[Congressional Record Volume 162, Number 23 (Tuesday, February 9, 2016)]
[Extensions of Remarks]
[Pages E149-E150]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




       TO AMPLIFY CONCERNS OF IMMIGRANT DEATHS IN PRIVATE PRISONS

                                 ______
                                 

                         HON. JOHN CONYERS, JR.

                              of michigan

                    in the house of representatives

                       Tuesday, February 9, 2016

  Mr. CONYERS. Mr. Speaker, I would like to submit the first sections 
of a terrific article, entitled, `This Man Will Almost Certainly Die' 
by Seth Freed Wessler, and published by The Nation. As we continue to 
discuss Criminal Justice Reform, I hope that this article can be 
invaluable resource to my colleagues.

       Where Claudio Fagardo-Saucedo grew up, on the colonial 
     streets of the Mexican city of Durango, migrating to the 
     United States was almost a rite of passage. It was following 
     the stream of departures from Durango in the 1980s that the 
     lanky young man left his family and traveled north. His 
     mother, Julieta Saucedo Salazar, heard that he'd found jobs 
     working as a laborer in Los Angeles. But they soon lost 
     touch. ``We did not know much about him, really,'' his 
     younger sister told me.
       This article was reported in partnership with the 
     Investigative Fund at the Nation Institute, with support from 
     the Puffin Foundation. It will be part of the February 6 
     episode of Reveal, a new podcast and public radio show 
     produced by The Center for Investigative Reporting and PRX. 
     Fagardo-Saucedo worked, his jobs sometimes taking him out of 
     California, and occasionally he got into trouble--once for 
     ``possession for sale'' of cocaine, another time for stealing 
     jewelry. Every seven or eight years, his mother recalled, 
     he'd return to her house--but never by choice. ``They caught 
     him all the time for being illegal,'' Julieta said. She 
     always hoped her wandering son might stay, get to know the 
     family again, but he never did. ``He would be here a month, 
     and then he'd go again.''
       In the summer of 2003, immigration agents detained Fagardo-
     Saucedo on his way back to California, but this time the 
     Border Patrol referred him to federal prosecutors, who 
     charged him with ``illegal re-entry,'' or returning to the 
     United States after deportation. He served nearly five years 
     before being sent back to Mexico. Again, he tried to return. 
     Early one morning in August of 2008, Fagardo-Saucedo 
     triggered an infrared sensor as he and two others ran across 
     the border near Tijuana. He pleaded guilty in a U.S. District 
     Court to another ``illegal re-entry'' charge. The judge 
     sentenced him to four years in federal prison.
       When Fagardo-Saucedo arrived at Reeves, a prison complex in 
     rural West Texas, he entered a little-known segment of the 
     federal prison system. Over the previous decade, elected 
     officials and federal agencies had quietly recast the 
     relationship between criminal justice and immigration 
     enforcement. These changes have done as much to bloat the 
     federal prison population as the War on Drugs; they have also 
     helped make Latinos the largest racial or ethnic group 
     sentenced to federal custody.
       Until the 1990s, border crossing was almost always treated 
     as a civil offense, punishable by deportation. But in the 
     late 1980s, Congress started to change that. By 1996, 
     crossing the border after deportation was punishable by years 
     of imprisonment, with enhanced sentences for people 
     previously convicted of crimes--most often drug offenses. 
