Introduction

Thank you for the opportunity to testify today. My name is Jasmine Tyler and I am the Advocacy Director for the US Program at Human Rights Watch, an international nonprofit organization dedicated to defending human rights around the world. Human Rights Watch has been documenting rights abuses within the US immigration system for over 20 years. Two of our most recent US immigration reports have focused on immigration detention, and specifically the deadly consequences of inadequate medical care. There are myriad failures within the US detention system – which are being addressed ably by many of my colleagues here -- so I will focus my remarks today on the persistent problem of dangerously substandard medical care.

Dangerously Substandard Medical Care

Since March 2010, ICE has reported a total of 82 deaths in adult immigration detention. (These numbers do not include the recent deaths of two children and an adult in Border Patrol custody.) In 52 of these deaths, ICE completed and released death reviews, which summarize ICE’s investigation and analysis into how and why the person died.
 
Human Rights Watch, working with the American Civil Liberties Union, Detention Watch Network, and the National Immigrant Justice Center, asked independent medical experts to review 15 recent cases in which ICE had released death reviews. These experts found that in eight cases, or over half, subpar medical care contributed or led to the fatalities. Looking at all 52 cases for which we have independent medical analysis since 2010, experts found inadequate care contributed or led to 23 deaths.
 
In other words, subpar medical care is a persistent problem in the US immigration detention system, and people are dying as a result.
 
The indifference to human suffering throughout the detention system revealed in these deaths is staggering.
 
On the morning that Jose Azurdia died in 2015, an officer at the Adelanto Detention Facility told a nurse Mr. Azurdia was ill and vomiting. The nurse told him “she did not want to see Azurdia because she did not want to get sick.” This began a series of unconscionable delays for what turned out to be a fatal heart attack.
 
Thongchay Saengsiri suffered from the symptoms of congestive heart failure for most of the 15 months he was detained at the LaSalle Detention Facility in Louisiana, including fainting, swelling, anemia, coughing, and shortness of breath. Instead of properly diagnosing and treating these classic symptoms, a nurse recommended he increase his fluid intake, which likely increased his risk of heart failure.
 
Many of the cases we examined indicate a particularly troubling failure to provide adequate mental health care, as well as overuse of solitary confinement for people with serious mental health conditions.
JeanCarlo Alfonso Jimenez Joseph, 27, died by suicide at Stewart Detention Center in May 2017. ICE still has not released a death report for him, but the Georgia Bureau of Investigations found he had been in solitary confinement for 19 days as punishment for an act he described as an attempt to harm himself. He was identified as a suicide risk early on, but he was never put on suicide watch nor provided the upward adjustment on his anti-psychotic medication he begged for days before his death.

Dramatic Expansion of Detention, Including Child & Family Detention

In response to those documented failures, ICE has not only failed to remedy them, but it has also dramatically expanded the number of people subject to the detention system’s dangers. The Trump administration has pushed this expansion even farther and is detaining more vulnerable people, including pregnant women, children, and families.
 
In February of this year, ICE held a record 49,000 people in detention on average per day. The administration has asked Congress to allocate US$2.7 billion for Fiscal Year 2020 to lock up a daily average of 54,000 people per day, with the stated goal of detaining 60,000 people per day, including 10,000 family detention beds through an additional “Border Security and Immigration Enforcement Fund.”
 
At the same time, the Trump administration has requested less money for Department of Homeland Security (DHS) oversight of detention – oversight which is intended to ensure that conditions of confinement are safe.

Ongoing Failure to Provide Information on Deaths

In early 2018, Congress required that ICE publicly release all reporting on each in-custody death within 90 days of the death. ICE failed to meet this deadline for several deaths in 2018. When in December 2018, ICE began releasing what it called “detainee death reports” for FY 2018, these reports were nothing like the detailed analyses we had seen in the past. They were mere notifications, rather than summaries of investigations into why these people died.
 
We encourage the Commission to seek detailed information from DHS on its detention system and its enforcement policies in general, but in particular, we request the Commission press ICE to provide full investigations into deaths in detention and to explain its failure to meet its Congressional reporting requirements in a timely manner.