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About NYLPI
Founded 40 years ago, New York Lawyers for the Public Interest ("NYLPI") pursues
equality and justice for all New Yorkers. NYLPl's community-lawyering approach drives
its work in the areas of civil rights and health, disability, immigrant, and environmental
justice. NYLPI seeks lasting change through legal representation, community organizing,
policy advocacy, pro bono service, public education, and litigation.
The Health Justice Program brings a racial justice and immigrant rights focus to health
care advocacy in New York City and New York State . We work to : (1) challenge health
disparities; (2) eliminate racial and ethnic discrimination , and systemic and institutional
barriers that limit universal access to health care; (3) promote immigrant and language
access to health care, including representing undocumented and uninsured immigrants
and people confined to immigration detention with serious health care needs; and (4)
address the social determinants of health so that all New Yorkers can live a healthy life.
For more information, please visit us at www.nylpi.org and twitter: @nylpi.

February 201 7

NYLPI

Detained and Denied:
Healthcare Access in Immigration Detention

01

Executive Summary

04

Methodology and Background

06

Recurrent Problems With Access to
Adequate Medical Care

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Conclusion

16

Recommendations for Future
Advocacy

18

Acknowledgments

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References

NYLPI

Executive Summary
Each year, the federal government and its contractors detain thousands of New York City
residents in U.S. Immigrations and Customs Enforcement ("ICE") detention facilities
throughout the New York metropolitan area. 1 These facilities are housed within local
jails. Although they are confined, people in immigration detention are not charged with
criminal violations; they are primarily held to ensure that they attend future administrative
hearings concerning whether or not they will be removed from the U.S. 3
For more than a decade, both internal federal reviews and human rights investigations
have detailed egregious medical neglect in detention facilities across the country.
Conditions in these facilities have not improved. As a new President who vows to
conduct mass deportations on an unprecedented scale takes office, this report documents
grave ongoing problems with the healthcare provided to people confined in immigration
detention in New York City-area facilities in the past eighteen months.
In this report, we describe serious deficiencies in the medical care provided to people in
immigration detention. These failures pose serious risks to the health and lives of people
who are detained, and undermine their basic human dignity. ICE, and the New York
City-area facilities with which it contracts, routinely: deny vital medical treatment, such as
dialysis and blood transfusions, to people with serious health conditions; subject sick
people in need of surgery to unconscionable delays; ignore repeated complaints and
requests for care from people with serious symptoms; and refuse basic items such as
glasses and dentures to people with medical conditions such as diabetes. ICE and its
contractors' failures have caused people to end up hospitalized in intensive care units for
many months because of treatment delays. A number of people with serious mental
illnesses were released from detention facilities without any interim medication or
treatment plans. A man who needed surgery for gallstones was denied adequate care,
which required him to receive emergency surgery after he was released. Another man's
repeated medical complaints were ignored for many months, which led to a delayed
cancer diagnosis. One man with a pacemaker was denied access to a specialist, and
then forced to undergo emergency surgery to replace the battery. The list goes on and
on.
Between May 2015 and November 2016, New York Lawyers for the Public Interest
interviewed 47 people with serious health conditions who are currently or were recently
confined in immigration detention in the New York metropolitan area, at Hudson County
Correctional Facility, Bergen County Jail, or Orange County Correctional Facility
(collectively, "the New York City-area county facilities"). Those individuals interviewed
were detained for at least six months and up to three years.

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Detained and Denied

Methodology and Background
After receiving numerous complaints from community members, immigration legal service
providers, and advocates, NYLPI launched a project in May 2015 to assist seriously ill
immigrants obtain needed medical care while they were detained. This report documents
the dangerous conditions of confinement that thousands of immigrant New Yorkers face.
In it, we profile cases of medical neglect gleaned from our work over the past eighteen
months.

