VII. Recommendations

To the Division of Immigration Health Services

General Policy Recommendations

• Amend the Covered Services Package to remove inappropriate consideration of an individual’s deportation prospects in determining eligibility for medical procedures and harmonize the package with the revised ICE medical standard so that detained individuals can access a full continuum of health services, whether available inside or outside the detention facility.
• Create mechanisms to improve the timeliness of response to the health care needs of individuals in ICE custody and to their submission of complaints.
• Recruit qualified health professionals to maintain a sufficient number of medical staff at facilities to address the nationwide shortages.
• Ensure that individuals in custody can request translation during their medical visits and are advised of their right to do so.
• Increase the number of qualified staff reviewing Treatment Authorization Requests to remove bottlenecks that cause delays in treatment.
• Ensure that the pursuit of cost savings does not override the medical needs of the patients in the consideration of Treatment Authorization Requests.
• Improve the screening for sexual and gender-based violence according to Family Violence Prevention Fund and WHO guidance.[299]
• Encourage facilities to establish partnerships with community organizations that provide services to survivors of sexual and gender-based violence to increase women’s access to services during and following their period of detention.
• Encourage facilities to establish partnerships with community organizations to ensure that detainees receive referrals for medical care after detention.

Women’s Health Policy Recommendations

• Amend the Covered Services Package to ensure coverage for Pap smears and mammograms for screening purposes according to community standards.
• Amend the Covered Services Package to provide coverage for family planning services and ensure that detention center formularies stock contraceptives, including emergency contraceptive pills.
• Expand mental healthcare options for individuals detained to include scheduled, non-emergency counseling visits with a mental health professional.

Implementation and Training Recommendations

• Conduct intensive outreach to facilities to ensure that both health professionals and security personnel are aware that the men and women in their custody are entitled to the same level of medical care as individuals who are not detained and assure health professionals that ICE and DIHS policies are intended to support and not inhibit their delivery of care consistent with standards of medical practice in the United States.
• Ensure that all facility medical staff conducting intake examinations are aware of the jurisdiction’s legal standards and ICE’s policy on access to abortion. Require staff to apprise women testing positive for pregnancy that they have legal rights regarding the continuation or termination of their pregnancy, and refer women who have questions about access to abortion for a consultation with a licensed abortion provider.
• Ensure that facilities have ready access to breast pumps and are aware of their duty to offer them to nursing mothers who come into custody.
• Provide training to medical staff conducting intake examinations on the manifestations of trauma in women and appropriate techniques for talking about sexual and gender-based violence.

To Immigration and Customs Enforcement

General policy improvements

• Require all facilities holding individuals on behalf of ICE to maintain accreditation with the National Commission on Correctional Health Care.
• Improve precautions to protect the privacy of individuals’ medical examinations, including by requiring security personnel to remain outside the exam room in the absence of extraordinary security concerns.
• Amend the detention standards to require that certified health professionals conduct medical intake screening.
• Amend the detention standards to require that individuals receive their complete medical records on release or deportation and to mandate that the full medical record accompany individuals who are transferred between facilities, regardless of whether DIHS operates the facilities.

Improvements in the treatment of women

• Implement the recommendations of the UN special rapporteur on the human rights of migrants, including in particular the recommendations that ICE develop gender-specific detention standards with attention to the medical and mental health needs of women survivors of violence and refrain from detaining women who are suffering the effects of persecution or abuse, or who are pregnant or nursing infants.[300]
• Incorporate into the ICE medical standard the American Public Health Association’s standards on women’s health care in correctional institutions and the recommendations of the National Commission on Correctional Health Care’s policy statement on women’s health care.[301]
• Establish a formal process for ICE officers charged with case management to coordinate with health services personnel to ensure that nursing mothers, pregnant women, and other women with significant health concerns are immediately identified and considered for parole.
• Amend the ICE detention standard on the use of force to specifically prohibit the shackling of women during pregnancy, delivery, and in the immediate postnatal period.
• Consider the availability of specialist services for obstetrics and gynecology in the surrounding community when determining the suitability of facilities for the detention of women.
• Require that facilities make sanitary pads and other materials and facilities necessary for cleanliness and dignity available without restriction.

Implementation of existing and improved polices

• Improve the current system for receiving and tracking complaints made by individuals in ICE custody. Ensure that all individuals receive notice of complaint procedures in their native languages and that they are informed of the availability of these mechanisms for addressing medical care complaints.
• Provide public notice of penalties imposed on facilities for violations of the detention standard.
• Insist that private contractors engaged to monitor facility compliance with detention standards include professionals with medical expertise in the review of compliance with the medical standard. Provide copies of the private contractors’ findings to oversight committees in Congress.

To the US Department of Homeland Security

• Convert the ICE detention standards, including the ICE medical standard, into federal administrative regulations so that they have the strength of law and detained individuals and their advocates will be able to have recourse to courts to redress shortfalls in health care.
• Require detention facilities to provide regular reports to the DHS Office of Inspector General detailing the number of grievances received regarding medical care and their disposition at the facility level.
• Designate a focal point for the protection of the rights of women in immigration detention within the DHS’s Office for Civil Rights and Civil Liberties.

To the US Congress

• Pass legislation to require that all individuals in immigration detention have access to medical care that meets standards of medical practice in the United States.
• Establish a commission of independent experts to examine the status of the ICE medical system and identify means of ensuring that immigrants in ICE custody have access to medical care that meets standards of medical practice in the United States.
• Require ICE to provide relevant congressional oversight committees with the reviews of facility compliance with ICE detention standards completed by private contractors. Require DIHS to provide oversight committees with any future analyses of the cost savings generated by denying treatment authorization requests.