[Congressional Bills 118th Congress]
[From the U.S. Government Publishing Office]
[H.R. 5605 Introduced in House (IH)]

<DOC>






118th CONGRESS
  1st Session
                                H. R. 5605

  To require U.S. Customs and Border Protection to perform an initial 
         health screening on detainees, and for other purposes.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                           September 20, 2023

   Mr. Ruiz introduced the following bill; which was referred to the 
    Committee on the Judiciary, and in addition to the Committee on 
 Homeland Security, for a period to be subsequently determined by the 
  Speaker, in each case for consideration of such provisions as fall 
           within the jurisdiction of the committee concerned

_______________________________________________________________________

                                 A BILL


 
  To require U.S. Customs and Border Protection to perform an initial 
         health screening on detainees, and for other purposes.

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE; TABLE OF CONTENTS.

    (a) Short Title.--This Act may be cited as the ``Humanitarian 
Standards for Individuals in Customs and Border Protection Custody 
Act''.
    (b) Table of Contents.--The table of contents of this Act is as 
follows:

Sec. 1. Short title; table of contents.
Sec. 2. Initial health screening protocol.
Sec. 3. Water, sanitation, and hygiene.
Sec. 4. Food and nutrition.
Sec. 5. Shelter.
Sec. 6. Coordination and surge capacity.
Sec. 7. Training.
Sec. 8. Interfacility transfer of care.
Sec. 9. Planning and initial implementation.
Sec. 10. Contractor compliance.
Sec. 11. Inspections.
Sec. 12. GAO report.
Sec. 13. Rules of construction.
Sec. 14. Definitions.

SEC. 2. INITIAL HEALTH SCREENING PROTOCOL.

