Free Health Care for Illegal Aliens Needs Improvement, Some in Congress Say

By Penny Starr | March 3, 2009 | 8:29 PM EST

Capt. Jose Rodriguez, director of the Division of Immigration Health Services, U.S. Public Health Service, said some of the medical care ICE dispenses has saved lives. ( Starr)

( – Free health care provided to illegal aliens detained by Immigration and Customs Enforcement needs to be investigated and improved, some members of a congressional Homeland Security panel said on Tuesday, despite testimony that the number of detainee deaths is way down and that health screenings have saved lives.

Capt. Jose Rodriguez, director of the U.S. Public Health Service's Division of Immigration Health Services, testified that each individual taken into ICE custody is given a verbal health screening and is tested for tuberculosis within 12 hours. Dental exams also are provided, and women ages 10 to 55 are given pregnancy tests at the initial health screening.
Individuals who are still in custody after 14 days are given a complete physical.

“The purpose of this hearing is to investigate the health care services that ICE provides individuals held in its custody at detention centers around the country and to discuss efforts that Department of Homeland Security will do to improve those services,”  said Rep. David Price (D-N.C.), chairman of the House Appropriations Subcommittee on Homeland Security, at Tuesday's hearing. 

“Over the past several years there have been troubling media reports about detainee deaths that appear to have been preventable had the individuals in question been given appropriate and timely medical attention,” Price said.

Jim Hayes, director of ICE's Office of Detention and Removal, testified that since ICE was created in 2003 it has processed 1.7 million people who were in the United States illegally. ( Starr)

Witness Jim Hayes, director of ICE’s Office of Detention and Removal Operations, told the subcommittee that of the more than 1.7 million people who have been in ICE custody since its inception in 2003, 90 individuals have died.
Adding that even one death was unacceptable and that he looked forward to working with Homeland Security Secretary Janet Napolitano, Hayes said that the number of detainees that have died while in custody was reduced from 10.8 per 100,000 in 2004 to 2.7 per 100,000 in 2008.
Rep. Hal Rogers (R-Ky.) noted that most of the detainees come from countries that lack health care services and that many who come to the United States are in poor health.

Rep. Hal Rogers (R-Ky.) questioned witnesses at a hearing on Capitol Hill to investigate whether or not Immigration and Customs Enforcement gives proper medical care to individuals it detains who have violated immigration law. ( Starr)

“Have there been times when because of your examination of these people that you have saved lives?” Rogers asked.
“Yes, we have found conditions that, if not treated within weeks or months from the diagnosis, they would have died,” Rodriguez said. “Those screenings have been life saving for those detainees.”
Hayes said for many of the detainees, the physical examination is the first time in years, or even a lifetime, that they have been checked by a physician. Conditions diagnosed include hypertension, diabetes, HIV/AIDS and heart disease. Treatment has ranged from medication to surgery.
“People have even gotten procedures such as bypass (surgery),” Rodriguez said. “People have never dreamed of receiving that in their country, because they were not diagnosed that they have potentially lethal heart disease.”
“And have you intervened in those cases?” Rogers asked.
“Yes, we have, sir,” Rodriguez said.
“With what?” Rogers asked.
“Send them to a specialist who will perform the surgery,” Rodriguez said.
Congress’ 2009 appropriation for ICE included $2 million to fund an independent, comprehensive review of medical care provided to individuals in ICE custody.
The U.S. Government Accountability Office (GAO) conducted the review and concluded that while some standardization of record keeping and consistency of procedures at detention facilities could be implemented, the GAO also found that spending, staffing and services provided by ICE have consistently increased.
“For example, from fiscal year 2003 through fiscal year 2007, reported expenditures for medical claims and program operations increased by 47 percent, while the average daily population of detainees increased by about 40 percent,” the review said.

Alicia Puente Cackley of the Government Accountability Office was in charge of a $2 million review of ICE's medical treatment and testified at the hearing. ( Starr)

Rep. Lucille Roybal-Allard (D-Calif.) cited a news report about a woman who was shackled during childbirth and returned to jail after her baby was delivered. But Hayes said the woman, who was in the country illegally, was facing criminal charges in the county where she was jailed and was not in ICE custody at the time her child was born.
Another subcommittee member said a man was denied treatment for lesions on his genitals and eventually died of cancer.
But Rep. Rogers said that providing health care for individuals who are in the country illegally is “a humanitarian mission.”
“I think we have to keep in mind that this is the detention program for people who are illegally in the country,” Rogers said. “It’s not a health program. We are not talking about a health screening program here or hospitalization. We’re talking about detaining illegals before they are deported and whether or not we are furnishing adequate medical help while they are in our custody.”
Rogers used a chart to show the dramatic reduction in detainee deaths and asked Alicia Puente Cackley, director of health care at GAO who headed the review, about the statistics.
“I think you would have to agree that the chart that shows the decrease of mortality rates from 2004 to ’08 is quite remarkable, is it not?” Rogers said.
“We did not attempt to calculate a mortality rate, because we didn’t feel we had an actual population number,” Cackley said.
“I’m showing you what the facts are here,” Rogers said. “What’s your comment on the reduction of the mortality rate from 10.8 in ’04 to 2.7 in ’08? That’s quite remarkable, is it not?”
“I don’t know what the basis of that calculation is because I don’t have the population number,” Cackley said.
“Well, assuming (this chart) is correct, which it is,” Rogers said, “is that not remarkable?”
“It is a significant decrease, yes, sir,” Cackley said.
Then Rogers turned his attention to some other statistics generated by ICE.
“Now, Mr. Hayes, how many detainees have you handled since ’04?”
“I believe the number, sir, is greater than 1.7 million,” Hayes replied.
“1.7 million people and you have 90 deaths,” said Rogers, who added that the cause of death for those 90 individuals included cardiac arrest, a brain tumor and AIDS. “To me, that’s remarkable.”
“I don’t know what we’re complaining of here,” Rogers said. “In fact, I think we ought to be complimenting you on this tremendous reduction.”
The hearing also revealed other statistics generated by ICE since the agency was formed five years ago. Through its fugitive operation program, ICE has identified illegal aliens who are incarcerated in U.S. prisons. In 2006, 64,000 illegal inmates were identified, and last year 260,000 inmates were deemed illegal aliens.
Hayes said that, last year, 100,000 individuals were detained for violating immigration law, and in 2009, he expects his agency to arrest some 440,000 illegal aliens, the vast majority of whom have been involved in the U.S. criminal justice system.
In 2004, ICE's budget was 74 million and for FY 09 it is $151 million.

Dr. Dora Schriro, special advisor to Napolitano on ICE and Detention and Removal, also testified at the hearing.