Doctors in California analyzed medical emergencies in immigration detention centers. Here’s what they found

(Chris Carlson/AP)

Doctors in California analyzed medical emergencies in immigration detention centers. Here’s what they found

Immigration and the border

Andrea Castillo

November 29, 2023

This is evident from a study published on Wednesday in the Journal of the American Medical Association


n. found discrepancies between emergency situations at immigrant detention centers in California that were reported to local authorities and those

publicly reported

by the federal government.

The study, led by Dr. Annette Dekker, an assistant professor of emergency medicine at UCLA, analyzed approximately 1,200 emergencies between 2018 and 2022 at three detention centers: the Adelanto ICE Processing Center in San Bernardino County, the Otay Mesa Detention Center in San Diego and the Imperial Regional Detention Facility in the East. of San Diego. Most patients involved were men, and the average age was 39 years. Local authorities responsible for emergencies at two other facilities in California

did not provide data to UCLA. the other physicians who wrote the report are from UC San Diego and USC. Private prison companies operate seven immigrant detention centers in California on behalf of U.S. Immigration and Customs Enforcement, with space to hold more than 7,000 people.

Psychiatric emergencies made up only 48 of the EMS responses

reviewed by Dekker and four other doctors in California

less than 4%, despite significantly higher rates of such complaints reported by ICE

during the same period


In each facility, the number of psychiatric emergencies reported to EMS was less than or equal to the number of suicide attempts reported by ICE. When other ICE-reported mental health issues requiring observation were added to that total, Dekker said, there was a 10-fold increase over the total reported by local ambulance services. Dekker said she believes the discrepancy could be interpreted to mean that all but the most extreme psychiatric crises are appropriately handled by internal medical staff. But an A

A 2021 California Department of Justice inspection survey found significant mental health deficiencies at all three facilities, including understaffing and delays in care.

“It is possible that someone has attempted suicide that does not require an ambulance, but as an emergency physician there are many different psychiatric emergencies, some of which are related to


ideation, something related to psychosis, so it’s strange to me that the number of psychiatric emergencies reported by EMS is not higher,” Dekker said.” Why don’t the medical staff seek more help?

Medical assessments are not required unless a detainee dies while in custody, the report said.

Systematic substandard care has been identified as a factor linked to these deaths, including a lack of recognition of serious illness, dismissal of concerns about the health of medical staff and delays in activating external emergency care, the report said. These findings suggest that there are near misses

What is a “near miss” in this context? A situation in which someone almost dies as a result of suicide or otherwise? Yes

not recorded in death reports.

ICE did not immediately respond to a request for comment.

Inmates do not have access to 911 and must rely on staff to make calls on their behalf.


Death reviews show that some responses to requests for help have been delayed.

at all the facilities they looked at? No, reports of detailed deaths. Still, the report notes that given California’s stricter oversight, this data showing delays may reflect higher standards of care in California. Or are we talking about different data? I don’t follow this. This could represent higher standards of medical care than in other states. Moved to top in case we continue: The report raises questions about whether ICE is transporting a significant number of patients to hospitals in private vehicles, as has been documented in some detailed death reports. If it did, half of the patients would have been transported privately, raising questions about why the practice is common, the report said. ICE CREAM is too

known for mistakes

in data provided.

At the Adelanto and Imperial facilities, rates of EMS reported emergencies were lower among women than among men. But at Otay Mesa, the rate was significantly higher for women, including 12% of emergencies related to pregnancy issues.

An ICE directive issued on July 1, 2021


says ICE should not detain people who are pregnant, postpartum, or breastfeeding, and must ensure prompt release from custody. Seven EMS reported emergencies due to pregnancy-related issues

are included

after the directive went into effect, indicating that Otay Mesa continued to house pregnant individuals despite the ICE directives, the report said.

Authors of the JAMA report said it is unclear

or the higher number of emergencies

among female patients

at Otay Mesa represents higher disease rates or

better detailed health

monitoring. But the California DOJ’s 2021 inspection noted that all three facilities impermissibly house female inmates in restrictive housing under conditions different from those of male inmates.

More than a quarter of patients

at all three facilities

had at least one abnormal vital sign


during their encounter with doctors, they usually experienced an increased heart rate. These are the top three symptoms of all three facilities

reported by patients

were chest pain, abdominal pain and altered mental status.

Traumatic injuries were also one of the most commonly reported problems by ambulance personnel.

The number of emergencies

at all three facilities

increased during the pandemic, despite efforts to reduce facility capacity during that time.

Do we have quantifiable data that we can add about how successful these efforts were for the context? No

Between January 2019 and December 2021, there were 742 EMS reported emergencies. During the same period, ICE reported 1,481 medical emergencies.

Dekker said the discrepancy indicates that EMS data fails to capture the total number of medical emergencies in ICE facilities. This discrepancy suggests that the EMS data are an underestimate. What do they mean by “underestimation”? underreporting? Or is their estimate of the number of emergencies low? of medical emergencies occurring in ICE detention centers, the report said.

Unlike ICE, publicly funded health care systems like Medicare and Medicaid have more

government supervision that requires

them to report stricter statistics, Dekker said.

She said recent reports from the ICE facility contain less data than in years past and no longer include statistics such as off-site medical emergencies and the number of suicide attempts. The ICE facility inspection reports appear to have changed hands last year, are no longer managed by a contractor, but are now missing metrics for data such as off-site medical emergencies and the number of suicide attempts. So I’m not sure what we mean here. Can you rephrase or break down this sentence to make it clearer? Also “appears to have changed hands” is unclear and I’m not sure we can draw that conclusion. Would it work to say “XX said ICE facility inspection reports contain less data than before XX and no longer include statistics for XX”?

‘I walked away with significantly more questions than when I started

the research for the report? Yes

‘, says Dekker

of the report

. “The bottom line is that we need comprehensive reporting from ICE on health outcomes to understand what’s going on.”


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