[Congressional Record Volume 165, Number 114 (Tuesday, July 9, 2019)]
[Extensions of Remarks]
[Pages E877-E879]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]





           TREATMENT OF DETAINEES AT ICE DETENTION FACILITIES

                                 ______
                                 

                            HON. JASON CROW

                              of colorado

                    in the house of representatives

                         Tuesday, July 9, 2019

  Mr. CROW. Madam Speaker, today, I include in the Record two agency 
letters my office received in response to two inquiries I sent in 
February.
  The first is a June 25, 2019 letter in response to a February 28, 
2019 letter I wrote with 19 of my colleagues to the U.S. Immigration 
and Customs Enforcement (``ICE'') regarding public health risks and 
treatment of detainees at ICE detention facilities and contract 
facilities.
  The second is a June 28, 2019 letter in response to a February 20, 
2019 letter I wrote to the Department of Homeland Security regarding 
medical concerns at the ICE contract facility in Aurora, Colorado.

                                      U.S. Immigration and Customs


                                                  Enforcement,

                                                    June 18, 2019.
     Hon. Jason Crow,
     U.S. House of Representatives,
     Washington, DC.
       Dear Representative Crow: Thank you for your February 28, 
     2019 letter regarding public health risks and treatment of 
     detainees at U.S. Immigration and Customs Enforcement 
     detention facilities and contract facilities. Enclosed, 
     please find answers to the questions posed in your letter. 
     The co-signers of your letter will receive a separate, 
     identical response.
       Thank you again for your letter and interest in this 
     important matter. Should you wish to discuss this matter 
     further, please do not hesitate to contact me.
           Sincerely,

                                              Raymond Kovacic,

                                     Assistant Director, Office of
     Congressional Relations.
                                  ____


U.S. Immigration and Customs Enforcement (ICE) Response to the February 
    28, 2019 Letter regarding Public Health Risks and Treatment of 
                   Detainees at Detention Facilities

