Code Red: The Fatal Consequences of Dangerously Substandard Medical Care in Immigration Detention


June 22, 2018

Editor’s note: CHN Intern Page Brigham, a rising senior at Allegheny College, contributed to this blog post.
Katherine Bonilla will not get to see her father again.

Arrested by ICE on his way to work at a construction job, in what may have been a case of mistaken identity, her father, Rolando Meza-Espinoza, was held in custody at the Hudson County Correctional Center in New Jersey.

He suffered from cirrhosis of the liver, anemia, and diabetes. His family would later tell the New York Daily News that during his two months in detention, he repeatedly asked for his prescribed medications, but only received treatment for diabetes. On June 8, he was taken to the hospital with severe internal bleeding and died two days later.

“He didn’t receive the care for his illnesses that he needed, and as a result, I lost my dad,” Katherine says. “The way the system operates is not okay. I hold the immigration detention system responsible for my dad’s death.”

Meza-Espinoza’s story was part of a report released this week by Human Rights Watch and its allies – the American Civil Liberties Union, the National Immigrant Justice Center and Detention Watch Network. Code Red: The Fatal Consequences of Dangerously Substandard Medical Care in Immigration Detention, analyzed the deaths of 15 immigrant detainees during a 17-month period from December 2015 to April 2017. In 14 of the 15 cases analyzed, “subpar and dangerous practices” were identified, including the “suicide of a person with a psychological disability who place placed in isolation.”


Jose Azurdia died of a heart attack. On the morning of the day of his death, an officer at the Adelanto Detention Facility in California told a nurse that he was ill and vomiting. The nurse responded that she “did not want to see Azurdia because she did not want to get sick.” This was the beginning of a series of delays in getting care for Azurdia.

Thongchay Saengsiri suffered from 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 symptoms, a nurse recommended he increase his fluid intake, which likely increased his risk of heart failure. On March 17, 2016, he complained of symptoms suggesting a heart attack, but a nurse diagnosed him with asthma. He was hand- and leg-cuffed and belly-chained to a chair for half an hour, causing him to experience a panic attack. 911 was called, and two hours after presenting symptoms of a heart attack, he went into cardiac arrest and died.

Rafael Barcenas Padilla died from bronchopneumonia after a delay in transferring him to the hospital from the Otero County Processing Center in New Mexico, where nurses recorded his dangerously low oxygen levels over the course of three days that should have prompted immediate hospitalization.

As the population of immigrant detainees grows, so too does the number of deaths while in custody. Indeed, the report found that more people died in immigrant detention in fiscal year 2017 than any year since 2009, and many of the deaths are linked to dangerously inadequate medical care.

At least two physicians with expertise in correctional health analyzed the files associated with the 15 deaths that occurred between December 2015 and April 2017. They found that substandard medical care contributed to or led to eight of the 15 deaths. “In all but one of the 15 deaths we analyzed for this report, our experts found evidence of subpar and dangerous practices including unreasonable delays, poor practitioner and nursing care, and botched emergency response,” the authors state. “In line with cases we have previously documented, one of the 15 cases involved the suicide of a person with a psychosocial disability who was inappropriately placed in isolation.”

The report leads to an obvious question. If immigration authorities (and others responsible for holding detainees) cannot adequately care for people already in their custody, what will happen if or when the number of immigrant detainees expands?

Back in 1994, on any given day, approximately 6,800 people were held in immigration custody in civil detention awaiting action on their deportation cases. That number steadily increased over the years, hovering between 28,000 and 34,000 for most of the past decade. After a spike over the past two years beginning under the Obama Administration, detention numbers are now at highs previously unimaginable.

In fiscal year 2017, ICE held a daily average of nearly 40,500 people. The Trump Administration has asked Congress to allocate $2.8 billion for fiscal year 2019 to lock up a daily average of 52,000 immigrants in immigrant detention facilities, a record number representing nearly 30 percent expansion over the previous year.

Things could get worse, according to the report. Although the Trump Administration has requested more money to detain more people, it actually has requested less money for Department of Homeland Security oversight of detention to assure that conditions of confinement are safe. “These proposals would place more human beings than ever before into an abusive and wasteful system that already suffers from substandard medical care,” the report states.

The report offers a number of recommendations to Congress, to ICE, and to state and local governments.

It recommends that Congress reduce the number of immigrants in detention centers, oppose expansion of ICE and detention centers, and exercise meaningful oversight. It also recommends that Congress appoint an independent medical oversight board and increase transparency.

For ICE, the report recommends that the federal agency reduce detention by using alternatives such as parole, refrain from detaining those with serious medical/mental health needs, and ban prolonged/indefinite isolation and prohibit isolation for vulnerable detainees.

And for state and local governments, it urges increased local oversight capacity, and encourages local government entities to decline to expand detention capacity.