Detention In America

Since 9/11 there have been a lot of changes in how the United States deals with immigrants. One of the biggest is the explosive growth of a system of immigrant detention centers that few Americans know anything about.

Immigrants who come into the country illegally, or refugees who apply for political asylum, often go into detention, some for many months. Before 9/11, about 100,000 detainees went though the system each year. Today, with stricter immigration rules, that number has tripled to more than 300,000.

The surge appears to have overwhelmed the medical care provided to the immigrants.

Now, a investigation, joined by 60 Minutes correspondent Scott Pelley, has found evidence that immigrants are suffering from neglect and some don't survive detention in America.

"He was essentially arrested?" Pelley asks.

"Yes. I consider it an arrest," Danticat says. "Because …he had to ask for special relief for him not to be handcuffed. And they did allow him that, but told him that if he ran, they would shoot him."

Rev. Dantica raised Edwidge in Haiti; she moved to the U.S. at the age of 12 and grew up to become a prize-winning author. Danticat's recent book, "Brother, I'm Dying," recounts her uncle's ordeal.

She was waiting for him in Miami.

Asked what she was thinking when she heard her uncle had been detained, Danticat tells Pelley, "Well, I was horrified. Eighty one years old and, after the ordeal that he had been through in Haiti, I worried about his ability to handle that."

Records show that two days later, during an asylum hearing, he became violently ill and collapsed. A detention center physician's assistant failed to recognize that Dantica was in serious trouble.

"Help me understand from the records that you've seen precisely what the medic said about your uncle and his condition," Pelley asks.

"It appears that he said, 'I think he's faking,' or something to that effect," Danticat says.

It took four hours to get Rev. Dantica to an outside hospital. His family wasn't allowed to see him. In a day and a half, Rev. Dantica was dead. The medical examiner said it was pancreatitis.

Asked what she was thinking in that moment, Danticat says, "Just a series of things."

Crying, she continues, "Of course, you know, a great deal of sadness because he died so alone."

"He died without his family," Pelley remarks.

"Yeah. And after being treated like an animal," Danticat says. "Someone who was just trying to escape horrible things, who was so old and sick. Just had to die that way."

But in one sense, Rev. Dantica was not alone: he's among hundreds of sick or dying detainees inside 22 detention centers, plus some 350 state and local jails. The federal lock-ups range from a former warehouse in New Jersey that houses 325 people, to a desert facility near the Mexican border.

The centers are run by U.S. Immigration and Customs Enforcement, known by its initials "ICE."

Inside the detention centers, medical care is provided by another federal agency, the Division of Immigration Health Services, or DIHS. Reporters Dana Priest and Amy Goldstein of The Washington Post have been investigating DIHS.

"This is not just some deaths or just some sick people anecdotally. If you take them all together, they show poor medical judgments, faulty administrative practices, sloppy paperwork, lost medical records and very dangerous staffing levels," Priest explains.

Priest, who contributes to 60 Minutes, and Goldstein have obtained thousands of internal DIHS documents. They include investigations, e-mails, autopsy reports and complaints.

What sort of a picture did the documents paint of how DIHS is working?

"They show a bureaucracy that offers many immigrants no care or slow care or poor care," Priest says. "And they also show that the employees inside are panicked about this."

For example last year, 21-year-old detainee Juan Guevara was complaining of severe headaches. Soon he had died of a brain aneurysm. A staff member wrote in an e-mail "the detainee was prescribed Tylenol. The detainee was not seen or evaluated by an RN, midlevel (physician's assistant) or physician."

This internal report from 2007 was written after another detainee died of a contagious infection: "the clinical staff at all levels failed to recognize early signs and symptoms of meningitis."

This memo from 2007 sounds an alarm over staffing shortages in Buffalo, written in all caps, "CRITICAL STAFFING SITUATION OCCURRING, SITE IS DOWN TO ONLY 3 FULL TIME NURSES." In Arizona, "CRITICAL STAFFING levels. Site has reached a 48% nursing vacancy rate."

While the number of immigrants in detention has tripled since 9/11, the health services budget has grown only by 65 percent.

Priest reads from an email from the acting director of DIHS to a senior ICE official in August 2007: "We're facing critical staffing shortages at most every site. While we developed, executed and achieved major successes in our recruitment efforts, we've been unable to meet the demand."

One immigrant detained in 2007 was Amina Mudey. She fled Somalia after her father, brothers and sister were murdered. Amina landed in New York and requested political asylum.

"The medical treatment that Amina received was absolutely deplorable. Substandard, sanction-able, and flat out malpractice," says Ann Schofield Baker, Amina's lawyer.

Schofield Baker says Amina was detained in the former New Jersey warehouse facility and almost immediately was prescribed a powerful anti-psychotic drug called "Risperdal."