The Right to Healthcare in Immigration Detention
ICE holds people in civil custody whom the United States is seeking to deport, often in
local county jails that have signed contracts with ICE. Many detained people have lived
in this country for decades, maintained employment, and raised families here. Many are
Lawful Permanent Residents. Those in immigration detention disproportionately suffer
from serious health conditions, such as cancer, HIV, diabetes, and mental illnesses.
ICE's obligation to provide medical care to people confined to immigration detention is
clearly established by the U.S. Constitution, federal and state law, and ICE's own
policies.
The U.S. Constitution guarantees adequate healthcare to people in immigration
detention. 3 Recognizing that people in detention can only rely on jail authorities for their
medical care, the Supreme Court in 1976 in Estelle v. Gamble recognized adequate
medical care as a fundamental constitutional right for people who are incarcerated. The
Court thereby forbade government authorities like ICE from disregarding an excessive risk
to a detainee's health or safety. 4 The Constitution requires that ICE provide the actual
care necessary to treat a medical condition. 5

ICE-Contracted County Jail Immigration Detention Facilities
ICE itself has issued standards that require it to provide adequate medical care to
detainees. Since 2000, ICE has issued four sets of "Performance Based Standards" to
address conditions of confinement for people held in detention facilities. 6 These standards
act as guidelines for the hundreds of county jails and prisons operating as immigration
detention facilities around the United States.
ICE issued the most recent and
comprehensive standards in 2011, yet many facilities are only required to follow the
earlier and less robust iterations.
The New York City-area facilities examined in this report are local county jails with which
ICE contracts. 7 ICE pays the local jail to house people in civil immigration detention in the
same fashion that the jail houses the facility's existing criminally incarcerated population. 8
The New York City-area county facilities then contract with for-profit companies to provide
medical services. 9

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NYLPI

The Process for Receiving Healthcare in Immigration Detention Facilities
Upon entry into a facility, a person is supposed to receive a full medical review to
determine his or her health care needs. A person also should receive a handbook, which
explains the process for requesting medical care at the facility. Hudson, Orange and
Bergen County Detention Facilities have systems for receiving and processing medical
requests from individuals confined to their facilities. First, a detained person requests
medical care from a kiosk in the living unit; the jail's medical unit then receives the
request and the medical staff is supposed to assess the request within 48 hours to
determine priority for care. When specific treatment is needed, the medical providers
submit requests to ICE for approval.
When a detained individual needs medical care that the facility is not equipped to
provide, such as surgery or a biopsy, he or she should be referred to hospitals outside of
the correctional facility. 1 For example, Hudson County has formal agreements with local
medical facilities where confined people should receive emergency room services.

°

Advocating for Access to Healthcare for People in Immigration Detention
Many of the people profiled in this report were referred to NYLPI as part of an informal
partnership with advocates from the New York Immigrant Family Unity Project
("NYIFUP"). 11 NYIFUP attorneys provide immigration representation and other services
for individuals from New York City who are detained at the New York City-area county
facilities. They also have social workers on staff to provide support.
Following referrals from NYIFUP, NYLPI intervened on behalf of a number of people to
demo nd better hea Ith care or assist in seeking their release from detention. NYLPI 's leg a I
advocacy sought to compel ICE and the New York City-area county facilities to comply
with federal law and detention standards that govern how medical care should be
provided. Even with intensive legal advocacy, consistent and grave problems with
healthcare access remained, and people confined to immigration detention suffered.
NYLPI has advocated for seriously ill people in detention by contacting Deportation
Officers and ICE's Assistant and Acting Field Directors. We rarely received a response.
NYLPI has also provided supporting letters to immigration judges outlining the lack of
medical care at the detention facilities. These letters have helped detained people
receive a reasonable bond and release, and thereafter to seek medical care in the
community.
Between May 2015 and November 2016, NYLPI interviewed 47 people with serious
health conditions who are or were recently confined to immigration detention at facilities
in Hudson and Bergen Counties, New Jersey, and Orange County, New York. Each
person identified significant problems with their healthcare, and these problems are
described in this report.

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Detained and Denied

Recurrent Problems with Access to Adequate
Medical Care
Problems with the quality of healthcare provided by ICE and its contractors begins at
initial intake into the immigration detention facility, and continues through to people's
final discharge from the facility.

