	Some Instances of Noncompliance with Medical Care Standards Occurred

At the time of our visits, we observed instances of noncompliance with  ICE’s medical care standards at 3 of the 23 facilities we visited. However,  these instances did not show a pervasive or persistent pattern of  noncompliance across the facilities like we those identified with the  telephone system. At the San Diego Correctional Facility in California, an adult detention  facility, ICE reviewers that we accompanied cited PHS staff for failing to  administer the mandatory 14-day physical exam to approximately 260  detainees. At the Casa de San Juan Family Shelter in California, we found  that the facility staff did not administer medical screenings immediately  upon admission, as required in ICE medical care standards. Officials at some facilities told us that meeting the specialized medical and  mental health needs of detainees can be challenging. Some also cited  difficulties they had experienced in obtaining ICE approval for outside  nonroutine medical and mental health care as also presenting problems in  caring for detainees. On the other hand, we observed instances where  detainees were receiving specialized medical care at the facilities we  visited. ICE Compliance Inspections Also Show Some Instances of Noncompliance With Medical Standards

We reviewed the most recently available ICE annual inspection reports for  20 of the 23 detention facilities that we visited. The 20 inspection reports showed that ICE  reviewers had identified a total of 59 instances of noncompliance, 4 of  which involved medical care. Subsequent  to each annual inspection, a compliance rating report is to be prepared  and sent to the Director of the Office of Detention and Removal or his  representative within 14 days. The Wakulla County Sheriffs Office in Florida had  sick call request forms that were available only in English whereas the  population was largely Spanish speaking. The Cowlitz County Juvenile  Detention Facility in Washington state did not maintain the alien juvenile  medical records on-site. The San Diego Correctional facility staff, in  addition to the deficiencies noted earlier in this statement, failed to obtain  informed consent from the detainee when prescribing psychiatric  medication. Finally, the Broward Transitional Center in Florida did not  have medical staff on-site to screen detainees arriving after 5 p.m. and did  not have a properly locked medical cabinet. We did not determine whether  these deficiencies were subsequently addressed as required. Alien Detainee Complaints Included Concerns About Medical Care

Our review of available grievance data obtained from facilities and  discussions with facility management showed that the types of grievances  at the facilities we visited typically included the lack of timely response to  requests for medical treatment, missing property, high commissary prices,  poor quality or insufficient quantity of food, high telephone costs,  problems with telephones, and questions concerning detention case  management issues. ICE’s detainee grievance standard states that facilities  shall establish and implement procedures for informal and formal  resolution of detainee grievances. Four of the 23 facilities we visited did  not comply with all aspects of ICE’s detainee grievance standards. The primary mechanism for detainees to file external complaints is  directly with the OIG, either in writing or by phone using the DHS OIG  complaint hotline. We did not  independently assess the merits of detainee complaints. Of the approximately 1,700 detainee complaints in the OIG database  that were filed in fiscal years 2003 through 2006, OIG investigated 173  and referred the others to other DHS components. We could not determine the number of cases referred to DRO or their  disposition. On the basis of a limited review of DRO’s complaints  database and discussions with ICE officials knowledgeable about the  database, we concluded that DRO’s complaint database was not  sufficiently reliable for audit purposes.
Why GAO Did This Study

In fiscal year 2007, Department of Homeland Security's (DHS) U.S. Immigration and Customs Enforcement (ICE) detained over 311,000 aliens, with an average daily population of over 30,000 and an average length of stay of about 37 days in one of approximately 300 facilities. The care and treatment of aliens while in detention is a significant challenge to ICE, as concerns continue to be raised by members of Congress and advocacy groups about the treatment of the growing number of aliens while in ICE's custody. This testimony focuses on (1) the extent to which 23 facilities complied with medical care standards, (2) deficiencies found during ICE's annual compliance inspection reviews, and (3) the types of complaints filed by alien detainees about detention conditions. This testimony is based on GAO's July 2007 report evaluating, among other things, the extent to which 23 facilities complied with aspects of eight of ICE's 38 National Detention Standards. This report did not address quality of care issues.

What GAO Found

At the time of its visits, GAO observed instances of noncompliance with ICE's medical care standards at 3 of the 23 facilities visited. These instances related to staff not administering a mandatory 14-day physical exam to approximately 260 detainees, not administering medical screenings immediately upon admission, and first aid kits not being available as required. However, these instances did not show a pervasive or persistent pattern of noncompliance across all 23 facilities. Officials at some facilities told GAO that meeting the specialized medical and mental health needs of detainees had been challenging, citing difficulties they had experienced in obtaining ICE approval for outside nonroutine medical and mental health care. On the other hand, GAO observed instances where detainees were receiving specialized care at the facilities visited. At the time of its study, GAO reviewed the most recently available ICE annual inspection reports for 20 of the 23 detention facilities that it visited; these reports showed that ICE reviewers had identified a total of 59 instances of noncompliance with National Detention Standards, 4 of which involved medical care. One facility had sick call request forms that were available only in English whereas the population was largely Spanish speaking. Another did not maintain alien medical records on-site. One facility's staff failed to obtain informed consent from the detainee when prescribing psychiatric medication. Finally, another facility did not have medical staff on-site to screen detainees arriving after 5 p.m. and did not have a properly locked medical cabinet. GAO did not determine whether these instances of noncompliance were subsequently corrected as required. The types of grievances at the facilities GAO visited typically included the lack of timely response to requests for medical treatment, missing property, high commissary prices, poor food quality and insufficient food quantity, high telephone costs, problems with telephones, and questions concerning detention case management issues. ICE's detainee grievance standard states that facilities shall establish and implement procedures for informal and formal resolution of detainee grievances. Four of the 23 facilities GAO visited did not comply with all aspects of ICE's detainee grievance standards. For example, one facility did not properly log all grievances that GAO found in their facility files. Detainee complaints may also be filed with several governmental and nongovernmental organizations. The primary way for detainees to file complaints is to contact the DHS Office of Inspector General (OIG). About 11 percent of detainee complaints to the OIG between 2005 and 2006 involved medical treatment issues. However, we found that the OIG complaint hotline 1-800 number was blocked or otherwise restricted at 12 of the facilities we tested. OIG investigates the most serious complaints and refers the remainder to other DHS components. GAO could not determine the number of cases referred to ICE's Detention Removal Office and concluded that ICE's detainee complaint database was not sufficiently reliable.