"How did she come to be on Risperdal to begin with? I mean, was she psychotic?" Pelley asks.

"Not even remotely psychotic," Schofield Baker says. "When Amina first arrived at the detention center she hadn't slept in two or three days. She hadn't eaten. She'd never been on a plane before. She was disoriented. They brought her to the facility shackled. She was absolutely petrified. And she collapsed and had a panic attack. From that, someone concluded that she was psychotic."

Schofield Baker says on Risperdal, Amina was dazed, drooling and helpless. A human rights group asked her to represent Amina. She got her own doctors, who took Amina off the drug. And Amina was granted asylum. Now Amina is studying computers and English.

"What was it like when you walked out of there?" Pelley asks.

"Outside was beautiful," Amina says, with the help of a translator.

"It was a tough start for you," Pelley remarks.

"America is wonderful place. I like it, New York," Amina answers in English.

Amina's alleged misdiagnosis isn't an isolated case according to an internal memo from last year, written by the head of mental health at the Division of Immigration Health Services.

"The top psychologist worried about mental health," Priest says, as she quotes from an email he wrote: 'We need to stop looking for Band-Aid solutions for these problems."

"The little money managed care may save in the short run is going to be dwarfed by the millions that will be paid out by ICE when the lawsuits roll in.There have been just a handful of lawsuits so far. But they know they're sitting on a powder keg."

DIHS is being sued in the case of 35-year-old Francisco Castaneda, who testified in a deposition some three weeks before he died. By that time, he was bedridden and the cancer had spread to his lungs. His voice barely rose above a whisper.

Castaneda told of coming to the U.S. illegally from El Salvador at the age of ten. In 2004, he was sentenced to a few months in jail after a conviction on possession of methamphetamine, and later was sent to a detention center for deportation.

"When you look back on how he was treated at the detention center over those months, what do you think?" Pelley asks Castaneda's sister Yanira.

"I'm mad, sad," she says.

Yanira says her brother went into the detention center with a bleeding lesion on his genitals. There was concern it was cancer, but the DIHS turned down requests for a biopsy.

"How long do you believe the DIHS staff in the detention center knew or had a reasonable reason to suspect that he had cancer?" Pelley asks Conal Doyle, who, along with Adele Kimmel of the non-profit group Public Justice, represents the Castaneda family.

"The second day he entered the facility, of March 28th, 2006, a physician's assistant, Lieutenant Walker, specifically documented that he needed a urology consult and a biopsy to rule out cancer," Doyle says.

But Doyle says Castaneda never got that biopsy during his detention.

Castaneda filed grievances with the Division of Immigration Health Services. He wrote, "I am in a considerable amount of pain and I am in desperate need of medical attention."

DIHS said the surgery was elective and the government wouldn't pay for it. His request was denied for 10 months.

Then, for reasons that aren't clear, he was released. "They released him on February 5th, 2007. And he sought care on his own outside the facility. And had that biopsy on February 8th. Cancer was discovered, his penis was amputated on February 14th," Doyle says.

But the cancer had spread and Castaneda died a year later.

"The judge in this case in federal district court has entered an order describing the care received by Castaneda as transcending negligence by miles. And, being beyond cruel and unusual," Doyle says.

Immigration and Customs Enforcement declined an interview, but ICE did send 60 Minutes a letter which states in part, "The number of deaths per 100,000 is dramatically lower for ICE detainees than for U.S. prison and jail populations…."

ICE goes on to say that the nation as a whole is "experiencing severe shortages of qualified health professionals."

In October, Congress held hearings on immigrant healthcare. Gary Mead, a senior immigration official, told the Congress that ICE provides "state-of-the-art medical care," and "the best possible healthcare."

"Last year DIHS completed over 500,000 medical visits for the detainees in our custody. Many of our detainees receive almost daily attention. So it is an aggressive program, and we do everything possible to maintain the best quality of life for the detainees in our custody," Mead said.

ICE declined to talk about the detainees in mentioned in this story. In the case of Rev. Dantica, a government inspector general report said there was "no evidence of mistreatment or malfeasance" in his death. The Castaneda family is continuing its lawsuit in his case.

"What does the DIHS owe prisoners like Francisco Castaneda?" Pelley asks.

"Well, if the government's gonna detain someone, it's very clear. The Supreme Court has said that they are entitled to reasonable medical care. And that includes medical care for any serious medical need," Doyle says.

"You know that there are people watching this interview who are saying to themselves, 'Castaneda was an illegal immigrant. He had a drug conviction. The people of the United States owed him nothing,'" Pelley remarks.

"I'm sure there's people out there that think that," Doyle acknowledges. "But that's not what the law is. And that's not what a civilized society does. And you know, if it's true that you judge the degree of civilization in a society by entering its prisons, the United States has a long way to go on this particular issue."