November 19, 2008

Detainee Health Care

Background

The US Immigration and Customs Enforcement (ICE), Office of Detention and Removal Operations (DRO) is responsible for ensuring safe and humane conditions of confinement for detained aliens in federal custody, including the provision of reliable, consistent, appropriate and cost-effective health services.

Division of Immigration Health Services (DIHS) provides and arranges for primary health care services to detained aliens under the custody of ICE. This unit consists of U.S. Public Health Service Officers and contract medical professionals who work under their supervision. It serves as the medical authority for ICE related to medical issues. DIHS provides for the primary health care of detainees housed in DIHS-staffed detention centers, and oversees the financial authorization and payment for off-site specialty and emergency care for detainees in ICE custody. As of October 1, 2007, DIHS was detailed to DHS via a memorandum of agreement between DHS (signed by the Office of Health Affairs) and Health and Human Services. ICE provides administrative support and
oversight to DIHS.

Key Facts and Statistics

During FY08, the following number and types of health care services were provided:

• Intake Screenings 229,754
• Physical Exams 92,120
• Sick Calls 112,875
• Urgent Care 11,056
• Emergency Room/Off-Site Referrals 6,701
• Dental Visits 19,453
• Mental Health Interventions 29,423
• Chronic Disease Treatments 79,232
• Prescriptions Filled 197,453

Detainee Health Process

Each ICE detainee undergoes a health screening within the first 24 hours of admission to an ICE detention facility. This screening includes evaluation of the individual’s medical, dental and mental health status. A health history is taken. ICE detainees also receive a more detailed physical examination within fourteen days of admission to an ICE detention facility.

Individuals who have acute or chronic healthcare needs are referred to a primary care provider for medical treatment. Those found to have infectious diseases are placed in the appropriate healthcare setting and receive treatment for their conditions. Patients with diseases such as HIV/AIDS are treated in accordance with nationally recognized standards and guidelines. This care may be given on-site or off-site, as appropriate for the individual patient’s clinical condition. Pregnant detainees are referred to community obstetrics specialists to assure that appropriate prenatal care is delivered.

Each facility housing ICE detainees has a written plan for delivery of 24-hour emergency health care and for provisions of care when immediate outside medical attention is required. All facilities have current arrangements with nearby medical facilities or health care providers for health care not provided within the facility. These arrangements require appropriate custodial officers to transport and remain with the detainee for the duration of any off-site treatment or hospital admission.

Each detainee who is identified with a chronic-care issue is treated and educated on self-care needs, and appropriate treatment and follow-up are coordinated. DIHS includes approximately 734 doctors, nurses, and other health care professionals. Whoever the service provider, ICE detainees receive appropriate health services consistent with community standards and the ICE mission. The DIHS medical staff and the Epidemiology Branch monitor tuberculosis cases to ensure continuity of care, whether the detainee is to be released from custody into the United States or returned to his or her country of origin. ICE coordinated the repatriations to home countries of 205 individuals with active or suspected active tuberculosis. Coordination includes making arrangements with foreign nations’ tuberculosis control programs for patients to be received at the port of entry on arrival and ensuring completion of treatment without interruption. DIHS seeks to minimize threats to public health domestically and globally and prevent transmission of drug resistant and multi-drug-resistant tuberculosis.

Quality Assurance and Oversight

DIHS staffed facilities utilize applicable health care standards from the American Correctional Association (ACA), the National Commission on Correctional Health Care (NCCHC), the Joint Commission, and the ICE National Detention Standards to evaluate the care provided to detainees. At non-DIHS staffed facilities with an Intergovernmental Service Agreement, adherence to ICE National Detention Standards (NDS) is mandated.

U.S. Immigration and Customs Enforcement (ICE) was established in March 2003 as the largest investigative arm of the Department of Homeland Security. ICE is comprised of five integrated divisions that form a 21st century law enforcement agency with broad responsibilities for a number of key homeland security priorities.

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