Most Deaths in ICE Facilities Occurred Among Healthy Young Men

(Reuters Health) – Most of the deaths occurring at U.S. Immigration and Customs Enforcement (ICE) facilities between 2011 and 2018 were among men who had low burdens of preexisting disease, a new study suggests.

An analysis of 55 detainee deaths for which reviews were available revealed that 47 (85.5%) were among males, with a mean age at death of 42.7 years. Among the detainees who died, 18 (32.7%) had a Charlson Comorbidity Index score of 0, and 15 (27.3%) had a score of 1 or 2, according to the report in JAMA Network Open.

Eight of the deaths were by suicide, while the others were attributed to medical causes.

“We need increased transparency at these facilities and accountability in these cases, while still respecting the privacy of those who died,” said the study’s lead author, Dr. Molly Grassini, an emergency physician at LAC + USC Medicine and the Keck School of Medicine at the University of Southern California in Los Angeles. “It is important to do so in order to understand what is occurring in these facilities and to avoid further deaths.”

“The majority of the deaths attributable to medical causes were preceded by markedly abnormal signs,” Dr. Grassini said. “Individuals often demonstrated not just one single episode, but multiple encounters.”

Medical signs that indicated that patients might be in trouble included tachycardia, hypertension, fever and hypothermia, Dr. Grassini said.

To take a closer look at the issue, Dr. Grassini and her colleagues scrutinized DDRs (Detainee Death Reviews) for individuals who died while at ICE facilities between January 2011 and December 2018. Among 71 reported deaths, DDRs were available for 55.

Data from those reports included descriptions of the deceased detainees’ demographic information and immigration history and the chronology of ICE detention. Also included in the reports were data on where the individuals died – ICE detention facility, in transport to the hospital, emergency department, or other hospital ward – the method used to transport the individual to a higher level of care when applicable, whether CPR was initiated and why, information about the detainee’s medical and psychiatric history, whether past medical issues had not been disclosed by the individual who died, and the cause of death.

The researchers also recorded instances in which medical or security staff or other detained individuals had raised concerns about the deceased individual’s health to a supervisor or to other staff member in the days preceding the death, and whether the deceased individuals had themselves filed a grievance related to their health before their death.

The individuals who died had lived in the U.S. for a mean duration of 15.8 years before entering an ICE detention facility and spent a median 39 days in ICE custody before death. Thirty-four of the 55 deaths (61.8%) occurred in privately owned, for-profit detention facilities.

Of the 55 deaths, 47 (85.5%) were attributed to medical conditions. Markedly abnormal vital signs before 29 deaths from medical causes (61.7%) were documented in the death reviews, and 21 of these 29 deaths (72.4%) were preceded by abnormal vital signs during two or more encounters with ICE personnel before death or terminal hospital transfer.

Twenty-nine of the 47 medical deaths (61.7%) were attributed to noncommunicable diseases (cancer and stroke, for example), and 10 (21.2%) to communicable diseases (tuberculosis, other contagious infections, for example). Eight individuals (17.0%) died of a combination of both communicable and noncommunicable diseases.

Six reports (10.9%) noted that a fellow detained person had raised concerns about the physical or mental health of the deceased prior to the death. Nine reports (16.4%) noted that similar concerns had been raised by detention facility security or medical staff. Forty-two of the 55 individuals who died (76.4%) received CPR before death. In 18 instances, CPR was initiated by detention facility staff, and in two instances, CPR was started by another individual in ICE custody. In four instances, emergency medical service personnel initiated CPR – twice on arrival to the ICE facility in the presence of ICE medical staff responders and twice during transport.

The authors note that the death reviews contained references to facilities breaking their own rules.

“Given the numerous attempts to call for early release of ICE detainees because of substandard, unsanitary, and unsafe ICE detention facilities during the COVID-19 pandemic, the cited violations of medical care standards in the analysis of detainee death records from 2011 to 2018 are not surprising,” said Goleen Samari, an assistant professor in the Heilbrunn Department of Population and Family Health at Columbia University’s Mailman School of Public Health in New York City.

“In recent years, medical personnel have also spoken out against forced sterilizations of women in detention,” Samari said in an email. “In this study, the disregard for mental health care, dismissal of vital sign abnormalities, and premature death among young men in ICE detention ultimately further shows that violations of medical care standards are not uncommon in US detention facilities,” Samari noted.

“These medical violations are likely worse during the COVID-19 pandemic, and while we may have learned very little during the pandemic, we have learned that maintaining the health of noncitizens, detained or otherwise, is in the best interest of the economy and of public health,” Samari said.

SOURCE: JAMA Network Open, online July 7, 2021.

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