Incomplete Intake Assessments
In order to provide appropriate treatment, particularly for people with serious medical
conditions, doctors must obtain their patients' medical histories. During the required
medical intake process, immigration detention facilities may receive information that alerts
them to the critical need to obtain medical records from previous health care providers, or
to continue a course of treatment that a person was receiving in the community. However,
in multiple instances, ICE and its contractors failed to act on information received during
intake about people's medical histories, with dangerous consequences to those people's
health. For example, one NYLPI client had a history of cancer and surgical interventions,
and was HIV positive. In 2016, when he was detained and reported this medical history,
ICE and the Hudson and Orange County facilities each failed to obtain his prior medical
records from Dutchess County jail, where he was formerly held. At Hudson, the attending
physician repeatedly requested that ICE obtain the prior records, but ICE failed to do so.
Because the doctors lacked the necessary information about his previous cancer
occurrence, he was not prescribed an appropriate course of Antiretroviral Treatment to
treat his HIV. NYLPI intervened and obtained this individual's medical records so that he
could share them with his treating physician at the facility.

6

Ms. Querin: Interrupted Blood Transfusions and Dialysis
Treatment
Ms. Querin was denied continuing treatment of dialysis and blood transfusions while
she was detained at Hudson County from May through September 2015.12 Before she
was detained, she managed a lifelong sickle cell condition with consistent blood
transfusions, mechanical ventilation, and dialysis. During her initial intake at Hudson
and afterwards, she requested this necessary care. The facility doctors prescribed overthe-counter drugs, along with antibiotics and medicine for pain management. They
also recommended that she drink more fluids. Her health deteriorated rapidly. She
was released from ICE custody unexpectedly. On the same day of her release, she was
hospitalized for two months in an intensive care unit, which she believes was a direct
result of the lack of continued treatment. She is now on 24-hour oxygen therapy, in
addition to returning to the treatment regimen of dialysis and blood transfusions for her
sickle cell condition. ICE and Hudson County knew of Ms. Querin’s medical needs and
prior care regime, yet refused to provide the necessary health care.

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Mr. Sanchez: Language Access and Confidentiality Failures
NYLPI interviewed Mr. Sanchez, an LEP native-Spanish speaker who was detained at all
three New York City-area county facilities from 2013 to 2016, and who has a serious
mental illness. Mr. Sanchez also suffers from regular suicidal thoughts. Despite the
fact that Mr. Sanchez is LEP, his monthly consultations with a psychiatrist were
conducted in English, without an interpreter. Through NYLPI’s interpreter, he stated that
he had a hard time expressing the full extent of his symptoms to his doctor because of
the language barrier. Further, he continued to have auditory and visual hallucinations,
which he was unable to effectively communicate to his doctors. On rare occasions, a
correctional officer acted as an interpreter, but Mr. Sanchez felt uncomfortable sharing
private medical information with the officer present. Additionally, when he met with the
facility social worker to share confidential information, the social worker asked another
detainee to interpret.

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Mr. Francisco: Delays Equal Pain and Suffering
ICE ignored Mr. Francisco’s gallstones for months, causing him severe pain and
distress. In 2015, Mr. Francisco began experiencing acute pain in his abdomen. The
pain became so severe that he made several emergency calls for assistance to Hudson
County. The jail dismissed his complaints and treated him with an over-the-counter
antacid. Only after two months of complaining about increasing pain did ICE approve
an ultrasound, which demonstrated that Mr. Francisco had gallstones. Three months
after the ultrasound, ICE finally scheduled surgery. The surgery was then postponed.
Instead, Mr. Francisco was released from detention later that month without either the
surgery or planning for continuity of care (discharge planning).14 After he returned
home, he underwent emergency surgery to remove his gallbladder. This procedure was
dangerously delayed considering ICE and Hudson County were aware of his symptoms
when they first arose six months earlier.