     Though federal investigators have found no evidence that 
     criminalization has reduced the pace of border crossings over 
     the long term, prosecutions for illegal entry and re-entry 
     rose from fewer than 4,000 a year at the start of Bill 
     Clinton's presidency, to 31,000 in 2004 under George W. Bush, 
     to a high of 91,000 in 2013 under President Obama.
       By the late 1990s, the flood of inmates from this new class 
     of prisoner, coupled with a raging War on Drugs, sent the 
     Bureau of Prisons searching for places to put them. The BOP 
     turned to private companies to operate a new type of 
     facility, low-security prisons designed to hold only 
     noncitizens convicted of federal crimes. As of June 2015, 
     these facilities--which are distinct from immigration 
     detention centers, where people are held pending 
     deportation--housed nearly 23,000 people.
       Three private companies now run 11 immigrant-only contract 
     prisons. Five are run by the GEO Group, four by the 
     Corrections Corporation of America, and two by a privately 
     held company called the Management & Training Corporation. (A 
     third MTC prison was recently shut down after inmates 
     ransacked it in a protest.) Except for a prison largely used 
     to house inmates from Washington, DC, these 11 facilities are 
     the only privately run prisons in the federal criminal-
     justice system. In 2013, the BOP spent roughly $625 million 
     on them. The contracts include the provision of medical care, 
     for which the companies often hire health-services 
     subcontractors. In one such facility in Reeves County, Texas, 
     the BOP entered into an agreement with the county, which in 
     turn hired GEO to operate the prison and Correct Care 
     Solutions to manage prison healthcare.
       The BOP's contracts with these facilities are meant to cut 
     costs. Though the prisons are part of the federal 
     infrastructure, the companies that run them operate under a 
     different--and less stringent--set of rules in order to allow 
     cost-cutting innovations. As a retired BOP contracting 
     official said in an interview, ``The more specificity you put 
     in the contract, the more money the contractors are going to 
     want for performing the service.''
       At least five times since 2008, inmates have rioted in the 
     BOP's contract prisons. The unrest has often come after 
     medical-care complaints. (Pecos Enterprise, Smokey Briggs / 
     AP)
       Repeated federal audits and reports have found these 
     facilities to be in crisis. Prison medical care is 
     notoriously bad, but for years, immigrant- and prisoner-
     rights advocates have sounded the alarm about these sites in 
     particular, describing them as separate and unequal, 
     segregated on the basis of citizenship. ``These prisons 
     operate without the same systems of accountability as regular 
     Bureau of Prisons facilities, and prisoners suffer,'' said 
     Carl Takei, an ACLU attorney who coauthored a 2014 report 
     documenting the subpar conditions.
       Yet the full scale of the medical neglect at these 
     immigrant-only contract prisons has remained opaque--until 
     now. After two years of negotiations with the BOP in and out 
     of federal court over an open-records request, I obtained 
     more than 9,000 pages of medical records that contractors 
     submitted to the BOP. They include the records for 103 of at 
     least 137 people who have died in federal contract prisons 
     from 1998 (the year after the first one opened) through the 
     end of 2014. The records all concern men; women are sent to 
     regular BOP-run prisons. The documents include nurse and 
     doctor notes, records from hospital visits, psychological 
     files, autopsies,

