Medical care at U.S. border facilities is unsafe for migrants, DHS memo says


A Department of Homeland Security medical team investigating the recent death of an 8-year-old girl in South Texas told U.S. border officials that their system of care for migrants is unsafe and needs a major overhaul, according to an internal memo obtained by The Washington Post.

The June 8 memo from DHS acting chief medical officer Herbert O. Wolfe said the Border Patrol station where Anadith Reyes Álvarez and her family were held “lacked sufficient medical engagement and accountability to ensure safe, effective, humane and well-documented medical care.”

The child was not treated by a doctor despite worsening flu symptoms, a fever that reached 104.9 degrees and a medical history of sickle cell disease and heart problems. After eight days in U.S. custody, Anadith had a seizure and died May 17.

Wolfe’s memo to U.S. Customs and Border Protection (CBP) acting commissioner Troy Miller describes an ad hoc system with little ability to manage medical records, poor communication among staff and a lack of clear guidelines for seeking help from doctors outside the border agency.

The Harlingen, Tex., border station where Anadith and her family were held — designated by CBP for medical isolation cases — had a list of on-call doctors and pediatricians that was used so seldom it was “out of date,” according to Wolfe’s memo.

A separate internal investigation into Anadith’s death is being conducted by CBP’s Office of Professional Responsibility, but it has been complicated by a lack of closed-circuit video footage from inside the Harlingen station. The camera system was flagged for repair in mid-April but was not fixed until nearly a week after Anadith’s death, according to CBP records.

Anadith’s death prompted CBP to remove chief medical officer David Tarantino last week and place U.S. border facilities under the supervision of DHS medical officials and a team of uniformed doctors from the U.S. Public Health Service. Doctors from the Health Service have deployed to CBP facilities along the border to help provide care and make recommendations for additional improvements, according to CBP’s Miller.

In a June 9 response to the DHS memo, Miller told Wolfe the child’s death was “deeply upsetting and unacceptable.”

“We can and we will do better to ensure this event never happens again,” said the response, which was separately obtained by The Post.

Miller has ordered medically at-risk migrants transferred out of the Harlingen station, and the facility is no longer being used as an isolation unit, according to his response to Wolfe. CBP is checking to make sure camera systems at its other facilities are operating properly, Miller said.

CBP has told its medical contractor, Loyal Source Government Services, to “take immediate action to review practices and quality assurance plans to ensure appropriate care,” Miller wrote in the response. “These are only the first of many steps that CBP will take to address the issues you raised.”

CBP reassigns chief medical officer following child’s death in border custody

Border officials say they have raised their standards of care in recent years amid record numbers of crossings by migrant families and children whose needs are ill-suited to holding cells that were designed for adults.

CBP is supposed to transfer migrants from those holding cells to U.S. Immigration and Customs Enforcement or another agency within 72 hours. The agency has not developed the kind of medical record-keeping and case-management system used by ICE and other federal agencies that hold detainees long-term.

When border crossings surge, backups in CBP facilities can leave migrants spending a week or more in cramped conditions where illness can spread. CBP officials say they have opened 11 facilities over the past two years with dedicated spaces for medical triage, basic care and isolation wards to prevent the spread of communicable diseases. The agency says it has contracted more than 1,000 medical personnel to staff CBP facilities and border stations.

Federal records show Loyal Source Government Services received a $408 million medical services contract from CBP in 2020.

Wolfe’s memo recommended that individuals placed in CBP medical isolation have a documented consultation with a physician or pediatric adviser and said juveniles should receive clinical assessment every four hours.

Anadith, who was born in Panama to parents from Honduras, crossed into the United States on May 9 with her family as part of a large group of migrants, according to a CBP timeline released last month.

During an initial CBP medical screening, Anadith’s mother provided the agency with documents and information about the child’s medical history.

Four days later, Anadith was diagnosed with the flu after reporting abdominal pain and congestion. “During this medical encounter, CBP contracted medical personnel documented a past medical history including cardiomyopathy,” CBP noted.

The family was transferred to the Harlingen isolation unit that day. But the DHS medical team investigating Anadith’s death found CBP lacked a system to track the child’s care. “There was no documented communication between the custodial and medical personnel regarding awareness of at-risk individuals or acute medical care issues,” the DHS memo states.

As her daughter battled the flu and the child’s condition deteriorated, she “begged for her life,” Anadith’s mother, Mabel Alvarez Benedicks, said in an interview with the Associated Press.

Anadith was treated by a nurse practitioner four times on the day of her death, according to preliminary findings released June 1 by CBP. She was administered over-the-counter medications and had a normal heart rate and blood oxygen levels.

The nurse practitioner reported “denying three or four requests from the girl’s mother for an ambulance to be called or for her to be taken to the hospital,” CBP said. Another contracted medical staffer “reported having brought a pile of documents and a bottle of folic acid tablets from the family’s property to the nurse practitioner,” but the nurse practitioner declined to review the papers, the inquiry found.

The DHS memo said the mother’s requests for medical care were not properly documented, and the nurses attending the child at the Harlingen facility did not review the records the family had provided to CBP. “Clinical interactions, medical assessments, and encounters were documented inaccurately within [electronic medical records], not documented … and/or not shared with subsequent medical service providers,” the memo states.

In response to Wolfe, Miller said CBP has launched a review of its medical record-keeping system to implement “critical updates” and “to determine whether we may better served by replacing this system with a different system, such as a commercial medical record system.”

The DHS memo said CBP should produce a medical care manual within 90 days and take steps to “ensure information sharing and accountability at shift change for medically at-risk individuals in CBP custody.” Such information-sharing and accountability “must be electronically documented,” Wolfe said.

He also urged CBP to develop and disseminate verbal instructions and visible signage in isolation wards to spell out the procedures for requesting medical attention and “escalation” to more qualified physicians.

Anadith was the second minor to die in U.S. government custody within a one-week span. A 17-year-old Honduran boy died May 10 while staying at a shelter in Florida for minors who cross the border without their parents.

Miller told Wolfe that CBP had a “large number of individuals, including families, in custody for more than 72 hours” at the time of Anadith’s death, as border crossings spiked before the expiration of the Title 42 border policy on May 11.

Crossings have fallen 70 percent since then, the latest CBP data show. Miller told Wolfe his agency has reduced the average amount of time families with minor children are held in custody to fewer than 30 hours, and CBP is processing families with minor children “as expeditiously as possible” to move them out of border facilities.


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