In detention, I went through the most critical and undesirable
process of my life. The health care, and the care of a detainee
in detention, was something inhumane. The pain and suffering
I experienced is something that cannot be expressed in words.
I received inadequate health care, and almost lost my life.
-Mr. Francisco

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Mr. Helvicta: Ignoring Symptoms of Cancer
Mr. Helvicta is a gay, HIV-positive man who now has advanced anal and rectal cancer
because of Hudson County’s delayed testing and diagnosis of his condition. Mr.
Helvicta complained to facility medical personnel of severe pain in his rectum for a
period of six months. These symptoms should have triggered concern and action on
the part of Mr. Helvicta’s doctors,15 particularly in light of his increased risk for related
serious medical conditions.
Hudson County doctors misdiagnosed him with
hemorrhoids and provided ineffective topical treatment for the pain. After his initial
complaints, a facility doctor identified a mass tumor and recommended an immediate
biopsy, which did not take place for another two months. When the facility received the
biopsy results demonstrating anal and rectal cancer, they did not inform Mr. Helvicta for
another two weeks. A doctor never explained his diagnosis or treatment plan. About
six weeks after the biopsy, Mr. Helvicta was scheduled to begin chemotherapy and
radiation treatment. Six days before he was to start treatment, ICE released Mr.
Helvicta from its custody without any discharge planning. When Mr. Helvicta finally saw
an oncologist in the community, the doctor informed him that the cancer was in an
advanced stage because it was left untreated for such a long period of time.

One night when I was in a lot of pain, I asked the guard for help
but he said he could not send me to the medical unit because
there was no doctor or nurse available. In the morning I put in a
request to see the doctor but all he gave me was some cream and
Tylenol. They suggested the pain was due to exercising. Overall, I
feel like you fear for your life and have to be careful about what
you say. -Mr. Helvicta

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Mr. Ahmed: Pacemaker Emergency
Mr. Ahmed suffers from second degree heart block, a condition in which the normal
electrical conduction in the heart that allows for a regular heart rate and rhythm is
disrupted. He uses a pacemaker to treat his condition. Pacemakers need regular
monitoring and maintenance to detect malfunctioning, preserve normal cardiac
function, and prevent potentially life-threatening arrhythmias. Beginning in 2015,
Hudson County failed to monitor his pacemaker and put his life in jeopardy. Several
times while feeling chronic symptoms of distress, Mr. Ahmed requested to see a
specialist. ICE and Hudson County repeatedly refused these requests. At one of his
immigration hearings, Mr. Ahmed was so obviously in bad health, weak, and short of
breath, that the presiding judge called the paramedics to take him to the hospital. At
the hospital, doctors performed emergency surgery to replace his pacemaker battery.
When he returned to detention, Mr. Ahmed experienced symptoms suggesting that his
pacemaker was malfunctioning, including fatigue, shoulder pain and swelling, cramps
in his foot, heart palpitations at night, difficulty breathing, dizziness and inability to
swallow. ICE and Hudson County again refused to permit him to see a specialist who
would have the appropriate technology to test whether the pacemaker was working
properly. Not until an Immigration Judge granted him bond did Mr. Ahmed have the
opportunity to return to the community and regain ongoing care from a specialist, who
has assisted in him returning to health.

When I was detained I thought that at some point I
would be dead. They think we are animals and we just
have to accept whatever they say. -Mr. Ahmed

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Dangerous Complications from Ineffective Treatment for
Diabetes
People at Hudson County state that Type II Diabetes is prevalent amongst detained
people, yet they are unable to manage their illness and fear extreme consequences that
jeopardize their lives. For three people for whom NYLPI provided advocacy, a
consulting board-certified endocrinologist evaluated their medical records. This
physician found that, under the current regime overseen by ICE, all three people were
at risk of infections and diabetic complications such as retinopathy, renal failure, heart
attack or strokes--even while on their insulin regimen. Hudson County only provided
the detainees with a diet full of excessive complex carbohydrates including pasta, white
bread, white rice, potatoes and cookies, all foods extremely detrimental to their health.
Further, ICE refused to provide dentures to two people who, because of their diabetes,
were suffering from gum disease and losing their teeth. ICE also refused to provide
them with glasses despite their deteriorating vision, another type of diabetic
complication. An individual reported rashes all over his body and pain in his leg and
foot region that if left untreated could have led to amputation. An Immigration Judge
actually granted bond releasing all three people from custody based upon evidence of
inadequate healthcare that NYLPI provided, including a letter from the endocrinologist.

