Immigration advocates filed a sweeping, first-of-its kind class action lawsuit in federal court against the Trump administration on Monday, claiming official policies and lack of oversight related to the border and immigration crisis have led to major lapses in medical and mental health care in nearly 160 detention facilities across the country.
Detainees with medical and mental health conditions and those with disabilities face settings so brutal, including delays and denials of medical care, overuse of solitary confinement and lack of disability accommodations, they have led to permanent harm and 24 deaths in the last two years, according to a portion of the 200-page complaint shared with POLITICO.
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One plaintiff with a brain parasite has received no treatment for over a year. Another has not received surgery for a torn rotator cuff during three years in detention. One lost vision in his left eye due to lack of timely care in custody, the suit said.
Other suits have been filed on behalf of individuals in immigration detention and against conditions at specific facilities. But Monday’s lawsuit, filed in U.S District Court for the Central District of California, is one of the first arguing that Immigration and Customs Enforcement is deliberately and systematically denying care to about 55,000 migrants in custody at county jails and at both privately and publicly run detention centers.
“We’re hoping that this lawsuit will shine attention on the severity of the problem across the country,” said Elissa Johnson, senior supervising attorney at the Southern Poverty Law Center, one of the lawyers filing the suit. “The issues are so pervasive.”
ICE would not comment on pending litigation and said it couldn’t provide a timely response to a list of questions about detainee health care sent Friday morning.
“However, lack of comment should not be construed as agreement with or stipulation to any of the allegations,” said Shawn Neudauer, public affairs officer at ICE. “Our trained law enforcement professionals adhere to the Department’s mission and values, and uphold our laws while continuing to provide the nation with safety and security.”
Attorneys, advocates and current and former immigration officials say that detainees have long faced treatment delays and lack of care, especially in rural facilities.
But they say the problems have been exacerbated by the Trump administration’s focus on boosting the number of migrants in detention. That population has grown more than 60 percent over the past two years, without additional staff or resources for health care.
Infectious diseases, like outbreaks of mumps and chickenpox, that were previously rare have also spiked in overcrowded facilities.
“What we have seen in terms of access to health care is appalling,” said Laura Redman, director of the health justice program at New York Lawyers for the Public Interest. “It’s something that has been getting worse and worse and worse.”
The Trump administration has stepped up apprehensions at the border and within the country, such as raids at Mississippi poultry factories this month. It also reversed Obama-era guidance that encouraged releasing pregnant migrants and those with serious medical and mental conditions while they awaited deportation hearings.
Immigration officials have increased the use of county jails and private contractors to rapidly expand the number of beds for newly detained migrants. It’s also been relying on contractors to provide health care, rather than expanding ICE’s Health Services Corps, which cares for about 13,500 people in custody, according to the complaint.
County jails and privately contracted facilities have far worse medical care than ICE run facilities and are subject to less oversight, Kevin Landy, director of the ICE Office of Detention Policy and Planning until it was closed in January 2017 after Trump took office, wrote in an email.
The agency’s “ability to provide some level of oversight at those facilities is certainly strained beyond its capacity,” he said.
ICE failed to maintain records and persistently ignored internal oversight and Government Accountability Office reports calling out deficiencies in medical and mental health care that led to deaths, according to the lawsuit.
The agency continues to work with private medical providers that have faced numerous lawsuits and accusations of serious medical neglect, according to the complaint.
More migrants are also being sent to remote facilities in the rural South, which already suffers from provider shortages. Detention facilities in Louisiana and Mississippi could house as many as 20,000 migrants by the end of the year, according to Johnson from the Southern Poverty Law Center.
Detention facilities, especially those not directly run by ICE, are overly reliant on health workers with relatively little training like a licensed practical nurse; it’s not uncommon at some facilities for doctors to be on site for just about four hours a week. A registered nurse may be the most senior medical staff at some sites.
The Stewart Detention Center in rural Georgia, for example, lacked a staff physician for about three years until 2012, said Azadeh Shahshahani, legal and advocacy director at Project South, which wants the facility to be shut down.
The population at Stewart swelled nearly 18 percent from September 2017 to about 2,000 people in December 2018, overwhelming medical staff. Four people have died there in the past two years, including one who died of cardiac arrest last month after being transferred to a hospital. At least two detainees died by suicide after being held in solitary confinement for about three weeks. Project South has documented many cases of inadequate or untimely care, including not giving a man with diabetes the proper doses of his medication.
Several former Obama administration immigration officials told POLITICO that previous efforts to improve detainee medical and mental health care stalled because of lack of funding and internal resistance. But they said that officials would attempt to release vulnerable detainees while they awaited hearings and informally track which facilities were better equipped to handle detainees with health conditions.
“It was never easy in the Obama administration to get things done, but at least I know I could go to higher ups to be heard,” said Andrew Lorenzen-Strait, who left ICE in May and is now director of children and family services at the Lutheran Immigration and Refugee Service. “Now there is a total deafness to humanity at all levels.”
Shahshahsani said that under the Obama administration her organization could petition for the release of detainees with severe conditions, but that Trump administration officials aren’t responsive to such requests.