       1. How many and what kind of outbreaks have occurred at ICE 
     and contract detention facilities nationwide in the past 12 
     months and how many of those did the ICE Health Service Corps 
     oversee?
       Response: In the past 12 months, the U.S. Immigration and 
     Customs Enforcement (ICE) Health Service Corps (IHSC) was 
     notified of an estimated 308 public health investigations in 
     51 detention facilities housing ICE detainees; those 
     investigations affected 308 housing units. IHSC oversaw 112 
     of these investigations in 15 facilities where IHSC is the 
     facility medical authority that operates the medical clinic.
       2. What is the ICE Health Service Corps protocol for 
     treating these diseases, including the protocol to quarantine 
     detainees?
       Response: IHSC protocols and official guidance for treating 
     infectious diseases apply in 22 detention and staging 
     facilities where IHSC is the facility medical authority and 
     operates the medical clinic. ICE staff in these 22 facilities 
     conduct intake medical screening for detainees inclusive of 
     infectious diseases and coordinate with local ICE Enforcement 
     and Removal Operations (ERO) personnel to implement a medical 
     hold for detainees diagnosed with infectious diseases that 
     pose a public health threat to detainees, staff, visitors, 
     and the community until the detainee is rendered non-
     contagious. ICE policies for these 22 facilities are designed 
     to control or limit the spread of infectious diseases and 
     minimize the impact on ICE operations. This action allows ICE 
     staff sufficient time to facilitate the necessary 
     arrangements for continuity of care prior to the alien's 
     transfer, release, or removal.
       Additionally, in these 22 facilities, an IHSC medical 
     provider or designee orders medical isolation of detainees 
     diagnosed with infectious diseases in accordance with 
     guidelines on transmission-based precautions for the duration 
     of the infectious period to prevent transmission. ICE staff 
     are responsible for providing a recommendation on cohorting 
     with restricted movement in adult detention facilities and/or 
     social distancing in family residential facilities to help 
     reduce the spread of significant infectious diseases, if 
     appropriate.
       IHSC does not have medical authority in facilities where it 
     does not operate the medical clinic--each medical authority 
     is responsible for developing its own facility policies and 
     protocols for managing infectious and communicable diseases 
     in compliance with governing detention standards. IHSC's 
     assigned Field Medical Coordinators (FMCs) in each area of 
     responsibility conduct site visits at locations housing 
     detainees for over 72 hours to ensure that appropriate 
     medical services are being provided according to national 
     detention standards and contractual requirements.
       3. How is the ICE Health Services Corps ensuring that 
     detainees are treated properly, humanely and with dignity 
     while in quarantine?
       Response: ICE ERO oversees the civil immigration detention 
     of one of the most highly transient and diverse populations 
     of any detention or correctional system in the world. ICE 
     takes very seriously the health, safety, and welfare of those 
     in our custody, and comprehensive medical care is provided 
     from the moment detainees arrive and throughout the entirety 
     of their stay.
       As stated in Question 2, while IHSC does not have direct 
     operational oversight over medical care in facilities where 
     it does not provide that care, its FMCs in each area of 
     responsibility work to ensure proper medical services are 
     being provided and that national detention standards and 
     contractual requirements are met.
       In those facilities that are staffed by IHSC, daily 
     assessments are provided of those individuals that are 
     cohorted due to exposure to an infectious disease. IHSC 
     monitors for signs and symptoms associated with the condition 
     and also provides open access to sick call and urgent care 
     services that are usually provided within the cohorted unit. 
     During these interventions, detainees have the opportunity to 
     report any complaints related to their medical and housing 
     conditions.
       4. Please provide a list of ICE-owned and operated and 
     contracted detention facilities that ICE Health Services 
     Corps has treated for a disease outbreak and/or quarantine.
       Response: The following indicates where public health 
     investigations occurred in the past twelve months. Each 
     facility's medical authority is responsible for overseeing 
     public health investigations in collaboration with their 
     local health department.
       Facilities where IHSC is the medical authority: Alexandria 
     Staging Facility, Buffalo (Batavia) Service Processing 
     Center, Caroline Detention Facility, El Paso Service 
     Processing Center, Elizabeth Detention Center, Eloy Federal 
     Contract Facility, Florence Service Processing Center, 
     Houston Contract Detention Facility.
       LaSalle ICE Processing Center (Jena), Montgomery Processing 
     Center (Houston), Otay Mesa Detention Center (San Diego CDF), 
     Port Isabel, South Texas Family Residential Center (Dilley), 
     South Texas ICE Processing Center (Pearsall), T. Don Hutto 
     Residential Center.
       Facilities where IHSC is not the medical authority: 
     Adelanto ICE Processing Center, Albany County Jail, Broward 
     Transitional Center, Central Arizona Florence Correctional 
     Complex East, Cibola County Correctional Center, Coastal Bend 
     Detention Facility, Denver Contract Detention Facility, East 
     Hidalgo Detention Center, El Valle Detention Facility, 
     Folkston ICE Processing Center (D. Ray James), Geauga County 
     Jail (OH).
       IAH Polk Adult Detention Facility, Imperial Regional 
     Detention Facility, James A. Musick Facility, Jerome Combs 
     Detention Center, Joe Corley Detention Center, Johnson County 
     Law Enforcement, La Palma Correctional Center, Laredo 
     Processing Center, LaSalle County Regional Detention Center 
     (TX), McHenry County Jail (IL).
       Mesa Verde ICE Processing Center, Northeast Ohio 
     Correctional Ctr (Youngstown CDF), Otay Mesa Detention Center 
     (San Diego CDF), Otero County Processing Center, Pine Prairie 
     ICE Processing Center, Prairieland Detention Facility, 
     Pulaski County Detention Center, Rio Grande Detention Center, 
     San Luis Detention Facility, Stewart Detention Center.
       Tallahatchie County Correctional Center, Theo Lacey, Webb 
     County Detention Center (CCA), West Texas Detention Center, 
     York County Prison.
       5. How many inter-facility detainee transfers have occurred 
     in the last 12 months nationwide and how many of the 
     detainees has ICE Health Services Corps determined to have 
     had a viral disease?
       Response: ICE cannot statistically report this information 
     in the manner in which it was requested.
       6. What is the ICE Health Service Corps protocol for 
     ensuring that newly-transferred detainees do not pose a 
     health risk to themselves or other detainees?
       Response: At IHSC-staffed facilities, all detainees are 
     screened upon arriving at a facility and a prescreen is 
     conducted to identify those detainees who have acute or 
     urgent medical concerns so that further evaluation can be 
     prioritized. All facilities, including those at which ICE 
     houses its detainees pursuant to Intergovernmental Service 
     Agreements, conduct intake screenings to identify individuals 
     with time-sensitive health concerns.
       7. What is the ICE Health Service Corps guidance in place 
     to prevent communicable diseases from spreading among 
     detainee populations?

