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1 1 (April 2, 2024)

handle is hein.crs/goveowb0001 and id is 1 raw text is: Congressional Research Service Informing the legislative debate since 1914 0 April 2, 2024 Medical Care Standards in Immigrant Detention Facilities In recent years, the COVID-19 pandemic and whi stlelhwer cmplaits about medical neglect and unnecessary gynecological procedures have led to concerns over the medical care of noncitizens in the custody of Immigration and Customs Enforcement (ICE). This In Focus provides background on Immigrant Detention Facility medical care standards, medical care delivery, and the oversight of ICE detention facilities. ICE's Enforcement and Removal Operations (ERO) is responsible for immigration enforcement in the interior of the United States, including managing and overseeing the immigrant detention system. Federal law provides ICE with broad authority to detain noncitizens while awaiting a determination of whether they should be removed from the United States, and describes certain categories of noncitizens who are subject to mandatory detention (e.g., when the noncitizen is removable on account of certain criminal or terrorist activity) (8 U.S.C. §§1225, 1226, 1226a, 1231, and 1357). Federal law also provides authority for medical care for those in immigration detention (42 U.S.C. §§249 and 34.7(a)). ICE Detention Facilities Some detention facilities exclusively house adult ICE detainees (dedicated facilities), while others are state or local facilities or privately run facilities that house both state or local inmates as well as ICE detainees (non- dedicated facilities). ICE owns and opeates some of its ovn facIiltes; others are owned and operated by private companies or state or local governments, which have contracts or intergovernmental agreements, respectively, with ICE. Generally, facilities housing adult immigrant detainees must comply with one of several sets of ICE detention standards. Detention Standards ICE detention standards cover a wide range of areas related to safety, security, order, care (including medical care), activities (such as visitation), justice (such as a grievance system), and the administration and management of facilities. Generally, three sets of standards are applied at facilities that house the detained adult immigrant population. (There are other standards for specific types of immigration detention facilities, such as family detention centers and facilities under contract with the U.S. Marshals Service, which are outside the scope of this In Focus.) Contracts or agreements between ICE and the detention facility determine the standards to which the facility is required to adhere. The 2011 Performance-Based National Detention Stanudards (PBNDS) are applied at dedicated facilities that house 68% of the detained immigrant population. First developed in 2008, the updated 2011 PBNDS were revised in 2016 to meet detention standards consistent with federal legal and regulatory requirements as well as ICE policies and policy statements. Improvements to medical and mental health services were a significant part of the revision. (Although it was revised in 2016, the standards are still referred to as the 2011 PBNDS.) Some facilities still adhere to the 2008 PBNDS. These facilities hold 10% of the detained immigrant population. The National Dtenti Standards (NDS) 2000/2019 are applied at facilities that house 22% of all detainees. The revised 2011 PBNDS are considered to be the highest-quality set of detention standards, and ICE aims to implement them in the one-third of facilities not currently using them. Medical Care Standards Under all three standards, the services that are required to be provided directly or contractually to detainees include * initial medical, dental, and mental health screenings; * routine and preventive care, specialty care, emergency care, and hospitalization, as medically indicated; * timely responses to medical complaints; and * language services when needed during any appointment, treatment, or consultation. The 2011 PBNDS also include an array of protocols for staff, such as notifying detainees of health care services and guidance on informed consent and involuntary treatment. In addition, the 2011 PBNDS include a section dedicated to medical care specifically for women, including routine gynecological and obstetrical health care, and consideration of requests to be seen by a same-gender health care provider. In July 2021, ICE aimounued a new directive that specifies that immigrants who are pregnant, nursing, or postpartum will not be detained while they wait for immigration court proceedings, unless they are subject to mandatory detention. Delivery of Medical Care All detained immigrants' health care falls under the authority of the ICE Health Services Corps (IHSC). Accordint IHS( in FY2023 just over 40% of those in ICE custody received direct services from the IHSC for routine care. In non-IHSC staffed facilities, local government staff or private contractors provide similar services, with oversight by IHSC. Each facility has a health service administrator who is responsible for overall health care services within facilities. Every facility also has a designated clncal micai autr ity (CMA) who is a doctor (MD or DO) responsible

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