Ensuring Adequate Medical Care for Detained Immigrants

In 2008, Immigration and Customs Enforcement (ICE) announced a new medical care standard in an effort to address well-documented shortcomings of this system. The rollout of this standard has been delayed to 2010 pending review and further improvements. This new standard strengthens the level of care that ICE prescribes for detainees but three hurdles remain before this standard can actually result in improved care. First, the new medical care standard lacks a comprehensive enforcement mechanism. Effective oversight of facility contracts requires surveillance of medical care that is linked to a range of inducements, from collaborative to punitive. Given the commitment of ICE to continue a large detention program (>300,000 annually), having loss of contract as the main punitive response to poorly functioning facilities is unrealistic. A broad range of punitive measures, based on financial damages, would allow ICE to strongly enforce their medical standard. Second, few local public health authorities are involved in monitoring the level of medical care provided to ICE detainees, even in facilities where these authorities monitor care for criminal arrestees. These resources, such as state and city boards of correction and public health departments, should play a vital role in investigating complaints about detainee medical care as well as monitoring improvements in care. Such a change is warranted given that state and local governments have accrued tremendous earnings from ICE payments to county jails and private detention centers. Third, ICE has yet to widen the mission of the Division of Immigrant Health Services (DIHS, another division of the Department of Homeland Security) currently tasked with providing medical care to roughly 1/3 of detainees based on type of facility. Given the expertise and training of the DIHS, their mission should include monitoring and promotion of health for all detainees, whether in ICE, private or municipal facilities. Addressing each of these challenges will better ensure that the new medical standard promulgated by ICE will actually translate into improved care for detainees.