[[Page E878]]

       Response: Please see response to Question 2.
       8. Which agency is responsible for oversight of the ICE 
     Health Service Corps protocols?
       Response: IHSC is responsible for oversight of IHSC 
     protocols, which are only applicable in the 22 facilities for 
     which IHSC is the medical authority and where IHSC operates 
     the medical clinic. These protocols comply with state and 
     local requirements, as well as applicable detention 
     standards.
       9. What role does the Centers for Disease Control and 
     Prevention (CDC) play in responding to public health risks at 
     ICE and contract detention facilities?
       Response: ICE defers questions on CDC authorities and 
     responsibilities to the CDC. However, ICE notes that in 
     general, public health interventions fall under the authority 
     of local and state health departments, although state health 
     departments do occasionally request assistance from the CDC. 
     In ICE's case, IHSC routinely collaborates with the CDC on 
     public health interventions involving multiple jurisdictions.
                                  ____

                                              U.S. Immigration and


                                          Customs Enforcement,

                                                    June 28, 2019.
     Hon. Jason Crow,
     House of Representatives,
     Washington, DC.
       Dear Representative Crow: Thank you for your February 20, 
     2019 letter to the Department of Homeland Security.
       I appreciate your concerns regarding the recent expansion 
     of the Denver Contract Detention Facility and welcome the 
     opportunity to address them more fully. Please see the 
     attached enclosure with responses to the specific questions 
     posed in your letter.
       Thank you again for your letter and interest in this 
     important matter. Please contact the ICE Office of 
     Congressional Relations for additional assistance.
           Sincerely,
                                                   Mark A. Morgan,
     Acting Director.
                                  ____


The Department of Homeland Security's Response to Representative Jason 
                    Crow's February 20, 2019 Letter

