Rep. Conyers,Demand Answers on Immigration Detainee Medical Abuses
/ From Congressional Documents and Publications
***********
May 15, 2008
The Honorable Michael Chertoff
Secretary
U.S. Department of Homeland Security
Washington, DC 20528
Dear Secretary Chertoff:
On May 11, 2008, the Washington Post published the first article ("System of Neglect") in a four-part series concerning the newspaper's investigation into the provision of medical care at immigration detention facilities across the country. According to the article, "[t]he investigation found a hidden world of flawed medical judgments, faulty administrative practices, neglectful guards, ill-trained technicians, sloppy record-keeping, lost medical files and dangerous staff shortages." The article stated that poor medical care may have contributed to the deaths of at least 30 detainees in the custody of Immigration and Customs Enforcement (ICE), and there is evidence that infectious diseases such as tuberculosis and chicken pox are spreading inside ICE detention facilities.
According to the Post, its investigation was based in part on "thousands of pages of government documents," including "autopsy and medical records, investigative reports, notes, internal e-mails, and memorandums." A review of a small selection of these documents, which have been posted on the newspaper's website, is of great concern to us. Among other things, they indicate that immigration detainees are receiving sub-standard medical care and that your department has failed to address complaints and concerns from detainees and on-site medical care providers.
Given these concerns, we request that you provide to us, within 5 days of the date of this letter, complete and unredacted copies of all documents submitted to the Washington Post relating to the provision of medical and mental health care to immigration detainees. In addition, we request that you provide to us, within 14 days of the date of this letter, the following documents:
*Any and all documents (including, but not limited to, medical records, requests for medical or mental health care, treatment authorization requests, grievances, correspondence, e-mails, memoranda, notes, field guidance, incident reports, internal investigations, case summaries, autopsy reports, and death certificates) relating to detainees who have died in ICE custody since October 1, 2002.
*Any and all Immigration and Customs Enforcement (ICE) and Division of Immigration Health Services (DIHS) policies, protocols and procedures regarding the delivery or withholding of medical and mental health care to detainees in ICE custody, including, but not limited to, the use of Treatment Authorization Requests (TARs) and the factors to be considered in deciding whether to grant or deny such requests.
*Any and all documents (including, but not limited to, complaints, grievances, correspondence, e-mails, memoranda, notes, and field guidance) relating to concerns or complaints by ICE or DIHS employees or contractors, detainees in ICE custody, or persons advocating on their behalf, regarding the provision or withholding of medical or mental health care to detainees in ICE custody.
*Any and all documents (including, but not limited to, reports, assessments, analyses, reviews, audits, correspondence, e-mails, memoranda, notes, and field guidance) relating to the costs and savings associated with the provision or withholding of medical and mental health care to detainees in ICE custody.
*Any and all documents (including, but not limited to, reports, assessments, analyses, reviews, audits, correspondence, e-mails, memoranda, notes, and field guidance) relating to any investigations or evaluations of medical or mental health care provided to detainees in ICE custody.
*Any and all documents (including, but not limited to, reports, assessments, analyses, reviews, audits, correspondence, e-mails, memoranda, notes, and field guidance) relating to medical staffing levels-including, but not limited to, that of physicians, psychiatrists, psychologists, pharmacists, dentists, mid-level providers, nurses, social workers and other staff-at facilities used to hold detainees in ICE custody.
*A detailed explanation of the annual expenditures by ICE and DIHS relating to the provision of medical and mental health care to detainees in ICE custody from FY 2001 to FY 2007.
Additionally, we have concerns over an ICE-disseminated "Fact Sheet," entitled "Mortality Rates at ICE Detention Facilities." We are particularly concerned about the validity of ICE's claim that "[t]he number of deaths per 100,000 is dramatically lower for ICE detainees than for U.S. prisons and jails and the general U.S. population as a whole." It is our understanding that ICE's figures do not account for age, length of time in detention, or other factors necessary to make accurate comparisons. See Letter from New York University School of Medicine. For example, without standardizing length of detention, ICE could detain 300,000 people per year for one day each and compare their crude death rates to a prison population of 300,000 people detained for a full year. Such comparisons are meaningless. Consequently, we ask that you also provide for fiscal years 2003 through 2007 a detailed explanation, with supporting data, of:
*the morbidity rate of detainees in ICE custody;
*the mortality rate of detainees in ICE custody (expressed as x number of deaths per 100,000 detainees per full year of detention);
*the morbidity and mortality rates of detainees in ICE custody, factoring in length of time in custody (0-60 days, 61-120 days; 121-180 days; 181-240 days, etcetera up to five years.);
*the morbidity and mortality rates of detainees in ICE custody, adjusted for age of the detainees (0-18 years, 19-25 years, 26-30 years, 31-35 years, etcetera up to 100 years of age);
*the morbidity and mortality rates of detainees in ICE custody, adjusted for age of the detainees and for disease prevalence and incidence;
With respect to the documents and information requested above, "detainees in ICE custody" shall mean all persons in ICE custody under U.S. immigration law, regardless of whether the relevant detention facility is operated by ICE or by another entity through a contract or other agreement. With respect to documents requested in items 1 through 6, please provide all documents from October 1, 2002 to the present.
Thank you for your immediate consideration of this very important matter.
Sincerely,
John Conyers, Jr.
Chairman
Committee on the Judiciary
Zoe Lofgren
Chairwoman
Subcommittee on Immigration, Citizenship, Refugees, Border Security, and International Law