[[Page E150]]

     and secret internal investigations. In their pages can be 
     found striking tales of neglect. Each case file--sometimes 
     hundreds of pages long--was reviewed by at least two 
     independent doctors who rendered opinions on the adequacy of 
     the medical care provided. Some of the case files are meager 
     and appear to be missing pages. But of the 77 that provided 
     enough information to render a judgment, the doctors found 
     that 38 contained indications of inadequate medical care. In 
     25 of these--a third of the total--the reviewers said the 
     inadequacies likely contributed to the premature deaths of 
     the prisoners. In only 39 cases did at least one reviewer 
     find indications that the care had likely been in accordance 
     with recognized medical standards.
       Combined with interviews with relatives and cellmates of 
     the deceased inmates, and with correctional officers and 
     medical staff, the files tell the story of men sick with 
     cancer, AIDS, mental illness, and liver and heart disease, 
     forced to endure critical delays in care. They show prison 
     medical units repeatedly failing to diagnose patients 
     correctly despite obvious and painful symptoms, as well as 
     the use of underqualified workers pressed to operate on the 
     borders of their legal scope of practice. The files also show 
     men dying of treatable diseases--men who very likely would 
     have survived had they been given access to adequate care.
       Fagardo-Saucedo, then 43, was booked into Reeves, run by 
     the GEO Group and a separate medical contractor, on January 
     27, 2009. When he arrived, the facility was in tumult. Six 
     weeks earlier, inmates at the sprawling 3,700-bed complex had 
     rioted, protesting the death of a man who was left in 
     solitary confinement for a month without proper treatment for 
     his epilepsy; he died after suffering a seizure. Four days 
     after Fagardo-Saucedo's arrival, the prisoners rioted again 
     when another sick man was reportedly placed in segregation.
       According to the BOP, prisons holding people who will be 
     deported don't require the same level of inmate services as 
     regular prisons. (Josh Begley)
       Reeves was still recovering from the unrest when a prison 
     physician scrawled a cursory note in Fagardo-Saucedo's file. 
     The doctor noted that the inmate had arrived from pretrial 
     detention with records indicating that he'd tested positive 
     for latent tuberculosis and had complained of headaches. BOP 
     rules require that TB-positive inmates also be tested for 
     HIV, but an HIV test was never performed. Indeed, over the 
     next two years, Fagardo-Saucedo wasn't seen by a medical 
     doctor even once.
       After three weeks in Reeves, he began to show up in the 
     clinic complaining of pain--first tooth pain, then headaches, 
     then nausea and back pain. Over two years, Fagardo-Saucedo 
     went to the clinic 18 times. He was seen on nearly all of 
     these occasions by one of a rotating group of licensed 
     vocational nurses, or LVNs. Usually, the LVN sent him back to 
     his bed with a prescription for Tylenol or ibuprofen. 
     Meanwhile, his body was signaling a fatal breakdown, 
     something that doctors who reviewed his case said should have 
     been caught by the facility's care providers.
       The training for LVNs (known as licensed practical nurses, 
     or LPNs, in some states) takes only a year. They are taught 
     to change dressings, check blood pressure, help patients 
     bathe, and gather basic information. They're often hired to 
     provide routine care in nursing homes or to assist registered 
     nurses in hospitals. Unlike the RNs, who provide patients 
     with substantive medical care and perform triage and 
     evaluations, LVNs are intended as support staff.
       This is the reason that BOP-run prisons rarely hire LVNs, 
     said Sandy Parr, a vice president in the federal correctional 
     officers' union and formerly a registered nurse in a federal 
     prison. ``LVNs are too limited to make sense to hire,'' she 
     said. Yet in the BOP's immigrant-only contract prisons, LVNs 
     often appear in the files as the sole caregivers that sick 
     prisoners see for days or weeks. They seem to perform jobs 
     equivalent to those of registered nurses, a practice that 
     prison medical staff confirm. In 19 of the cases reviewed, at 
     least one medical doctor flagged the overextension of LVNs as 
     a factor impeding proper medical care.
       In only 39 of 77 cases did a reviewer find that the care 
     had likely been in accordance with recognized medical 
     standards.
       Martin Acosta, a Salvadoran man who served time in Reeves 
     for illegal re-entry at the same time as Fagardo-Saucedo, 
     began complaining of abdominal pain late in the summer of 
     2010. Over four and half months, he went to the clinic more 
     than 20 times. Other than a doctor's visit a month after his 
     complaints began, he saw only nursing staff until the last 
     two weeks of his incarceration; on 14 of those occasions, he 
     saw only LVNs. Notes in the handwritten medical logs and 
     nursing templates reveal a cascade of missed signs indicating 