       Please explain the number and types of disease outbreaks 
     (i.e., chicken pox) in the past year at the Denver Contract 
     Detention Facility in Aurora, including the number of 
     outbreaks requiring quarantines. What are the reporting 
     criteria and requirements for outbreaks and which entities 
     receive the reports?
       The Denver Contract Detention Center (CDF) has had seven 
     cases of varicella and 15 probable or confirmed cases of 
     mumps over the past year.
       In such cases, U.S. Immigration and Customs Enforcement's 
     (ICE) Health Service Corps (IHSC) Public Health, Safety, and 
     Preparedness Unit (PHSP) and the Colorado State Health 
     Department are notified. Per the ICE Performance-Based 
     National Detention Standards 2011 (PBNDS 2011), facilities 
     shall comply with current and future plans implemented by 
     federal, state, or local authorities addressing specific 
     public health issues including communicable disease reporting 
     requirements (specific requirements are codified in state 
     regulations). Designated medical staff shall notify the IHSC 
     PHSP of any ICE detainee with a significant communicable 
     disease and of any contact or outbreak investigations 
     involving ICE detainees exposed to a significant communicable 
     disease without known immunity.
       Significant communicable diseases include, but are not 
     limited to, varicella (chicken pox), measles, mumps, 
     pertussis (whooping cough), and typhoid. Additionally, IHSC 
     provides a weekly cohort report to ICE Enforcement and 
     Removal Operations (ERO) leadership in those situations where 
     cohorting of exposed detainees is required.
       2. What active have ICE and GEO taken to respond to the 
     recent varicella outbreaks and what measures are being put in 
     place to prevent future outbreaks?
       When active varicella is suspected or confirmed, the 
     patient is isolated, placed under airborne precautions, and 
     the dorm in which the patient was housed is placed under 
     cohort status. In addition, dorm members and susceptible 
     contacts are then tested for their immune status if 
     documentation of immunity is not available. Contacts with a 
     positive titer, which is suggestive of immunity, can be 
     released from cohort status. Health care staff monitor the 
     dorms placed under cohort status daily to identify any new 
     patients with signs and symptoms of varicella. The GEO Group 
     Inc. (GEO) followed these precautions in the seven cases 
     identified.
       Because medical staff from ICE and our vendor, GEO, often 
     do not know which detainees have been in contact with or 
     exposed to disease prior to being detained, observation of 
     early symptoms and prompt isolation are used to prevent the 
     spread of varicella. IHSC and GEO have also consulted with 
     the state and local health departments regarding their 
     recommendations.
       Additionally, ICE notes that six of the seven varicella 
     cases were at the facility for less than three weeks prior to 
     diagnosis. The incubation period for varicella is 10 to 21 
     days, so it is not known whether they were exposed to 
     varicella before or after entering the facility. All seven 
     individuals came from a facility in California where they 
     were housed for only a few days after crossing the border.
       3. Will ICE direct GEO to hire more properly-trained 
     medical staff to accommodate the increase in detainee 
     admissions? Please also describe what contract requirements 
     and oversight are in place to ensure that detainees receive 
     proper medical attention.
       ICE continually evaluates medical services nationwide to 
     ensure the highest level of care for its detained population. 
     In accordance with the terms and conditions related to the 
     number of full-time equivalent (FTE) medical staff positions 
     in ICE's Federal Acquisition Regulation (FAR)-based contract 
     with GEO, the service provider conducted a staffing analysis 
     and created a staffing plan for the delivery of health care 
     services. FAR-based medical staffing plans, which typically 
     include additional FTEs for overtime, shift rotations, and 
     facility-specific circumstances, are reviewed by IHSC as part 
     of the initial acquisition process and, thereafter, as deemed 
     necessary by ICE. IHSC also has a Field Medical Coordinator 
     (FMC) assigned to the Denver Area of Responsibility who is 
     responsible for monitoring medical concerns at the Denver 
     CDF. The FMC works with local GEO medical staff to ensure 
     detainee healthcare services are being provided appropriately 
     and timely to detainees irrespective of the day-to-day 
     changes in the Denver CDF's admissions and releases. In 
     addition, the FMC receives reports regarding medical cases on 
     a routine basis.
       All ICE-owned service processing centers, contract 
     detention facilities, and dedicated inter-governmental 
     service agreement facilities are inspected annually by an ICE 
     inspections contractor. ICE inspectors typically spend three 
     days auditing each facility. In addition to environmental 
     health, safety, and corrections experts, each inspection team 
     includes a Detainee Rights subject matter expert (SME) and a 
     health professional (e.g., physician, physician's assistant, 
     registered nurse, nurse practitioner, or a medical 
     professional SME). The health professional conducts a Quality 
     of Medical Care (QMC) review as part of the inspection, which 
     measures the quality of detainee health care across more than 
     20 areas of health care, including such measures as 
     medication, grievances, suicide watch, hunger strikes, 
     screening and health assessment, acute disease and chronic 
     conditions, sick call, urgent care, treatment of disability, 
     continuity of care, laboratory and diagnostics, staffing, 
     credentialing, and medical recordkeeping practices. The 
     results of the QMC are reviewed by the IHSC division.
       In addition to the annual inspection, detention facilities 
     are also subject to a number of special assessments conducted 
     by ICE ERO, as well as audits, reviews, and site visits 
     conducted by the Office of Detention Oversight (ODO) within 
     the ICE Office of Professional Responsibility and by the OHS 
     Office for Civil Rights and Civil Liberties (CRCL). When 
     deficiencies are found during any type of inspection or 
     review, ICE works with the field offices and facilities and 
     collaborates with ICE ODO and CRCL to ensure timely and 
     appropriate corrective actions are implemented to address 
     issues and concerns.
       4. What requirements are in the GEO contract or other ICE 
     guidance to ensure detainees are provided proper medical 
     care?
       ICE takes the health, safety, and welfare of those in our 
     care very seriously. Comprehensive medical care is provided 
     from the moment detainees arrive in ICE custody and continues 
     throughout the entirety of their stay. This care includes an 
     initial health screening, as well as subsequent medical 
     visits, referrals to specialists, and 24-hour access to 
     emergency care as necessary.
       Section IV.A.1.5-Management Plan of ICE's contract with GEO 
     states that GEO ``[u]understands the importance of a fully 
     qualified and trained professional staff in appropriate 
     number to operate a safe, secure, and efficient medical 
     department at the Aurora ICE Processing Center (the Center). 
     Our proposed staffing plan reflects a well thought out and 
     efficient strategy for staffing the Center in order to 
     provide detainees with access to medical care 24 hours a day 
     seven (7) days a week.''
       Also, at Section IV.A.I.I-Quality Control and Assurance. 
     GEO is required to establish a Quality Control Plan governing 
     health services at the Center to ensure that healthcare 
     services are in compliance with the Performance Bases 
     National Detention Standards, court orders, American 
     Correctional Association (ACA) standards, standards 
     established by the National Commission of Correctional Health 
     Care (NCCHC), and specific client policies.
       In addition, ICE's PBNDS 2011 clearly lay out the expected 
     outcomes and expected practices for detainee health care at 
     dedicated facilities like the Denver CDF in detention 
     standards 4.3-Medical Care and 4.4-Medical Care (Women). 
     These two standards cover topics such as designation of 
     authority, communicable disease and infection control, 
     notifying detainees about health care services, translation 
     and language access for detainees with limited English 
     proficiency, pharmaceutical management, medications, medical 
     personnel, medical and mental health screening of new 
     arrivals, substance dependence and detoxification, 
     comprehensive health assessment, mental health program, 
     medical/psychiatric alerts and holds, annual health 
     examinations, dental treatment, sick call, emergency medical 
     services and first aid, delivery of medication, health 
     education and wellness information, restraints, continuity of 
     care, informed consent and involuntary treatment, medical 
     records, and documentation.

