC interview, January 3, 2001.
311 FIAC, Cries for Help: Medical Care at Krome Service
Processing Center and in Florida’s County Jails, p. 32. December
1999.
312 Affidavit, June 1999. FIAC, Cries for Help: Medical Care
at Krome Service Processing Center and Florida’s County Jails, p. 16,
December 1999.
313 Affidavit, July 28, 1998. FIAC, Cries for Help: Medical
Care at Krome Service Processing Center and Florida’s County Jails,
p. 33, December 1999.
314 Eads deposition, at 141 at 141-142; Diaz deposition, at
97-100; second Hall deposition, at 26-27; Ex. 21, letter from
Cuban detainee in Bay County Jail Annex. FIAC, Florida
County Jails: INS’s Secret Detention World, p 38, November 1997.
315 On June 8, 1995 PHS Director Dr. Ada Rivera reported:
“We would like to take this opportunity to reiterate our
findings during our environmental health inspections for the
last couple of months. The overcrowding poses a health
problem due to the lack of cleanliness and appropriate air
circulation. We have noticed an increased in respiratory and
skin conditions. These issues must be urgently addressed to
prevent any potential epidemics.”
316 According to an Office of Inspector General (OIG) report,
INS officials in Miami tried to deceive the task force about
overcrowded conditions at Krome by releasing dozens of
detainees, without medical screening, and by sending dozens
others (19 of whom were returned to Krome several days later)
to a county jail in northwestern Florida or to an INS facility in
New Orleans. Even after the OIG investigation was
undertaken, Krome’s population remained high and the facility
overcrowded.
317 See e.g. Andres Viglucci, Immigrants allege abuse at jail in
N. Florida, The Miami Herald, July 30, 1998; Brutality at
county jails?, Editorial, The Miami Herald, July 31, 1998;
Andres Viglucci, Immigrants’ claims of torture stir probe, The
Miami Herald, July 31, 1998; Teresa Mears, A Shock to the

footnotes

System, Miami New Times, July 30-August 5, 1998.
318 Affidavit, July 28, 1998.
319 Statement of Chimene Noel, December 3, 2002. Also
Jacqueline Charles, Haitians struggle to unite families, The Miami
Herald, December 12, 2002.
320 Letter to Carmel Clay Thompson from FIAC’s Cheryl
Little, March 17, 2003.
321 Christmas Present for Noel, Washington Post. December 26,
2002; Alfonso Chardy, Young Haitian migrant released, The
Miami Herald, December 25, 2002.
322 Women’s Commission interview, June 2001.
323 Andres Viglucci, Critics of clinic paint a tarnished Krome,
The Miami Herald. September 21, 1998.
324 Statement of former detainee deported to St. Kitts, June
13, 2001.
325 Doses of Benadryl and Thorazine were administered on
December 6, 1991, the day before his scheduled deportation.
Doses were repeated every few hours for twelve and a half hours
and resumed at 6:30 the next morning. At 2:55 p.m. the next
day, he was given more Benadryl and Thorazine and Ativan.
326 Mark Dow, American Gulag, Inside U.S. Immigration
Prisons, pp. 69-84, University of California Press, Berkeley.
2004
327 The Removal of 22 Detainees on 11-09-01 from Krome SPC—
Synopsis, signed by 15 detainees.

FIAC is grateful to the following for
providing graphics used in this report:
- Edwidge Danticat
- The Washington Post

RAe

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