     serious illness, said doctors who reviewed the files. The 
     prison medical staff described Acosta as a difficult patient; 
     one thought he was simply trying to obtain a prescription for 
     narcotics. Acosta was sent back to his room with nothing but 
     Maalox nine times. Physicians who reviewed the files said the 
     nurses appear to have missed the larger story of a protracted 
     medical condition.
       ``For prison medicine to work, a doctor has to be able to 
     trust the people who work there,'' said Dr. Neal Collins, a 
     retired BOP and immigration detention-center physician and 
     clinical director who reviewed the Acosta files. ``If they 
     have competent nurse practitioners, then they can trust that 
     the system is catching it. But when people don't know what to 
     look for, that's what you worry about.''
       In significant discomfort on one of his many trips to plead 
     for help, Acosta told an LVN that he'd vomited a dark 
     substance and had seen blood in his stool. He asked to be 
     sent to a hospital, and the LVN took a stool sample. Leafing 
     through the file, I expected to find a hospital referral or 
     at least the test results. Instead, the records suggest that 
     the LVN eyeballed the stool sample and deemed it 
     unremarkable. There's no indication in the files that lab 
     tests were performed or a doctor was called. When Acosta 
     finally saw a physician at Reeves in December 2010, he could 
     no longer eat. He was transferred to a hospital, where a 
     massive tumor was found in his abdomen. Acosta was ultimately 
     diagnosed with severe metastatic stomach cancer.
       In early 2014, an LVN at another facility--this one run by 
     MTC--similarly failed to complete a basic test. Tasked with 
     evaluating a man who complained of chest pains, the LVN 
     attempted to use an electrocardiogram machine. But he wrote 
     in his notes that he couldn't get the machine to work because 
     the patient's ``skin is oily and electroids [sic] did not 
     stick.'' Rather than call a doctor, the LVN checked a box 
     marked ``No action indicated at this time on the form for 
     chest-pain complaints. The patient later died of a heart 
     attack, despite subsequent treatment. Doctors who reviewed 
     the file were divided about whether the shoddy care 
     contributed to his death. In the aftermath of the 2008 and 
     2009 riots at Reeves, BOP monitors began to visit the 
     facility more regularly to check on healthcare conditions. 
     But the increased oversight accomplished little: Each time 
     the monitors returned, they found that Reeves had failed to 
     fix the problems. One year after the riots, Reeves remained 
     derelict. ``The lack of an internal system of administrative 
     and clinical controls has contributed to the provision of 
     less than adequate medical care,'' the monitors wrote.
       Acosta's common-law wife, Guillermina Yanez, showed me a 
     photograph of him before his illness. Acosta appeared 
     youthful and strong, his T-shirt hugging muscular arms. Then 
     Guillermina showed me a picture taken after she and the 
     couple's 2-year-old daughter, Tania, boarded a bus from 
     Atlanta to visit him in the hospital. Acosta's frame was now 
     skeletal, his face sunken, his chest tattoo pinned to paper-
     thin skin. ``I asked a question to the guards: 'Looking at 
     him, how could you have left him to look like that?' 
     Guillermina recalled.
       Acosta died in late January 2011. In a will that a nurse's 
     assistant at the hospital helped him prepare, Acosta wrote: 
     ``I want the deed to my house and land''--in a small town by 
     a river on El Salvador's far eastern edge--``to be placed in 
     the name of the mother of my daughter.'' Salvadoran officials 
     facilitated the return of Acosta's body to the country of his 
     birth. Martin Acosta's daughter, Tania, shows pictures of her 
     father before and after stomach cancer drained away his body, 
     and life. (Courtesy of the Martin Acosta family)
       ``By the time he got to the hospital, it was too late,'' 
     said Collins, the retired prison doctor. ``If this case went 
     to court, would they win a malpractice suit? Yes, I think 
     they would.''
       Reeves continued to fall short. The Justice Department's 
     inspector general, Michael Horowitz, released the results of 
     an audit of the facility in April 2015. The audit found that 
     Reeves's medical contractor at the time, Correctional 
     Healthcare Companies, had failed to meet contractual staffing 
     obligations in the medical unit for at least 34 of the 37 
     months from 2010 to 2013. The BOP may have incentivized the 
     understaffing: The financial penalties for failing to fill 
     open LVN positions were so modest that it cost CHC less 
     simply to leave them vacant. The inspector general is 
     currently conducting a broader investigation of the BOP's 
     contracting. About the understaffing in the medical unit at 
     Reeves, Horowitz asks: ``Why was it happening for 34 to 37 
     months? Why wasn't that caught before we showed up?''

  The rest of the article can be found at http://www.thenation.com/
article/privatized-immigrant-prison-deaths/?nc=1.

                          ____________________