    (a) In General.--The Commissioner of U.S. Customs and Border 
Protection (referred to in this Act as the ``Commissioner''), in 
consultation with the Secretary of Health and Human Services, the 
Administrator of the Health Resources and Services Administration, and 
nongovernmental experts in the delivery of health care in humanitarian 
crises and in the delivery of health care to children, shall develop 
guidelines and protocols for the provision of health screenings and 
appropriate medical care for individuals in the custody of U.S. Customs 
and Border Protection (referred to in this Act as ``CBP''), as required 
under this section.
    (b) Initial Screening and Medical Assessment.--The Commissioner 
shall ensure that any individual who is detained in the custody of CBP 
(referred to in this Act as a ``detainee'') receives an initial in-
person screening by a licensed medical professional in accordance with 
the standards described in subsection (c)--
            (1) to assess and identify any illness, condition, or age-
        appropriate mental or physical symptoms that may have resulted 
        from distressing or traumatic experiences;
            (2) to identify acute conditions and high-risk 
        vulnerabilities; and
            (3) to ensure that appropriate healthcare is provided to 
        individuals as needed, including pediatric, obstetric, and 
        geriatric care.
    (c) Standardization of Initial Screening and Medical Assessment.--
            (1)  In general.--The initial screening and medical 
        assessment shall include--
                    (A) an interview and the use of a standardized 
                medical intake questionnaire or the equivalent;
                    (B) screening of vital signs, including pulse rate, 
                body temperature, blood pressure, oxygen saturation, 
                and respiration rate;
                    (C) screening for blood glucose for known or 
                suspected diabetics;
                    (D) weight assessment of detainees under 12 years 
                of age;
                    (E) a physical examination; and
                    (F) a risk-assessment and the development of a plan 
                for monitoring and care, when appropriate.
            (2) Prescription medication.--The medical professional 
        shall review any prescribed medication that is in the 
        detainee's possession or that was confiscated by CBP upon 
        arrival and determine if the medication may be kept by the 
        detainee for use during detention, properly stored by CBP with 
        appropriate access for use during detention, or maintained with 
        the detained individual's personal property. A detainee may not 
        be denied the use of necessary and appropriate medication for 
        the management of the detainee's illness.
            (3) Rule of construction.--Nothing in this subsection shall 
        be construed as requiring detainees to disclose their medical 
        status or history.
    (d) Timing.--
            (1) In general.--Except as provided in paragraph (2), the 
        initial screening and medical assessment described in 
        subsections (b) and (c) shall take place as soon as 
        practicable, but not later than 12 hours after a detainee's 
        arrival at a CBP facility.
            (2) High priority individuals.--The initial screening and 
        medical assessment described in subsections (b) and (c) shall 
        take place as soon as practicable, but not later than 6 hours 
        after a detainee's arrival at a CBP facility if the individual 
        reasonably self-identifies as having a medical condition that 
        requires prompt medical attention or is--
                    (A) exhibiting signs of acute or potentially severe 
                physical or mental illness, or otherwise has an acute 
                or chronic physical or mental disability or illness;
                    (B) pregnant;
                    (C) a child (with priority given, as appropriate, 
                to the youngest children); or
                    (D) elderly.
    (e) Further Care.--
            (1) In general.--If, as a result of the initial health 
        screening and medical assessment, the licensed medical 
        professional conducting the screening or assessment determines 
        that one or more of the detainee's vital sign measurements are 
        significantly outside normal ranges in accordance with the 
        National Emergency Services Education Standards, or if the 
        detainee is identified as high-risk or in need of medical 
        intervention, the detainee shall be provided, as expeditiously 
        as possible, with an in-person or technology-facilitated 
        medical consultation with a licensed emergency care 
        professional.
            (2) Re-evaluation.--
                    (A) In general.--Detainees described in paragraph 
                (1) shall be re-evaluated within 24 hours and monitored 
                thereafter as determined by an emergency care 
                professional (and in the care of a consultation 
                provided to a child, with a licensed emergency care 
                professional with a background in pediatric care).
                    (B) Reevaluation prior to transportation.--In 
                addition to the re-evaluations under subparagraph (A), 
                detainees shall have all vital signs re-evaluated and 
                be cleared as safe to travel by a medical professional 
                prior to transportation.
            (3) Pyschological and mental care.--The Commissioner shall 
        ensure that detainees who have experienced physical or sexual 
        violence or who have experienced events that may cause severe 
        trauma or toxic stress, are provided access to basic, humane, 
        and supportive psychological assistance.
    (f) Interpreters.--To ensure that health screenings and medical 
care required under this section are carried out in the best interests 
of the detainee, the Commissioner shall ensure that language-
appropriate interpretation services, including indigenous languages, 
are provided to each detainee and that each detainee is informed of the 
availability of interpretation services.
    (g) Chaperones.--To ensure that health screenings and medical care 
required under this section are carried out in the best interests of 
the detainee--
            (1) the Commissioner shall establish guidelines for and 
        ensure the presence of chaperones for all detainees during 
        medical screenings and examinations consistent with relevant 
        guidelines in the American Medical Association Code of Medical 
        Ethics, and recommendations of the American Academy of 
        Pediatrics; and
            (2) to the extent practicable, the physical examination of 
        a child shall always be performed in the presence of a parent 
        or legal guardian or in the presence of the detainee's closest 
        present adult relative if a parent or legal guardian is 
        unavailable.
    (h) Documentation.--The Commissioner shall ensure that the health 
screenings and medical care required under this section, along with any 
other medical evaluations and interventions for detainees, are 
documented in accordance with commonly accepted standards in the United 
States for medical record documentation. Such documentation shall be 
provided to any individual who received a health screening and 
subsequent medical treatment upon release from CBP custody.
    (i) Infrastructure and Equipment.--The Commissioner or the 
Administrator of General Services shall ensure that each location to 
which detainees are first transported after an initial encounter with 
an agent or officer of CBP has the following:
            (1) A private space that provides a comfortable and 
        considerate atmosphere for the patient and that ensures the 
        patient's dignity and right to privacy during the health 
        screening and medical assessment and any necessary follow-up 
        care.
            (2) All necessary and appropriate medical equipment and 
        facilities to conduct the health screenings and follow-up care 
        required under this section, to treat trauma, to provide 
        emergency care, including resuscitation of individuals of all 
        ages, and to prevent the spread of communicable diseases.
            (3) Basic over-the-counter medications appropriate for all 
        age groups.
            (4) Appropriate transportation to medical facilities in the 
        case of a medical emergency, or an on-call service with the 
        ability to arrive at the CBP facility within 30 minutes.
    (j) Personnel.--The Commissioner or the Administrator of General 
Services shall ensure that each location to which detainees are first 
transported after an initial encounter has onsite at least one licensed 
medical professional to conduct health screenings. Other personnel that 
are or may be necessary for carrying out the functions described in 
subsection (e), such as licensed emergency care professionals, 
specialty physicians (including physicians specializing in pediatrics, 
family medicine, obstetrics and gynecology, geriatric medicine, 
internal medicine, and infectious diseases), nurse practitioners, other 
nurses, physician assistants. licensed social workers, mental health 
professionals, public health professionals, dieticians, interpreters, 
and chaperones, shall be located on site to the extent practicable, or 
if not practicable, shall be available on call.
    (k) Ethical Guidelines.--The Commissioner shall ensure that all 
medical assessments and procedures conducted pursuant to this section 
are conducted in accordance with ethical guidelines in the applicable 
medical field, and respect human dignity.