[[Page E879]]

        The Denver CDF is accredited by the ACA and the NCCHC, and 
     the facility is obligated to comply with the requirements of 
     both the ICE PBNDS 2011 and the DHS Prison Rape Elimination 
     Act regulations. On October 4, 2018, ICE's inspection 
     contractor, The Nakamoto Group, completed an annual detention 
     inspection. The Lead Compliance inspector recommended a final 
     rating of ``Meets Standards'' and reported zero deficiencies 
     in medical care.
       5. Please describe the contract relationship between ICE 
     and GEO and attach copies of the relevant contract documents 
     (e.g. agreements, MOUs, guidance, etc.)
        GEO was awarded an indefinite-delivery/indefinite-quantity 
     contract to provide detention services at the Denver CDF on 
     September 15, 2011. The contract period of performance 
     included a 2-year base period and four 2-year option periods. 
     The contract Period of Performance expires on September 16, 
     2021.
       GEO provides full-time detention and transportation 
     services at the Denver CDF in Aurora, Colorado, for ICE 
     detainees. Services are provided in compliance with the ICE 
     PBNDS 2011, ACA standards for adult local detention 
     facilities, standards for health services in jails, NCCHC, 
     and other applicable state and local requirements.
       6. Since 2015, how many 911 calls were placed from the 
     Facility to local and state emergency professionals?
       ICE is unable to provide a response, as it does not track 
     this data. However, as previously noted, detainees have 
     access to 24-hour emergency care as necessary.
       7. When privately contracted facilities fail to comply with 
     their contractual obligations, ICE has the opportunity to 
     issue compliance waivers forgiving contractors for the 
     breach. Has ICE issued any compliance waivers for the 
     Facility? If so, how many, and what were the justifications 
     for those waivers?
       ICE has issued no compliance waiver to or on behalf of the 
     Denver CDF.
       8. Since 2015, has ICE submitted a Contract Discrepancy 
     Report for the Facility following the granting of any 
     compliance waivers? If so, please attach and all such reports 
     in your response.
       ICE has not submitted a Contract Discrepancy Report for the 
     facility.

                          ____________________