When Pablo Gracida-Conte was admitted to the Eloy immigrant detention center in Arizona on June 10, 2011, the 54-year-old Mexican immigrant had no history of chronic illness, and no significant medical issues.
Nine days after he arrived at Eloy — which is run by the private prison company Corrections Corporation of America and overseen by the federal Immigration and Customs Enforcement agency (ICE) — he went to the medical clinic complaining of vomiting and heavy sweating. Over the next three months, he continued reporting symptoms that included excruciating abdominal pain, headache, shortness of breath, difficulty breathing, dizziness, heartburn, insomnia, weakness, nausea, poor appetite, and eventually inability to speak without stopping to catch his breath.
On October 25, 2011, Gracida was finally sent to the ER, where he died five days later. An autopsy attributed his death to cardiomyopathy, a treatable disease affecting the heart muscle. His is one of eight cases of medical negligence-related deaths at ICE facilities around the country outlined in a report released on Thursday by the American Civil Liberties Union, the National Immigrant Justice Center, and the Detention Watch Network.
"Mr. Gracida's long list of sick call requests reads as a desperate, repeated cry for help that was ignored until it was too late," the report states.
ICE conducted an internal review of Gracida's death and found that medical staff had violated the agency's detention standards governing medical care in failing to provide timely treatment and send him to the ER earlier. It concluded that his death "might have been prevented." Despite ICE's own admission of negligence, a 2012 ICE inspection of medical care in the Eloy facility made note of Gracida's death but did not mention any problems with his care.
Stories of questionable deaths, abuse, and neglect at US immigrant detention facilities are nothing new — they've been piling up since the agency was created by the Homeland Security Act in 2002. The latest report argues that despite efforts by the Obama administration to reform the system, deaths related to healthcare failures continue and oversight of facilities remains abysmal.
"It doesn't seem possible for ICE to police itself," said Jennifer Chan, associate director of policy at NIJC and coauthor of the report. "Independent oversight and accountability is needed."
The report, which examined in-custody death reviews by ICE as well as facility inspection reports between 2010 to 2012, highlights eight deaths in which the agency identified non-compliance with its own medical standards as contributing to patients' demise, including four deaths that the agency deemed preventable. In addition to the standards violations in Gracida's case, documents attest to violations that include failure to pre-screen patients for illness and to refer patients to specialty care, failure to communicate crucial medical information between clinicians, and understaffing of personnel.
Following an investigative series of articles on detainee deaths published by the New York Times in 2008 and 2009, the Obama administration implemented several reforms to the immigrant detention system. It mandated death reviews, created a new facility inspection process, and introduced stricter standards governing conditions at detention centers.
But Thursday's report argues that these reforms aren't strong enough to prevent unnecessary deaths. Even though ICE's own reviews identified violations of medical protocols as contributing factors in these deaths, ICE detention facility inspections conducted before and after the deaths often did not even acknowledge those egregious medical mistakes. According to the report, ICE inspectors gave passing grades to all but one of the eight facilities before and after the deaths.
An ICE spokesperson said that the agency "takes seriously the health and welfare of all those in its custody," as well as the death of any individual that occurs in the agency's custody. "ICE will review the report when it is provided to assess what actions, if any, should be taken in response," she added. The spokesperson noted that ICE is working on improving conditions of confinement, and acknowledged that all detainees should receive timely care. Any detainee that requires follow-up treatment for a medical condition would be scheduled for appointments as needed, she said, including for outside specialty care.
In 2010, the Times called out the "culture of secrecy" at ICE, reporting that ICE officials worked regularly to cover up evidence of abuse. Chan says this culture persists today: "With all of these death reviews, it was like pulling teeth trying to get these documents released."
Much of the oversight failures by ICE boil down to the fact that its facilities, unlike the federal prisons in the Bureau of Prisons system, have no third-party overseer. So even if the Obama administration implements stricter healthcare and inspection rules, "there's no guarantee that [ICE is] training staff adequately or practicing" the new rules, Chan noted.
The White House did not respond to a request for comment as to whether it is considering creating such an ombudsman for ICE.
ICE's use of private prison contractors may also increase the likelihood of poor medical care for detainees. About two-thirds of immigrant detainees across the US are held in county jails and state prisons which contract with ICE, which operates under the Department of Homeland Security (DHS). The rest are kept in facilities run by private prison corporations or by ICE itself.
Of the eight deaths outlined in the report, six occurred at privately run detention centers run by the Corrections Corporation of America, the GEO Group, and Immigration Centers of America. Critics argue that these companies' cost-cutting incentives can lead to substandard care.
Dora Schriro, a former special advisor to DHS Secretary Janet Napolitano, said during a press call about the report on Thursday that "the reliance on others to perform core governmental duties" is dangerous.
A spokesperson for the GEO Group said that it cannot comment on individual cases due to privacy concerns, but said that the facilities in question provide "high-quality services... pursuant to strict contractual requirements."
"Our company strongly refutes allegations to the contrary," he said, adding that all of GEO's facilities are independently accredited by the American Correctional Association, and that during ACA's most recent assessment of GEO facilities, the detention centers concerned in the report received perfect scores.
The Corrections Corporation of America and Immigration Centers of America did not respond to requests for comment.
The US has the largest immigration detention system in the world, with an average of 34,000 people detained on a daily basis in more than 250 facilities around the country, and a price tag of $2 billion a year. The facilities are rife with allegations of abuse and neglect. The ACLU and Human Rights Watch have identified numerous cases of sexual abuse of immigrants held in ICE detention. NIJC has filed over a dozen complaints with DHS alleging mistreatment of LGBT immigrants, including denial of medical care, arbitrary long-term solitary confinement, sexual assault, and harassment.
There have been 56 deaths in ICE custody during the Obama administration, including six suicides. Because of the lack of transparency regarding in-custody deaths, it's hard to say how many of them over the years were due to medical neglect. A 2008 Washington Post investigation identified 30 questionable deaths that occurred at ICE facilities between 2003 and 2008.
"Being held in immigration detention should not be a death sentence," Chan said. "The Obama administration promised to make reforms to address the high number of deaths that happened in detention, and although the number has decreased... that doesn't mean that current deaths don't matter."
Follow Erika Eichelberger on Twitter: @eichelberger_e