SEC. 3. WATER, SANITATION, AND HYGIENE.

    The Commissioner shall ensure that detainees have access to--
            (1) not less than 1 gallon of drinking water per person per 
        day, and age-appropriate fluids as needed;
            (2) a private, safe, clean, and reliable permanent or 
        portable toilet with proper waste disposal and a hand washing 
        station, with not less than 1 toilet available for every 12 
        male detainees, and 1 toilet for every 8 female detainees;
            (3) a clean diaper changing facility, which includes proper 
        waste disposal, a hand washing station, and unrestricted access 
        to diapers;
            (4) the opportunity to bathe daily in a permanent or 
        portable shower that is private and secure; and
            (5) products for individuals of all age groups and with 
        disabilities to maintain basic personal hygiene, including 
        soap, a toothbrush, toothpaste, adult diapers, and feminine 
        hygiene products, as well as receptacles for the proper storage 
        and disposal of such products.

SEC. 4. FOOD AND NUTRITION.

    The Commissioner shall ensure that detainees have access to--
            (1) three meals per day including--
                    (A) in the case of an individual age 12 or older, a 
                diet that contains not less than 2,000 calories per 
                day; and
                    (B) in the case of a child who is under the age of 
                12, a diet that contains an appropriate number of 
                calories per day based on the child's age and weight;
            (2) accommodations for any dietary needs or restrictions; 
        and
            (3) access to food in a manner that follows applicable food 
        safety standards.

SEC. 5. SHELTER.