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Mr. Jones: No Help for Insufferable Pain
Mr. Jones, an individual detained at Hudson County since May 2016, has chronic
and excruciating pain from bullet fragments that remain in his leg from a gunshot
wound. Medical providers at Hudson County and ICE were aware of his condition.
Despite the intensity of the pain increasing over time, ICE refused requests for a
specialist to surgically evaluate. The pain is so severe that Mr. Jones has said he
would prefer amputation rather than continuing to endure the pain. An outside
doctor reviewed his medical records and concluded that the facility failed to properly
document his condition or provide a definitive treatment plan including assessing the
need for surgery to remove the bullet fragments.

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Mr. Xie: Discharged and Dumped
ICE’s failure to provide discharge planning caused Mr. Xie to be hospitalized in a
psychiatric ward for two months. Mr. Xie has bipolar and schizoaffective disorders, and
relies on a strict medicine regimen to manage his illnesses. He received regular
treatment for his illnesses while in detention from 2014 to 2015. On the day of his
release from immigration detention, ICE and the County Jail failed to provide Mr. Xie
with any plan for his continued mental healthcare, a single referral to a mental
healthcare provider, or any interim medication. Without a plan or the resources
necessary to obtain care, Mr. Xie’s mental health quickly spiraled downward. After two
weeks without treatment, Mr. Xie suffered total psychiatric decompensation – he was
incoherent, hallucinating, and suicidal. He was then admitted to a hospital’s
psychiatric unit where he remained under inpatient care for almost two months.

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NYLPI

Conclusion
Even with immigration representation and with NYLPl's advocacy efforts, the people
described in this report were denied the healthcare they needed while in ICE custody.
The wide-ranging failures to provide medical care to seriously ill immigrants who remain
in detention during their lengthy immigration proceeding is unfortunately not a new
problem. Over the past decade, other human rights groups have documented the
deplorable conditions in these jails, including that people who are detained lack access
to adequate health care. 18 Yet these conditions have not improved over time, and if
anything, continue to worsen.
NYLPI has advocated for many seriously ill people in detention. ICE has ignored many of
our requests, denied others, and in rare circumstances provided a minimal amount of
improved care.
NYLPI has also provided supporting letters to immigration judges
outlining the lack of medical care at the detention facilities. NYLPl's advocacy has helped
detained people receive a reasonable bond and release, and thereafter permit them to
seek medical care in the community.
The many immigrants in detention who do not have healthcare advocates are in a far
worse position.
ICE's unwillingness to address the systemic lack of adequate medical care in its detention
facilities presents an enormous challenge to advocates, especially at this time of likely
increases in the detained immigrant population. ICE and its contractors must live up to
their obligations to provide appropriate medical care to all people confined to
immigration detention.

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Detained and Denied

Acknowledgements
This report is a collaborative effort of NYLPl's ongoing campaign for Health in
Immigration Detention.
Sola Stamm, Health Justice Organizer, and Reena Arora, Senior Staff Attorney,
researched this report, and along with Laura Redman, Health Justice Program Director,
wrote this report. Evelin Gomez, Immigrant Health Coordinator, provided research and
advocacy assistance.
We are very grateful to the many NYIFUP attorneys at Brooklyn Defender Services, The
Legal Aid Society-Immigration Law Unit and The Bronx Defenders, for their support of
NYLPl's advocacy efforts, as well as their unflagging and extraordinary representation of
their clients.
We acknowledge the contributions of Dr. Joseph Shin, Assistant Attending at New York
Presbyterian Hospital, Assistant Professor of Medicine at Weill Cornell Medical College,
Medical Director for the Weill Cornell Center for Human Rights and Katie Rosenfeld,
Legal Director of NYLPI.
We thank the medical experts for their assistance with our advocacy: Dr. Homer
Venters, Clinical Instructor, NYU Langone School of Medicine, Center for Health and
Human Rights; Dr. Matt Anderson, Department of Family and Social Medicine,
Montefiore Medical Center; Dr. Allen Keller, Associate Professor of Medicine, Director,
Bellevue/NYU Program for Survivors of Torture, Director, NYU School of Medicine
Center for Health and Human Rights; Dr. Sire Sow, Albert Einstein Montefiore Medical
Center, Primary Care/Social Internal Medicine, PGY3; and Dr. Shruthi Rajashekara,
Residency Program in Primary Care and Social Internal Medicine Montefiore Medical
Center.

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