    The Commissioner shall ensure that each facility at which a 
detainee is detained meets the following requirements:
            (1) Except as provided in paragraph (2), males and females 
        shall be detained separately.
            (2) In the case of a minor child arriving in the United 
        States with an adult relative or legal guardian, such child 
        shall be detained with such relative or legal guardian unless 
        such an arrangement poses safety or security concerns. In no 
        case shall a minor who is detained apart from an adult relative 
        or legal guardian as a result of such safety or security 
        concerns be detained with other adults.
            (3) In the case of an unaccompanied minor arriving in the 
        United States without an adult relative or legal guardian, such 
        child shall be detained in an age-appropriate facility and 
        shall not be detained with adults.
            (4) A detainee with a temporary or permanent disability 
        shall be held in an accessible location and in a manner that 
        provides for his or her safety, comfort, and security, with 
        accommodations provided as needed.
            (5) No detainee shall be placed in a room for any period of 
        time if the detainee's placement would exceed the maximum 
        occupancy level as determined by the appropriate building code, 
        fire marshal, or other authority.
            (6) Each detainee shall be provided with temperature 
        appropriate clothing and bedding.
            (7) The facility shall be well lit and well ventilated, 
        with the humidity and temperature kept at comfortable levels 
        (between 68 and 74 degrees Fahrenheit).
            (8) Detainees who are in custody for more than 48 hours 
        shall have access to the outdoors for not less than 1 hour 
        during the daylight hours during each 24-hour period.
            (9) Detainees shall have the ability to practice their 
        religion or not to practice a religion, as applicable.
            (10) Detainees shall have access to lighting and noise 
        levels that are safe and conducive for sleeping throughout the 
        night between the hours of 10 p.m. and 6 a.m.
            (11) Officers, employees, and contracted personnel of CBP 
        shall--
                    (A) follow medical standards for the isolation and 
                prevention of communicable diseases; and
                    (B) ensure the physical and mental safety of 
                detainees who identify as lesbian, gay, bisexual, 
                transgender, and intersex.
            (12) The facility shall have video-monitoring to provide 
        for the safety of the detained population and to prevent sexual 
        abuse and physical harm of vulnerable detainees.
            (13) The Commissioner shall ensure that language-
        appropriate ``Detainee Bill of Rights'', including indigenous 
        languages, are posted or otherwise made available in all areas 
        where detainees are located. The ``Detainee Bill of Rights'' 
        shall include all rights afforded to the detainee under this 
        Act.
            (14) Video from video-monitoring must be preserved for 90 
        days and the detention facility must maintain certified records 
        that the video-monitoring is properly working at all times.

SEC. 6. COORDINATION AND SURGE CAPACITY.

    The Secretary of Homeland Security shall enter into memoranda of 
understanding with appropriate Federal agencies, such as the Department 
of Health and Human Services, and applicable emergency government 
relief services, as well as contracts with health care, public health, 
social work, and transportation professionals, for purposes of 
addressing surge capacity and ensuring compliance with this Act.

SEC. 7. TRAINING.

    The Commissioner shall ensure that CBP personnel assigned to each 
short-term custodial facility are professionally trained, including 
continuing education as the Commissioner deems appropriate, in all 
subjects necessary to ensure compliance with this Act, including--
            (1) humanitarian response protocols and standards;
            (2) indicators of physical and mental illness, and medical 
        distress in children and adults;
            (3) indicators of child sexual exploitation and effective 
        responses to missing migrant children; and
            (4) procedures to report incidents of suspected child 
        sexual abuse and exploitation directly to the National Center 
        for Missing and Exploited Children.

SEC. 8. INTERFACILITY TRANSFER OF CARE.

    (a) Transfer.--When a detainee is discharged from a medical 
facility or emergency department, the Commissioner shall ensure that 
responsibility of care is transferred from the medical facility or 
emergency department to an accepting licensed health care provider of 
CBP.
    (b) Responsibilities of Accepting Providers.--Such accepting 
licensed health care provider shall review the medical facility or 
emergency department's evaluation, diagnosis, treatment, management, 
and discharge care instructions to assess the safety of the discharge 
and transfer and to provide necessary follow-up care.

SEC. 9. PLANNING AND INITIAL IMPLEMENTATION.

    (a) Planning.--Not later than 60 days after the date of enactment 
of this Act, the Secretary of Homeland Security shall submit to 
Congress a detailed plan delineating the timeline, process, and 
challenges of carrying out the requirements of this Act.
    (b) Implementation.--The Secretary of Homeland Security shall 
ensure that the requirements of this Act are implemented not later than 
6 months after the date of enactment.

SEC. 10. CONTRACTOR COMPLIANCE.

    The Secretary of Homeland Security shall ensure that all personnel 
contracted to carry out this Act do so in accordance with the 
requirements of this Act.

SEC. 11. INSPECTIONS.

    (a) In General.--The Inspector General of the Department of 
Homeland Security shall--
            (1) conduct unannounced inspections of ports of entry, 
        border patrol stations, and detention facilities administered 
        by CBP or contractors of CBP; and
            (2) submit to Congress, reports on the results of such 
        inspections as well as other reports of the Inspector General 
        related to custody operations.
    (b) Particular Attention.--In carrying out subsection (a), the 
Inspector General of the Department of Homeland Security shall pay 
particular attention to--
            (1) the degree of compliance by CBP with the requirements 
        of this Act;
            (2) remedial actions taken by CBP;
            (3) the health needs of detainees; and
            (4) the degree of compliance with part 115 of title 6, Code 
        of Federal Regulations (commonly known as the ``Standards To 
        Prevent, Detect, and Respond to Sexual Abuse and Assault in 
        Confinement Facilities'').
    (c) Access to Facilities.--The Commissioner may not deny a Member 
of Congress entrance to any facility or building used, owned, or 
operated by CBP.

SEC. 12. GAO REPORT.

    (a) In General.--The Comptroller General of the United States 
shall--
            (1) not later than 6 months after the date of enactment of 
        this Act, commence a study on implementation of, and compliance 
        with, this Act; and
            (2) not later than 1 year after the date of enactment of 
        this Act, submit a report to Congress on the results of such 
        study.
    (b) Issues To Be Studied.--The study required by subsection (a) 
shall examine the management and oversight by CBP of ports of entry, 
border patrol stations, and other detention facilities, including the 
extent to which CBP and the Department of Homeland Security have 
effective processes in place to comply with this Act. The study shall 
also examine the extent to which CBP personnel, in carrying out this 
Act, make abusive, derisive, profane, or harassing statements or 
gestures, or engage in any other conduct evidencing hatred or invidious 
prejudice to or about one person or group on account of race, color, 
religion, national origin, sex, sexual orientation, age, or disability, 
including on social media.

SEC. 13. RULES OF CONSTRUCTION.

    Nothing in this Act may be construed--
            (1) as authorizing CBP to detain individuals for longer 
        than 72 hours;
            (2) as contradicting the March 7, 2014, Department of 
        Homeland Security rule adopting Standards to Prevent, Detect, 
        and Respond to Sexual Abuse and Assault in Confinement 
        Facilities, which includes a zero tolerance policy prohibiting 
        all forms of sexual abuse and assault of individuals in U.S. 
        Customs and Border Protection custody, including in holding 
        facilities, during transport, and during processing;
            (3) as contradicting current protocols related to 
        Department background checks in the hiring process;
            (4) as restricting the Department from denying employment 
        to or terminating the employment of any individual who would be 
        or is involved with the handling or processing at holding 
        facilities, during transport, or during processing, or care of 
        detainees, including the care of children, and has been 
        convicted of a sex crime or other offense involving a child 
        victim; or
            (5) as affecting the obligation to fully comply with all 
        applicable immigration laws, including being subject to any 
        penalties, fines, or other sanctions.

SEC. 14. DEFINITIONS.

    In this Act:
            (1) Interpretation services.--The term ``interpretation 
        services'' includes translation services that are performed 
        either in-person or through a telephone or video service.
            (2) Child.--The term ``child'' has the meaning given the 
        term in section 101(b)(1) of the Immigration and Nationality 
        Act (8 U.S.C. 1101(b)(1)).
            (3) U.S. customs and border protection facility.--The term 
        ``U.S. Customs and Border Protection Facility'' includes--
                    (A) U.S. Border Patrol stations;
                    (B) ports of entry;
                    (C) checkpoints;
                    (D) forward operating bases;
                    (E) secondary inspection areas; and
                    (F) short-term custody facilities.
            (4) Forward operating base.--The term ``forward operating 
        base'' means a permanent facility established by CBP in forward 
        or remote locations, and designated as such by CBP.
            (5) Publication of data on complaints of sexual abuse at 
        cbp facilities.--Not later than 90 days after the date of 
        enactment of this Act, the Secretary of Homeland Security, 
        acting in coordination with the Office of Inspector General and 
        Office for Civil Rights and Civil Liberties, shall publicly 
        release aggregate data on complaints of sexual abuse at CBP 
        facilities on its website on a quarterly basis, excluding any 
        personally identifiable information that may compromise the 
        confidentiality of individuals who reported abuse.
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